%0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e84576 %T Understanding Graduate Students’ Perspectives on Food Apps to Inform User-Centered Design: Explanatory Sequential Mixed Methods Survey Study %A Mokhtarnejad,Mehrnoush %A Fontes McCartin,Lyda %K food apps %K graduate students %K healthy eating %K food waste %K mobile apps %K mixed methods %K COM-B model %K capability, opportunity, and motivation-behavior model %D 2026 %7 27.3.2026 %9 %J JMIR Form Res %G English %X Background: Mobile food apps have the potential to promote healthier eating behaviors and more sustainable food practices. Graduate students often struggle to maintain healthy dietary habits due to lifestyle transitions, academic stress, limited time, and constrained budgets, which can lead to poor meal planning, irregular eating patterns, and increased food waste. Objective: This study aimed to examine graduate students’ dietary behaviors, food waste practices, and preferences for mobile food app features, with the intention of informing the design of user-centered tools that promote healthy eating and reduce food waste. Methods: This study used an explanatory sequential mixed methods design. In the first phase, 63 graduate students at the University of South Carolina completed an online survey between November and December 2024, which captured demographics, cooking habits, dietary preferences, food waste behaviors, and online recipe search behaviors. Findings from the survey shaped the design of interview questions, allowing qualitative inquiry to explain and expand upon the quantitative patterns. Ten purposively selected participants completed semistructured interviews. Quantitative data were analyzed descriptively and using the chi-square test with R software (version 4.3.1), while qualitative data were transcribed and thematically analyzed. Results: Survey findings revealed that 54% (34/63) of the participants ate out daily or almost daily; 25.3% (16/63) consumed fast, frozen, or canned food at least 3 to 5 times per week; and only 19% (12/63) cooked daily. Most participants consumed only 1 serving of vegetables (43/63, 68.2%) and fruits (33/63, 52.4%) daily. Nearly 70% (44/63) reported food waste, primarily from leftovers and unused ingredients. A significant association was found between shopping list use and reduced food waste (χ²1=9.66, P=.008; Cramér V=0.39). The interviews contextualized these patterns: the students described time constraints, limited cooking skills, and overbuying as key barriers to healthy eating and waste reduction, while recommending app features such as nutrition tracking, batch meal planning, personalized dietary filters, ingredient-based recipe generators, and grocery list tools with reminders. Participants also emphasized the importance of simple design, multimodal content, and accurate cooking time estimates. Conclusions: This study demonstrates that integrating quantitative and qualitative insights through the capability, opportunity, motivation-behavior (COM-B) framework provides a nuanced understanding of graduate students’ dietary practices, food waste behaviors, and app feature preferences. The findings highlight the need for mobile food apps that are not only evidence based but also user centered, offering simple, time-efficient, and customizable tools that simultaneously address capability deficits, opportunity barriers, and motivation maintenance. Such apps have the potential to address barriers unique to graduate students, such as limited time, minimal cooking skills, and organizational challenges, while supporting healthier eating and reducing food waste. %R 10.2196/84576 %U https://formative.jmir.org/2026/1/e84576 %U https://doi.org/10.2196/84576 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 14 %N %P e77616 %T Clinical Usability of Exercise Prescription Apps for Professional Use: Systematic Review and Multidimensional Evaluation %A Wu,Cheng-Hao %A Chang,Che-Ning %A Chang,Chu-Fang %A Lin,Ming-Hwai %A Chen,Hsing-Yu %A Chen,Yu-Chun %K exercise prescription %K mHealth apps %K behavior change techniques %K FITT principle %K digital health %K app usability %K clinical evaluation %K mobile health %K rehabilitation %K exercise adherence %D 2026 %7 25.3.2026 %9 %J JMIR Mhealth Uhealth %G English %X Background: Exercise prescription is a structured and individualized intervention that requires appropriate progression, tailoring, and behavioral support to ensure safety and long-term effectiveness. With the expansion of mobile health technologies, exercise prescription apps are increasingly used to support the remote delivery of prescribed exercise programs. However, the extent to which widely adopted apps align with established clinical standards remains unclear. Objective: This study aimed to evaluate the clinical usability of popular, no-cost exercise prescription apps from a professional perspective, focusing on clinical integrity, intervention fidelity, behavioral mechanisms, and clinician-assessed digital usability. Methods: A systematic search of Google Play and the Apple App Store identified widely adopted apps that enable clinician-directed exercise prescription. Eligible apps were evaluated using established frameworks, including the frequency, intensity, time, and type (FITT) and FITT, volume, and progression (FITT-VP) principles; the Consensus on Exercise Reporting Template (CERT); the Behavior Change Technique Taxonomy version 1 (BCTTv1); and the Mobile App Rating Scale (MARS). Descriptive analyses and interrater reliability assessments were performed. Results: Six apps met the inclusion criteria. All satisfied the basic FITT requirements; however, none incorporated explicit guidance on exercise progression or individualized adjustment consistent with the FITT-VP principles. CERT evaluation demonstrated comprehensive reporting of structural components but a consistent absence of progression logic, tailoring strategies, and adverse event documentation. Although multiple behavior change techniques were identified, several techniques considered important for graded progression and sustained adherence in unsupervised settings were infrequently implemented or absent. Overall app quality was moderate, characterized by strong functionality but limited engagement. Only 2 apps reported evidence of scientific evaluation. Conclusions: Widely adopted exercise prescription apps meet fundamental structural requirements but do not fully support the progressive and individualized processes central to clinical exercise prescription. These findings highlight a gap between structural prescription delivery and independent clinical exercise management. Exercise prescription apps may therefore be most appropriately positioned as adjunctive tools within clinician-guided or hybrid care models. Future development should prioritize transparent progression mechanisms, individualized adjustment, and the implementation of clinically relevant behavior change strategies to enhance safety and long-term effectiveness. %R 10.2196/77616 %U https://mhealth.jmir.org/2026/1/e77616 %U https://doi.org/10.2196/77616 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e77898 %T User Testing an mHealth Behavioral Health App for Hopi/Tewa Youth During the COVID-19 Pandemic: Usability Study %A Hagemann,Shelby %A Vigil-Hayes,Morgan %A Amresh,Ashish %A Adams,Marissa %A H Joseph,Darold %A Futterman Collier,Ann %K mobile app %K mHealth %K mobile health %K mental health %K Native American %K American