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Wong AKC, Bayuo J, Wong FKY, Chow KKS, Wong SM, Wong BB, Law KHY. Experiences of receiving an mHealth application with proactive nursing support among community-dwelling older adults: a mixed-methods study. BMC Nurs 2024; 23:232. [PMID: 38584270 PMCID: PMC10999086 DOI: 10.1186/s12912-024-01909-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 04/02/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND As the population ages, a plethora of digital and mobile health applications for assistance with independent living have emerged. Still unknown, however, is how older adults sustain the use of these applications. AIM This study sought to explore the experiences of older adults following their participation in a programme that combined the use of an mHealth application with proactive telecare nursing support. METHODS We employed a concurrent mixed-methods design for this study. The quantitative strand included a survey, whereas the qualitative strand included open-ended questions as part of the survey to understand the participants' experiences. Participants for this study were community-dwelling older adults who had taken part in an interventional study that sought to examine the effects of mHealth and nurse support. A convenience sampling approach was employed to recruit potential participants for this study. FINDINGS Fifty-five older adults participated. The majority expressed positive attitudes and satisfaction with the app and the nurses' support. The app and nurses' support helped participants to understand their health status and obtain health information. Reasons to halt app usage included technical issues and limited social support. CONCLUSION Mobile apps with professional follow-up support could potentially support older adults in the community, although emerging concerns need to be addressed to sustain long-term usage of these apps.
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Affiliation(s)
- Arkers Kwan Ching Wong
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Kowloon, Hong Kong, China.
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Kowloon, Hong Kong, China
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Kowloon, Hong Kong, China
| | | | - Siu Man Wong
- Hong Kong Lutheran Social Services, Homantin, Kowloon, Hong Kong, China
| | - Bonnie Bo Wong
- Hong Kong Lutheran Social Services, Homantin, Kowloon, Hong Kong, China
| | - Khloe Hau Yi Law
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Kowloon, Hong Kong, China
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Van Wier MF, Urry E, Lissenberg-Witte BI, Kramer SE. User characteristics associated with use of wrist-worn wearables and physical activity apps by adults with and without impaired speech-in-noise recognition: a cross-sectional analysis. Int J Audiol 2024; 63:49-56. [PMID: 36373621 DOI: 10.1080/14992027.2022.2135031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study weekly use of smartwatches, fitness watches and physical activity apps among adults with and without impaired speech-in-noise (SIN) recognition, to identify subgroups of users. DESIGN Cross-sectional study. STUDY SAMPLE Adults (aged 28-80 years) with impaired (n = 384) and normal SIN recognition (n = 341) as measured with a web-based digits-in-noise test, from the Netherlands Longitudinal Study on Hearing. Multiple logistic regression analyses were used to study differences and to build an association model. RESULTS Employed adults in both groups are more likely to use each type of fitness technology (all ORs >3.4, all p-values < 0.004). Specific to fitness watch use, adults living with others use it more (OR 2.5, 95%CI 1.1;5.8, p = 0.033) whereas those abstaining from alcohol (OR 0.3, 95%CI 0.1;0.6) or consuming >2 glasses/week (OR 0.4, 95%CI 0.2;0.81, overall p = 0.006) and hearing aid users (OR 0.5, 95%CI 0.2;0.9, p = 0.024) make less use. CONCLUSIONS Subgroups of adults more and less likely to use fitness technology exist, but do not differ between adults with and without impaired SIN recognition. More research is needed to confirm these results and to develop interventions to increase physical activity levels among adults with hearing loss.
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Affiliation(s)
- Marieke F Van Wier
- Otolaryngology-Head and Neck Surgery, Section Ear & Hearing, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Emily Urry
- Research & Development, Sonova AG, Stäfa, Switzerland
| | - Birgit I Lissenberg-Witte
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sophia E Kramer
- Otolaryngology-Head and Neck Surgery, Section Ear & Hearing, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Onder H, Dinc E, Yucesan K, Comoglu S. The gait parameters in patients with Parkinson's Disease under STN-DBS therapy and associated clinical features. Neurol Res 2023:1-7. [PMID: 37139777 DOI: 10.1080/01616412.2023.2208478] [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: 05/05/2023]
Abstract
OBJECTIVE We aimed to investigate the gait parameters in patients with subthalamic nucleus deep brain stimulation (STN-DBS) therapy using quantitative gait analyses and reveal the associated clinical features. METHODS Parkinson's disease (PD) subjects with STN-DBS who applied to our movement disorders outpatient clinics between December/2021 and March/2022 were enrolled. In addition to the evaluation of the demographic data and the clinical features; clinical scales measuring the freezing of gait (FOG), falls and quality of life were performed. A gait analyzer program was used to perform gait analysis. RESULTS Thirty patients with a mean age of 59.4 ± 8.3 (F/M = 7/23) were enrolled. The comparative analyses between the tremor-dominant and akinetic-rigid (AR) subtype patients showed that the step time asymmetry measures were higher in the AR group. The comparative analyses according to the symptom onset side showed that the step length was smaller in those with left-side symptom onset. The correlation analyses showed that there were correlations between the quality-of-life indexes and FOG questionnaire and falls efficacy scale (FES) scores. Finally, the correlation analyses between clinical scales and gait parameters revealed that there were significant correlations between the FES scores and the step length asymmetry (SLA). CONCLUSION We found a strong relationship between falls and quality of life indexes of our patients under STN-DBS therapy. In this patient group, particular evaluation of fallings and the follow-up of SLA in gait analysis may constitute important points during the evaluation of patients in routine clinical practice.
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Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ege Dinc
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Kubra Yucesan
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Selcuk Comoglu
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Bizpinar O, Onder H. Investigation of the gait parameters after donepezil treatment in patients with alzheimer' s disease. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-5. [PMID: 36745707 DOI: 10.1080/23279095.2023.2172681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Clinical studies remark that gait disturbance is common in patients with Alzheimer's disease (AD). However, the treatment response of gait disturbance in those patients may constitute a more interesting issue that is rarely addressed. METHODS In this prospective, interventional study, we included 14 consecutive patients with a new diagnosis of AD. Basal gait analysis was performed using a 'Gait Analyzer' program that was uploaded to a mobile phone. The gait parameters including Step time (ST), step length (SL), step number (SN), gait velocity (GV), and cadence were measured. Afterward, donepezil 5 mg daily was initiated, and the re-assessments were re-performed 8 weeks after the treatment. RESULTS The mean age was 71.78 ± 5.02 (F/M = 8/6). The evaluations after the donepezil treatment showed that there was a significant improvement in the SN (p = 0.021) and SL (p = 0.001) in comparison to the basal evaluations. The repeated analysis in the subgroup of early-stage AD subjects (n = 10) yielded that there were significant improvements in SN (p = 0.003), SL (p = 0.005), and cadence (p = 0.026) after treatment. CONCLUSIONS Our results support the efficiency of cholinergic treatment in gait functions in AD subjects.
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Affiliation(s)
- Ozlem Bizpinar
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Scanferla WH, Oliveira C, Lousada ML, Teixeira LC. The Usability and Acceptability of the mHealth "Health and Voice" for Promoting Teachers' Vocal Health. J Voice 2023:S0892-1997(22)00396-4. [PMID: 36690506 DOI: 10.1016/j.jvoice.2022.12.007] [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: 09/21/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the usability and acceptability of "Health and Voice" for the promotion of vocal health, and to analyze the same with sociodemographic data, work data, self-knowledge data on vocal care, voice disadvantage, and vocal fatigue symptoms in elementary school teachers. MATERIAL AND METHODS A cross-sectional observational study, with a sample of 277 elementary school teachers from a Brazilian capital. Teachers were invited to access, interact and evaluate the mHealth: "Health and Voice". The evaluation instruments were the questionnaire with information on socio-demographic and work data, the System Usability Scale (SUS), the questionnaire with questions about acceptability, the Voice Handicap Index Protocol (VHI-10), and the Vocal Fatigue Index Protocol (VFI). Descriptive and association analyses were performed by the Chi-square, Fisher exact, Mann-Whitney, and Wilcoxon tests (P ≤ 0.05) RESULTS: the mean SUS score was 81.9 points; the mean of the acceptability questions was 17.24; the VHI-10 was 6.96 points; the VFI was 21.11 points. Most participants rated the acceptability of mHealth as high. There was an association between acceptability and working in two shifts (P = 0.019); between acceptability and usability (P < 0.001); and between usability and self-perception of knowledge about voice care after using mHealth (P = 0.000). The activity perceived as most important was guidance on voice care. CONCLUSION "Health and Voice" is a vocal guidance tool for teachers that promotes vocal health. It has high usability and acceptability by elementary school teachers. Self-reported knowledge about vocal care increases after its use and those who evaluate the technology with high acceptability are 3.6 times more likely to also classify it with high usability.
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Affiliation(s)
- Willian Hote Scanferla
- Speech-Language Therapy Science - School of Medicine, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil
| | - Catarina Oliveira
- Linguistics - School of Health Sciences (ESSUA)/Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| | - Marisa Lobo Lousada
- Speech-language Therapy - Center for Health Technology and Services Research (CINTESIS.UA@RISE), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Letícia Caldas Teixeira
- Speech-Language Therapy Science, School of Medicine, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil
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Armbruster C, Knaub M, Farin-Glattacker E, von der Warth R. Predictors of Adherence to Cancer-Related mHealth Apps in Cancer Patients Undergoing Oncological or Follow-Up Treatment-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13689. [PMID: 36294265 PMCID: PMC9603736 DOI: 10.3390/ijerph192013689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
mHealth interventions in cancer care are being increasingly applied in various settings. Nevertheless, there is a phenomenon wherein individuals show different usage patterns, which could affect the effectiveness of the intervention. In general, it is important to know the predictors of app adherence and usage patterns to improve the design and content (i.e., tailoring). The aim of this scoping review was to provide an overview of predictors of adherence to cancer-related mHealth apps in cancer patients. A systematic literature search was conducted in March 2021 in the electronic databases PubMed, CINAHL, and PsychINFO without limitation in year, focusing on cancer patients undergoing oncological or follow-up treatment using mHealth apps. The initial database search yielded a total of N = 8035 records. After title, abstract, and full-text screening, 10 articles met inclusion criteria. Studies were published between 2013 and 2020. Studies focused on children and adolescents (2/10) as well as adults (8/10). The predictors identified could be categorized into sociodemographic variables, cancer-related factors and others. This study provides an initial insight into relevant predictors of app adherence in cancer patients. However, no clear predictor of increased app adherence was found. Further research of usage patterns is therefore needed so that mHealth interventions can be tailored during development.
