The impact of mobile health interventions on service users' health outcomes and the role of health professions: a systematic review of systematic reviews-protocol

BACKGROUND

Mobile health tools have gained prominence in global health care in recent years. Mobile health (mHealth) interventions have demonstrated their impact on managing healthcare service users' health. A pilot search revealed many systematic reviews on the effectiveness of mobile health tools on service users' health outcomes. However, how the role of healthcare professionals in promoting the adoption of mobile health may lead to improved outcomes needs to be clarified. Therefore, this systematic review aims to synthesise existing systematic reviews that examine both the impact of mobile health interventions on service users' outcomes and the role of healthcare professionals in facilitating the adoption of mobile health solutions.

METHODS

Five electronic databases will be searched: EMBASE, CINHAL Plus, MEDLINE, Web of Science, and the Cochrane Library for systematic reviews exploring the impact of mobile health interventions on service users' outcomes and the role of healthcare professionals in facilitating the adoption of mobile health solutions. Systematic reviews published in English dated from January 2015 to June 2024 will be included. Screening and selection of the reviews against inclusion and exclusion criteria will be performed by three independent reviewers, as well as data extraction and quality assessment.

DISCUSSION

Current systematic reviews in mHealth have primarily focused on assessing the effectiveness of mHealth interventions for managing a range of conditions. While these reviews provide valuable input into the outcomes for mHealth, more is needed to know about the impact of the involvement of health professions on service users' outcomes when adopting mHealth. This systematic review of systematic reviews aims to bridge this critical gap in the literature by critically appraising and synthesising the evidence of mHealth interventions' impact on service user outcomes and the level of involvement of health professionals.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD 42023414435.

Behavioral Lifestyle Intervention Program Using Mobile Application Improves Diet Quality in Adults With Prediabetes (D'LITE Study): A Randomized Controlled Trial

BACKGROUND

Mobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking.

OBJECTIVE

The objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss.

DESIGN

A secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D'LITE) was conducted, with participants recruited from October 2017 to September 2019.

PARTICIPANTS/SETTING

Community-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study.

INTERVENTION

Participants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice.

MAIN OUTCOME MEASURES

Dietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined.

STATISTICAL ANALYSES

Between-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss.

RESULTS

There was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8-8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, -0.8, -0.2; P < 0.001) and sodium by 726 mg/day (95% CI, -983, -468; P < .001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months.

CONCLUSION

For adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss.

Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review

BACKGROUND

In the modern world, mobile apps are essential for human advancement, and pandemic control is no exception. The use of mobile apps and technology for the detection and diagnosis of COVID-19 has been the subject of numerous investigations, although no thorough analysis of COVID-19 pandemic prevention has been conducted using mobile apps, creating a gap.

OBJECTIVE

With the intention of helping software companies and clinical researchers, this study provides comprehensive information regarding the different fields in which mobile apps were used to diagnose COVID-19 during the pandemic.

METHODS

In this systematic review, 535 studies were found after searching 5 major research databases (ScienceDirect, Scopus, PubMed, Web of Science, and IEEE). Of these, only 42 (7.9%) studies concerned with diagnosing and detecting COVID-19 were chosen after applying inclusion and exclusion criteria using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol.

RESULTS

Mobile apps were categorized into 6 areas based on the content of these 42 studies: contact tracing, data gathering, data visualization, artificial intelligence (AI)-based diagnosis, rule- and guideline-based diagnosis, and data transformation. Patients with COVID-19 were identified via mobile apps using a variety of clinical, geographic, demographic, radiological, serological, and laboratory data. Most studies concentrated on using AI methods to identify people who might have COVID-19. Additionally, symptoms, cough sounds, and radiological images were used more frequently compared to other data types. Deep learning techniques, such as convolutional neural networks, performed comparatively better in the processing of health care data than other types of AI techniques, which improved the diagnosis of COVID-19.

CONCLUSIONS

Mobile apps could soon play a significant role as a powerful tool for data collection, epidemic health data analysis, and the early identification of suspected cases. These technologies can work with the internet of things, cloud storage, 5th-generation technology, and cloud computing. Processing pipelines can be moved to mobile device processing cores using new deep learning methods, such as lightweight neural networks. In the event of future pandemics, mobile apps will play a critical role in rapid diagnosis using various image data and clinical symptoms. Consequently, the rapid diagnosis of these diseases can improve the management of their effects and obtain excellent results in treating patients.

Assessing the e-health literacy level and its predictors in heart patients: A Case Study in a Heart Hospital Center in Iran

BACKGROUND

eHealth literacy has many benefits for patients and community members, including the direct impact on improving the quality of patient education and reducing direct and indirect healthcare costs. Benefiting from eHealth literacy in patients with cardiovascular diseases can effectively provide healthcare services and manage these patients. This study aimed to evaluate eHealth literacy level and its factors affecting patients with cardiovascular diseases in a Heart Center Hospital.