Indian/Alaska Native %K remote user testing %D 2026 %7 24.3.2026 %9 %J JMIR Form Res %G English %X Background: American Indian/Alaska Native (AI/AN) people represent a culturally diverse people group within the United States. AI/AN people experience some of the most severe health disparities in the United States, including behavioral health. A quarter of AI/AN people in the United States live on tribal lands, experiencing significant barriers to mental health resources and broadband infrastructure for telehealth. We developed Amplifying Resilience Over Restricted Internet Access (ARORA)—a mobile health (mHealth) smartphone app, promoting mindfulness practices and community building through AI/AN culture and values. Originally co-designed with both Hopi/Tewa and Navajo youth and adults, this study evaluated app resonance among Hopi/Tewa youth, supporting its iterative design. While we initially planned in-person user testing, this was moved online due to the COVID-19 pandemic. Objective: This study assessed the potential and acceptability of an mHealth app supporting Hopi/Tewa youth practicing mindfulness inspired by their culture, values, and beliefs. This research served as preliminary work for an ongoing, iterative participatory action research study, identifying points of improvement to align with our partner community’s goals. Methods: After meeting with 6 community advisory board members and focus groups prior to this study, we developed a prototype for ARORA. This study evaluated intuitiveness and usability through testing and interviews with Hopi/Tewa youth. All meetings with stakeholders were moved online due to the COVID-19 pandemic. Using screen-sharing via Zoom (Zoom Communications, Inc) and Android emulators, we received feedback for the iterative design process. Results: This study involved 9 participants aged 16-24 years. Of these participants, 1 was male and 8 were female; all identified as Hopi/Tewa and/or Tewa. This study included a quantitative assessment using a modified version of the User Version of the Mobile Application Rating Scale. The mean score across all questions was 3.71 (SD 0.427), suggesting generally positive reception. Qualitative results from thematically analyzing open-ended focus group data produced 5 open codes and 12 axial themes, reaching thematic saturation after engaging with 9 participants. Qualitative feedback revealed that while its use was generally enjoyable, the ARORA app could be more specific to Hopi/Tewa culture. Finally, we reflect on adaptations made to our initial protocol in response to the COVID-19 pandemic, offering guidelines for future mHealth work involving rural or hard-to-reach communities. Conclusions: In this evaluation and usability testing of the ARORA prototype, participants expressed interest and engagement in the mindfulness activities. Participants also identified spaces in which the app could improve, both in usability and in cultural groundedness, especially with the visual dimensions of the app. Reflecting on our experience in facilitating remote user testing, we encourage future work in rural mHealth to consider practices for conducting research when in-person meetings are not feasible. %R 10.2196/77898 %U https://formative.jmir.org/2026/1/e77898 %U https://doi.org/10.2196/77898 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e88768 %T Development of a Culturally Adapted Smartphone App (IndigeQuit) Designed to Help American Indian and Alaska Native People Quit Commercial Cigarettes: User-Centered Mixed Methods Study %A Bricker,Jonathan B %A Santiago-Torres,Margarita %A Sullivan,Brianna M %A Mull,Kristin E %A Clark,Hershel W %A Fogel,Camille A %A Hwang,Soo Bin %A Keith,Alison R %A Kornacki,Chase %A Afraid of Lightning-Craddock,Trivia %A Martinez,Sydney A %A Seneca,Dean S %A Stanford,Crystal M %A Terry,Christeine %A Wilcox,Sierra L %A Nelson,Lonnie %A Henderson,Patricia Nez %+ Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, United States, 1 2066674780, msantiag@fredhutch.org %K American Indian %K Alaska Native %K ceremonial tobacco %K commercial cigarettes %K cultural adaptation %K iCanQuit %K Indigenous %K IndigeQuit %K Native %K smartphone apps %K smoking cessation %K tailoring %K Tribal communities %D 2026 %7 24.3.2026 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to the colonization of tobacco plants by European settlers and the subsequent intensive marketing of commercial tobacco products to American Indian and Alaska Native (AI/AN) communities in the United States, commercial cigarette smoking accounts for half of all deaths among AI/AN people. Limited awareness, access to treatment, and the absence of culturally relevant, effective smoking cessation interventions contribute to these high death rates. Objective: This study aims to culturally adapt iCanQuit, a smartphone smoking cessation app proven efficacious for the general population, for AI/AN people. Methods: A user-centered and community-based participatory research (CBPR) mixed methods approach was applied to culturally adapt iCanQuit for AI/AN people in collaboration with a community advisory board (CAB) of AI/AN individuals using a 3-step process. Step 1 identified ways to culturally adapt the iCanQuit for AI/AN people through 1-on-1 qualitative interviews with 8 prior iCanQuit AI/AN participants. Step 2 involved developing prototypes of cultural refinements identified in step 1 through regular biweekly meetings of the CAB, research, and app development teams. The prototypes were then evaluated with a separate group of 4 prior iCanQuit AI/AN participants through 1-on-1 qualitative interviews. Step 3 involved beta testing the app through a 6-day diary study followed by 1-on-1 qualitative interviews with a nationally recruited group of 7 AI/AN adults who smoke commercial cigarettes. The development work associated with step 3 was further informed by the CAB and the research and app development teams. Results: Key findings identified 5 cultural refinements that informed subsequent app development and testing: (1) stories featuring AI/AN adults and elders emphasizing culture, spirituality, family, and community; (2) honoring the Earth as a motivator for cessation; (3) a guide character representative of AI/AN people; (4) clear distinction between ceremonial and commercial tobacco use; and (5) use of earth tones in visual design. In Step 3, all 7 (100%) diary study participants rated the beta version of the app as excellent or good/meets expectations (5/7, 71%, and 2/7, 29%, respectively) and that it felt made for them. They suggested 6 modifications which were incorporated into the final version of the app: (1) include vaping frequently asked questions, (2) feature motivation icons more prominently, (3) increase notification frequency, (4) track today’s cigarettes rather than yesterday’s, (5) allow users to update how much they spend per pack of cigarettes; and (6) rename the medications tool to reflect the inclusion of AI/AN traditional healing modalities. Conclusions: A user-centered and CBPR development process yielded IndigeQuit—one of the first known apps developed specifically to help AI/AN adults quit commercial cigarette smoking. Trial Registration: ClinicalTrials.gov NCT06145763; https://clinicaltrials.gov/ct2/show/NCT06145763 %M 41875428 %R 10.2196/88768 %U https://formative.jmir.org/2026/1/e88768 %U https://doi.org/10.2196/88768 %U http://www.ncbi.nlm.nih.gov/pubmed/41875428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e83430 %T Help on Demand, a Self-Directed Mobile App Intervention for Gambling Problems: Development and Usability Study %A Brazeau,Brad W %A Cunningham,John A %A Hodgins,David C %K gambling %K addictive behavior %K ecological momentary intervention %K just-in-time adaptive intervention %K mobile app %K telemedicine %K self-help %K self-directed treatment %D 2026 %7 24.3.2026 %9 %J JMIR Form Res %G English %X Background: Compared with other mental health problems, self-directed interventions for gambling problems lack in quantity, accessibility, and in some cases, evidence base. Moreover, engagement with these interventions remains modest. Mobile apps may be a viable format to deliver self-directed interventions that enhance user engagement. Objective: The aims of this study were to develop a self-directed mobile app intervention for gambling problems and to conduct initial feasibility and acceptability testing with a small sample of Canadian adults with past or present gambling problems (n=30). Methods: Participants were invited via email from a list of people who had previously volunteered in similar research in our laboratory. Theory and content of the mobile app intervention were primarily based on a self-directed workbook that has been evaluated in paperback and static web-based formats. The current app prototype included daily gambling diaries, recommended activities based on diary responses, and psychoeducation. It was available for 2 weeks, after which users provided feedback via surveys (n=30) and a virtual focus group (n=8). Quantitative and qualitative feedback, as well as app usage data, were analyzed to provide descriptive statistics and summaries. Results: Regarding feasibility, median completion time for activities ranged from 48 (IQR 35-90) to 137 (IQR 93-328) seconds. Daily diary completion rate was 51%. One-third of activities were accessed via prompt, and two-thirds on demand. Many participants repeated at least 1 activity, and all activities were repeated by at least 1 participant. Results also indicated favorable user reviews, particularly regarding the app’s credibility, ease of use, and potential impact. The feedback on some app features was highly variable, such as the perceived utility of daily diaries. Specific recommendations for improvement were provided, such as the inclusion of information on concurrent substance use and more interactive psychoeducation. Conclusions: Overall, the app met or exceeded heuristic thresholds for feasibility and acceptability testing. These results will inform improvements and subsequent effectiveness testing. The variability in user feedback underscores the demand for further personalization. %R 10.2196/83430 %U https://formative.jmir.org/2026/1/e83430 %U https://doi.org/10.2196/83430 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e85583 %T Mobile Health App Attitudes and Adoption Among Oncology Providers: Cross-Sectional National Survey %A Lau,Nancy %A Srinakarin,Kavin %A Hong,Shannon JH %A Aalfs,Homer %A Roth,Michael E %A Ingram,Karly M %A Berkman,Amy %A Chan,Sherilynn %A Patten,Joanna %A Iwata,Wade %A Taylor,Mallory R %A Fann,Jesse R %A Chow,Eric J %A Palermo,Tonya M %+ Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 206 884 8238, nancy.lau@seattlechildrens.org %K digital health technology %K digital health technologies %K mobile application %K mobile app %K mobile health %K mHealth %K health personnel %K oncology, psycho-oncology %K delivery of health care %K health care delivery %D 2026 %7 23.3.2026 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps can address health inequities and enhance access to care for individuals with immunocompromising conditions. Although hundreds of oncology apps exist, research on provider perspectives regarding their use in clinical care remains limited. Objective: This study aimed to describe oncology providers’ recommended apps, mHealth attitudes and beliefs, and perceived barriers to and facilitators of mHealth adoption. Exploratory aims examined differences based on provider type (medical vs psychosocial), provider age (<45 vs ≥45 years old), and patient population (pediatric vs adult). Methods: We conducted a cross-sectional survey administered via REDCap (Research Electronic Data Capture) to oncology providers across the United States between June and November 2024. Data were summarized using descriptive statistics. Pearson’s chi-square analyses examined exploratory group differences based on provider type, provider age, and patient age. Results: Of 188 respondents, the majority self-identified as female (150/188, 79.8%), White (161/188, 85.6%), and non-Hispanic/Latino (174/188, 92.6%). Nearly all providers (178/188, 94.7%) reported either recommending or using mHealth apps with their patients, with primary use for patient-provider communication (139/188, 73.9%). Providers perceived potential benefit across a broad spectrum of holistic care functions. Providers, on average, reported a growth mindset and confidence in their ability to learn mHealth tools and in its potential to improve care access. Key facilitators included alignment with patient needs, increased accessibility, and cost-effectiveness, while barriers included disparities in technology access, digital health literacy, and data security and privacy. Exploratory analyses showed some significant group differences by provider role, provider age, and patient age. Psychosocial providers were significantly more likely to recommend or use apps for pain management (χ21=14.34, P<.001, φ=0.28), mental health (χ21=50.54, P<.001, φ=0.53), and sleep health (χ21=25.47, P<.001, φ= 0.38). Psychosocial providers also perceived higher benefit for sleep health apps (χ21=6.40, P=.01, φ=0.19). Medical providers were significantly more likely to perceive medication management apps as potentially beneficial (χ21=10.93, P<.001, φ=0.25). Older providers (16/88, 18.2%) and adult care providers (8/32, 25%) were significantly more likely to recommend or use disease management apps compared to younger providers (5/100, 5%; χ21=8.20, P=.004, φ=0.21) and pediatric care providers (6/101, 5.9%; χ22=9.22, P=.01, Cramer V=0.22), respectively. Pediatric care providers (83/101, 82.2%) were more likely to recommend or use medical team communication apps compared to adult care providers (15/32, 46.9%; χ22=15.66, P<.001, Cramer V=0.29). Conclusions: Our study underscores the opportunity to develop inclusive mHealth solutions tailored to the diverse needs of individuals across the cancer care continuum, including those in active treatment and survivorship care. Engaging diverse medical and psychosocial providers is essential to inform clinical integration of mHealth technologies in oncology care. %M 41871339 %R 10.2196/85583 %U https://www.jmir.org/2026/1/e85583 %U https://doi.org/10.2196/85583 %U http://www.ncbi.nlm.nih.gov/pubmed/41871339 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 9 %N %P e71681 %T Development and Usability Testing of the Mobile Childhood Asthma Management Program (mCHAMP) App: Sequential Mixed Methods Study %A Lucero,Robert J %A Shear,Kristen %A Fidler,Andrea %A Fedele,David %A Xia,Yunpeng %A Janicke,David %+ Chicano Studies Research Center, School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, United States, 1 347 304 1238, rlucero@sonnet.ucla.edu %K health promotion %K self-management %K mobile health %K mHealth %K asthma %K obesity %K pediatrics %K usability %K family %K family caregiver %K ambulatory nursing %D 2026 %7 20.3.2026 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: More than 6 million children in the United States have asthma, and more than 20% are clinically obese. Youth with asthma and obesity are susceptible to poor health outcomes, including greater asthma symptom severity and hospitalizations, reduced physical activity, and poorer quality of life. Mobile health technologies can increase access to chronic disease self-management interventions, and family members can be powerful influencers given their substantial control over a child’s behavior and home environment. Objective: The Mobile Childhood Asthma Management Program (mCHAMP) app is based on the in-person Childhood Asthma Management Program (CHAMP) behavioral family intervention pilot trial of school-aged children with asthma and obesity. In this study, we translated the CHAMP content into digital content and conducted summative testing to measure the usability, learnability, and efficiency of the mCHAMP app. Methods: We applied a sequential mixed methods approach. The mCHAMP app targeted adult caregivers of children living with asthma and obesity aged 6 to 12 years. A consumer-centered approach was used to guide the identification of user requirements and conduct of summative usability testing. While the mCHAMP app is primarily caregiver facing, it is intended to connect caregivers with registered nurse (RN) interventionists. Therefore, we sought feedback from RNs as key stakeholders. Results: Caregivers (n=10) were female (n=10, 100%) and mostly African American (n=8, 80%), and half (n=5, 50%) had an annual household income of 0.78; (2) face validity testing with 10 CHWs using a recommended face validity index threshold of ≥0.60; and (3) reliability testing using responses from 30 CHWs, with a Cronbach α coefficient of ≥0.70 indicating acceptable internal consistency. Results: Of the 25 items assessed, 22 (88%) achieved a content validity index score of >0.78 for both clarity and relevance. The face validity index across all 22 items was 0.991, indicating strong comprehensibility and relevance to CHWs. Internal consistency was high: the Cronbach α was 0.86 for the mHealth App Usability Questionnaire items, 0.73 for the Practitioner Opinion (Acceptability) Scale items, and 0.87 for the newly developed questions. The final tool—named the Community Health Worker mHealth Usability and Acceptability Assessment Tool—included 22 items with strong content validity, face validity, and internal reliability. Conclusions: This study presents a rigorously adapted and validated tool for assessing mHealth usability and acceptability among CHWs in Rwanda. The Community Health Worker mHealth Usability and Acceptability Assessment Tool can guide future evaluations of mHealth interventions in similar contexts and serve as a model for localizing mHealth assessment tools in low- and middle-income country settings to ensure fit-for-purpose implementation. %M 41719539 %R 10.2196/64916 %U https://mhealth.jmir.org/2026/1/e64916 %U https://doi.org/10.2196/64916 %U http://www.ncbi.nlm.nih.gov/pubmed/41719539 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e75616 %T Co-Designed Mental Health Screening App (Here for You) for University Students: Pilot Feasibility Mixed Methods Study %A Singh Sethi,Manik Inder %A Manickam,Thirunavukarasu %A Chakraborty,Tanmoy %A Bada Math,Suresh %+ Department of Electrical Engineering, Yardi School of Artificial Intelligence, Indian Institute of Technology Delhi, IIT Delhi Main Road, Delhi, 110016, India, 91 9064247025, tanchak@iitd.ac.in %K mobile health %K mHealth %K co-design %K user engagement %K mental health screening %K university students %K artificial intelligence %K AI %D 2026 %7 20.2.2026 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health disorders are a growing public health concern among university students globally and in India, exacerbated by stigma and limited access to care. Mobile health (mHealth) apps offer a potential solution, but user engagement and cultural relevance remain key challenges. This pilot study evaluated Here for You, a mental health screening app co-designed with Indian university students to provide accessible, nonstigmatizing support. Objective: This mixed methods study aimed to (1) describe the user-centered codevelopment and pilot testing process of the Here for You app; (2) evaluate the app’s feasibility, user acceptability, and engagement; and (3) assess the concurrent validity of the app’s screening tool, the Depression, Anxiety, and Stress Scale-21 (DASS-21) against established clinical measures (Hamilton Depression Rating Scale [HAM-D], Hamilton Anxiety Rating Scale [HAM-A], and Perceived Stress Scale [PSS]). Methods: This study used a 4-phase user-centered design involving students with lived mental health experience, clinicians, and developers. A purposive sample of 30 university students (mean age 21, SD 1.8 years; n=15, 50% female) diagnosed with depression, anxiety, or stress participated. Participants completed the DASS-21 via the app and underwent clinical assessments using the HAM-D, HAM-A, and PSS scales. User experience was evaluated using the User Mobile App Rating Scale and qualitative feedback. Data analysis included Pearson correlation coefficients and thematic analysis. Results: App-based DASS-21 scores showed strong correlations with clinician-administered scales: HAM-D (r=0.819; P<.001), HAM-A (r=0.887; P<.001), and PSS (r=0.972; P<.001), indicating high concurrent validity. However, wide CIs reflected the small sample size typical of pilot studies. The app received high usability ratings on a 5-point scale (User Mobile App Rating Scale mean score 4.4), exceeding published benchmarks for mental health apps in low-resource settings, particularly for functionality (mean 4.7, SD 0.3) and aesthetics (mean 4.5, SD 0.4). Qualitative feedback highlighted usability and enhanced privacy due to features such as quick exit, cultural resonance, and the desire for integrated support features. The co-design process directly addressed student concerns, implementing features such as simplified language and crisis support links. Conclusions: This pilot study provides preliminary evidence for the feasibility and user acceptability of the Here for You app, co-designed using a participatory approach with Indian university students. Strong correlations between app-based screening and clinical assessments (r=0.819, r=0.887, and r=0.972) suggest promising concurrent validity. These findings from a single-site pilot study require validation through multisite studies across diverse educational and cultural contexts before broader implementation recommendations. By integrating user experience, clinical rigor, and ethical safeguards, such as adherence to digital personal data protection guidelines, the app offers a culturally resonant and scalable model for digital mental health screening in low-resource settings. This approach underscores the value of the “nothing about us without us” principle in developing effective mHealth interventions. %M 41719540 %R 10.2196/75616 %U https://formative.jmir.org/2026/1/e75616 %U https://doi.org/10.2196/75616 %U http://www.ncbi.nlm.nih.gov/pubmed/41719540 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e78328 %T The Role of Digital Tools in Meeting the Needs of Adults With Tourette Syndrome: A Human-Centered Design Approach %A Harmon,Sarah M %A Reese,Hannah E %K Tourette syndrome %K tics %K tic disorders %K user experience %K user research %K accessibility %K qualitative analysis %K online %K internet %K apps %K mobile phone %D 2026 %7 19.2.2026 %9 %J JMIR Form Res %G English %X Background: Individuals with tic disorders (TDs) have access to a small but growing number of digital tools (such as apps and websites) for tic management and support. While prior work has shown promise for these tools, they have traditionally been designed by researchers first and evaluated by members of the TD community after tool development is complete. A human-centered design process targeting this domain has the potential to reveal new insights relevant to the development of future tools. We seek to establish a preliminary understanding of how the TD community uses and perceives current resources for tic management and support as well as their overall concerns and needs in this area. Objective: This study aimed to explore the design potential of future digital tools for helping adults manage their tics by gathering an initial set of needs and requirements from adult members of the TD community in the United States. Methods: An online survey was distributed via TD community groups and also via TD clinicians and researchers in the United States. The survey contained a combination of dichotomous, multiple-choice, and open-ended questions, with opportunities for participants to specify how they currently receive support, rank their preferred features and requirements, and express their needs and concerns relevant to future work. Qualitative responses were analyzed with inductive thematic analysis. Results: Most respondents typically sought answers from digital platforms first (124/158, 78.5%) when confronting a question about their tics. Even so, only 18.4% (29/158) reported having previously used a digital tool to help with their tics or any other aspect of their health. Simultaneously, 88.9% (136/153) indicated that they would be very (81/153, 52.9%) or somewhat (55/153, 35.9%) likely to use a digital tool designed for adults with tics. Of those listing concerns (42/158, 26.6%), common reported concerns included the tool being too time-consuming, difficult to use, or generally not meeting accessibility standards. When asked to rank the one feature of a digital tool that they believed to be most important, tic monitoring (66/154, 42.9%) and trigger monitoring (54/154, 35.1%) were among the most popular requested features as opposed to other options, such as information gathering, reminders to practice a therapeutic skill or take medicine, social support, or opportunities to share their story. While screen navigation was most preferred, results indicated that a multimodal design overall would support the most users. Conclusions: Our study participants reported a lack of useful technology for tic management and indicated a need for accessible tools to assist in tic and trigger monitoring in particular. Other concerns included that new tools would be difficult to use or learn due to tics. Findings suggest a cautious excitement for future digital tools in this area. %R 10.2196/78328 %U https://formative.jmir.org/2026/1/e78328 %U https://doi.org/10.2196/78328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e86042 %T Adherence, Acceptability, and Sexual Health Outcomes of the Odeya App–Based Intervention for Sexual Distress in Women With Endometriosis: Randomized Controlled Mixed Methods Trial %A Kronthaler,Selina Marie %A Kosman,Eden %A Tissen-Diabaté,Tatjana %A Mühle,Elena %A Weber- Schallauer,Luzia %A Pross,Therese %A Karsten,Maria Margarete %A Beier,Klaus Michael %A Hatzler,Laura %+ , Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Charité Platz 1, Berlin, 10117, Germany, 49 30 450 617 139, laura.hatzler@charite.de %K app-based intervention %K digital health intervention %K endometriosis %K randomized controlled trial %K sexual distress %K sexual dysfunction %D 2026 %7 19.2.2026 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence-based interventions effectively treat sexual dysfunctions. Up to 13.5% of women with gynecological conditions are affected, yet access to therapy is limited. Self-guided digital interventions may offer scalable, accessible first-line support. Objective: This randomized controlled mixed methods pilot trial evaluated adherence, acceptance, and safety of the Odeya app and changes in sexual and health outcomes among women with sexual dysfunctions and endometriosis. Methods: Following online and flyer-based recruitment, participants completed an online screening and were randomized to either an intervention group (IG) receiving 8 self-guided app modules targeting biopsychosocial aspects of sexuality or to a control group (CG) receiving routine care. Self-administered online questionnaires were completed at baseline (T0), midintervention (T1), postintervention (T2), and 6-month follow-up (T3). Standardized instruments assessed acceptance (Client Satisfaction Questionnaire-Internet [CSQ-I] and German mHealth App Usability Questionnaire [G-MAUQ]), safety (Inventory for the balanced assessment of Negative Effects of Psychotherapy-Online Intervention), sexual health (Female Sexual Distress Scale-Desire/Arousal/Orgasm [FSDS-DAO], Female Sexual Function Index-German version [FSFI-d], and Partnership Questionnaire), and overall health (Patient-Reported Outcome Measurement Information System-29-Item Profile, Beck Depression Inventory-II, and Generalized Anxiety Disorder-7). Adherence indicators included module completion, dropout rates, and symptom tracker use. Group differences were examined descriptively and using Cohen d. Qualitative data were collected through free-list questionnaires from dropouts (n=11) and interviews with completers (IG: n=3; CG: n=2). Results: A total of 60 women (mean age 31.12, SD 6.67 years) with confirmed or suspected endometriosis and sexual distress (FSDS-DAO score >18) were randomized to the IG (n=29) or CG (n=31). IG participants completed on average 61.2% (4.9/8) of modules; the dropout rate was 65.5% (19/29). Emotional strain, time demands, and technical issues were key barriers causing dropout, while persona-based stories facilitated engagement. Participants wished for more professional interaction. IG completers (n=10, 34.5%) showed lower baseline depression and anxiety but higher sexual distress. Satisfaction was high (CSQ-I=26.60; G-MAUQ=5.38). Although some adverse health changes were reported, findings indicate safety. FSDS-DAO scores decreased in both groups, with mean reductions from baseline of −10.39, −12.61, and −14.98 in the IG and −3.68, −14.83, and −6.92 in the CG from T1 to T3, respectively. Moderate to large between-group effects favoring the IG were observed at T1 (d=−0.66) and T3 (d=−0.79). Sexual function (FSFI-d) improved only in the IG (T1-T3: d=0.16-1.00). Qualitative findings highlighted rediscovery of positive sexual experiences, improved communication, and increased openness. Both groups reported improvements in anxiety, depression, and physical functioning, with additional gains in emotion regulation, distress reduction, and body awareness reported in the IG. Women emphasized symptom complexity and a need for more professional guidance. Conclusions: The self-guided intervention was well accepted and showed preliminary improvements among completers. Adherence and sustained engagement seemed shaped by baseline psychosocial health, pointing to a need for tailored adaptations and larger confirmatory