Prevalence, Demographic Correlates, and Perceived Impacts of Mobile Health App Use Amongst Chinese Adults: Cross-Sectional Survey Study

Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis

BACKGROUND

Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China.

OBJECTIVE

In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement.

METHODS

We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators.

RESULTS

The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9%, SD 24.2%) lagged behind general PI protection (mean 90.4%, SD 14.7%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9%, SD 24.2%). Although most apps (n=41, 79%) committed to supervising subcontractors, only a quarter (n=13, 25%) required users' explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2%, SD 29.3%) and incident management (mean 71.8%, SD 36.6%), half of the assessed apps (n=27, 52%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77%) and instances of PI deletion or anonymization (n=41, 79%), but fewer (n=20, 38.5%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42%) or to refuse advertisement based on automated decision-making (n=13, 25%). Significant deficiencies remained in regular compliance audits (mean 11.5%, SD 37.8%), impact assessments (mean 13.5%, SD 15.2%), and PI officer disclosure (mean 48.1%, SD 49.3%).

CONCLUSIONS

Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps' privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages.

A Comparative Study on the Prevalence of Lifestyle Risk Factors Among Users and Non-users of Any Health-Based Mobile App Among University Students in Chennai

Introduction Adolescents and young adults are often neglected in terms of healthcare, despite forming a significant demographic and economic force. This study aims to compare the prevalence of lifestyle risk factors among users and non-users of health-based mobile apps among university students in Chennai. Methods This cross-sectional study was conducted from January 2019 to June 2019, with a sample size of 680 undergraduate college students. A standardized WHO STEPwise approach to noncommunicable disease (NCD) risk factor surveillance (WHO STEPS) questionnaire was used to collect data on sociodemographic features, behavioral risk factors, and mobile app usage, along with physical measurements like height, weight, waist circumference, and blood pressure. Results About 238 (35%) study participants were regularly using health-based mobile apps, and 442 (65%) were not using any health-based mobile apps, of which 540 (79.41%) were between 22 and 24 years old, with the majority being female (362, 53.2%). The prevalence of various risk factors was higher among non-users of mobile health apps, except for physical activity, which was similar in both groups. On adjusted multivariable analysis, age category, place of current stay, and unhealthy diet were found to be significant. Conclusion This study helps assess the efficacy of health-based mobile apps in promoting healthy lifestyles among university students. Health-based mobile apps for delivering effective healthcare services are to be promoted among college students for a healthy lifestyle and well-being.

Willingness to pay for health apps, its sociodemographic correlates, and reasons for being unwilling to pay

Background

Knowledge about whether, how much, and why individuals are willing to pay for health apps is limited.

Objectives

This study aimed to examine (1) the proportion of individuals willing to pay for health apps, (2) their willingness to pay (WTP; i.e. the maximum price the individual is willing to pay) for health apps, (3) the sociodemographic correlates determining whether individuals are willing to pay for these apps, (4) the sociodemographic correlates of their WTP, and (5) reasons for being unwilling to pay.

Methods

Six hundred adults were invited to participate in a questionnaire survey examining their sociodemographic characteristics, WTP for health apps, and reasons for being unwilling to pay. Sociodemographic characteristics and WTP for health apps were analyzed using descriptive statistics. Logistic regression was applied to examine the sociodemographic variables correlated with whether individuals were willing to pay for health apps. Among those who were willing to pay, log-linear regression was conducted to examine the sociodemographic correlates of their WTP. The reasons for unwillingness to pay were descriptively analyzed.

Results

A total of 577 individuals completed the questionnaire. Of them, 58.9% were willing to pay for health apps. Their median WTP was HK$50 (HK$1 ≈ US$0.13). Participants with a bachelor's degree or higher and those who had previously installed health apps were more inclined to pay for health apps. WTP was positively associated with the maximum price previously paid for a health app. The most frequently cited reasons for being unwilling to pay were the belief that the government should provide free health apps, distrust in health apps, and a lack of awareness of health apps and their benefits.

Conclusions

This study provides insights that can inform strategies to enhance the marketability, affordability, and accessibility of health apps.

Design, development and evaluation of a mobile-based self-care application for patients with COVID-19 not requiring hospitalization; a study of Northwest of Iran

BACKGROUND

Given the effective role of a mobile applications in disease management, disease monitoring, and self-care in patients with COVID-19 disease, we aimed to design, development and evaluation of a self-care Mobile app for COVID-19 patients not requiring hospitalization.

METHODS

The design, development and evaluation the usability of the self-care and education mobile app for patients with COVID-19 disease were conducted in two main phases at 2021 in Northwest of IRAN; (1) Determine the features and capabilities and (2) Design, development and evaluation of self-care mobile App. JAVA programming languages and Android Operating System were used and selected to design and development of a mobile app. There were 25 participants who conducted evaluations of the mobile app's usability and impact using the mobile health app usability a Questionnaire of User Interface Satisfaction was administered to assess the usability of the developed application. The results were analyzed via Excel 2013.

RESULTS

The model of developing a mobile app as an Information System was the Waterfall model. The smartphone application based on a set of capabilities and features was designed and consists of two main parts: the login screen for user registration, and the main home menu. The user interface includes three main pages or activities; (a) Main Menu for quick access to all of the pages, (b) Symptom management and monitoring to monitor the signs and symptoms during the illness, and (c) Set Reminders and Alarms to notify patients. The users' mean score of the application usability was calculated as 7.91 out of 9 indicating a good level of satisfaction.

CONCLUSION

This app can be a guideline and a useful tools for managing and monitoring symptoms, reminding medications, and implementing self-care instructions in outpatients. The authors suggest evaluating the efficacy and functionality test of mobile-based applications for COVID-19 in clinical trial studies.

Use Patterns of Smartphone Apps and Wearable Devices Supporting Physical Activity and Exercise: Large-Scale Cross-Sectional Survey

Background

Physical inactivity is a global health issue, and mobile health (mHealth) apps are expected to play an important role in promoting physical activity. Empirical studies have demonstrated the efficacy and efficiency of app-based interventions, and an increasing number of apps with more functions and richer content have been released. Regardless of the success of mHealth apps, there are important evidence gaps in the literature; that is, it is largely unknown who uses what app functions and which functions are associated with physical activity.

Objective

This study aims to investigate the use patterns of apps and wearables supporting physical activity and exercise in a Japanese-speaking community sample.

Methods

We recruited 20,573 web-based panelists who completed questionnaires concerning demographics, regular physical activity levels, and use of apps and wearables supporting physical activity. Participants who indicated that they were using a physical activity app or wearable were presented with a list of app functions (eg, sensor information, goal setting, journaling, and reward), among which they selected any functions they used.

Results

Approximately one-quarter (n=4465) of the sample was identified as app users and showed similar demographic characteristics to samples documented in the literature; that is, compared with app nonusers, app users were younger (odds ratio [OR] 0.57, 95% CI 0.50-0.65), were more likely to be men (OR 0.83, 95% CI 0.77-0.90), had higher BMI scores (OR 1.02, 95% CI 1.01-1.03), had higher levels of education (university or above; OR 1.528, 95% CI 1.19-1.99), were more likely to have a child (OR 1.16, 95% CI 1.05-1.28) and job (OR 1.28, 95% CI 1.17-1.40), and had a higher household income (OR 1.40, 95% CI 1.21-1.62). Our results revealed unique associations between demographic variables and specific app functions. For example, sensor information, journaling, and GPS were more frequently used by men than women (ORs <0.84). Another important finding is that people used a median of 2 (IQR 1-4) different functions within an app, and the most common pattern was to use sensor information (ie, self-monitoring) and one other function such as goal setting or reminders.

Conclusions

Regardless of the current trend in app development toward multifunctionality, our findings highlight the importance of app simplicity. A set of two functions (more precisely, self-monitoring and one other function) might be the minimum that can be accepted by most users. In addition, the identified individual differences will help developers and stakeholders pave the way for the personalization of app functions.

Consumers' Preferences for Purchasing mHealth Apps: Discrete Choice Experiment

Background

There is growing interest in mobile health apps; however, not all of them have been successful. The most common issue has been users' nonadoption or abandonment of health apps because the app designs do not meet their preferences. Therefore, to facilitate design-preference fit, understanding consumers' preferences for health apps is necessary, which can be accomplished by using a discrete choice experiment.

Objective

This study aims to examine consumer preferences for health apps and how these preferences differ across individuals with different sociodemographic characteristics and health app usage and purchase experiences.