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Wenz B, Graf J, Du Y, Teti A, Gabrys L. Physical Activity Treatment in Adults with Type 2 Diabetes Mellitus per National Treatment Guidelines for Germany: A Telephone-Survey-Based Analysis. Healthcare (Basel) 2022; 10:1857. [PMID: 36292304 PMCID: PMC9601844 DOI: 10.3390/healthcare10101857] [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: 08/31/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
Physical activity (PA) is effective in the prevention of type 2 diabetes mellitus (T2DM). According to the German national treatment guidelines for T2DM, PA is recommended at all stages of the treatment process. Adults with T2DM were recruited within the cross-sectional telephone survey 'Disease knowledge and information needs-Diabetes mellitus (2017)'. Self-reported data on socio-demographic characteristics, previous and current T2DM treatment, and PA behavior were collected. Using multivariable logistic regression models, the correlation between PA treatment (referrals and recommendations) and PA was investigated. Overall, 1149 adults diagnosed with T2DM are included in the analysis. Of the participants, 66.7% reported having ever received PA as part of their T2DM treatment with 61% of the participants reporting PA treatment at the time of the initial T2DM diagnosis and 54% at the time of the interview. Women, older participants, and those with a lower educational level were less likely to have ever been treated with PA. Currently being treated with PA as part of the T2DM treatment was associated with higher rates of achieving the World Health Organization's PA recommendations (≥150 min per week) (OR = 1.95, 95% CI: 1.42-2.68), as well as ever being treated with PA (OR = 1.74, 95% CI: 1.20-2.38). The analyses showed that PA treatment plays a role in the treatment process of T2DM, but not all patient subgroups benefit in the same way. Efforts to increase PA treatment as part of T2DM treatment are needed, especially for those who are currently not treated with PA. Further research is needed to better understand the type of PA (e.g., structured or unstructured) undertaken by adults with T2DM to develop tailored PA interventions for adults with T2DM and for those in vulnerable subgroups.
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Affiliation(s)
- Benjamin Wenz
- University of Applied Sciences for Sport and Management Potsdam, Am Luftschiffhafen 1, 14471 Potsdam, Germany
- Institute of Gerontology, Faculty I, Vechta University, Driverstraße 22, 49377 Vechta, Germany
| | - Jonathan Graf
- Institute of Gerontology, Faculty I, Vechta University, Driverstraße 22, 49377 Vechta, Germany
| | - Yong Du
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, 12101 Berlin, Germany
| | - Andrea Teti
- Institute of Gerontology, Faculty I, Vechta University, Driverstraße 22, 49377 Vechta, Germany
| | - Lars Gabrys
- University of Applied Sciences for Sport and Management Potsdam, Am Luftschiffhafen 1, 14471 Potsdam, Germany
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Vieira WDO, Ostolin TLVDP, Simões MDSMP, Proença NL, Dourado VZ. Profile of adults users of smartphone applications for monitoring the level of physical activity and associated factors: A cross-sectional study. Front Public Health 2022; 10:966470. [PMID: 36203689 PMCID: PMC9530973 DOI: 10.3389/fpubh.2022.966470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023] Open
Abstract
Background There are currently more than 200 million smartphones in Brazil. The potential of mobile technologies for favorable changes in health behavior such as physical activity has been previously described in the literature. Results of surveys in developed countries indicate that applications (APPs) are developed for people who are better educated, younger, and with higher incomes compared to non-users. However, the profile of users in developing countries like Brazil is not well-known. Understanding the profile of APP users might ease the development turned to physically inactive people and those at higher cardiovascular risk. Furthermore, the physiological and functional factors associated with the use of such APP are unknown. Objectives To characterize the profile of APP users to monitor the physical activity level (PAL) and assess the demographic, socioeconomic, clinical, physiological, and functional characteristics associated with the use of smartphone APPs to monitor physical activity in Brazilian adults. Methods We assessed 176 asymptomatic men and 178 women (43 ± 12 years; 27 ± 5 kg/m2). We initially asked participants about their current use of a smartphone APP containing PAL monitoring functionality, such as exercise session logs and/or step counts. In a cross-sectional design, we investigated schooling, socioeconomic status (Critério Brasil), and classic self-reported cardiovascular risk factors. We evaluated several physiological and functional variables such as maximum O2 consumption on a treadmill (VO2 max), blood pressure, body composition (bioelectrical impedance), handgrip strength, and isokinetic muscle strength of the dominant lower limb. Participants used a triaxial accelerometer for 7 days to quantify daily physical activity. We also assessed health-related quality of life (WHOQOL BREF), perceived stress (PSS14 Scale), and the built environment (NEWS Scale). We compared continuous variables using the Student's t-test and categorical variables using the χ2 test, between APP users and non-users. After univariate analysis, we included the main variables associated with the use of APP in a multiple logistic regression model. Results One hundred and two participants (28.3%), unrelated to gender, reported using a smartphone APP for physical activity at the time of assessment. Except for perceived stress and the built environment that were not associated with the use of APP, users of APP were younger and had higher education, lower cardiovascular risk, better socioeconomic status, a better quality of life, better cardiorespiratory function, better body composition, greater physical fitness and more moderate to vigorous physical activity in daily life. The results of the multiple logistic regression showed that age, hypertension, VO2 max, socioeconomic status (Critério Brasil), and quality of life (WHOQOL BREF total score) were the variables most significantly associated with the use of the APP. Conclusions Our results indicate that smartphone APPs to monitor physical activity are developed for younger adults with better socioeconomic status, lower cardiovascular risk, higher quality of life, and greater cardiorespiratory fitness. Greater efforts are needed to develop a science-based APP for people who most need this technology, enabling greater potential to prevent undesirable health outcomes in asymptomatic adults.
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Affiliation(s)
- Wesley de Oliveira Vieira
- Laboratory of Epidemiology and Human Movement, Department of Human Movement Sciences, Institute of Health and Society, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Thatiane Lopes Valentim di Paschoale Ostolin
- Laboratory of Epidemiology and Human Movement, Department of Human Movement Sciences, Institute of Health and Society, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria do Socorro Morais Pereira Simões
- Laboratory of Epidemiology and Human Movement, Department of Human Movement Sciences, Institute of Health and Society, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Neli Leite Proença
- Laboratory of Epidemiology and Human Movement, Department of Human Movement Sciences, Institute of Health and Society, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Victor Zuniga Dourado
- Laboratory of Epidemiology and Human Movement, Department of Human Movement Sciences, Institute of Health and Society, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Lown Scholars Program, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Alaslawi H, Berrou I, Al Hamid A, Alhuwail D, Aslanpour Z. Diabetes Self-management Apps: Systematic Review of Adoption Determinants and Future Research Agenda. JMIR Diabetes 2022; 7:e28153. [PMID: 35900826 PMCID: PMC9377471 DOI: 10.2196/28153] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/30/2021] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most diabetes management involves self-management. Effective self-management of the condition improves diabetes control, reduces the risk of complications, and improves patient outcomes. Mobile apps for diabetes self-management (DSM) can enhance patients' self-management activities. However, they are only effective if clinicians recommend them, and patients use them. OBJECTIVE This study aimed to explore the determinants of DSM apps' use by patients and their recommendations by health care professionals (HCPs). It also outlines the future research agenda for using DSM apps in diabetes care. METHODS We systematically reviewed the factors affecting the adoption of DSM apps by both patients and HCPs. Searches were performed using PubMed, Scopus, CINAHL, Cochrane Central, ACM, and Xplore digital libraries for articles published from 2008 to 2020. The search terms were diabetes, mobile apps, and self-management. Relevant data were extracted from the included studies and analyzed using a thematic synthesis approach. RESULTS A total of 28 studies met the inclusion criteria. We identified a range of determinants related to patients' and HCPs' characteristics, experiences, and preferences. Young female patients were more likely to adopt DSM apps. Patients' perceptions of the benefits of apps, ease of use, and recommendations by patients and other HCPs strongly affect their intention to use DSM apps. HCPs are less likely to recommend these apps if they do not perceive their benefits and may not recommend their use if they are unaware of their existence or credibility. Young and technology-savvy HCPs were more likely to recommend DSM apps. CONCLUSIONS Despite the potential of DSM apps to improve patients' self-care activities and diabetes outcomes, HCPs and patients remain hesitant to use them. However, the COVID-19 pandemic may hasten the integration of technology into diabetes care. The use of DSM apps may become a part of the new normal.
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Affiliation(s)
- Hessah Alaslawi
- Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Ilhem Berrou
- School of Health & Social Wellbeing, University of the West of England, Bristol, United Kingdom
| | | | - Dari Alhuwail
- Department of Information Science, College of Computing Sciences and Engineering, Kuwait University, Kuwait, Kuwait
| | - Zoe Aslanpour
- Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Wong NWM, Ho LK. E‐government and the hurdle of the “digital divide”? Rethinking the responses of the underprivileged in COVID‐19 Hong Kong. ASIAN POLITICS & POLICY 2022; 14:10.1111/aspp.12650. [PMCID: PMC9349440 DOI: 10.1111/aspp.12650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/27/2022] [Accepted: 05/29/2022] [Indexed: 02/07/2024]
Abstract
The digital divide and insufficient social capital of aging, undereducated, and low‐income nonnetizens are usually explained by the underpopularization of e‐government. This review article moves beyond the mainstream concern over resources and technicalities and seeks to explore the reasons for reluctance, from digital vulnerabilities to e‐service. We examine the varying responses to the three e‐services launched by the Hong Kong government during the coronavirus disease 2019 (COVID‐19) pandemic, online vaccination registration, electronic consumption vouchers, and social distancing apps in smartphones, and find that their perception of trust and security could be the major reservation of e‐service users. How could we understand the “values” they harbor, and in what circumstances would they be more accepting of the new inventories? Our findings from this developed society in the Asian context might assist policymakers in pushing e‐government forward in the post‐COVID era.