trials. Trial Registration: German Clinical Trials Register DRKS00034351; https://drks.de/search/en/trial/DRKS00034351 %M 41712923 %R 10.2196/86042 %U https://www.jmir.org/2026/1/e86042 %U https://doi.org/10.2196/86042 %U http://www.ncbi.nlm.nih.gov/pubmed/41712923 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e82356 %T Exploring Strategies for a Digital Tool to Support Medication Adherence Among Adolescents and Young Adults Undergoing Hematopoietic Stem Cell Transplant and Their Care Partners: Qualitative Formative Study %A Raab,Gavin %A Bowen,Zoe %A Shea,Skyla %A Shani,Guy %A Rozwadowski,Michelle %A Murphy,Susan Allbritton %A Nahum-Shani,Inbal Billie %A Xu,Ziping %A Psihogios,Alexandra %A Choi,Sung Won %+ Department of Pediatrics, University of Michigan, Michigan Medicine, 1500 E. Medical Center Dr., D4115 Medical Professional Building, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K adherence %K adolescent %K family caregiver %K family relations %K hematopoietic stem cell transplant %K medication %K mHealth %K mobile health %K young adult %D 2026 %7 17.2.2026 %9 Original Paper %J JMIR Form Res %G English %X Background: Allogeneic hematopoietic stem cell transplant (HCT) is a complex but essential treatment for malignant and nonmalignant conditions, requiring strict posttransplant adherence to immunosuppressant medications to prevent complications such as graft-versus-host disease. Adolescents and young adults undergoing HCT face unique challenges, including balancing growing independence with ongoing reliance on care partners, often parents. Medication adherence in this group is often suboptimal, and few interventions address adolescent and young adult–care partner dyads. To address this gap, we aim to develop a mobile health (mHealth) app that engages both the patients and care partner to improve adherence. Objective: As formative research for early-stage intervention development, this study aimed to (1) explore current HCT medication adherence strategies and challenges; (2) understand attitudes toward digital technology, including dyadic perspectives on app use to support adherence; and (3) assess adolescent and young adult–care partner relationships, including views on care partner involvement. This process was intended to inform the design of a relevant, user-centered mHealth app. Methods: Eligible participants included adolescents and young adult patients aged 12-39 years and primary care partners, such as parents, involved in medication management. Participants were recruited from a large academic medical center through direct outreach and electronic health records. Data collection involved 2 focus groups (6 dyads and 2 additional adolescents and young adults), 4 individual interviews (2 patients and 2 care partners), and 6 dyadic interviews. Semistructured sessions (in person or virtual) gathered feedback on medication adherence practices and app design preferences. All sessions were audio recorded with consent and professionally transcribed. Qualitative data were analyzed systematically: transcripts were deidentified, coded using both inductive and deductive strategies, and themes were refined through team consensus. Patterns were organized into major themes, and representative quotations were selected to illustrate findings. Data management was facilitated by NVivo (version 13; Lumivero) software. Results: We included 28 participants (15 adolescents and young adults and 13 care partners). The median age of adolescents and young adults was 18 (range 13-39) years and 53% (8/15) were female. Adolescents and young adults were 47% (7/15) White, 40% (6/15) Black, and 13% (2/15) mixed race. Care partners’ median age was 48 (range 36-72) years, with 92% (12/13) female and 77% (10/13) White. Three principal themes emerged: (1) existing reminders and organizational tools are often insufficient for consistent adherence; (2) adherence barriers are multifaceted, often involving autonomy vs care partner support; and (3) both adolescents and young adults and care partners showed strong interest in a dyadic digital health intervention to foster collaboration and support shared adherence goals. Conclusions: This formative study highlights the complex dynamics of medication adherence in adolescent and young adult–care partner dyads and supports the need for a dyadic mHealth app to enhance adherence, collaboration, and relationship quality. %M 41701968 %R 10.2196/82356 %U https://formative.jmir.org/2026/1/e82356 %U https://doi.org/10.2196/82356 %U http://www.ncbi.nlm.nih.gov/pubmed/41701968 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 14 %N %P e71412 %T Reluctance to Use a Psycho-Oncology Mobile App Among Patients With Primary Breast Cancer: Retrospective Cross-Sectional Survey %A Pawełczak-Szastok,Marta %A Syska-Bielak,Anna %A Krzywon,Aleksandra %A Jarząb,Michał %K eHealth %K eHealth barriers %K breast cancer %K psychoemotional functioning %K psycho-oncology %K refusal to participate %K mobile app %K clinical trial %D 2026 %7 13.2.2026 %9 %J JMIR Mhealth Uhealth %G English %X Background: eHealth is an increasingly used method of health care in the field of psycho-oncology. While many reports highlight the positive impact of psychological eHealth tools, some patients refuse to use them. Objective: This study aimed to expand knowledge of the motivation and psychoemotional functioning of patients who consciously refuse to use eHealth technology in the form of a mobile psycho-oncology app offered as part of a clinical trial. To our knowledge, this is the first study to address this topic. Methods: A retrospective cross-sectional study was conducted between December 2022 and February 2023 to investigate the reasons why 56 patients with breast cancer refused to use the psycho-oncology mobile app offered as part of a clinical trial by the Breast Cancer Unit. The primary aim of the study was to analyze patients’ self-reported reasons for not engaging with the app, while also exploring their psychoemotional functioning, including stress levels (measured using the distress thermometer), personality traits (measured using the Ten-Item Personality Inventory), coping strategies (measured using the Coping Orientation to Problems Experienced Questionnaire), and Self-efficacy (measured using the General Self-Efficacy Scale). Participants in this study declined the app intervention but agreed to participate in this separate observational study, indicating that their refusal was related to the app itself rather than to participation in clinical research in general. Results: The patients experienced a clinically meaningful elevation in stress levels (mean 5, SD 2.1 points) and Self-efficacy (mean 32.1, SD 5.1 points). Among 5 dimensions of personality traits, patients scored highest in Agreeableness (mean 6.5, SD 0.8 stens) and Conscientiousness (mean 6.4, SD 0.9) and lowest in Neuroticism (mean 3.4, SD 1.8) (other dimensions: Extraversion [mean 5.8, SD 1.6 stens] and Openness to Experiences [mean 4.4, SD 1.5 stens]). In terms of coping with stress, patients most frequently used the strategies of Active Coping (mean 2.6, SD 0.5 points), Acceptance (mean 2.6, SD 0.6 points), and Seeking Emotional Support (mean 2.6, SD 0.6 points), and least frequently used the strategies of Psychoactive Substance Use (mean 0.2, SD 0.6 points) and Restraint (mean 0.5, SD 0.7 points). Patient responses regarding refusal to participate in app testing were divided into four categories: (1) Focus on Life