Methods

A cross-sectional discrete choice experiment questionnaire survey was conducted with 593 adults living in Hong Kong. A total of 7 health app attributes that might affect consumers' preferences for health apps were examined, including usefulness, ease of use, security and privacy, health care professionals' attitudes, smartphone storage consumption, mobile data consumption, and cost. Mixed-effect logit regressions were used to examine how these attributes affected consumer preferences for health apps. Fixed effects (coefficient β) of the attributes and random effects of individual differences were modeled. Subgroup analyses of consumer preferences by sex, age, household income, education level, and health app usage and purchase experiences were conducted.

Results

Cost was the attribute that had the greatest effect on consumers' choice of health apps (compared to HK $10 [US $1.27]-HK $50 [US $6.37]: β=-1.064; P<.001; HK $100 [US $12.75]: β=-2.053; P<.001), followed by security and privacy (compared to no security insurance-some security policies: β=.782; P<.001; complete security system: β=1.164; P<.001) and usefulness (compared to slightly useful-moderately useful: β=.234; P<.001; very useful: β=.979; P=.007), mobile data consumption (compared to data-consuming-a bit data-consuming: β=.647; P<.001; data-saving: β=.815; P<.001), smartphone storage consumption (compared to >100 MB-around 38 MB: β=.334; P<.001; <10 MB: β=.511; P<.001), and attitudes of health care professionals (compared to neutral-moderately supportive: β=.301; P<.001; very supportive: β=.324; P<.001). In terms of ease of use, consumers preferred health apps that were moderately easy to use (compared to not easy to use-moderately easy to use: β=.761; P<.001; very easy to use: β=.690; P<.001). Our results also showed that consumers with different sociodemographic characteristics and different usage and purchase experiences with health apps differed in their preferences for health apps.

Conclusions

It is recommended that future health apps keep their mobile data and phone storage consumption low, include a complete security system to protect personal health information, provide useful content and features, adopt user-friendly interfaces, and involve health care professionals. In addition, health app developers should identify the characteristics of their intended users and design and develop health apps to fit the preferences of the intended users.

Evaluation on the adoption of eHealth App for electronic health record sharing system in Hong Kong

In Hong Kong, the eHealth App was launched in January 2021, as part of Stage Two development of the Electronic Health Record Sharing System. It provides the healthcare recipients, that is, those who have registered in the system, a series of functions to manage their health, such as accessing electronic health records and self-inputting health information.1 We conducted a study to evaluate how the general population adopted the eHealth App and identify the contributing factors that may influence its adoption.

Factors influencing user acceptance of weight management apps among Chinese obese individuals during the COVID-19 pandemic

Background

During the COVID-19 epidemic, the number of obesities increased rapidly in China. Weight management apps have potential value in controlling obesity.

Objective

Explore the mechanisms behind the adoption of weight management applications by overweight and obese individuals, including psychological factors and demographic variables.

Methods

The theoretical model was extended from the technology acceptance model (TAM), and the structural equation model was used for hypothesis testing. From January 2020 to December 2021, we conducted a cross-sectional survey in six megacities in mainland China during the COVID-19 pandemic by an online questionnaire.

Results

1364 participants completed the questionnaire, and the proposed theoretical model explained 55.7% of the variance in behavioral intention. Perceived usefulness was predicted by perceived ease of use (β = 0. 290), attitude was jointly predicted by perceived usefulness (β = 0.118) and perceived ease of use (β = 0.159). Behavioral intention was predicted by perceived usefulness (β = 0. 256), perceived ease of use (β = 0. 463), attitude (β = 0. 293), and perceived risk (β = -0.136). Health awareness (β=0.016) did not significantly affect behavioral intention. Four demographic variables gender, age, education, and residence exerted significant moderating effects in theoretical model.

Conclusions

During the COVID-19 epidemic, the health awareness and behavior patterns of obese people have changed significantly. Psychological factors and demographic characteristics dynamically interact to generate user behavioral intentions of weight management applications. Weight management application developers and marketers should focus on perceived usefulness, safety, ease of use, and health awareness.

Usability of a mobile application for the clinical follow-up of patients with chronic obstructive pulmonary disease and home oxygen therapy

BACKGROUND

Technological health tools (e-Health) may potentially facilitate the treatment of patients with chronic diseases through development of self-management and -care skills in patients and caregivers. However, these tools are usually marketed without prior analysis and without providing any context to final users, which frequently results in low adherence to their use.

PURPOSE

To determine the usability of and satisfaction toward a mobile app for the clinical monitoring of patients with chronic obstructive pulmonary disease (COPD) receiving oxygen therapy at home.

METHODS

This was a participative-qualitative study focused on final users-with direct intervention by patients and professionals-consisting of three phases as follows: (i) medium-fidelity mockups design, (ii) development of a usability test for each user profile, and (iii) assessment of the satisfaction level regarding the usability of the mobile app. A sample was established and selected through non-probability convenience sampling and was divided into two groups as follows: healthcare professionals (n = 13) and patients (n = 7). Each participant received a smartphone with mockup designs. The "think-aloud" method was applied in the usability test. Participants were audio recorded and the anonymous transcriptions were analyzed, highlighting fragments about mockups characteristics and the usability test. The difficulty level of the tasks was assessed with a scale from 1 (very easy) to 5 (too difficult), and task non-completion was considered a critical mistake. The satisfaction level related to test usability was assessed with a 4-score Likert scale ranging from 4 (totally agree) to 1 (totally disagree).

RESULTS

Regarding the difficulty level, >60% of professionals described most tasks as "very easy" and 70% of patients as "easy." No participant made critical mistakes and both groups reported a high satisfaction level regarding the usability variables. The patient and professionals group required 18 and 11 min to complete all tasks, respectively.

CONCLUSIONS

Participants described the app as intuitive and easy to use. The usability satisfaction results show a high level of satisfaction for both groups. This positive assessment and performance in user tests showed that the mobile application was able to be apprehended and used by participants in the circumstances of use in the usability tests. Usability evaluation through satisfaction surveys and qualitative data analysis allows for greater insight into the use of mobile applications in healthcare.

Effectiveness of the Lilly Connected Care Program in Improving Glycemic Management Among Patients With Type 2 Diabetes in China: Retrospective Real-world Study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a worldwide public health concern. Mobile health management platforms could be a potential way to achieve effective glycemic control.

OBJECTIVE

This study aimed to evaluate the real-world effectiveness of the Lilly Connected Care Program (LCCP) platform in glycemic control among patients with T2DM in China.

METHODS

This retrospective study included Chinese patients with T2DM (aged ≥18 years) from April 1, 2017, to January 31, 2020, for the LCCP group and from January 1, 2015, to January 31, 2020, for the non-LCCP group. Propensity score matching was used to match the LCCP and non-LCCP groups to reduce confounding, with covariates including age, sex, the duration of diabetes, baseline hemoglobin A_1c (HbA_1c), and the number of oral antidiabetic medication classes. HbA_1c reduction over 4 months, the proportions of patients achieving an HbA_1c reduction of ≥0.5% or ≥1%, and the proportions of patients reaching to target HbA_1c level of ≤6.5% or <7% were compared between the LCCP and non-LCCP groups. Multivariate linear regression was used to assess factors associated with HbA_1c reduction.

RESULTS

A total of 923 patients were included, among whom 303 pairs of patients were well matched after propensity score matching. HbA_1c reduction during the 4-month follow-up was significantly larger in the LCCP group than the non-LCCP group (mean 2.21%, SD 2.37% vs mean 1.65%, SD 2.29%; P=.003). The LCCP group had a higher proportion of patients with an HbA_1c reduction of ≥1% (209/303, 69% vs 174/303, 57.4%; P=.003) and ≥0.5% (229/303, 75.6% vs 206/303, 68%; P=.04). The proportions of patients reaching the target HbA_1c level of ≤6.5% were significantly different between the LCCP and non-LCCP groups (88/303, 29% vs 61/303, 20.1%; P=.01), whereas the difference in the proportions of patients reaching the target HbA_1c level of <7% was not statistically significant (LCCP vs non-LCCP: 128/303, 42.2% vs 109/303, 36%; P=.11). LCCP participation and higher baseline HbA_1c were associated with a larger HbA_1c reduction, whereas older age, longer diabetes duration, and higher baseline dose of premixed insulin analogue were associated with a smaller HbA_1c reduction.