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Paradis S, Roussel J, Bosson JL, Kern JB. Use of Smartphone Health Apps Among Patients Aged 18 to 69 Years in Primary Care: Population-Based Cross-sectional Survey. JMIR Form Res 2022; 6:e34882. [PMID: 35708744 PMCID: PMC9247815 DOI: 10.2196/34882] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background The World Health Organization has defined mobile health (mHealth) as the “use of mobile and wireless technologies to support the achievement of health objectives.” Smartphones currently represent one of the main media forms for mHealth democratization. Health apps can be an interesting tool for changing health behaviors. However, their use in France is still poorly documented. Objective The main aim of this study was to evaluate the frequency of use of health apps among patients consulting in the primary care setting in France. The secondary aims were to evaluate the use of health apps according to the sociodemographic and medical characteristics of patients and to determine their use. Methods A population-based cross-sectional survey was carried out between November 2017 and January 2018 in the Grenoble area of France among patients aged between 18 and 69 years who were consulting at 13 primary care physician offices. Patients were provided with anonymous paper self-questionnaires. The main criterion for participation was the use of a smartphone health app, defined for the purpose of this study as any app supporting patients in efforts to be healthy. Results The participation rate was 49.27% (739/1500; 95% CI 46.7%-51.8%). The smartphone use was estimated at 82.6% (597/723; 95% CI 79.6%-85.2%). Of 597 smartphone owners, 47.7% (283/595; CI 43.6%-51.6%) used at least one smartphone health app. Health apps identified in this study were mainly related to wellness, prevention, and fitness (66.1%), as well as medication, treatments, and follow-up care (50.0%). The main factors associated with health app use were: use of social networks (odds ratio [OR] 3.4, 95% CI 2.1-5.3), age under 30 years (OR 2.7, CI 1.4-4.9), city size between 5001 and 10,000 inhabitants (OR 1.8, CI 1.1-2.8), and city size more than 10,000 inhabitants (OR 2.1, CI 1.4-3.2). Conclusions In this survey, nearly one out of two patients reported the use of smartphone health apps, which are currently focused on wellness, prevention, and fitness, and are largely used by the younger population. Trial Registration ClinicalTrials.gov NCT03351491; https://clinicaltrials.gov/ct2/show/NCT03351491
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Affiliation(s)
- Sabrina Paradis
- Department of General Practice, University Grenoble Alpes, Grenoble, France
- Translational Innovation in Medicine and Complexity, National Institute of Health and Medical Research, La Tronche, France
| | - Jeremy Roussel
- Department of General Practice, University Grenoble Alpes, Grenoble, France
| | - Jean-Luc Bosson
- Translational Innovation in Medicine and Complexity, National Institute of Health and Medical Research, La Tronche, France
- Department of Public Health, University Grenoble Alpes, Grenoble, France
| | - Jean-Baptiste Kern
- Department of General Practice, University Grenoble Alpes, Grenoble, France
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Suh A, Li M. How the use of mobile fitness technology influences older adults’ physical and psychological well-being. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rosenberg D, Mano R, Mesch GS. Ethnicity and Perceived Influence of Social Media-Based Health Information on Health Decisions and Behaviors: A Test of the Social Diversification Hypothesis. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2022. [DOI: 10.1080/15398285.2021.1997055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dennis Rosenberg
- Department of Social Sciences and Philosophy, University of Jyvaskyla, Jyvaskyla, Finland
- School of Public Health, University of Haifa, Haifa, Israel
| | - Rita Mano
- Faculty of Social Welfare and Health Sciences, Department of Human Services, University of Haifa, Haifa, Israel
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14
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Al Ansari FS, Alfayez A, Alsalman D, Alanezi F, Alhodaib H, Al-Rayes S, Aljabri D, Alrawiai S, Alakrawi Z, Saadah A, Al-Juwair MM, Aljaffary A, AlThani B, Mushcab H, Alanzi TM, AlNujaidi H, Al-Saif AK, Attar R, Alumran A, Al-Mubarak S, Alyousef S. Using mobile health applications to enhance physical activity in Saudi Arabia: a cross-sectional study on users' perceptions. Int Health 2022; 15:47-55. [PMID: 35348719 PMCID: PMC9808522 DOI: 10.1093/inthealth/ihac008] [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] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/15/2021] [Accepted: 03/17/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This research aims to assess the users' perceptions of usability and quality of mobile health applications used for promoting physical activity in Saudi Arabia. METHODS This was a quantitative cross-sectional study. A survey was developed based on the Technology Acceptance Model (TAM) and the Mobile Application Rating Scale (MARS) and distributed among the Saudi population through social media to assess the users' perceptions of using mobile applications to enhance physical activity. The survey questionnaire consisted of 27 questions in six sections, including demographics (nine items), perceived usefulness (three items), perceived ease of use (three items), attitudes (three items), user experience (six items) and subjective quality (three items). All the participants were in Saudi Arabia and >15 y of age. RESULTS A total of 195 m-Health users participated in the survey. Of the total participants, 25.1% were overweight and 21.0% were obese. The workout frequency of most users was rarely (32.3%) and three to four times a week (29.2%). In addition, 55.9% of the users agreed that the application they use served all fitness levels and >80% either agreed or strongly agreed that it was easy for them to learn how to use the application. More than 70% of users agreed or strongly agreed that the application enhanced their knowledge of workouts and physical activity and >90% would recommend the application to others. There were no differences identified between the male and female participants and younger (<40 y) and older (>40 y) participants with respect to perceived usefulness and ease of use, attitudes, experiences and subjective quality. However, significant differences were observed between participants <40 y and >40 y of age in terms of perceived ease of use of mHealth applications. CONCLUSION mHealth users across Saudi Arabia believe that the mHealth applications have good usability and quality factors. As a result, they can motivate people and help them achieve their goals in relation to physical activities.
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Affiliation(s)
- Fatimah Salah Al Ansari
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Asma Alfayez
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Demah Alsalman
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Hala Alhodaib
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia
| | - Saja Al-Rayes
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Duaa Aljabri
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sumaiah Alrawiai
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zahraa Alakrawi
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amjad Saadah
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mona M Al-Juwair
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Afnan Aljaffary
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bashair AlThani
- College of Business Administration, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hayat Mushcab
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Turki M Alanzi
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Heba AlNujaidi
- College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Atheer K Al-Saif
- College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Razaz Attar
- Princess Nourah Bint Abdul Rahman University, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sama'a Al-Mubarak
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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15
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Montazeri M, Khajouei R. Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users' Work. Radiol Res Pract 2022; 2022:4306714. [PMID: 35265375 PMCID: PMC8901356 DOI: 10.1155/2022/4306714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
The impact of the picture archiving and communication system (PACS) on healthcare costs, information access, image quality, and user workflow has been well studied. However, there is insufficient evidence on the effect of this system on different dimensions of the users' work. The objective of this study was to evaluate the impact of the PACS on different dimensions of users' work (external communication, service quality, user intention to use the PACS, daily routine, and complaints on users) and to compare the opinions of different groups of users about the PACS. This study was performed on the PACS users (n = 72) at Kerman University of Medical Sciences, including radiologists, radiology staff, ward heads, and physicians. Data were collected using a questionnaire consisting of two parts: demographic information of the participants and 5-point Likert scale questions concerning the five dimensions of users' work. Data were analyzed using descriptive statistics, ANOVA, and Pearson's correlation coefficient statistical tests. The mean of scores given by the PACS users was 4.31 ± 0.86 for external communication, 4.18 ± 0.96 for user intention to use the PACS, 3.91 ± 0.7 for service quality, 3.16 ± 0.56 for daily routine, and 3.08 ± 1.05 for complaints on users. Radiologists and radiology staff had a more positive opinion about the PACS than other clinicians such as physicians (P < 0.01, CI = 95%). Factors such as user age (P < 0.01, CI = 95%), job (P < 0.001, CI = 95%), work experience (P < 0.001, CI = 95%), and PACS training method (P=0.037, CI = 95%) were related to the impact of the PACS on different dimensions of users' work. This study showed that the PACS has a positive effect on different dimensions of users' work, especially on external communication, user intention to use the system, and service quality. It is recommended to implement PACSs in medical centers to support users' work and to maintain and strengthen the capabilities and functions of radiology departments.
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Affiliation(s)
- Mahdieh Montazeri
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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16
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Stewart TM, Martin CK, Williamson DA. The Complicated Relationship between Dieting, Dietary Restraint, Caloric Restriction, and Eating Disorders: Is a Shift in Public Health Messaging Warranted? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:491. [PMID: 35010751 PMCID: PMC8745028 DOI: 10.3390/ijerph19010491] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 02/01/2023]
Abstract
The origins of theories specifying dietary restraint as a cause of eating disorders can be traced to the 1970s. This paper will present an overview of the origins of dietary restraint theories and a brief historical review of evidence will be summarized. Recent research will be presented, including the results from the CALERIE Phase 1 study, as well as CALERIE Phase 2, which were NIH-sponsored randomized controlled trials. CALERIE 2 provided a test of the effect of two years of caloric restriction (CR) on the development of eating disorder syndromes and symptoms in comparison to a control group that did not alter eating behavior or body weight. The intervention was effective for inducing a chronic (two-year) reduction in total energy expenditure and increased dietary restraint but did not increase symptoms of eating disorders. The results of this recent investigation and other studies have not provided experimental support for conventional dietary restraint theories of eating disorders. These findings are discussed in terms of potential revisions of dietary restraint theory, as well as the implications for a paradigm shift in public health messaging related to dieting.
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Affiliation(s)
- Tiffany M. Stewart
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; (C.K.M.); (D.A.W.)
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17
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Hui CLM, Lam BST, Wong AKH, Tao TJ, Ho ECN, Suen YN, Lee EHM, Chan SKW, Chang WC, Chong CSY, Siu CMW, Lo WTL, Chen EYH. ReMind, a smartphone application for psychotic relapse prediction: A longitudinal study protocol. Early Interv Psychiatry 2021; 15:1659-1666. [PMID: 33369162 DOI: 10.1111/eip.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/29/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychotic disorders are associated with a high rate of relapse. In addition to medication non-adherence, some psychosocial factors have been found to be predictive of relapse (e.g., poor premorbid adjustment, high expressed emotion and substance misuse). Impairments in cognitive functions including general memory functioning, set shifting, attention, processing speed and working memory have also been indicative of a subsequent psychotic episode. As clinical appointments do not always allow for timely or accurate detection of these early warning signs, the ReMind app is developed to explore potential relapse predictors and enhance the process of relapse monitoring. AIM The ReMind app aims (1) to assess whether verbal or visual working memory predicts psychotic relapse in 1 year and (2) to determine whether social factors such as stressful life events, level of expressed emotion and medication adherence also predict relapse in 1 year. METHODS This is a one-year prospective follow-up study involving 176 remitted patients diagnosed with schizophrenia or non-affective psychoses. Monthly relapse predictor assessments will be conducted via ReMind throughout the one-year study duration. These assessments include neurocognitive tasks and psychosocial questionnaires. RESULTS Recruitment began in August 2017 and is still ongoing. Preliminary user feedback suggested an overall positive experience with the app. CONCLUSION The ReMind app presents a step forward to the identification and sensitive detection of reliable psychosis relapse predictors. With its anticipated success, it may offer an alternative means of monitoring relapse for the Chinese-speaking population in the future.
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Affiliation(s)
| | | | | | | | | | - Yi-Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | | | - Sherry Kit-Wa Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Wing-Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | | | | | | | - Eric Yu-Hai Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
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Kim E, Han S. Determinants of Continuance Intention to Use Health Apps among Users over 60: A Test of Social Cognitive Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910367. [PMID: 34639666 PMCID: PMC8508305 DOI: 10.3390/ijerph181910367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022]
Abstract
Promoting healthy behavior among seniors is important in reducing the burden of care and healthcare expenses in a rapidly aging society. Health apps can play an important role in health promotion for older adults, but the level of user retention in health apps is low. To increase continued health app use among older adults, this study examined the factors influencing older users’ continuance intentions to use health apps. The research model was developed based on the social cognitive theory of health behavior, which integrates cognitive, environmental, and behavioral perspectives. To test the research model, an anonymous online survey was conducted among respondents aged 60 to 79 years who were using health apps. The measurement items in the questionnaire were developed based on validated scales from the literature. A total of 250 samples were analyzed. The assessment of the measurement model indicates that the reliability and validity of the items are satisfactory. The results of testing the structural model illustrate the determinants of health app continuance intention: health technology self-efficacy, self-evaluative outcome expectations, self-regulation, and privacy risk. The interrelationships among determinants are also investigated. Theoretical and practical implications are suggested to encourage older adults’ continued health app use and promote their health behavior over the long term.