Outside the Disease, (2) Focus on Disease and Treatment, (3) Denial Mechanism, and (4) Technical Issues. Statistically significant differences were found between the groups. The Focus on Life Outside the Disease group of patients had higher levels of Self-efficacy, lower Neuroticism, and more frequent use of the Positive reevaluation strategy compared to the other groups. Conclusions: Our patients’ decision not to use the eHealth psycho-oncology app was mainly influenced by characteristics suggesting better emotional coping with the disease and treatment. These factors were significantly more influential than other factors studied, particularly those related to technology. Assessing reasons for opting out of eHealth and associated psychomotional functioning may be important for improving patients’ adoption of eHealth solutions. %R 10.2196/71412 %U https://mhealth.jmir.org/2026/1/e71412 %U https://doi.org/10.2196/71412 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 15 %N %P e88401 %T Usability and Cultural Relevance of an mHealth App for Hispanic/Latino Individuals Living With Rheumatoid Arthritis: Protocol for a Mixed Methods Study %A Alves,Thais F %A Horner,Ronnie %A Montas,Marie Chantel %A Cozad,Melanie %K digital health intervention %K mobile health %K arthritis, rheumatoid %K Hispanic or Latino %K cultural relevance %K usability %D 2026 %7 13.2.2026 %9 %J JMIR Res Protoc %G English %X Background: Hispanic and Latino individuals represent 14.6% of rheumatoid arthritis (RA) cases in the United States and experience significant disparities in access to rheumatologic care, disease management, and health outcomes. Mobile health (mHealth) apps are promising tools to improve patient-provider communication and self-management among populations with language and literacy barriers. However, few RA-focused digital health interventions (DHIs) have been culturally adapted for Spanish-speaking Hispanic and Latino individuals. Objective: This study aims to assess the health literacy, eHealth literacy, technology trust, and digital self-efficacy of Hispanic and Latino individuals with RA, and to evaluate the cultural relevance, usability, and patient satisfaction of the Spanish-language RunRA app. Additionally, it will explore health care providers’ perceptions of the app’s usefulness for clinical decision-making and communication with Hispanic and Latino patients. Methods: A prospective, iterative convergent mixed methods design integrated with the Framework for Reporting Adaptations and Modifications–Expanded (FRAME) will be used. We will recruit 25 Hispanic and Latino patients with RA and 7 Spanish-speaking health care professionals. Quantitative data will include standardized questionnaires (SAHL-S, eHEALS, Human-Computer Trust Scale, Digital Self-Efficacy Scale) and app analytics. Qualitative data will be collected via interviews and focus groups using the Cultural Relevance Questionnaire (CRQ), System Usability Scale (SUS), and Mobile Application Rating Scale (uMARS). Data will be analyzed using an independent intramethod strategy, with integration guided by FRAME to inform culturally relevant app modifications. Results: We anticipate enrolling 32 participants (25 patients and 7 providers). This study will be the first to evaluate the cultural relevance and usability of an mHealth app specifically designed for Spanish-speaking Hispanic and Latino individuals living with RA. Conclusions: Our long-term goal is to assess the potential for the mHealth app to act as a vehicle for the dissemination of accurate, useful, usable, and understandable health information to populations that experience health disparities and their health care providers. Findings will inform iterative refinements to RunRA and contribute to the development of culturally responsive DHIs aimed at improving communication, shared decision-making, and health outcomes in underserved populations. International Registered Report Identifier (IRRID): PRR1-10.2196/88401 %R 10.2196/88401 %U https://www.researchprotocols.org/2026/1/e88401 %U https://doi.org/10.2196/88401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 15 %N %P e83276 %T Evaluating an AI-Enabled Mobile Mental Health Monitoring Tool Among Family Caregivers of Adults Living With Cancer: Single-Arm Feasibility and Acceptability Trial Protocol %A Acquati,Chiara %A Aratow,Michael %A Nazreen,Tahmida %A Bhattacharjee,Arunima %A Marra,Isabella K %A Alexander,Ashley S %+ , Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX, 77004, United States, 1 713 743 4343, cacquati@central.uh.edu %K cancer %K caregiving %K psychological distress %K speech-based monitoring %K artificial intelligence (AI) %K feasibility & acceptability study %K mobile health (mHealth) %K acoustic analysis %K semantic analysis %K depression %K anxiety %D 2026 %7 12.2.2026 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychological distress, particularly symptoms of depression and anxiety (D&A), is highly prevalent among family caregivers of individuals living with cancer, who often assume central roles in care coordination, treatment adherence, symptom monitoring, and emotional support. Rates of distress among caregivers frequently equal or exceed those observed in patients themselves. Despite increased attention to caregivers’ mental health needs, routine distress screening remains limited in oncology care settings. Advances in mobile health technology and artificial intelligence (AI) offer opportunities to address these needs by providing accessible and user-driven tools. The Ellipsis Caregiver Assessment Enhancement (eCARE; Ellipsis Health, Inc) is a speech-based, AI-enabled mobile app designed to screen and monitor symptoms of depression and anxiety. By collecting brief voice recordings and in-app survey data, eCARE offers a scalable approach for integrating caregiver distress monitoring into cancer care. Objective: This single-arm trial will evaluate the feasibility and acceptability of the eCARE app among family members who are the primary caregivers of patients diagnosed with cancer within the past 5 years. Specifically, the study aims to (1) determine feasibility based on platform completion rates, (2) assess acceptability using validated measures, and (3) identify barriers and facilitators influencing the uptake and sustained use of eCARE. Methods: In Phase 1, a total of 60 United States–based family caregivers will be recruited from community health clinics, cancer and caregiving advocacy groups, and online postings. Screened and enrolled caregivers will complete 6 eCARE sessions over an 8-week period. Pre- and posttest surveys assess depression, anxiety, caregiving burden, and relational processes. Feasibility will be evaluated based on the proportion of participants who complete at least 66% of weekly assessments, and acceptability will be assessed using the acceptability of intervention measure (AIM). In Phase 2, a total of 20 caregivers will be invited to participate in semi-structured online interviews to explore user experience, including perceived benefits, barriers to use, and preferences for future implementation. Qualitative data will be analyzed thematically to inform tool refinement. Results: The study has received Institutional Review Board approval from the University of Houston. Participant recruitment and enrollment began in June 2024, with data collection expected to conclude by August 2025. Data analysis will begin in December 2025, with preliminary results