CONCLUSIONS

The LCCP mobile platform was effective in glycemic control among patients with T2DM in China in the real world.

Willingness to Use Mobile Health Devices in the Post-COVID-19 Era: Nationwide Cross-sectional Study in China

BACKGROUND

Despite the increased development and use of mobile health (mHealth) devices during the COVID-19 pandemic, there is little knowledge of willingness of the Chinese people to use mHealth devices and the key factors associated with their use in the post-COVID-19 era. Therefore, a more comprehensive and multiangle investigation is required.

OBJECTIVE

We aimed to probe Chinese attitudes regarding the use of mHealth and analyze possible associations between the attitude of willingness to use mHealth devices and some factors based on the socioecological model.

METHODS

A survey was conducted using quota sampling to recruit participants from 148 cities in China between June 20 and August 31, 2022. Data from the survey were analyzed using multiple stepwise regression to examine the factors associated with willingness to use mHealth devices. Standardized regression coefficients (β) and 95% CIs were calculated using multiple stepwise regression.

RESULTS

The survey contained a collection of 21,916 questionnaires and 21,897 were valid questionnaires, with a 99.91% effective response rate. The median score of willingness to use mHealth in the post-COVID-19 era was 70 points on a scale from 0 to 100. Multiple stepwise regression results showed that the female gender (β=.03, 95% CI 1.04-2.35), openness personality trait (β=.05, 95% CI 0.53-0.96), higher household per capita monthly income (β=.03, 95% CI 0.77-2.24), and commercial and multiple insurance (β=.04, 95% CI 1.77-3.47) were factors associated with the willingness to use mHealth devices. In addition, people with high scores of health literacy (β=.13, 95% CI 0.53-0.68), self-reported health rating (β=.22, 95% CI 0.24-0.27), social support (β=.08, 95% CI 0.40-0.61), family health (β=.03, 95% CI 0.03-0.16), neighbor relations (β=.12, 95% CI 2.09-2.63), and family social status (β=.07, 95% CI 1.19-1.69) were more likely to use mHealth devices.

CONCLUSIONS

On the basis of the theoretical framework of socioecological model, this study identified factors specifically associated with willingness of the Chinese people to use mHealth devices in the post-COVID-19 era. These findings provide reference information for the research, development, promotion, and application of future mHealth devices.

Perceptions of a machine learning-based lower-limb exercise training system among older adults with knee pain

Objective

To facilitate the older adults with knee pain to perform exercises and improve knee health, we proposed the design of a machine learning-based system for lower-limb exercise training that features three main components: video demonstration of exercises, real-time movement feedback, and tracking of exercise progress. At this early stage of design, we aimed to examine the perceptions of a paper-based prototype among older adults with knee pain and investigate the factors that may influence their perceptions of the system.

Methods

A cross-sectional survey of the participants' (N = 94) perceptions of the system was conducted using a questionnaire, which assessed their perceived effects of the system, perceived ease of use of the system, attitude toward the system, and intention to use the system. Ordinal logistic regression was conducted to examine whether the participants' perceptions of the system were influenced by their demographic and clinical characteristics, physical activity level, and exercise experience.

Results

The participants' responses to the perception statements exhibited consensus agreement (≥ 75%). Age, gender, duration of knee pain, knee pain intensity, experience with exercise therapy, and experience with technology-supported exercise programs were significantly associated with the participants' perceptions of the system.

Conclusions

Our results demonstrate that the system appears promising for use by older adults to manage their knee pain. Therefore, it is needed to develop a computer-based system and further investigate its usability, acceptance, and clinical effectiveness.

Exploring Saudi Individuals' Perspectives and Needs to Design a Hypertension Management Mobile Technology Solution: Qualitative Study

Hypertension is a chronic condition caused by a poor lifestyle that affects patients' lives. Adherence to self-management programs increases hypertension self-monitoring, and allows greater prevention and disease management. Patient compliance with hypertension self-management is low in general; therefore, mobile health applications (mHealth-Apps) are becoming a daily necessity and provide opportunities to improve the prevention and treatment of chronic diseases, including hypertension. This research aims to explore Saudi individuals' perspectives and needs regarding designing a hypertension management mobile app to be used by hypertension patients to better manage their illnesses. Semi-structured interviews were conducted with 21 Saudi participants to explore their perspectives and views about the needs and requirements in designing a hypertension mobile technology solution, as well as usability and culture in the Saudi context. The study used NVivo to analyze data and divided the themes into four main themes: the app's perceived health benefits, features and usability, suggestions for the app's content, and security and privacy. The results showed that there are many suggestions for improvements in mobile health apps that developers should take into consideration when designing apps. The mobile health apps should include physical activity tracking, related diet information, and reminders, which are promising, and could increase adherence to healthy lifestyles and consequently improve the self-management of hypertension patients. Mobile health apps provide opportunities to improve hypertension patients' self-management and self-monitoring. However, this study asserts that mobile health apps should not share users' data, and that adequate privacy disclosures should be implemented.

Development of a Mobile-Based Self-care Application for Patients with Breast Cancer-Related Lymphedema in Iran

BACKGROUND

Due to the chronic, progressive, and debilitating nature of breast cancer-related lymphedema (BCRL), it is necessary to observe and maintain self-care management accordingly. This study was conducted to develop a mobile application based on the Android operating system for self-care management of Iranian patients with BCRL.

METHODS

An applied developmental study was conducted in 2020. The users' information needs assessment as well as design, development, implementation, and evaluation of the mobile app for self-care management of patients with BCRL was done by searching the literature, reviewing the existing mobile applications, and surveying the users' needs. The mobile app was designed using the Android Studio environment and Java programming language in the Android operating system. The usability of the app was evaluated by 30 patients with BCRL using the questionnaire for user interface satisfaction-seventh version (QUIS 7).

RESULTS

The mobile app for BCRL included demographic information, clinical information, lifestyle and system functions (drug use, nutrition, exercise, smoking cessation, communication, and test time reminder). User usability evaluation of the app content and functions confirmed that it was appropriate and satisfactory for the self-management of women with BCRL.

CONCLUSION

The mobile app was appropriate in terms of the content, function, and quality for improving the patients' lifestyle and education and self-management of BCRL symptoms according to its usability evaluation from the end-users' (patients) perspective. It is suggested that studies should be performed to confirm the effectiveness and identify the clinical significance of the app.

Consumers’ Willingness to Pay for eHealth and Its Influencing Factors: Systematic Review and Meta-analysis

Background

Despite the great potential of eHealth, substantial costs are involved in its implementation, and it is essential to know whether these costs can be justified by its benefits. Such needs have led to an increased interest in measuring the benefits of eHealth, especially using the willingness to pay (WTP) metric as an accurate proxy for consumers’ perceived benefits of eHealth. This offered us an opportunity to systematically review and synthesize evidence from the literature to better understand WTP for eHealth and its influencing factors.

Objective

This study aimed to provide a systematic review of WTP for eHealth and its influencing factors.

Methods

This study was performed and reported as per the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL Plus, Cochrane Library, EconLit, and PsycINFO databases were searched from their inception to April 19, 2022. We conducted random-effects meta-analyses to calculate WTP values for eHealth (at 2021 US dollar rates) and meta-regression analyses to examine the factors affecting WTP.

Results

A total of 30 articles representing 35 studies were included in the review. We found that WTP for eHealth varied across studies; when expressed as a 1-time payment, it ranged from US $0.88 to US $191.84, and when expressed as a monthly payment, it ranged from US $5.25 to US $45.64. Meta-regression analyses showed that WTP for eHealth was negatively associated with the percentages of women (β=−.76; P<.001) and positively associated with the percentages of college-educated respondents (β=.63; P<.001) and a country’s gross domestic product per capita (multiples of US $1000; β=.03; P<.001). Compared with eHealth provided through websites, people reported a lower WTP for eHealth provided through asynchronous communication (β=−1.43; P<.001) and a higher WTP for eHealth provided through medical devices (β=.66; P<.001), health apps (β=.25; P=.01), and synchronous communication (β=.58; P<.001). As for the methods used to measure WTP, single-bounded dichotomous choice (β=2.13; P<.001), double-bounded dichotomous choice (β=2.20; P<.001), and payment scale (β=1.11; P<.001) were shown to obtain higher WTP values than the open-ended format. Compared with ex ante evaluations, ex post evaluations were shown to obtain lower WTP values (β=−.37; P<.001).

