Review and content analysis of mobile apps for inflammatory bowel disease management using the mobile application rating scale (MARS): Systematic search in app stores

BACKGROUND

People with inflammatory bowel disease (IBD) need tools for self-management of their disease with the ultimate goal of improving medication adherence and health outcomes. Mobile apps represent a novel opportunity to provide self-management for patients with IBD. Many mobile apps have been developed for IBD self-management, but more evidence is needed about the quality of these mobile apps.

OBJECTIVE

This study evaluated mobile apps developed for the IBD community and rated the quality of these apps to provide a roadmap for future development.

MATERIALS AND METHODS

The Apple App Store and Google Play Store were systematically searched to identify IBD mobile apps for patients and physicians based on the IBD-related keywords. We included mobile apps that focus on IBD, are in the English language, and are free. The related app quality was evaluated independently by two reviewers using the Mobile Application Rating Scale (MARS).

RESULTS

We identified 401 mobile apps. After removing duplicates and unrelated apps, 44 apps were included in the review. Overall, the mean MARS scores were 3.5 (SD = 0.5) on a scale from 1.00 to 5.00, which was the acceptable range.; 12 apps got scores ≥ 4.00. The highest mean domain score belonged to the functionality dimension (mean = 3.9, SD = 0.6) and the lowest belonged to the engagement dimension (mean = 3.2, SD = 0.8).

CONCLUSION

The MARS ratings showed that the IBD mobile apps quality meet acceptable criteria. However, more attention must be paid to design features that improve user interest and engagement, especially among children and adolescents. Healthcare professional involvement is crucial for designing mobile health apps.

The preferred IT sources and tools of Iranian people for accessing health information

INTRODUCTION

People need health information to maintain their health. Despite the variety of sources and tools for providing health information, there is little evidence about Iranian people's preferences in using these sources and tools. The objective of this study was to identify the preferred health information sources, tools, and methods for presenting health information in these tools.

METHODS

This national survey was conducted among a sample of 4000 Iranian people between April and September 2021. The data was collected using a valid and reliable questionnaire (α = 0.86) consisting of four sections: participants' demographic information, current sources of obtaining health information, preferred information technology (IT) tools for accessing health information, and the method of presenting this information. Linear regression was used to investigate the relationship between demographic factors and other questions.

RESULTS

The participants received health information mostly from the "Internet" (3.62), "family or friends" (3.43), "social networks" (3.41), "specific websites" (3.41), and "mobile apps" (3.27). "Social networks" (3.67), Internet "websites" (3.56), and "mobile apps" (3.50) were the most suitable tools for receiving health information. The participants preferred the presentation of health information in the form of "Images" (3.85), "educational videos" (3.69), and "texts" (3.53). Age, education, and marital status had a significant relationship with most of the preferred information sources, tools, and information presentation methods (p < 0.05).

CONCLUSION

The results of this study showed that Iranian people are more active information seekers than passive ones compared to a decade ago. The preferred sources and tools identified in this research can be used by healthcare planners and policy-makers in Iran and other developing countries to design and develop IT interventions that meet people's needs. Improving access to the Internet, social networks, and mobile apps and providing health information via images, educational videos, and texts on these platforms enhance access to the information people need.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care

Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56-66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.

The 2023 Impact of Inflammatory Bowel Disease in Canada: The Influence of Sex and Gender on Canadians Living With Inflammatory Bowel Disease

Sex (the physical and physiologic effects resulting from having specific combinations of sex chromosomes) and gender (sex-associated behaviours, expectations, identities, and roles) significantly affect the course of inflammatory bowel disease (IBD) and the experience of living with IBD. Sex-influenced physiologic states, like puberty, the menstrual cycle, pregnancy, and andropause/menopause may also impact and be impacted by IBD. While neither Crohn's disease nor ulcerative colitis is commonly considered sex-determined illnesses, the relative incidence of Crohn's disease and ulcerative colitis between males and females varies over the life cycle. In terms of gender, women tend to use healthcare resources at slightly higher rates than men and are more likely to have fragmented care. Women are more commonly prescribed opioid medications and are less likely than men to undergo colectomy. Women tend to report lower quality of life and have higher indirect costs due to higher rates of disability. Women are also more likely to take on caregiver roles for children with IBD. Women with IBD are more commonly burdened with adverse mental health concerns and having poor mental health has a more profound impact on women than men. Pregnant people with active IBD have higher rates of adverse outcomes in pregnancy, made worse in regions with poor access to IBD specialist care. The majority of individuals with IBD in Canada do not have access to a pregnancy-in-IBD specialist; access to this type of care has been shown to allay fears and increase knowledge among pregnant people with IBD.