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19
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Franzmair J, Diesner-Treiber SC, Voitl JJM, Voitl P. Effective German and English Language mHealth Apps for Self-management of Bronchial Asthma in Children and Adolescents: Comparison Study. JMIR Mhealth Uhealth 2021; 9:e24907. [PMID: 34009134 PMCID: PMC8173395 DOI: 10.2196/24907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/18/2021] [Accepted: 04/16/2021] [Indexed: 12/22/2022] Open
Abstract
Background Mobile health (mHealth) apps hold great potential for asthma self-management. Data on the suitability of asthma apps intended for children are insufficient, and the availability of German language apps is still inadequate compared with English language apps. Objective This study aims to identify functional asthma apps for children in German and to compare them with English language apps. In line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the Google Play Store and Apple App Store are systematically searched to preselect the most efficient apps, which are then compared according to a self-compiled criteria catalog. Methods Both app stores were screened for the term asthma. Following a PRISMA preselection process, the apps that met the inclusion criteria (ie, available free of charge, German or English language, and suitable for children) were rated by 3 independent persons following a criteria catalog consisting of 9 categories, some conceived for this purpose (availability, child-friendly, learning factor, and range of functions) and some adopted from existing validated catalogs (functionality and design, ease of use, potential for improving asthma self-management, fun factor and incentives, and information management and medical accuracy). The highest rated apps in German and English were compared. Results A total of 403 apps were identified on the Google Play Store and the Apple App Store. Finally, 24 apps that met the inclusion criteria were analyzed. In the first step of the quality assessment, only 4 available German language asthma apps were compared with 20 English language asthma apps. The 4 German language apps were then compared with the 4 highest rated English language apps. All selected apps, independent of the language, were comparable in the following categories: availability, functionality and design, ease of use, and information management and medical accuracy. The English language apps scored significantly higher in the following categories: potential for improving self-management, child-friendly, fun factor, learning factor, and range of function. English language apps (mean total points 34.164, SD 1.09) performed significantly better than German language asthma apps (mean total points 22.91, SD 2.898; P=.003). The best rated English language app was Kiss my asthma (36/42 points), whereas the best rated German language app Kata achieved only 27.33 points. Conclusions The recommended English language apps are Kiss my asthma, AsthmaXcel, AsthmaAustralia, and Ask Me, AsthMe!, whereas the only recommended German language app is Kata. The use of apps plays an increasingly important role in patients’ lives and in the medical field, making mHealth a staple in the future of asthma treatment plans. Although validated recommendations on rating mHealth apps have been published, it remains a challenging task for physicians and patients to choose a suitable app for each case, especially in non–English-speaking countries.
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Affiliation(s)
| | | | | | - Peter Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria.,Sigmund Freud University, Vienna, Austria
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20
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Bhattarai P, Newton-John T, Phillips JL. Apps for Older People's Pain Self-Management: Perspectives of Primary Care and Allied Health Clinicians. PAIN MEDICINE 2021; 21:686-694. [PMID: 31502649 DOI: 10.1093/pm/pnz218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Chronic arthritic pain is one of the major causes of physical suffering and disability among older people. Primary care and allied health clinicians use various approaches to help their older clients better manage their arthritic pain. The growing uptake of technology among older people offers the potential for clinicians to integrate an arthritic pain app into their patients' self-management plans. This study explored the perspectives of Australian primary care and allied health clinicians regarding the use of pain self-management apps to help their older patients/clients better manage their arthritic pain. METHODS Qualitative design using a semistructured interview approach. Interviews were conducted via telephone with primary and allied health clinicians (N = 17) across Australia. RESULTS The overarching theme underlying participants' views on integration of apps into older people's pain self-management strategy was that this approach is an idealistic but uniquely challenging endeavor. Four subthemes emerged, namely: 1) self-management apps are a potentially useful tool but require careful consideration; 2) clinicians' involvement is crucial yet potentially onerous; 3) no single app is right for every older person with arthritic pain; and 4) patient data access is beneficial, but caution is needed for real-time data access. DISCUSSION The predominant clinician perspective of integrating apps into their older patients/clients' pain self-management strategies was that this approach is an idealistic but uniquely challenging endeavor. Apps were seen as having potential to support various aspects of patients' self-management behaviors; however, there were notable concerns with regards to the challenges inherent in this approach for both clinicians and older users (patients/clients).
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Affiliation(s)
- Priyanka Bhattarai
- School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia
| | | | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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21
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Guo N, Guo Z, Zhao S, Ho SY, Fong DYT, Lai AYK, Chan SSC, Wang MP, Lam TH. Digital inequalities in health information seeking behaviors and experiences in the age of web 2.0: A population-based study in Hong Kong. PLoS One 2021; 16:e0249400. [PMID: 33784362 PMCID: PMC8009409 DOI: 10.1371/journal.pone.0249400] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Inequalities in health information seeking behaviors (HISBs) using mass media and internet websites (web 1.0) are well documented. Little is known about web 2.0 such as social networking sites (SNS) and instant messaging (IM) and experiences of HISBs. METHODS We surveyed representative Hong Kong Chinese adults (N = 10143, 54.9% female; 72.3% aged 25-64 years) on frequency of HISBs using traditional sources, internet websites, SNS (e.g., Facebook, Twitter), and IM (e.g., WhatsApp, WeChat) and experiences measured using Information Seeking Experience Scale. Adjusted prevalence ratios (aPRs) for HISBs and experiences by sociodemographic and health-related characteristics were yielded using multivariable Poisson regression with robust variance estimators. aPRs for experiences by HISBs using internet websites, SNS, and IM adjusting for sociodemographic and health-related characteristics were also yielded. RESULTS Being female, higher educational attainment, not smoking, and being physically active were associated with HISBs using any source (all P<0.05). Older age had decreased aPRs for HISBs using traditional sources (P for trend = 0.03), internet websites (P for trend<0.001), and SNS (P for trend<0.001) but not for IM (aged 45-64 years: aPR = 1.48, 95% CI 1.07, 2.03). Lower educational attainment and income were associated with negative experiences including feelings of effort and difficulties in understanding the information (all P for trend<0.05). Older age had increased aPRs for difficulties in understanding the information (P for trend = 0.003). Compared with internet websites, HISBs using IM was associated with feelings of frustration (aPR = 1.39, 95% CI 1.08, 1.79), difficulties in understanding the information (aPR = 1.36, 95% CI 1.12, 1.65), and quality concern (aPR = 1.20, 95% CI 1.08, 1.32). CONCLUSIONS We identified correlates of web-based health information seeking and experiences in Hong Kong Chinese adults. Providing greater access to and improved information environment of web 2.0 to the target groups may help address digital inequalities.
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Affiliation(s)
- Ningyuan Guo
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Ziqiu Guo
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Shengzhi Zhao
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong, China
| | | | | | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
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22
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Influencing Factors of Acceptance and Use Behavior of Mobile Health Application Users: Systematic Review. Healthcare (Basel) 2021; 9:healthcare9030357. [PMID: 33809828 PMCID: PMC8004182 DOI: 10.3390/healthcare9030357] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose/Significance: Mobile health applications provide a convenient way for users to obtain health information and services. Studying the factors that influence users’ acceptance and use of mobile health applications (apps or Apps) will help to improve users’ actual usage behavior. Method/Process: Based on the literature review method and using the Web of Science core database as the data source, this paper summarizes the relevant research results regarding the influencing factors of the acceptance and use behavior of mobile health application users and makes a systematic review of the influencing factors from the perspectives of the individual, society, and application (app or App) design. Result/Conclusion: In terms of the individual dimension, the users’ behavior is influenced by demographic characteristics and motivations. Social attributes, source credibility, and legal issues all affect user behavior in the social dimension. In the application design dimension, functionality, perceived ease of use and usefulness, security, and cost are the main factors. At the end of the paper, suggestions are given to improve the users’ acceptability of mobile health applications and improve their use behavior.
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Zhang Y, Liu C, Luo S, Huang J, Yang Y, Ma X, Li X, Zhou Z. Effectiveness of the Family Portal Function on the Lilly Connected Care Program (LCCP) for Patients With Type 2 Diabetes: Retrospective Cohort Study With Propensity Score Matching. JMIR Mhealth Uhealth 2021; 9:e25122. [PMID: 33544081 PMCID: PMC7895638 DOI: 10.2196/25122] [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: 10/29/2020] [Revised: 12/03/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background Diabetes is a major health concern worldwide. Family member engagement in diabetes self-management education programs can improve patients’ diabetes management. However, there is limited evidence that the family portal on diabetes management apps is effective in the glycemic control of patients with diabetes. Objective We aimed to evaluate the effectiveness of family support through the family portal function on Lilly Connected Care Program (LCCP) platform. Methods This retrospective cohort study included patients with type 2 diabetes recruited to the LCCP platform from September 1, 2018, to August 31, 2019. Propensity score matching was used to match family (group A) and non–family (group B) portal use groups with similar baseline characteristics. The patients were followed up with for 12 weeks. The main objectives were differences in mean fasting blood glucose, proportion of patients achieving fasting blood glucose target <7mmol/L, mean postprandial blood glucose, proportion of patients achieving postprandial blood glucose target <10mmol/L, proportion of patients achieving both fasting blood glucose <7mmol/L and postprandial blood glucose <10mmol/L, self-monitoring of blood glucose frequency at week 12 and the number of diabetes education courses patients completed during the 12 weeks. Moreover, logistic regression analysis was used to explore the baseline factors which may be associated with the use of family portal, and odds ratios with 95% confidence intervals were calculated. Results A total of 6582 adult patients (aged ≥18 years) with type 2 diabetes who were receiving insulin therapy were enrolled in the study. Overall, 6.1% (402/6582) of the patients chose to engage their family members to use the family portal. Two groups of 394 patients were well-matched regarding baseline characteristics. After matching, mean fasting blood glucose and postprandial blood glucose at week 12 were significantly lower in group A than in group B (fasting blood glucose: 7.12 mmol/L, SD 1.70 vs 7.42 mmol/L, SD 1.88, respectively, P=.02; postprandial blood glucose: 8.56 mmol/L, SD 2.51 vs 9.10 mmol/L, SD 2.69, respectively, P=.002). When comparing group A to group B, the proportion of patients achieving both fasting blood glucose <7mmol and postprandial blood glucose <10mmol/L at week 12 (46.8% vs 39.4%, respectively, P=.04), self-monitoring of blood glucose frequency at week 12 (8.92 times per week, SD 6.77 vs 8.02 times per week, SD 5.97, respectively, P=.05) and number of diabetes education courses completed in 12 weeks (23.00, IQR9.00-38.00 vs 15.00, IQR 4.00-36.00, respectively, P<.001) was higher. Additionally, multivariate logistic regression analysis showed that higher age (OR=0.987, 95% CI 0.978-0.996, P=.006) and higher baseline fasting blood glucose (OR=0.914, 95% CI 0.859-0.972, P=.004) were correlated with less use of the family portal function, while increased baseline self-monitoring of blood glucose frequency (OR=1.022, 95% CI 1.012-1.032], P<.001) as well as increased education courses (OR=1.026, 95% CI 1.015-1.036, P<.001) were associated with more use of the family portal function. Conclusions Family support through the LCCP family portal is effective for glycemic control and self-management behavior improvement in type 2 diabetes patients.