MATERIALS AND METHODS

This cross-sectional study was conducted in 2022. A valid and reliable questionnaire has been used for data gathering. From 147 distributed questionnaires among patients with cardiovascular diseases at Madani Heart Center Hospital in Khorramabad city, finally, 86 questionnaires have been collected completely. Data analyses were done using IBM Statistical Package for the Social Sciences (SPSS) software version 22 descriptive and analytical tests such as one-way ANOVA, independent sample t-test, and Spearman correlation coefficient based on the study objectives.

RESULTS

The study showed that heart patients' eHealth literacy status is moderate (3.38 out of 5). The awareness of the availability of resources on the Internet had the highest score (3.79). The importance of using the Internet to obtain health information (r = 0.62, P < 0.001) and the ability to use the Internet (r = 0.62, P < 0.001) had the most significant relationship with eHealth literacy among patients with cardiovascular diseases.

CONCLUSION

It is suggested that by increasing the level of Internet skills, expanding the use of the Internet for health-related services, using the Internet to make accurate health decisions among patients, extending the use of the Internet to access health resources, and reducing the patient's level of concern about their health status to improve the level of eHealth literacy of cardiovascular patients.

Nutrition fact label (NFL) use is related to meeting the requirements for vitamins and minerals not listed on NFLs: Data from the Korea National Health and Nutritional Examination Survey VIII (2019-2021) for the prepandemic and pandemic periods

The credibility and wide usability of nutrition fact labels (NFLs) have increased due to the pandemic, which may lead to healthier nutritional choices. This cross-sectional study aimed to evaluate the association between NFL use and meeting the estimated average requirements (EARs) for vitamins and minerals not listed on NFLs during the prepandemic (2019, n = 6606) and pandemic periods (2020 and 2021, n = 12085) using KNHANES data. Household surveys, health behavior interviews, and health checkup examinations were conducted for all participants. Subjects were included in the unAware+noUse, Aware+noUse, and Aware+Use groups according to NFL usage, and nutritional intake was analyzed by the 24-hour recall method. Complex-sample multiple logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for meeting the EARs according to NFL usage in the crude and adjusted (including metabolic conditions) models. The primary finding was that awareness and NFL use were associated with adequate intake above the EARs for vitamin A, vitamin B2, niacin, folate, Ca, Fe, and P; this association was more evident during the pandemic. After adjusting for covariates, during the pandemic, the ORs of meeting the EARs in the Aware+noUse group and Aware+Use group were 1.25 (CI 1.06-1.47) and 1.36 (CI 1.05-1.75) for vitamin A, 1.26 (CI 1.06-1.50) and 1.54 (CI 1.19-2.00) for vitamin B2, 1.32 (CI 1.13-1.56) and 1.46 (CI 1.15-1.85) for folate, and 1.46 (CI 1.06-2.00) and 1.73 (1.09-2.75) for P, respectively. Additionally, the ORs for niacin (1.21, 1.02-1.43) and Fe (1.29, 1.08-1.54) were significant in the Aware+noUse group, and that for Ca (1.39, 1.08-1.78) was significant in the Aware+Use group (all p <0.05). In conclusion, NFL awareness and use are associated with meeting the EARs for vitamins and minerals not listed on NFLs. For future recurring health crises, effective NFL use is necessary for healthy dietary practices.

Facilitators and barriers of mHealth interventions during the Covid-19 pandemic: systematic review

BACKGROUND

With the spread of Covid-19 disease, health interventions related to the control, prevention, and treatment of this disease and other diseases were given real attention. The purpose of this systematic review is to express facilitators and barriers of using mobile health (mHealth) interventions during the Covid-19 pandemic.

METHODS

In this systematic review, original studies were searched using keywords in the electronic database of PubMed until August 2022. The objectives and outcomes of these studies were extracted. Finally, to identify the facilitators and barriers of mHealth interventions, a qualitative content analysis was conducted based on the strengths, weaknesses, opportunities, and threats (SWOT) analysis method with Atlas.ti 8 software. We evaluated the studies using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

In total, 1598 articles were identified and 55 articles were included in this study. Most of the studies used mobile applications to provide and receive health services during the Covid-19 pandemic (96.4%). The purpose of the applications was to help prevention (17), follow-up (15), treatment (12), and diagnosis (8). Using SWOT analysis, 13 facilitators and 18 barriers to patients' use of mHealth services were identified.

CONCLUSION

Mobile applications are very flexible technologies that can be customized for each person, patient, and population. During the Covid-19 pandemic, the applications designed due to lack of interaction, lack of time, lack of attention to privacy, and non-academic nature have not met their expectations of them.