Conclusions

WTP for eHealth varied significantly depending on the study population, modality used to provide eHealth, and methods used to measure it. WTP for eHealth was lower among certain population segments, suggesting that these segments may be at a disadvantage in terms of accessing and benefiting from eHealth. We also identified the modalities of eHealth that were highly valued by consumers and offered suggestions for the design of eHealth interventions. In addition, we found that different methods of measuring WTP led to significantly different WTP estimates, highlighting the need to undertake further methodological explorations of approaches to elicit WTP values.

Mobile Health Use by Older Individuals at Risk of Cardiovascular Disease and Type 2 Diabetes Mellitus in an Australian Cohort: Cross-sectional Survey Study

BACKGROUND

The digital transformation has the potential to change health care toward more consumers' involvement, for example, in the form of health-related apps which are already widely available through app stores. These could be useful in helping people understand their risk of chronic conditions and helping them to live more healthily.

OBJECTIVE

With this study, we assessed mobile health app use among older Australians in general and among those who were at risk of cardiovascular disease or type 2 diabetes mellitus.

METHODS

In this cross-sectional analysis, we used data from the second follow-up wave of the 45 and Up Study. It is a cohort study from New South Wales, Australia, with 267,153 participants aged 45 years and older that is based on a random sample from the Services Australia (formerly the Australian Government Department of Human Services) Medicare enrollment database. The 2019 follow-up questionnaire contained questions about technology and mobile health use. We further used data on prescribed drugs and hospitalizations to identify participants who already had cardiovascular disease or diabetes or who were at risk of these conditions. Our primary outcome measure was mobile health use, defined as having used a mobile health app before. We used descriptive statistics and multivariate logistic regression to answer the research questions.

RESULTS

Overall, 31,946 individuals with a median age of 69 (IQR 63-76) years had completed the follow-up questionnaire in 2019. We classified half (16,422/31,946, 51.41%) of these as being at risk of cardiovascular disease or type 2 diabetes mellitus and 38.04% (12,152/31,946) as having cardiovascular disease or type 1 or type 2 diabetes mellitus. The proportion of mobile health app users among the at-risk group was 31.46% (5166/16,422) compared to 29.16% (9314/31,946) in the total sample. Those who used mobile health apps were more likely to be female, younger, without physical disability, and with a higher income. People at risk of cardiovascular disease or type 2 diabetes mellitus were not statistically significantly more likely to use mobile health than were people without risk (odds ratio 1.06, 95% CI 0.97-1.16; P=.18; adjusted for age, sex, income, and physical disability).

CONCLUSIONS

People at risk of cardiovascular disease or type 2 diabetes mellitus were not more likely to use mobile health apps than were people without risk. Those who used mobile health apps were less likely to be male, older, with a physical disability, and with a lower income. From the results, we concluded that aspects of equity must be considered when implementing a mobile health intervention to reach all those that can potentially benefit from it.

Mobile health application for Thai women: investigation and model

Background

Women’s mobile health (m-health) applications are currently widely used for health education, medication, prevention of illness, etcetera. However, women are extremely sensitive to their design. While the number of m-health applications for women is increasing, many are of poor quality and have development issues.

Objective

This paper aims to develop and evaluate an m-health application for Thai women based on a user-centred design (UCD). Current women’s m-health applications were investigated to identify any lack of development in usability, functionality and graphical user interface. The results were evaluated and used to create criteria for the trial of a prototype application.

Methods

UCD methodology was used to design a graphical user interface, analyse the application’s functionality, and enhance its usability. Data from thirty female end-users were collected and maintained locally, and thirteen information technology (IT) experts provided feedback on the prototype trial. Interviews and questionnaires were used to gather user data and identify problems.

Results

The average scores of the evaluation by the end-users (n = 30) and IT experts (n = 13) were compared using a t-test statistical analysis. For the first version, the end-users gave higher usability scores (average = 4.440), with no statistical significance and a P value of 0.05. In comparison, lower scores for functionality were given by the IT experts (average = 4.034), with no statistical significance and a P value of 0.05. For the second version, the average scores from the end-users were higher than those from the IT experts. The highest score was related to usability (average = 4.494), with no statistical significance and a P value of 0.05. The lowest score was for the user interface from the group of IT experts (average = 4.084), with no statistical significance and a P value of 0.05.

Conclusion

A UCD was utilised to construct a process taxonomy to understand, analyse, design and develop an application suitable for Thai women. It was found from an evaluation of the currently-available women’s m-health applications that usability is their main weakness; therefore, this aspect needed to be prioritised in the new design. According to the results, IT experts’ perspective of the development of an m-health application was different from that of end-users. Hence, it was evident that both end-users and IT experts needed to be involved in helping developers to analyse, prioritise and establish a strategy for developing an m-health application, particularly one for women’s health. This would give researchers an in-depth understanding of the end-users’ expectations.

Making Mobile Health Information Advice Persuasive

As M-Health apps become more popular, users can access more mobile health information (MHI) through these platforms. Yet one preeminent question among both researchers and practitioners is how to bridge the gap between simply providing MHI and persuading users to buy into the MHI for health self-management. To solve this challenge, this study extends the Elaboration Likelihood Model to explore how to make MHI advice persuasive by identifying the important central and peripheral cues of MHI under individual difference. The proposed research model was validated through a survey. The results confirm that (1) both information matching and platform credibility, as central and peripheral cues, respectively, have significant positive effects on attitudes toward MHI, but only information matching could directly affect health behavior changes; (2) health concern significantly moderates the link between information matching and cognitive attitude and only marginally moderates the link between platform credibility and attitudes. Theoretical and practical implications are also discussed.

Prevalence and correlates of medication reminder app ‘use and use intention’ among older adults

Background

Medication adherence is relatively poor among older adults. Although there exist medication reminder apps, data on the prevalence and correlates of their ‘use and use intention’ by older adults are limited.

Objective

To examine the prevalence, and socio-demographic and health correlates of medication reminder app use and use intention among older adults in Singapore.

Methods

Data from a nationally representative survey of 2228 adults aged 62 years and above, who were taking at least one prescription medication, were analysed. Medication reminder app use (in the past one month) and use intention (in the next one month) were self-reported. Bivariate and multivariable logistic regression models were used to identify the correlates of medication reminder app use and use intention.

Results

The prevalence of medication reminder app use and use intention was low at 2.6% (comprising 0.5% for use and 2.1% for use intention). Age, ethnicity, education level, previous participation in information technology/computer-related courses, comorbidity, health literacy, medication adherence and polypharmacy were correlated with app use and use intention in multivariable analyses.

Conclusion

The very low prevalence of medication reminder app use and use intention among older adults in Singapore and identified correlates point to opportunities to increase the use of such apps.

Factors impacting the use of the NZ COVID Tracer application in New Zealand"

The COVID-19 pandemic has clearly created devastating damage on world economics and public health. This project identifies key concerns of end-users toward the NZ COVID-19 contact tracing app in New Zealand. The key research objective in this study is to understand the usage behaviour towards the mobile application NZ COVID-19 Tracer used for contact tracing purposes. Secondly, the study explores the reasons for using the contact tracing app. Thirdly, it examines the relationship between usage behaviour of the NZ-COVID Tracer app with age, the user's perceived health, attitude towards COVID-19, whether family or friends are infected by COVID-19, trust in maintaining social distancing, trust in data privacy, smartphone usage and the media's role in motivating people to use this app. Consequently, understanding these issues and challenges could help improve the usage of this contact tracing app, which in turn would contribute to better public health outcomes in disease management and containment. Findings of the study reveals that age, smartphone usage behaviour, and trust in privacy data protection from the app provider has a statistically significant relationship on usage behaviour of the NZ COVID Tracer app. Self-perceived health status and attitudes towards the COVID-19 pandemic did not have a significant relationship on NZ COVID Tracer app usage behaviour. While social media, such as Facebook, has been shown to be the most popular source of news for COVID-19 among New Zealanders, it is television that acted as a motivational tool to encourage people to use the contact tracing mobile application and to practice other measures to help protect against the COVID-19 pandemic.