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Affiliation(s)
- Yiyu Zhang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Endocrinology, Changsha Central Hospital, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuoming Luo
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jin Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuxin Yang
- Lilly Suzhou Pharmaceutical Company, Suzhou, China
| | - Xiao Ma
- Lilly Suzhou Pharmaceutical Company, Suzhou, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
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24
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Cho J, Kim S. Personal and social predictors of use and non-use of fitness/diet app: Application of Random Forest algorithm. TELEMATICS AND INFORMATICS 2020. [DOI: 10.1016/j.tele.2019.101301] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Brusniak K, Arndt HM, Feisst M, Haßdenteufel K, Matthies LM, Deutsch TM, Hudalla H, Abele H, Wallwiener M, Wallwiener S. Challenges in Acceptance and Compliance in Digital Health Assessments During Pregnancy: Prospective Cohort Study. JMIR Mhealth Uhealth 2020; 8:e17377. [PMID: 33052134 PMCID: PMC7593860 DOI: 10.2196/17377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pregnant women are increasingly using mobile apps to access health information during the antenatal period. Therefore, digital health solutions can potentially be used as monitoring instruments during pregnancy. However, a main factor of success is high user engagement. OBJECTIVE The aim of this study was to analyze engagement and factors influencing compliance in a longitudinal study targeting pregnant women using a digital health app with self-tracking. METHODS Digitally collected data concerning demographics, medical history, technical aspects, and mental health from 585 pregnant women were analyzed. Patients filling out ≥80% of items at every study visit were considered to be highly compliant. Factors associated with high compliance were identified using logistic regression. The effect of a change in mental and physical well-being on compliance was assessed using a one-sample t test. RESULTS Only 25% of patients could be considered compliant. Overall, 63% left at least one visit blank. Influential variables for higher engagement included higher education, higher income, private health insurance, nonsmoking, and German origin. There was no relationship between a change in the number of physical complaints or depressive symptoms and study dropout. CONCLUSIONS Maintaining high engagement with digital monitoring devices over a long time remains challenging. As cultural and socioeconomic background factors had the strongest influence, more effort needs to be directed toward understanding the needs of patients from different demographic backgrounds to ensure high-quality care for all patients. More studies need to report on compliance to disclose potential demographic bias.
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Affiliation(s)
- Katharina Brusniak
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hannah Maria Arndt
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Kathrin Haßdenteufel
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Lina Maria Matthies
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Hannes Hudalla
- Department of Neonatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Harald Abele
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Section of Midwifery Science, Institute for Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
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Bach RL, Wenz A. Studying health-related internet and mobile device use using web logs and smartphone records. PLoS One 2020; 15:e0234663. [PMID: 32530937 PMCID: PMC7292384 DOI: 10.1371/journal.pone.0234663] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/30/2020] [Indexed: 11/19/2022] Open
Abstract
Many people use the internet to seek information that will help them understand their body and their health. Motivations for such behaviors are numerous. For example, users may wish to figure out a medical condition by searching for symptoms they experience. Similarly, they may seek more information on how to treat conditions they have been diagnosed with or seek resources on how to live a healthy life. With the ubiquitous availability of the internet, searching and finding relevant information is easier than ever before and a widespread phenomenon. To understand how people use the internet for health-related information, we use data from a sample of 1,959 internet users. A unique combination of data containing four months of users' browsing histories and mobile application use on computers and mobile devices allows us to study which health websites they visited, what information they searched for and which health applications they used. Survey data inform us about users' socio-demographic background, medical conditions and other health-related behaviors. Results show that women, young users, users with a university education and nonsmokers are most likely to use the internet and mobile applications for health-related purposes. On search engines, internet users most frequently search for pharmacies, symptoms of medical conditions and pain. Moreover, users seem most interested in information on how to live a healthy life, alternative medicine, mental health and women's health. With this study, we extend the field's understanding of who seeks and consumes health information online, what users look for as well as how individuals use mobile applications to monitor their health. Moreover, we contribute to methodological research by exploring new sources of data for understanding humans, their preferences and behaviors.
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Affiliation(s)
- Ruben L. Bach
- Collaborative Research Center 884 Political Economy of Reforms, University of Mannheim, Mannheim, Germany
- * E-mail:
| | - Alexander Wenz
- Collaborative Research Center 884 Political Economy of Reforms, University of Mannheim, Mannheim, Germany
- Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom
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Lee JJ, Wang MP, Luk TT, Guo N, Chan SSC, Lam TH. Associations of Electronic Device Use Before and After Sleep With Psychological Distress Among Chinese Adults in Hong Kong: Cross-Sectional Study. JMIR Ment Health 2020; 7:e15403. [PMID: 32525489 PMCID: PMC7317625 DOI: 10.2196/15403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 02/07/2020] [Accepted: 04/20/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Hong Kong has a high rate of electronic device (e-device; computer, smartphone, and tablet) use. However, little is known about the associations of the duration of e-device use before and after sleep with psychological symptoms. OBJECTIVE This study aimed to investigate the associations of the duration of e-device use before and after sleep with psychological distress. METHODS A probability-based telephone survey was conducted on 3162 Hong Kong adults (54.6% female; mean age 47.4 years, SD 18.3 years) in 2016. Multivariate linear and Poisson regressions were used to calculate adjusted regression coefficients (aBs) and prevalence ratios (aPRs) of anxiety and depressive symptoms (measured by Patient Health Questionnaire-4) for the duration from waking to the first e-device use (≥61, 31-60, 6-30, and ≤5 minutes) and the duration of e-device use before sleeping (≤5, 6-30, 31-60, and ≥61 minutes). RESULTS The first e-device use in ≤5 (vs ≥61) minutes after waking was associated with anxiety (aB 0.35, 95% CI 0.24-0.46; aPR 1.74, 95% CI 1.34-2.25) and depressive symptoms (aB 0.27, 95% CI 0.18-0.37; aPR 1.84, 95% CI 1.33-2.54). Using e-devices for ≥61 (vs ≤5) minutes before sleeping was also associated with anxiety (aB 0.17, 95% CI 0.04-0.31; aPR 1.32, 95% CI 1.01-1.73) and depressive symptoms (aB 0.17, 95% CI 0.05-0.28; aPR 1.47, 95% CI 1.07-2.02). E-device use both ≤5 minutes after waking and for ≥61 minutes before sleeping was strongly associated with anxiety (aB 0.68, 95% CI 0.47-0.90; aPR 2.64, 95% CI 1.90-3.67) and depressive symptoms (aB 0.55, 95% CI 0.36-0.74; aPR 2.56, 95% CI 1.69-3.88). CONCLUSIONS E-device use immediately (≤5 minutes) after waking and use for a long duration (≥61 minutes) before sleeping were associated with anxiety and depressive symptoms among Chinese adults in Hong Kong.
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Affiliation(s)
- Jung Jae Lee
- School of Nursing, University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tzu Tsun Luk
- School of Nursing, University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Ningyuan Guo
- School of Nursing, University of Hong Kong, Hong Kong, China (Hong Kong)
| | | | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China (Hong Kong)
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Lin TTC, Bautista JR, Core R. Seniors and mobiles: A qualitative inquiry of mHealth adoption among Singapore seniors. Inform Health Soc Care 2020; 45:360-373. [PMID: 32484720 DOI: 10.1080/17538157.2020.1755974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study examines how seniors in Singapore use mobile devices for healthcare purposes. METHODS Semi-structured interviews with 35 mobile phone users aged between 58-82 years old. RESULTS Seniors regard mobile phones as important personal devices for socialization, security, and emergency purposes. Most of the seniors consider mobile telephony (voice calls and text messaging) as an accessible platform to access healthcare. Perceived usefulness, ease of use, compatibility, technology anxiety, financial cost, and self-efficacy were identified as factors affecting the use of mHealth among seniors. Although a few adopt mHealth applications and mobile Internet for health-information seeking, some younger seniors show enthusiastic attitudes toward its adoption. Additionally, some seniors also have technology anxiety and resistance toward using mHealth applications. CONCLUSION Seniors use mobile phones for healthcare purposes in their daily life, and its use involves several facilitators and barriers. Interpersonal training is likely to reduce their anxiety and increase mHealth literacy and adoption. Theoretical and practical implications are discussed.
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Affiliation(s)
- Trisha T C Lin
- Department of Radio & Television, National Chengchi University, Taipei, Taiwan
| | - John Robert Bautista
- School of Information, The University of Texas at Austin, Austin, Texas, USA.,Center for Health Communication, The University of Texas at Austin, Austin, Texas, USA
| | - Rachel Core
- College of Arts and Sciences, Stetson University, DeLand, Florida, USA
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Rathnayake S, Moyle W, Jones C, Calleja P. Family carers’ needs related to management of functional disability in dementia care and use of mHealth applications in health information seeking: An online survey. Collegian 2020. [DOI: 10.1016/j.colegn.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stühmann LM, Paprott R, Heidemann C, Baumert J, Hansen S, Zahn D, Scheidt-Nave C, Gellert P. Health App Use and Its Correlates Among Individuals With and Without Type 2 Diabetes: Nationwide Population-Based Survey. JMIR Diabetes 2020; 5:e14396. [PMID: 32432555 PMCID: PMC7270854 DOI: 10.2196/14396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/17/2019] [Accepted: 02/05/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Evidence suggests that mobile health app use is beneficial for the prevention and management of type 2 diabetes (T2D) and its associated complications; however, population-based research on specific determinants of health app use in people with and without T2D is scarce. OBJECTIVE This cross-sectional study aimed to provide population-based evidence on rates and determinants of health app use among adults with and without T2D, thereby covering a prevention perspective and a diabetes management perspective, respectively. METHODS The study population included 2327 adults without a known diabetes diagnosis and 1149 adults with known T2D from a nationwide telephone survey in Germany conducted in 2017. Rates of smartphone ownership and health app use were estimated based on weighted sample proportions. Among smartphone owners, determinants of health app use were identified for both groups separately in multivariable logistic regression models. Sociodemographic factors, diabetes-related factors or indicators, psychological and health-related factors, and physician-provided information were selected as potential determinants. RESULTS Among participants without known diabetes, 74.72% (1690/2327) were smartphone owners. Of those, 49.27% (717/1690) used health apps, most often to improve regular physical activity. Among participants with T2D, 42.26% (481/1149) were smartphone owners. Of those, 41.1% (171/481) used health apps, most commonly to target a healthy diet. Among people without known diabetes, determinants significantly (all P values <.05) associated with an increased likelihood of health app use compared with their reference group were as follows: younger and middle age of 18 to 44 or 45 to 64 years (odds ratios [ORs] 3.89; P<.001 and 1.76; P=.004, respectively), overweight or obesity (ORs 1.58; P<.001 and 2.07; P<.001, respectively), hypertension diagnosis (OR 1.31; P=.045), former or current smoking (ORs 1.51; P=.002 and 1.58; P<.001, respectively), perceiving health as very good (OR 2.21; P<.001), other chronic diseases (OR 1.48; P=.002), and having received health advice from a physician (OR 1.48; P<.001). A slight or high perceived diabetes risk (ORs 0.78; P=.04 and 0.23; P<.001, respectively) was significantly associated with a decreased likelihood of health app use. Among people with T2D, younger and middle age (18-64 years; OR 1.84; P=.007), female gender (OR 1.61; P=.02), and using a glucose sensor in addition or instead of a glucose meter (OR 2.74; P=.04) were significantly positively associated with health app use. CONCLUSIONS In terms of T2D prevention, age, diabetes-related risk factors, psychological and health-related factors, and medical health advice may inform app development for specific target groups. In addition, health professionals may encourage health app use when giving advice on health behaviors. Concerning T2D management, only a few determinants seem relevant for explaining health app use among people with T2D, indicating a need for more future research on which people with T2D use health apps and why.