Digital Technologies to Enhance Infectious Disease Surveillance in Tanzania: A Scoping Review

Mobile phones and computer-based applications can speed up disease outbreak detection and control. Hence, it is not surprising that stakeholders in the health sector are becoming more interested in funding these technologies in Tanzania, Africa, where outbreaks occur frequently. The objective of this situational review is, therefore, to summarize available literature on the application of mobile phones and computer-based technologies for infectious disease surveillance in Tanzania and to inform on existing gaps. Four databases were searched-Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PubMed, and Scopus-yielding a total of 145 publications. In addition, 26 publications were obtained from the Google search engine. Inclusion and exclusion criteria were met by 35 papers: they described mobile phone-based and computer-based systems designed for infectious disease surveillance in Tanzania, were published in English between 2012 and 2022, and had full texts that could be read online. The publications discussed 13 technologies, of which 8 were for community-based surveillance, 2 were for facility-based surveillance, and 3 combined both forms of surveillance. Most of them were designed for reporting purposes and lacked interoperability features. While undoubtedly useful, the stand-alone character limits their impact on public health surveillance.

Insights from Review and Content Analysis of Current COVID-19 Mobile Apps and Recommendations for Future Pandemics

A number of mobile health apps related to coronavirus infectious disease 2019 (COVID-19) have been developed, but research into app content analytics for effective surveillance and management is still in its preliminary stages. The present study aimed to identify the purpose and functions of the currently available COVID-19 apps using content analysis. The secondary aim was to propose directions for the future development of apps that aid infectious disease surveillance and control with a focus on enhancing the app content and quality. Prior to conducting an app search in the App Store and the Google Play Store, we reviewed previous studies on COVID-19 apps found in Google Scholar and PubMed to examine the main purposes of the apps. Using the five selected keywords based on the review, we searched the two app stores to retrieve eligible COVID-19 apps including those already addressed in the reviewed literature. We conducted descriptive and content analyses of the selected apps. We classified the purpose types of the COVID-19 apps into the following five categories: Information provision, tracking, monitoring, mental health management, and engagement. We identified 890 apps from the review articles and the app stores: 47 apps met the selection criteria and were included in the content analysis. Among the selected apps, iOS apps outnumbered Android apps, 27 apps were government-developed, and most of the apps were created in the United States. The most common function for the iOS apps (63.6%) and Android apps (62.5%) was to provide COVID-19-related knowledge. The most common function among the tracking apps was to notify users of contact with infected people by the iOS apps (40.9%) and Android apps (37.5%). About 29.5% of the iOS apps and 25.0% of the Android apps were used to record symptoms and self-diagnose. Significantly fewer apps targeted mental health management and engagement. Six iOS apps (6/44, 13.6%) and four Android apps (4/24, 16.7%) provided behavioral guidelines about the pandemic. Two iOS apps (2/44, 4.5%) and two Android apps (2/24, 8.3%) featured communication functions. The present content analysis revealed that most of the apps provided unilateral information and contact tracing or location tracking. Several apps malfunctioned. Future research and development of COVID-19 apps or apps for other emerging infectious diseases should address the quality and functional improvements, which should begin with continuous monitoring and actions to mitigate any technical errors.

Infodemic Challenges During COVID-19 Pandemic and the Strategies to Deal with Them: A Review Article

Context: The phenomenon of infodemic following the outbreak of COVID-19 has led to several adverse public health consequences. Infodemic poses challenges at the community level, and identifying and adopting effective strategies against it can address many of these challenges. The present study aimed to determine the infodemic challenges of COVID-19 and the strategy to deal with them. Evidence acquisition: We searched PubMed and Scopus scientific databases using related keywords up to April 2022. The article selection process was based on the study’s inclusion and exclusion criteria. Data extraction was carried out using a data extraction form. We analyzed the extracted data through the content analyses method. Results: We identified infodemic challenges from related studies and classified them into nine main categories. These challenges included social hazards, improper health behavior, and scientific hazards. Other results show that strategies to deal with COVID-19 and other similar conditions can be classified into seven main categories, including the active confrontation with centers and scientific sources, the effective intervention of health care professionals, responsible participatory actions, actions of governments and authorities, monitoring and identifying incorrect information, heightening people’s awareness, and encouragement for vaccination. Conclusions: In this study, we identified and reported different coping strategies from all around the world that are very broad, and different countries and societies can use appropriate methods according to their situations and characteristics. Efforts to disseminate accurate information and prevent the propagation of incorrect information during a pandemic crisis can be vital.

Stress, PTSD, and COVID-19: the Utility of Disaster Mental Health Interventions During the COVID-19 Pandemic

Purpose of review

In the context of an ongoing, highly uncertain pandemic, disaster mental health measures can increase community capacity for resilience and well-being, support formal mental health treatment, and help address the risk for mental health reactions in high-stress occupations. The purpose of this review is to summarize the literature on disaster mental health interventions that have been helpful both prior to and during the pandemic in a broad range of applications, including for use with high-stress occupations in an effort to mitigate risk for post-traumatic stress disorder (PTSD) and other mental health sequelae.