The 2023 Impact of Inflammatory Bowel Disease in Canada: COVID-19 and IBD

The COVID-19 pandemic had a monumental impact on the inflammatory bowel disease (IBD) community. At the beginning of the pandemic, knowledge on the effect of SARS-CoV-2 on IBD was lacking, especially in those with medication-suppressed immune systems. Throughout the pandemic, scientific literature exponentially expanded, resulting in clinical guidance and vaccine recommendations for individuals with IBD. Crohn's and Colitis Canada established the COVID-19 and IBD Taskforce to process and communicate rapidly transforming knowledge into guidance for individuals with IBD and their caregivers, healthcare providers, and policy makers. Recommendations at the onset of the pandemic were based on conjecture from experience of prior viruses, with a precautionary principle in mind. We now know that the risk of acquiring COVID-19 in those with IBD is the same as the general population. As with healthy populations, advanced age and comorbidities increase the risk for severe COVID-19. Individuals with IBD who are actively flaring and/or who require high doses of prednisone are susceptible to severe COVID-19 outcomes. Consequently, sustaining maintenance therapies (e.g., biologics) is recommended. A three-dose mRNA COVID-19 vaccine regimen in those with IBD produces a robust antibody response with a similar adverse event profile as the general population. Breakthrough infections following vaccine have been observed, particularly as the virus continues to evolve, which supports receiving a bivalent vaccine booster. Limited data exist on the impact of IBD and its therapies on long-term outcomes following COVID-19. Ongoing research is necessary to address new concerns manifesting in those with IBD throughout the evolving pandemic.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease

Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn's disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.

A217 A REVIEW OF MOBILE HEALTH APPLICATIONS FOR INDIVIDUALS LIVING WITH INFLAMMATORY BOWEL DISEASE USING MOBILE APPLICATION RATING SCALE (MARS)

Background

Inflammatory bowel disease (IBD) is a chronic disorder that can be managed but not cured. The relapsing and remitting symptoms of IBD impact patients' quality of life and is associated with considerable healthcare costs. Different mobile health apps have been developed around the world for IBD and other chronic medical conditions. These apps can potentially decrease healthcare utilization and the burden of the disease.

Purpose

We aimed to review IBD mobile health apps available in English and evaluate their quality and content.

Method

We searched the Apple Store and Play Store in July 2022 using IBD-related keywords (e.g., “IBD,” “Crohn,” “Crohns,” “colitis,” “ulcerative colitis,” and “inflammatory bowel disease.”) to identify apps for iOS and Android devices, respectively. We included apps available in English, designed specifically for IBD, and free to download and use. Two researchers reviewed, rated, and evaluated the retrieved apps independently. The Mobile App Rating Scale (MARS) was used to rate the included apps. The MARS rates apps on a scale of 1 to 5 and includes an overall score as well as scores for engagement, functionality, information, aesthetics, and subject quality. A score ≥3 is deemed acceptable.

Result(s)

Search queries yielded 88 relevant apps, of which 38 met the inclusion criteria and were included in this review. The included apps for IBD were most tracking and monitoring symptoms of the disease (n=22). Two of the apps were affiliated with universities, and three of the apps were specifically developed for children. In addition, 11 apps were designed for IBD, regardless of disease subtype (Crohn’s disease [CD] or ulcerative colitis [UC]), and 27 apps were designed specifically for either UC or CD. The mean MARS score for IBD apps was 3.3 (SD=0.6), with more than half deemed acceptable. Apps scored highest on the functionality (mean=3.7, SD=0.6) and information (mean=3.6, SD=0.5) dimension of MARS and lowest on the engagement dimension (mean=3, SD=0.8).

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Conclusion(s)

Most IBD-related apps provide acceptable information and functionality but should improve their engagement to be welcomed by users. This review provides a roadmap for improving available apps and future app development for individuals with IBD. App developers in the field of IBD must ensure they create high-quality, engaging, esthetic and evidence-based apps.

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Disclosure of Interest

None Declared

A web-based information intervention for family caregivers of patients with Dementia: A randomized controlled trial

This study aimed to evaluate the efficacy of a web-based health information intervention on knowledge, care burden and attitudes of family caregivers of patients with dementia. This study is a unblinded randomised controlled trial. The study population consisted of family caregivers of patients with dementia ( n = 50) which were randomly allocated to the intervention group (access to the web-based health information) or control group (access to information as usual). The participants completed knowledge, care burden and attitude questionnaire at baseline and at two months follow-up. A total of 50 caregivers participated in this study. Before the intervention, there was no statistically significant difference between the knowledge, care burden and attitude score between the two groups ( p > 0.001). In comparison to the control group after the intervention, participants in the intervention group showed significant improvements in all outcomes ( p < 0.001). These findings provide further evidence that web-based information interventions helped caregivers feel more confident, empathetic and concerned about dementia care with less care burden.