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Affiliation(s)
- Lena M Stühmann
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Sylvia Hansen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, Cologne, Germany
| | - Daniela Zahn
- Preventive Cardiology and Medical Prevention, Department of Cardiology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
- Federal Center for Health Education (BZgA), Office for National Education and Communication on Diabetes Mellitus, Cologne, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Paul Gellert
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Zhong R, Rau PLP. A Mobile Phone-Based Gait Assessment App for the Elderly: Development and Evaluation. JMIR Mhealth Uhealth 2020; 8:e14453. [PMID: 32452821 PMCID: PMC7284482 DOI: 10.2196/14453] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background Gait disorders are common among older adults. With an increase in the use of technology among older adults, a mobile phone app provides a solution for older adults to self-monitor their gait quality in daily life. Objective This study aimed to develop a gait-monitoring mobile phone app (Pocket Gait) and evaluate its acceptability and usability among potential older users. Methods The app was developed to allow older adults to track their gait quality, including step frequency, acceleration root mean square (RMS), step regularity, step symmetry, and step variability. We recruited a total of 148 community-dwelling older adults aged 60 years and older from two cities in China: Beijing and Chongqing. They walked in three ways (single task, dual task, and fast walking) using a smartphone with the gait-monitoring app installed and completed an acceptability and usability survey after the walk test. User acceptability was measured by a questionnaire including four quantitative measures: perceived ease of use, perceived usefulness, ease of learning, and intention to use. Usability was measured using the System Usability Scale (SUS). Interviews were conducted with participants to collect open-ended feedback questions. Results Task type had a significant effect on all gait parameters, namely, step frequency, RMS, step variability, step regularity, and step symmetry (all P values <.001). Age had a significant effect on step frequency (P=.01), and region had a significant effect on step regularity (P=.04). The acceptability of the gait-monitoring app was positive among older adults. Participants identified the usability of the system with an overall score of 59.7 (SD 10.7) out of 100. Older adults from Beijing scored significantly higher SUS compared with older adults from Chongqing (P<.001). The age of older adults was significantly associated with their SUS score (P=.048). Older adults identified improvements such as a larger font size, inclusion of reference values for gait parameters, and inclusion of heart rate and blood pressure monitoring. Conclusions This mobile phone app is a health management tool for older adults to self-manage their gait quality and prevent adverse outcomes. In the future, it will be important to take factors such as age and region into consideration while designing a mobile phone–based gait assessment app. The feedback of the participants would help to design more elderly-friendly products.
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Affiliation(s)
- Runting Zhong
- School of Business, Jiangnan University, Wuxi, China.,Department of Industrial Engineering, Tsinghua University, Beijing, China
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32
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Mayer MA, Rodríguez Blanco O, Torrejon A. Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study. JMIR Mhealth Uhealth 2019; 7:e15195. [PMID: 31682587 PMCID: PMC6858615 DOI: 10.2196/15195] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/25/2019] [Accepted: 09/27/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In the last few years, the number of mobile apps for health professionals has increased exponentially. Nevertheless, there is a lack of knowledge about the professional use, training requirements, and quality perception of these apps among health care professionals such as nurses. Considering that the nursing profession is the largest segment of health care workforce in many countries such as Spain, the impact of the use of health apps by these professionals can be critical to the future of modern health care. OBJECTIVE The main objective of this study was to determine if nurses were using health apps professionally and what types of apps they were using. The secondary objectives were (1) to find out if, among nurses, there is a need for training in the use of health apps and (2) to explore nurses' perceptions of health professional apps, determining whether there is a need for a certification process for health apps and the type of institution or organization that should review and validate these apps for professional use. METHODS After an initial piloting survey, all registered nurses at the Nursing Association of Barcelona were invited to participate in a 34-item online survey. Eventually, 1293 nurses participated in the survey; however, 52 did not complete the survey properly, omitting both age or gender information, and they were excluded from the analysis. RESULTS About half of the respondents (600/1241, 48.35%) had health professional apps installed on their devices and were included for analysis. Most participants in the survey were women (474/600, 79.0%) and the remaining were men (126/600, 21.0%). The most popular types of apps used and installed among nurses were related to drug information, health calculators, and health guidelines. Overall, 97.0% (582/600) of nurses thought that the health apps should be certified, and 80.0% (480/600) agreed that the certification process should be carried out by professional or health institutions. Furthermore, 14.5% (87/600) of participants mentioned that they were asked by their patients to prescribe a health app and only 6.5% (28/430) recommended them often. Most nurses (354/433, 81.8%) who answered the question about the importance of receiving specific training on using and prescribing health apps considered this point a very relevant issue. CONCLUSIONS About half of the nurses in Catalonia use health apps for professional purposes, and they believe that these types of tools should be validated and certified by health or professional institutions before using them in clinical environments. Although the prescription of health apps in clinical environments is infrequent among nurses, they would be willing to prescribe apps if they were certified by a health organization. Finally, among nurses, there is a need for training in using and prescribing health apps for health care purposes.
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Affiliation(s)
- Miguel Angel Mayer
- Research Programme on Biomedical Informatics. Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Antonio Torrejon
- Col·legi Oficial d'Infermeres i Infermers de Barcelona, Barcelona, Spain
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Mahmood A, Kedia S, Wyant DK, Ahn S, Bhuyan SS. Use of mobile health applications for health-promoting behavior among individuals with chronic medical conditions. Digit Health 2019; 5:2055207619882181. [PMID: 31656632 PMCID: PMC6791047 DOI: 10.1177/2055207619882181] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/20/2019] [Indexed: 01/10/2023] Open
Abstract
Background Chronic medical conditions (CCs) are leading causes of morbidity and mortality in the United States. Strategies to control CCs include targeting unhealthy behaviors, often through the use of patient empowerment tools, such as mobile health (mHealth) technology. However, no conclusive evidence exists that mHealth applications (apps) are effective among individuals with CCs for chronic disease self-management. Methods We used data from the Health Information National Trends Survey (HINTS 5, Cycle 1, 2017). A sample of 1864 non-institutionalized US adults (≥18 years) who had a smartphone and/or a tablet computer and at least one CC was analyzed. Using multivariable logistic regressions, we assessed predisposing, enabling, and need predictors of three health-promoting behaviors (HPBs): tracking progress on a health-related goal, making a health-related decision, and health-related discussions with a care provider among smart device and mHealth apps owners. Results Compared to those without mHealth apps, individuals with mHealth apps had significantly higher odds of using their smart devices to track progress on a health-related goal (adjusted odds ratio (aOR) 8.74, 95% confidence interval (CI): 5.66–13.50, P < .001), to make a health-related decision (aOR 1.77, 95% CI: 1.16–2.71, P < .01) and in health-related discussions with care providers (aOR 2.0, 95% CI: 1.26–3.19, P < .01). Other significant factors of at least one type of HPB among smart device and mHealth apps users were age, gender, education, occupational status, having a regular provider, and self-rated general health. Conclusion mHealth apps are associated with increased rates of HPB among individuals with CCs. However, certain groups, like older adults, are most affected by a digital divide where they have lower access to mHealth apps and thus are not able to take advantage of these tools. Rigorous randomized clinical trials among various segments of the population and different health conditions are needed to establish the effectiveness of these mHealth apps. Healthcare providers should encourage validated mHealth apps for patients with CCs.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - David K Wyant
- The Jack C Massey Graduate School of Business, Belmont University, Nashville, TN, USA
| | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Soumitra S Bhuyan
- Edward J Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
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Zhang Y, Liu C, Luo S, Xie Y, Liu F, Li X, Zhou Z. Factors Influencing Patients' Intentions to Use Diabetes Management Apps Based on an Extended Unified Theory of Acceptance and Use of Technology Model: Web-Based Survey. J Med Internet Res 2019; 21:e15023. [PMID: 31411146 PMCID: PMC6711042 DOI: 10.2196/15023] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetes poses heavy social and economic burdens worldwide. Diabetes management apps show great potential for diabetes self-management. However, the adoption of diabetes management apps by diabetes patients is poor. The factors influencing patients' intention to use these apps are unclear. Understanding the patients' behavioral intention is necessary to support the development and promotion of diabetes app use. OBJECTIVE This study aimed to identify the determinants of patients' intention to use diabetes management apps based on an integrated theoretical model. METHODS The hypotheses of our research model were developed based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT). From April 20 to May 20, 2019, adult patients with diabetes across China, who were familiar with diabetes management apps, were surveyed using the Web-based survey tool Sojump. Structural equation modeling was used to analyze the data. RESULTS A total of 746 participants who met the inclusion criteria completed the survey. The fitness indices suggested that the collected data fit well with the research model. The model explained 62.6% of the variance in performance expectancy and 57.1% of the variance in behavioral intention. Performance expectancy and social influence had the strongest total effects on behavioral intention (β=0.482; P=.001). Performance expectancy (β=0.482; P=.001), social influence (β=0.223; P=.003), facilitating conditions (β=0.17; P=.006), perceived disease threat (β=0.073; P=.005), and perceived privacy risk (β=-0.073; P=.012) had direct effects on behavioral intention. Additionally, social influence, effort expectancy, and facilitating conditions had indirect effects on behavioral intention that were mediated by performance expectancy. Social influence had the highest indirect effects among the three constructs (β=0.259; P=.001). CONCLUSIONS Performance expectancy and social influence are the most important determinants of the intention to use diabetes management apps. Health care technology companies should improve the usefulness of apps and carry out research to provide clinical evidence for the apps' effectiveness, which will benefit the promotion of these apps. Facilitating conditions and perceived privacy risk also have an impact on behavioral intention. Therefore, it is necessary to improve facilitating conditions and provide solid privacy protection. Our study supports the use of UTAUT in explaining patients' intention to use diabetes management apps. Context-related determinants should also be taken into consideration.
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Affiliation(s)
- Yiyu Zhang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
- National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuoming Luo
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
- National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Yuting Xie
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
- National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
- National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
- National Clinical Research Center for Metabolic Diseases, Changsha, China
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Short Sleep Duration and Insomnia Symptoms were Associated with Lower Happiness Levels in Chinese Adults in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122079. [PMID: 31212815 PMCID: PMC6616396 DOI: 10.3390/ijerph16122079] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 01/29/2023]
Abstract
Study objective: To examine the association of sleep duration and insomnia symptoms with happiness. Methods: A random sample of 1691 Chinese adult (mean age 54 ± 20.1, male 51%) were interviewed in a population-based telephone survey. Happiness was measured by the subjective happiness scale (SHS) and the one-item global happiness index (GHI). Information on sleep included mean past seven-day sleep duration (<6 h, ≥6 to <8 h and ≥8 h) and insomnia symptoms: Difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), and early morning awakening (EMA). Adjusted beta-coefficient (β) of SHS and adjusted odds ratio (aOR) of GHI in relation to sleep problems were calculated. Interaction effects by age (18–65 vs. ≥65) and by sex were assessed. Results: Compared to ≥8 h of sleep, having <6 h of sleep had lower SHS (adjusted β −0.32, 95% CI −0.46 to −0.17) and GHI (aOR 0.54, 95% CI 0.38 to 0.78). The associations were stronger in younger adults and in women (p < 0.05). DIS, DMS, and EMA were associated with lower SHS (adjusted β ranged from −0.20 to −0.06) and GHI (aOR ranged from 0.57 to 0.89). Dose-response association between the number of insomnia symptoms and lower SHS was observed (p < 0.001). These associations were generally stronger in older adults and among women. Conclusions: Lower levels of happiness were observed, particularly in younger adults and females with short sleep duration and older adults and females with insomnia symptoms. Prospective studies are needed to confirm the findings and understand the mechanisms between sleep and happiness.