Recent findings

Evidence-based and evidence-informed disaster mental health interventions, frameworks, and treatments have been studied in pilot studies, non-randomized trials, and randomized clinical trials prior to and in the context of the current COVID-19 pandemic. The studies have demonstrated feasibility and acceptability of these modalities and improved perceived support, as well as significant reductions in distress, and mental health symptoms such as depression, anxiety, and PTSD.

Summary

A disaster mental health approach to the COVID-19 pandemic can generate opportunities for prevention and support at multiple levels with timely interventions tailored for different concerns, cultures, and available resources.

Mobile technology: A tool for healthcare and a boon in pandemic

Healthcare systems deal with disease prevention, early detection, diagnosis, investigation, and timely, affordable, and safe treatment. For the delivery of services in the health sector, communication is the key to linking the service provider and the patients. Mobile technology in the recent past has rendered various platforms of communications for the healthcare system. Thus, in health, mobile technology has greatly contributed to time management and cost reduction for healthcare at every level including hospital visits to individual appointments with doctors, hence the convenience. With advancements in mobile technologies and the growing number of mobile users, newer opportunities have opened up for the use of mobiles for patient care. Emerging information and communication technologies with the help of the Internet of Things (IoT) have been instrumental in integrating different domains of the health sector with mobile technology. Thus, the technology may have the potential to become powerful medical tools to support the health sector at all levels of care. In this review, the concept, applications, and advantages of mobile technology for health and the present pandemic have been discussed. It also discusses mobile health technology, as a support system for convenient and safer healthcare for public health, and the opportunities to improve its applications for unseen future health crises.

Investigating the effective factors of using mHealth apps for monitoring COVID-19 symptoms and contact tracing: A survey among Iranian citizens

BACKGROUND AND OBJECTIVES

The use of mHealth applications depends on cognitive and social factors of individuals in different nations. This study aimed to identify the factors influencing the use of mHealth applications for both "contact-tracing" and "symptom-monitoring" of COVID-19 among Iranian citizens.

METHODS

A cross-sectional study with an online survey was conducted among Iranian citizens. Correlation calculation and multiple linear regression analysis were performed on the studied variables to find the effective factors.

RESULTS

A total of 1031 Iranian citizens over the age of 18 participated in this survey. A large percentage of the participants wanted to use the mHealth app to trace contacts of COVID-19 (74.5%) and the mHealth app to identify and monitor COVID-19 symptoms (74.0%). Gender, age, level of education, attitude towards technology, and fear of COVID-19 were among the factors that influenced the intention to use these two apps. The top reasons for using these apps were: "to keep myself and my family safe", "to control the spread of the coronavirus in general", and "to cooperate with healthcare professionals". The reasons given for not using these two apps were related to the issues of "security and privacy" and "doubt in efficiency and usefulness" of them.

CONCLUSIONS

The study showed that many participants in this survey were interested in using the COVID-19 apps. Policies, regulations and procedures are needed to protect the privacy of individuals by ensuring data governance. Further investigation with a larger sample is suggested to generalize these results.

Digital Community Inclusion of Individuals With Serious Mental Illness: A National Survey to Map Digital Technology Use and Community Participation Patterns in the Digital Era

BACKGROUND

Despite the growing interest in developing and using mobile health (mHealth) and digital technologies in mental health, little is known about the scope and nature of virtual community inclusion.

OBJECTIVE

The overarching goal of this study was to understand and conceptualize virtual community inclusion of individuals with serious mental illness (SMI). Specific objectives of this study were as follows: (1) mapping the prevalence, trends, and experiences related to mHealth and digital technology use among individuals with SMI; (2) comparing patterns of technology use by individuals with and those without SMI; and (3) examining whether use of mHealth and digital technologies predicts recovery among individuals with SMI.

METHODS

A web-based survey of technology use and virtual participation was developed and distributed among adults with and those without SMI via social media, national email discussion lists, nonprofit organizations, and advocacy groups.

RESULTS

A total of 381 adults aged 18 years or older participated in the survey, of whom 199 (52%) identified as having a SMI. Participants with SMI reported significantly greater access to technology and significantly fewer days of face-to-face participation in community activities than those without SMI. Among participants with SMI, greater technology use was positively associated with positive emotions and significantly predicted recovery.

CONCLUSIONS

This study is the first to explore, map, and conceptualize virtual community inclusion among adults with SMI. Our findings indicate a gap in the literature and research on community inclusion and participation, and emphasize the need for virtual community inclusion, particularly during the COVID-19 pandemic and its future implications.