The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression: A qualitative study

Objectives

This study aimed to describe the experience of healthcare professionals in providing mental health services to women with postpartum depression (PPD).

Methods

In this qualitative study, data were collected through semi-structured interviews with five physicians, five midwives and five psychologists from 14 urban healthcare centres in Kerman, Iran, from April 2019 to September 2019. Purposeful sampling was used to select the participants. Data were qualitatively analysed using a content analysis approach.

Results

Data analysis revealed the main theme of the study: ‘the long way ahead for comprehensive, integrated and responsive mental health services’. This theme included four categories: ‘postpartum depression challenges’, ‘social and personal factors’, ‘structural challenges’ and ‘need for change in mental health services’. The participants described that depression diagnosis is difficult due to insufficient knowledge among healthcare providers and the hidden signs of PPD. They also described how different factors such as economic and cultural factors, personality traits, a community’s lack of knowledge, negative attitude towards depression and limited family support might cause depression. Moreover, providing mental health services involves certain challenges, such as limited human resources, insufficient financial resources and incomplete or inefficient policy-making.

Conclusion

Although measures have been taken to provide mental health services, there are many challenges regarding providing mental health services to mothers. Therefore, serious measures should be taken to improve mental health services and re-define the existing measures. Informing the community, empowering the healthcare providers and attempting to change the community’s attitudes and beliefs can affect the mental healthcare of women with depression.

Review of Systematic Reviews in the Field of Telemedicine

Background: Although the systematic reviews regarding telemedicine have increased in recent decades, no comprehensive studies have been conducted to review these systematic reviews. The present study aimed to review the published systematic reviews regarding telemedicine applications for the report and appraisal of several aspects.

Methods: The literature search was performed in the PubMed database for the systematic reviews published during January 2010-June 2020 in the field of telemedicine using “telemedicine” Mesh terms. The extracted data from the selected articles were the year of publication, telemedicine specialty, clinical outcomes, cost evaluation, and satisfaction assessment. Data analysis was performed using descriptive statistics.

Results: Among 746 retrieved articles, 191 cases were selected and reviewed. Most of the studies were focused on telemedicine (n=35; 18.3%), followed by telerehabilitation (n=22; 11.5%), tele-diabetes (n=18; 9.4%), telecardiology (n=16; 8.3%), home telecare (n=13; 6.8%), telepsychiatry (n=12; 6.3%), teledermatology (n=11; 5.7%), and teleneurology (n=9; 4.7%). The selected studies were primarily focused on clinical outcomes (72.7%), followed by cost-effectiveness (32.4%) and user satisfaction (29.3%). In addition, they mostly indicated that telemedicine services yielded acceptable clinical outcomes (72.5%), cost-effectiveness (67.7%), and healthcare provider/patient satisfaction (83.9%).

Conclusion: Although telerehabilitation, tele-diabetes, telecardiology, home telecare, and telepsychiatry were studied further, there are still some specific specialties such as teleradiology, telepathology, and telepediatric that should be considered more. Moreover, investigation of various outcomes could result in a more comprehensive view of this field. Therefore, further investigations in this regard would improve telemedicine applications and encourage potential telemedicine providers to initiate these applications.

How to deal with the mental health consequences of global health emergencies? A nutshell of telemental health services and its requirements

The coronavirus disease (COVID-19) pandemic is a global health crisis of our time. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently. In addition, the COVID-19 pandemic has disrupted or halted critical mental health services in many countries worldwide. One way to overcome this situation is to use Telemental health services and people can take advantage of these services to meet their mental health needs. However, there are some barriers to provide Telemental health services, which should be considered by policymakers before the crisis.

Health Pandemic and Social Media: A Content Analysis of COVID-Related Posts on a Telegram Channel With More Than One Million Subscribers

BACKGROUND

Mobile-based social media play an important role in the dissemination of information during public health emergencies.

OBJECTIVES

This study aimed to analyze the contents and trends of public messages posted on Telegram during Coronavirus Disease 2019 (COVID-19) pandemic.

METHODS

A content analysis of the 1781 messages, posted in a public Telegram channel with more than one million subscribers performed over 9-weeks. The messages were categorized into seven categories.