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Guan L, Peng TQ, Zhu JJH. Who is Tracking Health on Mobile Devices: Behavioral Logfile Analysis in Hong Kong. JMIR Mhealth Uhealth 2019; 7:e13679. [PMID: 31120429 PMCID: PMC6552450 DOI: 10.2196/13679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 04/29/2019] [Indexed: 01/10/2023] Open
Abstract
Background Health apps on mobile devices provide an unprecedented opportunity for ordinary people to develop social connections revolving around health issues. With increasing penetration of mobile devices and well-recorded behavioral data on such devices, it is desirable to employ digital traces on mobile devices rather than self-reported measures to capture the behavioral patterns underlying the use of mobile health (mHealth) apps in a more direct and valid way. Objective The objectives of this study were to (1) assess the demographic predictors of the adoption of mHealth apps; (2) investigate the temporal pattern underlying the use of mHealth apps; and (3) explore the impacts of demographic variables, temporal features, and app genres on the use of mHealth apps. Methods Logfile data of mobile devices were collected from a representative panel of about 2500 users in Hong Kong. Users’ mHealth app activities were analyzed. We first conducted a binary logistic regression analysis to uncover demographic predictors of users’ adoption status. Then we utilized a multilevel negative binomial regression to examine the impacts of demographic characteristics, temporal features, and app genres on mHealth app use. Results It was found that 27.5% of mobile device users in Hong Kong adopt at least one genre of mHealth app. Adopters of mHealth apps tend to be female and better educated. However, demographic characteristics did not showcase the predictive powers on the use of mHealth apps, except for the gender effect (Bfemale vs Bmale=–0.18; P=.006). The use of mHealth apps demonstrates a significant temporal pattern, which is found to be moderately active during daytime and intensifying at weekends and at night. Such temporal patterns in mHealth apps use are moderated by individuals’ demographic characteristics. Finally, demographic characteristics were also found to condition the use of different genres of mHealth apps. Conclusions Our findings suggest the importance of dynamic perspective in understanding users’ mHealth app activities. mHealth app developers should consider more the demographic differences in temporal patterns of mHealth apps in the development of mHealth apps. Furthermore, our research also contributes to the promotion of mHealth apps by emphasizing the differences of usage needs for various groups of users.
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Affiliation(s)
- Lu Guan
- Department of Media and Communication, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tai-Quan Peng
- Department of Communication, Michigan State University, East Lansing, MI, United States
| | - Jonathan J H Zhu
- Department of Media and Communication, City University of Hong Kong, Hong Kong, China (Hong Kong).,School of Data Science, City University of Hong Kong, Hong Kong, China (Hong Kong)
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Petrovčič A, Peek S, Dolničar V. Predictors of Seniors' Interest in Assistive Applications on Smartphones: Evidence from a Population-Based Survey in Slovenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1623. [PMID: 31075879 PMCID: PMC6539287 DOI: 10.3390/ijerph16091623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 11/29/2022]
Abstract
Assistive applications (apps) on smartphones could contribute to a better quality of life for seniors living independently at home. At present, there is a lack of empirical evidence of seniors' acceptance of such apps. The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS) model was recently proposed for studying the interplay between acceptance factors by integrating the personal, social and technological domains of seniors' daily lives. This study aimed to explore how four groups of factors, clustered in accordance with the C-TAILS model, predict seniors' interest in assistive apps, on a representative sample of the Slovenian population aged 55 years or older. The 617 respondents, who were contacted though a telephone survey, answered a questionnaire about their interest in three groups of assistive apps and four groups of potentially associated acceptance factors. Three linear regression models were used to analyse the association between the factors and the seniors' interest in the three types of assistive apps. Smartphone-related dispositional traits were the strongest predictors across all three models. Among mobile phone usage patterns, smartphone use and the breadth of mobile phone features used were significant factors, while the significance of seniors' personal characteristics and socio-economic conditions varied across the models. Hence, awareness that these factors play different roles in the acceptance of different assistive apps is needed in order to design viable interventions for their acceptance among seniors.
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Affiliation(s)
- Andraž Petrovčič
- Faculty of Social Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia.
| | - Sebastiaan Peek
- School of Social and Behavioral Sciences, Department of Tranzo, Tilburg University, 5000 LE Tilburg, The Netherlands.
| | - Vesna Dolničar
- Faculty of Social Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia.
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Schramm K, Grassl N, Nees J, Hoffmann J, Stepan H, Bruckner T, Haun MW, Maatouk I, Haist M, Schott TC, Sohn C, Schott S. Women's Attitudes Toward Self-Monitoring of Their Pregnancy Using Noninvasive Electronic Devices: Cross-Sectional Multicenter Study. JMIR Mhealth Uhealth 2019; 7:e11458. [PMID: 30617040 PMCID: PMC6329419 DOI: 10.2196/11458] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/08/2018] [Accepted: 09/27/2018] [Indexed: 01/19/2023] Open
Abstract
Background Pregnancy can be distressing, particularly if expectant mothers are worried about the well-being of their fetus. Consequently, the desire for reassurance and frequent fetal monitoring is often pronounced. Smart wearable devices and telemedicine are promising tools that could assist women in self-monitoring their pregnancy at home, hence disburdening emergency departments (EDs). They present the possibility to clarify the need for urgent care remotely and offer tighter pregnancy monitoring. However, patients’ acceptance of such new technologies for fetal monitoring has not yet been explored extensively. Objective This survey aimed to elucidate the attitudes of women toward self-monitoring of their pregnancy using noninvasive electronic devices. The technical details of the proposed devices were not specified. Methods A cross-sectional multicenter study was conducted at the departments of obstetrics of the University Hospitals of Heidelberg and Leipzig, Germany. All patients seen in the obstetrics clinic who were above 18 years were offered participation. We designed a survey questionnaire including validated instruments covering population characteristics, issues in current and past pregnancies, as well as attitudes toward self-monitoring of pregnancy with smart devices. Results A total of 509 pregnant women with no previous experience in telemedicine participated. Only a small minority of 5.9% (29/493) regarded self-monitoring with wearable devices as an alternative to consulting their physicians. Along these lines, only 7.7% (38/496) strongly believed they would visit the ED less often if such devices were readily available. However, if the procedure were combined with a Web-based telemetric physician consult, 13.5% (66/487) would be highly motivated to use the devices. Furthermore, significantly more women regarded it as an alternative prior to seeing a doctor when they perceived a decline in fetal movements (P<.001). Interestingly, women with university degrees had a higher propensity to engage in pregnancy self-monitoring compared with women without one (37% vs 23%; P=.001). Of the participants, 77.9% (381/489) would like smart wearable devices to measure fetal heart sounds, and 62.6% (306/489) wished to use the devices on their own. Feedback from a doctor or midwife was also very important in their choice of such devices (61.8%, 301/487 wished feedback). The intended frequency of use differed vastly among women, ranging from 13.8% (65/471) who would like to use such a device several times per day to 31.6% (149/471) who favored once per week at most. Conclusions Our results point to a skeptical attitude toward pregnancy self-monitoring among pregnant women. Nevertheless, many women are open to using devices for pregnancy monitoring in parallel to consulting their physician. The intention to use such devices several times daily or weekly, expressed by more than half of the participants, highlights the potential of such technologies.
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Affiliation(s)
- Katharina Schramm
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Niklas Grassl
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Janine Hoffmann
- Department of Gynecology and Obstetrics, University Women's Clinic Leipzig, Leipzig, Germany
| | - Holger Stepan
- Department of Gynecology and Obstetrics, University Women's Clinic Leipzig, Leipzig, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Haist
- Frauenarztpraxis Markus Haist & Anja Ritthaler, Pforzheim, Germany
| | - Timm C Schott
- Centre of Dentistry, Department of Orthodontics and Orofacial Orthopedics, University of Tuebingen, Tuebingen, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Heidelberg, Germany
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Luk TT, Wang MP, Shen C, Wan A, Chau PH, Oliffe J, Viswanath K, Chan SSC, Lam TH. Short version of the Smartphone Addiction Scale in Chinese adults: Psychometric properties, sociodemographic, and health behavioral correlates. J Behav Addict 2018; 7:1157-1165. [PMID: 30418073 PMCID: PMC6376375 DOI: 10.1556/2006.7.2018.105] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND AIMS Problematic smartphone use (PSU) is an emerging but understudied public health issue. Little is known about the epidemiology of PSU at the population level. We evaluated the psychometric properties of the Smartphone Addiction Scale - Short Version (SAS-SV) and examined its associated sociodemographic factors and health behaviors in Chinese adults in Hong Kong. METHODS A random sample of 3,211 adults aged ≥18 years (mean ± SD: 43.3 ± 15.7, 45.3% men) participated in a population-based telephone survey in Hong Kong and completed the Chinese SAS-SV. Multivariable linear regressions examined the associations of sociodemographic factors, health behaviors, and chronic disease status with SAS-SV score. Data were weighted by age, sex, and education attainment distributions of the Hong Kong general population. RESULTS The Chinese SAS-SV is internally consistent (Cronbach's α = .844) and stable over 1 week (intraclass correlation coefficient = .76, p < .001). Confirmatory factor analysis supported a unidimensional structure established by previous studies. The weighted prevalence of PSU was 38.5% (95% confidence interval: 36.9%, 40.2%). Female sex, younger age, being married/cohabitated or divorced/separated (vs. unmarried), and lower education level were associated with a higher SAS-SV score (all ps <.05). Current smoking, weekly to daily alcohol drinking, and physical inactivity predict greater PSU after controlling for sociodemographic factors and mutual adjustment. DISCUSSION AND CONCLUSIONS The Chinese SAS-SV was found valid and reliable for assessing PSU in Hong Kong adults. Several sociodemographic and health behavioral factors were associated with PSU at the population level, which may have implication for prevention of PSU and future research.