Prevalence and Determinants of Mobile Health Applications Usage: A National Descriptive Study

We aimed to determine the prevalence of MHAs' usage and explore the context and determinants of using MHAs among inhabitants in Saudi Arabia (SA). This cross-sectional study randomly selected 679 adult inhabitants from the 20 health regions in SA through an electronic, self-administered, well-structured, and validated Arabic questionnaire. The prevalence of using MHAs was 47.9%, and it was significantly higher among younger, Saudis, highly educated, and working participants, as well as those with chronic diseases (p < 0.05). The main motives for using MHAs were to promote health status (68.6%) and to lose weight (33.2%). The most used apps were related to daily steps-counting (54.2%), and among females was tracking ovulation period apps (43.5%). The most common reported advantage of using MHAs was saving time (64%). Despite the potential benefits of MHAs, they were used by only about half of the study participants in SA. The most effective MHAs in improving health status were exercise, calorie-related, water uptake, and daily steps-counting apps. Policymakers looking to address reform aimed at improving health with mobile apps will find our study interesting.

A longitudinal examination of tablet self-management technology acceptance by patients with chronic diseases: Integrating perceived hand function, perceived visual function, and perceived home space adequacy with the TAM and TPB

BACKGROUND

Health information technologies (HITs) are increasingly being used to support the self-management of chronic diseases. However, patients' initial or continued acceptance of such technologies is not always achieved.

OBJECTIVE

The aim of this study was to develop a theory-driven HIT acceptance model to examine factors affecting acceptance of HIT (measured by behavioral intention; BI) for disease self-management among patients with chronic diseases, in which we also focused on three additional, previously unexplored factors related to perceived hand function (PHF), perceived visual function (PVF), and perceived space adequacy (PSA) and a longitudinal scrutinization of changes in the effects of these factors on acceptance over time.

METHODS

The theoretical basis of our acceptance model was drawn from the technology acceptance model and the theory of planned behavior. The model was further extended by including patients' PHF, PVF (related to patients with chronic diseases who are mostly elderly), and PSA (related to the patients' home environment). The model was tested in the context of type 2 diabetes and hypertension self-management via a touchscreen tablet-based system over a 24-week period. A questionnaire was administered at four time points (baseline and 8, 16, and 24 weeks after implementation) to collect data from 151 patients with coexisting type 2 diabetes and hypertension. We tested the model at each time point using partial least squares structural equation modeling.

RESULTS

Perceived usefulness of the self-management system influenced BI directly at 8 and 24 weeks and indirectly at 8, 16, and 24 weeks. Perceived ease of use indirectly affected BI at 8, 16, and 24 weeks. Attitude directly affected BI at 8, 16, and 24 weeks. Perceived behavioral control directly influenced BI at baseline and 8 and 16 weeks. Subjective norms indirectly influenced BI at 8, 16, and 24 weeks. PHF and PVF indirectly influenced BI over the entire study period. PSA influenced BI directly at 16 weeks and indirectly at 8, 16, and 24 weeks.

CONCLUSION

The effects of the proposed factors in our model on patient-focused HIT acceptance changed over a longer time period, emphasizing the importance of further investigation of the longitudinal mechanisms influencing technology acceptance behavior. It is recommended that healthcare practitioners consider such changes when implementing comparable technologies. Moreover, beyond technology attributes, the characteristics, needs, and limitations of older adults and elderly patient users and their home environments should also be considered in the design and implementation of patient-focused HIT systems for chronic disease self-management at home.

Demographic Characteristics and Digital Platforms for Physical Activity Among the Chinese Residents During the COVID-19 Pandemic: A Mediating Analysis

Background

Aim

Methods

Results

Conclusion

Socio-demographic digital divide in mHealth app use among clients at outpatient departments in Inner Mongolia, China: a cross-sectional study (Preprint)

Background

Mobile health (mHealth) apps have become part of the infrastructure for access to health care in hospitals, especially during the COVID-19 pandemic. However, little is known about the effects of sociodemographic characteristics on the digital divide regarding the use of hospital-based mHealth apps and their benefits to patients and caregivers.

Objective

The aim of this study was to document the cascade of potential influences from digital access to digital use and then to mHealth use, as well as the potential influence of sociodemographic variables on elements of the cascade.

Methods

A cross-sectional survey was conducted from January to February 2021 among adult clients at outpatient departments in 12 tertiary hospitals of Inner Mongolia, China. Structural equation modeling was conducted after the construct comprising digital access, digital use, and mHealth use was validated.

Results

Of 2115 participants, the β coefficients (95% CI) of potential influence of digital access on digital use, and potential influence of digital use on mHealth use, were 0.28 (95% CI 0.22-0.34) and 0.51 (95% CI 0.38-0.64), respectively. Older adults were disadvantaged with regard to mHealth access and use (β=–0.38 and β=–0.41), as were less educated subgroups (β=–0.24 and β=–0.27), and these two factors had nonsignificant direct effects on mHealth use.

Conclusions

To overcome the mHealth use divide, it is important to improve digital access and digital use among older adults and less educated groups.

User Engagement and Abandonment of mHealth: A Cross-Sectional Survey

Mobile health (mHealth) apps have great potential to improve health outcomes. Given that mHealth apps have become ubiquitous, there is limited focus on their abandonment. Data concerning crucial metrics, including reasons for adoption and discontinued use, are limited. This study aims to gain broad insights into utilization of mHealth and game-like features promoting user engagement. We conducted a cross-sectional survey of 209 mHealth users worldwide. The 17-item survey assessed sociodemographics, as well as the key motivators for mHealth uptake and discontinued use. Our findings show that sports and fitness activity tracking were the most common categories of health apps, with most users engaging with them at least several times a week. Interestingly, the most downloaded mHealth apps among younger adults include MyFitnessPal, Fitbit, Nike Run Club, and Samsung Health. Critical drivers of abandonment of mHealth apps were amotivation, loss of interest, and experimenting with different apps to identify the most suitable tool. Additionally, the financial cost of mHealth apps is crucial, with most participants advocating for free or more affordable apps. The study findings suggest that while many individuals utilize mHealth, several factors drive their abandonment. Moreover, data indicate that mHealth developers need to consider gamification strategies to sustain user commitment, as well as psychological variables, such as intrinsic motivation.

Active Usage of Mobile Health Applications: Cross-sectional Study

Background

Mobile health applications are being increasingly used for people’s health management. The different uses of mobile health applications lead to different health outcomes. Although active usage of mobile health applications is shown to be linked to the effectiveness of mobile health services, the factors that influence people’s active usage of mobile health applications are not well studied.

Objective

This paper aims to examine the antecedents of active usage of mobile health applications.

Methods

Grounded on the 3-factor theory, we proposed 10 attributes of mobile health applications that influence the active usage of mobile health applications through consumers’ satisfaction and dissatisfaction. We classified these 10 attributes into 3 categories (ie, excitement attributes, performance attributes, and basic attributes). Using the survey method, 494 valid responses were collected and analyzed using structural equation modeling.

Results

Our analysis results revealed that both consumer satisfaction (β=0.351, t=6.299, P<.001) and dissatisfaction (β=–0.251, t=5.119, P<.001) significantly influenced active usage. With regard to the effect of attributes, excitement attributes (β=0.525, t=12.861, P<.001) and performance attributes (β=0.297, t=6.508, P<.001) positively influenced consumer satisfaction, while performance attributes (β=–0.231, t=3.729, P<.001) and basic attributes (β=–0.412, t=7.132, P<.001) negatively influenced consumer dissatisfaction. The results of the analysis confirmed our proposed hypotheses.

Conclusions

Our study provides a novel perspective to study the active usage of mobile health applications. By categorizing the attributes of mobile health applications into 3 categories, the differential effects of different attributes can be tested. Meanwhile, consumer satisfaction and dissatisfaction are confirmed to be independent from each other.

Feasibility and Effectiveness of Assessing Subhealth Using a Mobile Health Management App (MibyeongBogam) in Early Middle-Aged Koreans: Randomized Controlled Trial

BACKGROUND

Mobile health (mHealth) is a major source of health management systems. Moreover, the demand for mHealth, which is in need of change due to the COVID-19 pandemic, is increasing worldwide. Accordingly, interest in health care in everyday life and the importance of mHealth are growing.

OBJECTIVE

We developed the MibyeongBogam (MBBG) app that evaluates the user's subhealth status via a smartphone and provides a health management method based on that user's subhealth status for use in everyday life. Subhealth is defined as a state in which the capacity to recover to a healthy state is diminished, but without the presence of clinical disease. The objective of this study was to compare the awareness and status of subhealth after the use of the MBBG app between intervention and control groups, and to evaluate the app's practicality.