RESULTS

In total, 39% (n=703) of all messages were related to COVID-19. With the official confirmation of the case of COVID-19 in Iran, the number of COVID-related massages started to rise. Overall, the most frequent messages were of joke and humor (n=292, 41.5%), followed by educational messages (n=140, 19.9%).

CONCLUSION

Our study showed that the most popular messages during first weeks of COVID pandemic were satirical, indicating that people may not had taken the risks of this pandemic seriously. It is crucial for health organizations to develop strategies for dissemination of reliable health information through social media.

A cross-sectional online survey on patients' satisfaction using store-and-forward voice and text messaging teleconsultation service during the COVID‑19 pandemic

AIM

This study aimed to evaluate the patients' satisfaction with using store-and-forward voice and text messaging teleconsultation service to provide primary health care to patients during the COVID-19 pandemic.

METHOD

A cross-sectional survey was conducted between October 1 and December 1, 2020, in Iran. The study population consisted of patients who used the service. Three hundred-ninety-six patients were enrolled in the study by convenience sampling. Data were collected by a researcher-made questionnaire. The face, comprehensibility, and content validity of the questionnaire were tested and met. The reliability of this questionnaire was confirmed (r = 0.9). Descriptive statistics and multinomial logistic regression were conducted. Data were analyzed using STATA 14.0 software.

RESULTS

In total, 396 patients responded to the online questionnaire. The mean age of patients was 37 ± 10.31 years. More than half of them had an academic degree (65.40 %). Teleconsultation was considered satisfactory by 172 patients (43.43 %), while more than half of the patients (56.57 %) were unsatisfied with teleconsultation. In terms of "quality of care provided" and "patient information privacy" components, around 41 % of patients were satisfied. However, the number of patients who feel satisfied with teleconsultation's similarity to a face-to-face encounter was lower (37.88 %). The results showed no significant relationship between age, gender, education, and overall satisfaction (p > 0.05). The association between overall satisfaction and health status was (AOR = 1.51, 95 % CI = 1.16-1.96).

CONCLUSION

More than half of patients from our study did not have a good experience with teleconsultation. This is also partially due to the use of existing communication platform, instead of custom-made solution. It is necessary to improve the services' quality and meet patients' needs to optimize patients' experience, particularly during a health crisis, resulting in better health outcomes and end-user satisfaction.

Effectiveness of an app-based cognitive behavioral therapy program for postpartum depression in primary care: A randomized controlled trial

OBJECTIVE

The objective of this study was to examine the effect of mobile phone applications (App) based cognitive behavioral therapy (CBT) on postpartum depression.

METHOD

A non-blinded parallel-group randomized controlled trial was conducted. The study population consisted of women attended to three health care centers in Kerman, Iran. Participants were recruited between September and November 2018, and randomized 1:1 to either the intervention group (mobile application access) or control group (no mobile application access). All participants completed the Edinburgh Postnatal Depression Scale (EPDS) at the baseline and 2 months after baseline. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression.

RESULTS

A total of 75 women with an average age of 27 years participated in this study. Before the intervention, there was no statistically significant difference between the EPDS score between the two groups (p > 0.001). However, in the intervention group, the average EPDS score after intervention was 8.18 and in the control group was 15.05, which was statistically significant (p < 0.001).

CONCLUSION

These findings provide proof that providing a CBT program using a mobile application can lead to clinically important improvements in outcomes for mothers who suffer from postpartum depression.

Optimization low-fat and low cholesterol mayonnaise production by central composite design

In this study, the optimized process variables for mayonnaise low in cholestrol and fat, which contained soy milk as a yolk substitute with different levels of Xanthan gum, Zodo gum, and oil, were determined by response surface methodology using a central composite design. Polynomial equation was fitted with an insignificant lack of fit factor in order to study the relationship between variables and responses including apparent viscosity, consistency coefficient, flow index, firmness, and stability of mayonnaise sauces. Results showed that increased amounts of Xanthan gum, Zodo gum and oil led to an increase in the apparent viscosity, the consistency coefficient, the firmness/emulsion stability of the mayonnaise, while the mayonnaise flow index was reduced. The interaction effects between Xanthan gum and Zodo gum, and between Xanthan gum and oil were significant on apparent viscosity. Optimum conditions of variables were obtained due to response ranges of commercial mayonnaise as following ingredients: 0.25% Xanthan gum, 3.84% Zodo gum, 37.50% oil, and with the replacement of 63.61% soy milk. Yolk, however, was replaced with soy milk without emulsion fracture up to 100%. This study showed good potential for Zodo gum native mixed with Xanthan gum and soy milk to be used as a fat and yolk substitute in mayonnaise, respectively.