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Affiliation(s)
- Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China,Corresponding author: Man Ping Wang; School of Nursing, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China; Phone: +852 3917 6636; Fax: +852 2872 6079; E-mail:
| | - Chen Shen
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Alice Wan
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Pui Hing Chau
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - John Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Kasisomayajula Viswanath
- Center for Community-Based Research, Dana-Farber Cancer Institute, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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DÖNER GÜNER PINAR, BÖLÜKBAŞI HANDE, KOKAÇYA SÜMEYYAHAVVA, YENGİL ERHAN, ÖZER CAHİT. Mustafa Kemal Üniversitesi Öğrencilerinin Mobil Sağlık Uygulamalarını Kullanımı. KONURALP TIP DERGISI 2018. [DOI: 10.18521/ktd.426863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Test-retest reliability and validity of a single-item Self-reported Family Happiness Scale in Hong Kong Chinese: findings from Hong Kong Jockey Club FAMILY Project. Qual Life Res 2018; 28:535-543. [PMID: 30284182 DOI: 10.1007/s11136-018-2019-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE Family happiness is one major theme of family well-being in Chinese culture. We investigated the reliability and validity of the single-item Self-reported Family Happiness Scale (SFHS-1) with the score of 0-10, based on two studies in Hong Kong Chinese. METHODS Study 1 was a territory-wide population-based telephone survey (n = 4038) conducted in 2016. Study 2 was a community-based family intervention program conducted during 2012-2013 (n = 1261) to enhance family communication and well-being. Test-retest reliability of the SFHS-1 was assessed over 1 month in Study 2. Family APGAR (Adaption, Partnership, Growth, Affection, Resolve) Scale, Family Communication Scale, Subjective Happiness Scale, 12-item Short Form Health Survey Version 2, and 2-item Patient Health Questionnaire were used to assess the convergent and discriminant validities of the SFHS-1 in both studies. Multiple regression analysis was used to assess the incremental validity by identifying the additional contribution of the SFHS-1 score in predicting subjective happiness. RESULTS The 1-month test-retest reliability assessed by intraclass correlation was 0.76. Family happiness was moderately to strongly correlated with family function, family communication, subjective happiness, mental health-related quality of life and depression, but weakly correlated with physical health-related quality of life. Furthermore, the score of the SFHS-1 added predictive power to mental health-related quality of life and depression in assessing subjective happiness. CONCLUSIONS Our results have shown the SFHS-1 as a reliable and valid measurement of family happiness in Hong Kong Chinese, suggesting SFHS-1 is highly practicable for future large epidemiological and community-based intervention studies.
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Shen C, Wang MP, Wan A, Viswanath K, Chan SSC, Lam TH. Health information exposure from information and communication technologies and its associations with health behaviors: Population-based survey. Prev Med 2018; 113:140-146. [PMID: 29787775 DOI: 10.1016/j.ypmed.2018.05.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/12/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
Health information and communication technologies (ICTs) are increasingly used but little is known about routine exposure to health information from ICTs and its associations with health behaviors. A territory-wide population-based dual landline and mobile telephone survey was conducted in 2016 in Hong Kong, where smartphone ownership and Internet access are among the most prevalent, easiest and fastest in the world. Health information exposure from traditional sources (television/radio/newspaper/magazine), Internet websites, social media sites and instant messaging (IM); and information on smoking, alcohol consumption and physical activity were recorded. Prevalence was weighted by age, sex and education level of the general population. Multinomial logistic regression was used to assess the association of health information exposure with smoking and alcohol consumption, whilst multivariable linear regression was used to assess the association with frequency of moderate and vigorous physical activity (days/week). Of 3063 respondents, most (71.6%) were often or sometimes exposed to health information from traditional sources, followed by Internet websites (40.9%), social media sites (40.7%), and IM (27.0%). Respondents with lower education and household income were less frequently exposed to health information from Internet websites, social media sites and IM (all P < 0.001). Health information exposure from IM was associated with being never smokers, and more frequent moderate and vigorous physical activity (all P for trend <0.05). Health information exposure from IM was least frequent but associated with healthier behaviors. Further public health education campaigns can consider using IM to deliver information, particularly to disadvantaged groups.
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Affiliation(s)
- Chen Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong.
| | - Alice Wan
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Kasisomayajula Viswanath
- Center for Community-Based Research, Dana-Farber Cancer Institute/Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Cambridge, MA, United States
| | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
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Huang Z, Soljak M, Boehm BO, Car J. Clinical relevance of smartphone apps for diabetes management: A global overview. Diabetes Metab Res Rev 2018; 34:e2990. [PMID: 29431916 DOI: 10.1002/dmrr.2990] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/15/2018] [Accepted: 01/26/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND We assessed the number, proportion, and clinical relevance of diabetes self-management apps in major languages spoken by 10 countries with the highest number of people with diabetes. METHODS China, India, USA, Brazil, Russian Federation, Mexico, Indonesia, Egypt, Japan, and Pakistan were identified as the 10 countries with the largest number of people with diabetes based on the latest NCD-RisC survey. Android and iOS apps in the 10 national languages were extracted with a search strategy. App titles and descriptions were systematically screened by trained reviewers, including apps specific for diabetes self-management and excluding apps for health care providers, general well-being, health and product promotion, and traditional cure. Eighteen apps in the above languages were then downloaded based on availability and popularity and assessed for clinical relevance to diabetes self-management with reference to current clinical guidelines. RESULTS The diabetes-related search terms identified 3374 Android and 4477 iOS apps, where 1019 Android and 1303 iOS apps were screened as being relevant for diabetes self-management. Chinese and English language apps constitute above 80% of the diabetes apps, have more downloads, and more comprehensive clinically relevant functions compared with other languages. None of the apps assessed met all criteria for information provision and app functionalities nor provided information cited from accredited sources. CONCLUSIONS Our study showed that apps could play an important role in complementing multifaceted diabetes care, but should preferably be regulated, context specific, and more tailored to users' needs with clear guidance for patients and clinicians about the choices.
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Affiliation(s)
- Zhilian Huang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- NTU Institute for Health Technologies (HealthTech NTU), Interdisciplinary Disciplinary School, Nanyang Technological University, Singapore
| | - Michael Soljak
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Bernhard Otto Boehm
- Immuno-Metabolism Laboratory, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Rasche P, Mertens A, Brandl C, Liu S, Buecking B, Bliemel C, Horst K, Weber CD, Lichte P, Knobe M. Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults. JMIR Mhealth Uhealth 2018; 6:e75. [PMID: 29588268 PMCID: PMC5893889 DOI: 10.2196/mhealth.9467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 01/15/2023] Open
Abstract
Background Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). Conclusions The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Alexander Mertens
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Benjamin Buecking
- Hand and Reconstructive Surgery, Department of Trauma, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Hand and Reconstructive Surgery, Department of Trauma, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Christian David Weber
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Philipp Lichte
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
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Rasche P, Wille M, Bröhl C, Theis S, Schäfer K, Knobe M, Mertens A. Prevalence of Health App Use Among Older Adults in Germany: National Survey. JMIR Mhealth Uhealth 2018; 6:e26. [PMID: 29362211 PMCID: PMC5801520 DOI: 10.2196/mhealth.8619] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/05/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022] Open
Abstract
Background Health apps are increasingly becoming an integral part of health care. Especially in older adults, the self-management of chronic diseases by health apps might become an integral part of health care services. Objective The aim of this explorative study was to investigate the prevalence of health app use and related demographic factors, as well as health status among older adults in Germany. Methods A nationwide postal survey was conducted. Of the 5000 individuals contacted, a total of 576 participants completed this survey. On the basis of their self-indicated assignment to one of the three predefined user groups (health app users, general app users, and nonusers of apps), participants answered various questions regarding app and health app use, including frequency of use and number of installed apps, demographic factors, and health status. Results In total, 16.5% (95/576) used health apps, whereas 37.5% (216/576) indicated only using general apps, and 46.0% (265/576) reported using no apps at all. The number of installed health apps was most frequently reported as between 1 and 5 apps per participant, which were usually used on a weekly basis. The most frequently cited type of health apps were exercise-related ones. Individuals using health apps were found to be younger (MeanmHealth 66.6, SD 4.7) and to have a higher level of technical readiness compared with general app users and nonusers of apps (adjusted odds ratio, AOR=4.02 [95% CI 2.23-7.25] for technical readiness, and AOR=0.905 [95% CI 0.85-0.97] for age). The most frequently mentioned sources of information about apps within the group of health and general app users were family and friends. Identified barriers against the use of health apps were a lack of trust, data privacy concerns, and fear of misdiagnosis. Conclusions Health apps are already used by older adults in Germany. The main type of apps used are exercise-related ones. Barriers to and incentives for the use of health apps and associations with health status and users’ demographics were revealed.
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Affiliation(s)
- Peter Rasche
- Department of Mechanical Engineering, Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany
| | - Matthias Wille
- Department of Mechanical Engineering, Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany
| | - Christina Bröhl
- Department of Mechanical Engineering, Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany
| | - Sabine Theis
- Department of Mechanical Engineering, Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany
| | - Katharina Schäfer
- Department of Mechanical Engineering, Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Alexander Mertens
- Department of Mechanical Engineering, Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany
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Shen C, Wang MP, Chu JT, Wan A, Viswanath K, Chan SSC, Lam TH. Sharing Family Life Information Through Video Calls and Other Information and Communication Technologies and the Association With Family Well-Being: Population-Based Survey. JMIR Ment Health 2017; 4:e57. [PMID: 29170145 PMCID: PMC5721212 DOI: 10.2196/mental.8139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/23/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The use of information and communication technologies (ICTs) for information sharing among family members is increasing dramatically. However, little is known about the associated factors and the influence on family well-being. OBJECTIVE The authors investigated the pattern and social determinants of family life information sharing with family and the associations of different methods of sharing with perceived family health, happiness, and harmony (3Hs) in Hong Kong, where mobile phone ownership and Internet access are among the most prevalent, easiest, and fastest in the world. METHODS A territory-wide population-based telephone survey was conducted from January to August 2016 on different methods of family life information (ie, information related to family communication, relationships with family members, emotion and stress management) sharing with family members, including face-to-face, phone, instant messaging (IM), social media sites, video calls, and email. Family well-being was assessed by three single items on perceived family health, happiness, and harmony, with higher scores indicating better family well-being. Adjusted prevalence ratios were used to assess the associations of sociodemographic factors with family life information sharing, and adjusted beta coefficients for family well-being. RESULTS Of 2017 respondents, face-to-face was the most common method to share family life information (74.45%, 1502/2017), followed by IM (40.86%, 824/2017), phone (28.10%, 567/2017), social media sites (11.91%, 240/2017), video calls (5.89%, 119/2017), and email (5.48%, 111/2017). Younger age and higher education were associated with the use of any (at least one) method, face-to-face, IM, and social media sites for sharing family life information (all P for trend <.01). Higher education was most strongly associated with the use of video calls (adjusted prevalence ratio=5.61, 95% CI 2.29-13.74). Higher household income was significantly associated with the use of any method, face-to-face, and IM (all P for trend <.05). Sharing family life information was associated with a higher level of perceived family well-being (beta=0.56, 95% CI 0.37-0.75), especially by face-to-face (beta=0.62, 95% CI 0.45-0.80) and video calls (beta=0.34, 95% CI 0.04-0.65). The combination of face-to-face and video calls was most strongly associated with a higher level of perceived family well-being (beta=0.81, 95% CI 0.45-1.16). CONCLUSIONS The differential use of ICTs to share family life information was observed. The prevalence of video calls was low, but associated with much better family well-being. The results need to be confirmed by prospective and intervention studies to promote the use of video calls to communicate and share information with family, particularly in disadvantaged groups.
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Affiliation(s)
- Chen Shen
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joanna Tw Chu
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Alice Wan
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Kasisomayajula Viswanath
- Center for Community-Based Research, Dana-Farber Cancer Institute, Harvard TH Chan School of Public Health, Cambridge, MA, United States.,Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Cambridge, MA, United States
| | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Lang M. Heart Rate Monitoring Apps: Information for Engineers and Researchers About the New European Medical Devices Regulation 2017/745. JMIR BIOMEDICAL ENGINEERING 2017. [DOI: 10.2196/biomedeng.8179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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