METHODS

This study was a prospective, open-label, parallel group, randomized controlled trial. The study was conducted at two hospitals in Korea with 150 healthy people in their 30s and 40s, at a 1:1 allocation ratio. Participants visited the hospital three times as follows: preintervention, intermediate visit 6 weeks after the intervention, and final visit 12 weeks after the intervention. Key endpoints were measured at the first visit before the intervention and at 12 weeks after the intervention. The primary outcome was the awareness of subhealth, and the secondary outcomes were subhealth status, health-promoting behaviors, and motivation to engage in healthy behaviors.

RESULTS

The primary outcome, subhealth awareness, tended to slightly increase for both groups after the uncompensated intervention, but there was no significant difference in the score between the two groups (intervention group: mean 23.69, SD 0.25 vs control group: mean 23.1, SD 0.25; P=.09). In the case of secondary outcomes, only some variables of the subhealth status showed significant differences between the two groups after the intervention, and the intervention group showed an improvement in the total scores of subhealth (P=.03), sleep disturbance (P=.02), depression (P=.003), anger (P=.01), and anxiety symptoms (P=.009) compared with the control group.

CONCLUSIONS

In this study, the MBBG app showed potential for improving the health, especially with regard to sleep disturbance and depression, of individuals without particular health problems. However, the effects of the app on subhealth awareness and health-promoting behaviors were not clearly evaluated. Therefore, further studies to assess improvements in health after the use of personalized health management programs provided by the MBBG app are needed. The MBBG app may be useful for members of the general public, who are not diagnosed with a disease but are unable to lead an optimal daily life due to discomfort, to seek strategies that can improve their health.

TRIAL REGISTRATION

Clinical Research Information Service KCT0003488; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=14379.

Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The study sought to examine the effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain by a systematic review and meta-analysis of randomized controlled trials.

MATERIALS AND METHODS

We searched MEDLINE, EMBASE, CINAHL Plus, and the Cochrane Library from database inception to August 2020. A meta-analysis and subgroup analyses, stratified by technology type and program feature, were conducted.

RESULTS

Twelve randomized controlled trials were reviewed, all of which implemented the programs for 4 weeks to 6 months. Telephone, Web, mobile app, computer, and virtual reality were used to deliver the programs. The meta-analysis showed that these programs were associated with significant improvements in knee pain (standardized mean difference [SMD] = -0.29; 95% confidence interval [CI], -0.48 to -0.10; P = .003) and quality of life (SMD = 0.25; 95% CI, 0.04 to 0.46; P = .02) but not with significant improvement in physical function (SMD = 0.22; 95% CI, 0 to 0.43; P = .053). Subgroup analyses showed that some technology types and program features were suggestive of potential benefits.

CONCLUSIONS

Using technology to deliver the exercise programs appears to offer benefits. The technology types and program features that were associated with health values have been identified, based on which suggestions are discussed for the further research and development of such programs.

Weight Management Apps in Saudi Arabia: Evaluation of Features and Quality

Background

Weight management apps may provide support and management options for individuals with overweight and obesity. Research on the quality of weight management mHealth apps among the Saudi population is insufficient despite frequent use.

Objective

The aims of this study were to explore user perceptions of weight management apps, explore reasons for starting and stopping app use, appraise the quality of weight management apps available in the App Store, and compare the features currently available within the app market and those that are most desirable to weight management app users.

Methods

A web-based survey consisted of 31 open and closed questions about sociodemographic information, general health questions, app use, app user perceptions, and discontinuation of app use. The quality of the weight management apps available on the App Store was assessed using the Mobile App Rating Scale and evidence-based strategies. We also used six sigma evaluations to ensure that the quality measured by the tools consistently meets customer expectations.

Results

Data from the survey were analyzed. Of the respondents, 30.17% (324/1074) had used a weight management app, 18.16% (195/1074) used the apps and stopped, and 51.68% (555/1074) had never used a weight management app. Of apps mentioned, 23 met the inclusion criteria. The overall average Mobile App Rating Scale quality of apps was acceptable; 30% (7/23) received a quality mean score of 4 or higher (out of 5), and 30% (7/23) did not meet the acceptability score of 3 or higher. Evidence-based strategy results showed that feedback was not observed in any of the apps, and motivation strategy was observed in only 1 app. The sigma results of evidence-based strategies reflect that most of the apps fail to pass the mean.

Conclusions

App users desired a feature that allows them to communicate with a specialist, which is a missing in the available free apps. Despite the large number and accessibility of weight management apps, the quality and features of most are variable. It can be concluded from six sigma results that passing the mean does not ensure that the quality is consistently distributed through all app quality properties and Mobile App Rating Scale and evidence-based strategies do not give developers an indication of the acceptance of their apps by mobile users. This finding stresses the importance of reevaluating the passing criterion, which is ≥50% for designing an effective app.

Ease of Use of the Electroconvulsive Therapy App by Its Users: Cross-Sectional Questionnaire Study

Background

Electroconvulsive therapy (ECT) is one of the oldest, most effective, and potentially life-saving noninvasive brain stimulation treatments for psychiatric illnesses such as severe depression, mania, and catatonia. The decision-making process to use ECT involves well-informed discussion between the clinician and the client. A platform, like an app, which provides this information in an easy-to-understand format may be of benefit to various stakeholders in making an informed decision. Apps developed by clinicians/hospitals taking into consideration user perspectives will filter and provide trustworthy information to the users. In this regard, the ECT app, an app which is freely available for download at the Apple Store, was developed by the Leicestershire Partnership National Health Service (NHS) Trust and Leicestershire Health Informatics Service (LHIS).

Objective

The objective of this study is to evaluate and demonstrate the accessibility of the ECT app to the chosen audiences it was created for, via a paper and electronic questionnaire.

Methods

A survey was conducted between January 2017 and March 2019. A survey questionnaire designed for the study was sent to mental health professionals, medical students, patients, carers, and members of the public via post, email, and SurveyMonkey or informed via posts shared in Psychiatry online groups and face-to-face contact. All participants who were willing to participate in the study were included.

Results

Results were collected via paper forms, email responses, and SurveyMonkey and all were inputted into SurveyMonkey to facilitate analysis. A total of 20 responses were received during the study period (January 2017 to March 2019). The participants of the survey, which included a mixed group of professionals (12/20, 60%), patients (3/20, 15%), and carers (1/20, 5%), opined that the app was easy to download (14/20, 70%) and use (9/20, 45%); contained adequate information (19/20, 95%); they felt more informed after having used the app (9/20, 45%); and they would recommend it to others (19/20, 95%). The participants of the survey also provided suggestions on the app (10/20, 50%).

Conclusions

The ECT app can be beneficial in sharing appropriate information to professionals and the public alike and help in gathering unbiased and nonjudgmental information on the current use of ECT as a treatment option.

An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension

BACKGROUND

Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence.

METHODS

We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression.

RESULTS

Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes.

CONCLUSIONS

Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.

Effectiveness of Mobile App-Assisted Self-Care Interventions for Improving Patient Outcomes in Type 2 Diabetes and/or Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Mobile app-assisted self-care interventions are emerging promising tools to support self-care of patients with chronic diseases such as type 2 diabetes and hypertension. The effectiveness of such interventions requires further exploration for more supporting evidence.

Objective

A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to examine the effectiveness of mobile app-assisted self-care interventions developed for type 2 diabetes and/or hypertension in improving patient outcomes.

Methods

We followed the Cochrane Collaboration guidelines and searched MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus for relevant studies published between January 2007 and January 2019. Primary outcomes included changes in hemoglobin A_1c (HbA_1c) levels, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Changes in other clinical-, behavioral-, knowledge-, and psychosocial-related outcomes were included as secondary outcomes. Primary outcomes and objective secondary outcomes that were reported in at least two trials were meta-analyzed; otherwise, a narrative synthesis was used for data analysis.

Results

A total of 27 trials were identified and analyzed. For primary outcomes, the use of mobile app-assisted self-care interventions was associated with significant reductions in HbA_1c levels (standardized mean difference [SMD] −0.44, 95% CI −0.59 to −0.29; P<.001), SBP (SMD −0.17, 95% CI −0.31 to −0.03, P=.02), and DBP (SMD −0.17, 95% CI −0.30 to −0.03, P=.02). Subgroup analyses for primary outcomes showed that several intervention features were supportive of self-management, including blood glucose, blood pressure, and medication monitoring, communication with health care providers, automated feedback, personalized goal setting, reminders, education materials, and data visualization. In addition, 8 objective secondary outcomes were meta-analyzed, which showed that the interventions had significant lowering effects on fasting blood glucose levels and waist circumference. A total of 42 secondary outcomes were narratively synthesized, and mixed results were found.

Conclusions

Mobile app-assisted self-care interventions can be effective tools for managing blood glucose and blood pressure, likely because their use facilitates remote management of health issues and data, provision of personalized self-care recommendations, patient–care provider communication, and decision making. More studies are required to further determine which combinations of intervention features are most effective in improving the control of the diseases. Moreover, evidence regarding the effects of these interventions on the behavioral, knowledge, and psychosocial outcomes of patients is still scarce, which warrants further examination.

Studying health-related internet and mobile device use using web logs and smartphone records

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.

Attitudes and Use of Information and Communication Technologies in Older Adults With Mild Cognitive Impairment or Early Stages of Dementia and Their Caregivers: Cross-Sectional Study

Background

Information and communication technologies are promising tools to increase the quality of life of people with dementia or mild cognitive impairment and that of their caregivers. However, there are barriers to their use associated with sociodemographic factors and negative attitudes, as well as inadequate knowledge about technologies.

Objective

The aim of this study was to analyze technophilia (attitudes toward new technologies) and the use of smartphones and tablets along with associated factors in people with dementia/mild cognitive impairment and their caregivers.

Methods

Data from the first visit of the Support Monitoring and Reminder for Mild Dementia (SMART4MD) randomized multicenter clinical trial were used for this analysis. Data were obtained from two European countries, Spain and Sweden, and from three centers: Consorci Sanitari de Terrassa (Catalonia, Spain), Servicio Andaluz de Salud (Andalusia, Spain), and the Blekinge Institute of Technology (Sweden). Participants with a score between 20 and 28 in the Mini Mental State Examination, with memory problems (for more than 6 months), and who were over the age of 55 years were included in the study, along with their caregivers. The bivariate Chi square and Mann-Whitney tests, and multivariate linear and logistic regression models were used for statistical analysis.

Results

A total of 1086 dyads were included (N=2172). Overall, 299 (27.53%) of people with dementia/mild cognitive impairment had a diagnosis of dementia. In addition, 588 (54.14%) of people with dementia/mild cognitive impairment reported using a smartphone almost every day, and 106 (9.76%) used specific apps or software to support their memory. Among the caregivers, 839 (77.26%) used smartphones and tablets almost every day, and 181 (16.67%) used specific apps or software to support their memory. The people with dementia/mild cognitive impairment showed a lower level of technophilia in comparison to that of their caregivers after adjusting for confounders (B=0.074, P=.02) with differences in technology enthusiasm (B=0.360, P<.001), but not in technology anxiety (B=–0.042, P=.37). Technophilia was associated with lower age (B=–0.009, P=.004), male gender (B=–0.160, P<.001), higher education level (P=.01), living arrangement (living with children vs single; B=–2.538, P=.01), country of residence (Sweden vs Spain; B=0.256, P<.001), lower depression (B=–0.046, P<.001), and better health status (B=0.004, P<.001) in people with dementia/mild cognitive impairment. Among caregivers, technophilia was associated with comparable sociodemographic factors (except for living arrangement), along with a lower caregiver burden (B=–0.005, P=.04) and better quality of life (B=0.348, P<.001).

Conclusions

Technophilia was associated with a better quality of life and sociodemographic variables in people with dementia/mild cognitive impairment and caregivers, suggesting potential barriers for technological interventions. People with dementia/mild cognitive impairment frequently use smartphones and tablets, but the use of specific apps or software to support memory is limited. Interventions using these technologies are needed to overcome barriers in this population related to sociodemographic characteristics and the lack of enthusiasm for new technologies.

Trial Registration

ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699

Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

BACKGROUND

The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools.

OBJECTIVE

This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults.

METHODS

We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF).

RESULTS

Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E).

CONCLUSIONS

Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps.

Media Complementarity and Health Information Acquisition: A Cross-sectional Analysis of the 2017 HINTS-China Survey

Given the myriad of media channels and available health information, it is important to investigate how health consumers navigate and choose from multiple media channels in seeking health information and their preferences among different media sources. Previous research has routinely measured health information-seeking behavior (HISB), especially online health information seeking as a whole, which does not capture the complexity and diversity of media channels used in HISB. On the basis of the channel complementarity theory, this study further classified new media into search engines, social media, and mobile health applications. The results of a secondary analysis of the Health Information National Trends Survey in China (HINTS-China) reinforced the occurrence of media complementary between information-oriented media (newspapers and magazines) and entertainment-oriented media (television). In addition, people used traditional media complementarily with new media, except information-oriented media and search engine use exhibited a displacement relationship. Moreover, the results indicated different profiles of health information seekers varied according to the diverse media channels, although media trust, perceived poor health status, chronic disease, and family cancer history consistently propelled HISB for both online and offline media channels. Implications for theory and practice for health communication were discussed.

Improving Self-Care in Patients With Coexisting Type 2 Diabetes and Hypertension by Technological Surrogate Nursing: Randomized Controlled Trial

BACKGROUND

Technological surrogate nursing (TSN) derives from the idea that nurse-caregiver substitutes can be created by technology to support chronic disease self-care.

OBJECTIVE

This paper begins by arguing that TSN is a useful and viable approach to chronic disease self-care. The analysis then focuses on the empirical research question of testing and demonstrating the effectiveness and safety of prototype TSN supplied to patients with the typical complex chronic disease of coexisting type 2 diabetes and hypertension. At the policy level, it is shown that the data allow for a calibration of TSN technology augmentation, which can be readily applied to health care management.

METHODS

A 24-week, parallel-group, randomized controlled trial (RCT) was designed and implemented among diabetic and hypertensive outpatients in two Hong Kong public hospitals. Participants were randomly assigned to an intervention group, supplied with a tablet-based TSN app prototype, or to a conventional self-managing control group. Primary indices-hemoglobin A1c, systolic blood pressure, and diastolic blood pressure-and secondary indices were measured at baseline and at 8, 12, 16, and 24 weeks after initiation, after which the data were applied to test TSN effectiveness and safety.

RESULTS

A total of 299 participating patients were randomized to the intervention group (n=151) or the control group (n=148). Statistically significant outcomes that directly indicated TSN effectiveness in terms of hemoglobin 1c were found in both groups but not with regard to systolic and diastolic blood pressure. These findings also offered indirect empirical support for TSN safety. Statistically significant comparative changes in these primary indices were not observed between the groups but were suggestive of an operational calibration of TSN technology augmentation. Statistically significant changes in secondary indices were obtained in one or both groups, but not between the groups.

CONCLUSIONS

The RCT's strong behavioral basis, as well as the importance of safety and effectiveness when complex chronic illness is proximately self-managed by layperson patients, prompted the formulation of the empirical joint hypothesis that TSN would improve patient self-care while satisfying the condition of patient self-safety. Statistical and decision analysis applied to the experimental outcomes offered support for this hypothesis. Policy relevance of the research is demonstrated by the derivation of a data-grounded operational calibration of TSN technology augmentation with ready application to health care management.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02799953; https://clinicaltrials.gov/ct2/show/NCT02799953.

Effectiveness of Lilly Connected Care Program (LCCP) App-Based Diabetes Education for Patients With Type 2 Diabetes Treated With Insulin: Retrospective Real-World Study

Background

Diabetes poses heavy economic and social burdens worldwide. Mobile apps show great potential for diabetes self-management education. However, there is limited evidence for the effectiveness of providing general diabetes education through mobile apps.

Objective

The aim of this study was to clarify the effectiveness of Lilly Connected Care Program (LCCP) app-based diabetes education for glycemic control.

Methods

This retrospective cohort study included patients with diabetes recruited to the LCCP platform from September 1, 2018, to May 31, 2019. Each patient was followed for 12 weeks. According to the number of diabetes education courses they had completed, the patients were divided into the following three groups: group A (0-4 courses), group B (5-29 courses), and group C (≥30 courses). The main outcomes were the change in blood glucose at the 12th week compared with baseline and the differences in blood glucose at the 12th week among the three groups. The associations of the number of diabetes education courses completed with the average blood glucose and frequency of self-monitoring of blood glucose (SMBG) at the 12th week were assessed by multivariate linear regression analyses controlling for other confounding covariates. Univariate and multivariate linear regression analyses were used to assess factors influencing patients’ engagement in the diabetes education courses.

Results

A total of 5011 participants were enrolled. Their mean fasting blood glucose (FBG) and postprandial blood glucose (PBG) were significantly lower at the 12th week than at baseline (FBG, 7.46 [standard deviation (SD) 1.95] vs 7.79 [SD 2.18] mmol/L, P<.001; PBG, 8.94 [SD 2.74] vs 9.53 [SD 2.81] mmol/L, P<.001). The groups that completed more diabetes education courses had lower FBG (group B, β=−0.14, 95% CI −0.26 to −0.03; group C, β=−0.29, 95% CI −0.41 to −0.16; P for trend <.001) and PBG (group B, β=−0.29, 95% CI −0.46 to −0.11; group C, β=−0.47, 95% CI −0.66 to −0.28; P for trend <.001) and a higher frequency of SMBG at the 12th week (group B, β=1.17, 95% CI 0.81-1.53; group C, β=4.21, 95% CI 3.81-4.62; P for trend <.001) when compared with the findings in group A. Age and education were related to patients’ engagement in the diabetes education courses. Middle-aged patients (35-59 years old) and elderly patients (≥60 years old) completed more diabetes education courses (middle-aged group, β=2.22, P=.01; elderly group, β=2.42, P=.02) than young patients (18-34 years old).

Conclusions

LCCP app-based diabetes education is effective for glycemic control and SMBG behavior improvement in patients with type 2 diabetes receiving insulin therapy. Young patients’ engagement in the education courses was relatively low. We need to conduct in-depth interviews with users to further improve the curriculum.

Patient Attitudes and Their Awareness Towards Skin Cancer-Related Apps: Cross-Sectional Survey

BACKGROUND

In the emerging era of digitalization and electronic health, skin cancer-related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps.

OBJECTIVE

The aim of this study was to investigate patient attitudes and their awareness toward skin cancer-related apps.

METHODS

A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer-related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire.

RESULTS

A total of 98.9% (195/197) of patients had never used skin cancer-related apps or could not remember. In 49.7% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app.

CONCLUSIONS

The experience and knowledge of skin cancer-related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source.

Associations of Health App Use and Perceived Effectiveness in People With Cardiovascular Diseases and Diabetes: Population-Based Survey

BACKGROUND

Mobile health apps can help to change health-related behaviors and manage chronic conditions in patients with cardiovascular diseases (CVDs) and diabetes mellitus, but a certain level of health literacy and electronic health (eHealth) literacy may be needed.

OBJECTIVE

The aim of this study was to identify factors associated with mobile health app use in individuals with CVD or diabetes and detect relations with the perceived effectiveness of health apps among app users.

METHODS

The study used population-based Web-based survey (N=1500) among Germans, aged 35 years and older, with CVD, diabetes, or both. A total of 3 subgroups were examined: (1) Individuals with CVD (n=1325), (2) Individuals with diabetes (n=681), and (3) Individuals with CVD and diabetes (n=524). Sociodemographics, health behaviors, CVD, diabetes, health and eHealth literacy, characteristics of health app use, and characteristics of apps themselves were assessed by questionnaires. Linear and logistic regression models were applied.

RESULTS

Overall, patterns of factors associated with health app use were comparable in individuals with CVD or diabetes or both. Across subgroups, about every fourth patient reported using apps for health-related purposes, with physical activity and weight loss being the most prominent target behaviors. Health app users were younger, more likely to be female (except in those with CVD and diabetes combined), better educated, and reported more physical activity. App users had higher eHealth literacy than nonusers. Those users who perceived the app to have a greater effectiveness on their health behaviors tended to be more health and eHealth literate and rated the app to use more behavior change techniques (BCTs).

CONCLUSIONS

There are health- and literacy-related disparities in the access to health app use among patients with CVD, diabetes, or both, which are relevant to specific health care professionals such as endocrinologists, dieticians, cardiologists, or general practitioners. Apps containing more BCTs had a higher perceived effect on people's health, and app developers should take the complexity of needs into account. Furthermore, eHealth literacy appears to be a requirement to use health apps successfully, which should be considered in health education strategies to improve health in patients with CVD and diabetes.

How Women Use Digital Technologies for Health: Qualitative Interview and Focus Group Study

Background

A range of digital technologies are available to lay people to find, share, and generate health-related information. Few studies have directed attention specifically to how women are using these technologies from the diverse array available to them. Even fewer have focused on Australian women’s use of digital health.

Objective

The Australian Women and Digital Health Project aimed to investigate which types of digital technologies women used regularly for health-related purposes and which they found most helpful and useful. Qualitative methods—semistructured interviews and focus groups—were employed to shed light on the situated complexities of the participants’ enactments of digital health technologies. The project adopted a feminist new materialism theoretical perspective, focusing on the affordances, relational connections, and affective forces that came together to open up or close off the agential capacities generated with and through these enactments.

Methods

The project comprised two separate studies including a total of 66 women. In study 1, 36 women living in the city of Canberra took part in face-to-face interviews and focus groups, while study 2 involved telephone interviews with 30 women from other areas of Australia.

Results

The affordances of search engines to locate health information and websites and social media platforms for providing information and peer support were highly used and valued. Affective forces such as the desire for trust, motivation, empowerment, reassurance, control, care, and connection emerged in the participants’ accounts. Agential capacities generated with and through digital health technologies included the capacity to seek and generate information and create a better sense of knowledge and expertise about bodies, illness, and health care, including the women’s own bodies and health, that of their families and friends, and that of their often anonymous online social networks. The participants referred time and again to appreciating the feelings of agency and control that using digital health technologies afforded them. When the technologies failed to work as expected, these agential capacities were not realized. Women responded with feelings of frustration, disappointment, and annoyance, leading them to become disenchanted with the possibilities of the digital technologies they had tried.

Conclusions

The findings demonstrate the nuanced and complex ways in which the participants were engaging with and contributing to online sources of information and using these sources together with face-to-face encounters with doctors and other health care professionals and friends and family members. They highlight the lay forms of expertise that the women had developed in finding, assessing, and creating health knowledges. The study also emphasized the key role that many women play in providing advice and health care for family members not only as digitally engaged patients but also as digitally engaged carers.

A human centered approach to design a diet app for patients with metabolic syndrome

BACKGROUND

The objective of this study was to utilize a human-centered approach in designing a diet app that would assist in management of patients with metabolic syndrome.

METHODS

A convenience sample of 10 dietetic interns (DIs) who were attending their informatics rotation at the City University of New York School of Public Health and Health Policy (CUNY GSPHHP) were recruited during October 2017. The study was conducted in two phases. In phase 1, the DIs received a tutorial on the use of human-centered approach in designing mobile health applications. In phase 2, the DIs were provided a case study for which they designed an app for patients to manage metabolic syndrome using a human centered approach. The goal of phase 2 was to identify the features that were believed to be most important when designing this metabolic syndrome app. An initial questionnaire was administered to the DIs to gather information on their socio-demographics, prior training in nutrition, smart phone usage, perceptions about food logs, and calorie intake calculations. Subsequent questionnaires gathered information from the DIs on their preferred diet app components, app features, rankings of the features, and mock representations of the diet app with the selected features.

RESULTS

The DIs were enrolled in the supervised practice component of their training to be Registered Dietitian Nutritionists (RDNs). Fifty percent of them had previously worked in a nutrition-related field. One-third of them were currently using a nutrition app. The top five features of the proposed diet app which the DIs identified as very important included (I) personalization of the app based on user preferences (80%, n=8); (II) disease specific education tips (90%, n=9); (III) ability to track progress (80%; n=8); (IV) reminders (70%, n=7) and (V) reinforcement based on user feedback (50%, n=5). In translating the identified features into functional requirements, majority of the DIs felt that the five key features identified should incorporate the following components: (I) personalization of the app should comprise information on medical factors, personal information, personal preferences, and recording weights; (II) disease specific educational tips should comprise information on food selections, low sodium options, and recipes for diabetes; (III) tracking progress should comprise features for storing audio files, viewing previous logs and uploading photos into a library; (IV) reminders should comprise daily messages to the users from the app; and (V) reinforcement should comprise provisions to enter motivational messages.

CONCLUSIONS

Our study lends support to the need for utilizing human-centered design (HCD) approaches in developing e-health dietary apps as well other non-diet related apps. App developers are encouraged to incorporate user characteristics, needs and preferences using a HCD framework that will allow for reproducibility, tailoring, user satisfaction, and effectiveness assessments.