anticipated by May 2026. Conclusions: This study will generate preliminary evidence on the feasibility, acceptability, and utility of a speech-based, AI-enabled smartphone tool for monitoring D&A symptoms among family cancer caregivers. Findings will inform the design of a larger, fully powered trial and guide future implementation of remote psychological distress monitoring strategies in oncology care. By offering a low-burden, caregiver-centered approach, eCARE has the potential to expand access to psychosocial support and facilitate timely identification of needs and coordination of services across cancer care settings. International Registered Report Identifier (IRRID): DERR1-10.2196/83276 %M 41678797 %R 10.2196/83276 %U https://www.researchprotocols.org/2026/1/e83276 %U https://doi.org/10.2196/83276 %U http://www.ncbi.nlm.nih.gov/pubmed/41678797 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 14 %N %P e83984 %T Designing mHealth Apps for Substance Use Recovery Through Real-World Co-Design and Deployment: Mixed Methods Study %A Masrani,Teale %A Hodgins,David C %A Kim,Hyoun S %A Rittenbach,Katherine %A Johnson,Erika %A Messier,Geoffrey %+ Department of Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 5110, gmessier@ucalgary.ca %K co-design %K digital health %K mHealth %K smartphone application %K substance use disorder %D 2026 %7 11.2.2026 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have shown promise to support recovery from substance use disorders. However, evidence on engagement and efficacy is still inconclusive. Objective: This study aims to identify design considerations for optimizing engagement in mHealth apps for those recovering from problematic substance use, by analyzing real-world experiences with co-designed app features. Methods: We co-designed, deployed, and evaluated an mHealth app. Initial co-design interviews with 14 individuals in recovery led to 3 new features integrated into an existing mHealth app. The app was deployed for a 6-week trial with 53 participants using it during their daily routines without researcher supervision. Usage patterns were analyzed throughout the trial period, and follow-up interviews with 12 app users foregrounded subjective usage experiences and considerations for future design. Results: We developed 3 new features following co-design interviews: a goal-setting feature, a craving tracker, and a meetings log. Usage metrics revealed mixed engagement, with 45.3% (24/53) of users actively engaging with the app throughout the trial. These active users opened the app 27.1 unique times on average, with a retention rate after 30 days among active users of 45.8% (11/24), exceeding the typical mobile app retention benchmark of 7% after 30 days. Interviews revealed that participants preferred app functionality to extend beyond substance use domains to support other dimensions of their lives not directly pertaining to substance use, such as general goals and daily routines. Participants further suggested that recovery apps should act as private digital journals while also providing a sense of community and connection to broader recovery ecosystems. Additionally, mHealth designs that allow users to configure their own personalized recovery pathways in the app can benefit some users who appreciate increased autonomy, while others may become overwhelmed by a lack of prescriptive guidance. Conclusions: It is valuable to incorporate iterative co-design methodologies into digital health and recovery app research to help optimize engagement. Furthermore, recovery apps can benefit from flexible designs with customizable degrees of user autonomy. Future designers can better cater to individual user preferences by personalizing mHealth designs so that they strike a balance between system control and user control over digital recovery pathways. %M 41672473 %R 10.2196/83984 %U https://mhealth.jmir.org/2026/1/e83984 %U https://doi.org/10.2196/83984 %U http://www.ncbi.nlm.nih.gov/pubmed/41672473 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e83075 %T User Profiles and Engagement in a Hypertension Self-Management App: Cross-Sectional Survey %A Muehlensiepen,Felix %A May,Susann %A Seifert,Frances %A Wengemuth,Eileen %A Johannsen,Olen %A Middeke,Martin %A Heinze,Martin %A Petit,Pascal %A Vuillerme,Nicolas %A Spethmann,Sebastian %A Bruch,Dunja %K digital health %K mHealth %K digital divide %K hypertension %K cardiology %K chronic disease %K questionnaire %K health services research %K user perspectives %K equity %K digital public health %K mobile health %D 2026 %7 11.2.2026 %9 %J J Med Internet Res %G English %X Background: Mobile health (mHealth) technologies can improve hypertension self-management, yet real-world adoption remains limited and unequally distributed. Objective: This study aimed to characterize the profiles, usage patterns, and engagement of active users of a hypertension self-management app (Hypertension.APP) in Germany, with a focus on user engagement and potential digital divides. Methods: We conducted a cross-sectional online survey among adult users of Hypertension.APP in Germany between January and September 2023. An 88-item questionnaire assessed app usage patterns, perceived utility, integration into clinical care, sociodemographic and clinical data, and digital health literacy (eHealth Literacy Scale; scores 16‐40). Digital health literacy was categorized as low (16‐23.99), moderate (24‐31.99), or high (32-40). Descriptive statistics and univariable ordinal logistic regression were used to explore associations between sociodemographic and clinical variables and app usage frequency. Results: Of 254 respondents, the mean age was 53.6 years, and 54.3% (138/254) were male. A total of 44.5% (113/254) had a university or technical college degree, and 44.5% (113/254) reported a monthly net income higher than €2500 (US $2950). Most participants (224/254, 88.2%) reported access to at least two digital devices. Overall, 88.2% (224/254) had moderate or high digital health literacy (eHealth Literacy Scale ≥24). App engagement was high: 80.7% (205/254) reported using the app at least weekly, and 52.4% (133/254) reported using the app to prepare for medical visits. However, only 20.1% (51/254) reported that the app was formally integrated into their medical care, and 11.8% (30/254) indicated that medication had been adjusted based on app data. In univariable ordinal logistic regression analyses, higher education, longer duration of hypertension, and living in a small town (5000‐20,000 inhabitants) were associated with more frequent app use, whereas systolic blood pressure of 140 mm Hg or higher was associated with less frequent use. Digital health literacy was not clearly associated with app usage frequency among current users. Conclusions: Users of this hypertension self-management app were predominantly well-educated, digitally literate individuals with established hypertension, reinforcing concerns about a persistent digital divide. While app usability and engagement were high, formal clinical integration remained limited. Simply making an app available is insufficient; strategies to promote equitable access, strengthen clinical integration, and support patients with lower digital health literacy are needed for mHealth to contribute effectively to hypertension management. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/en/trial/DRKS00029761/details %R 10.2196/83075 %U https://www.jmir.org/2026/1/e83075 %U https://doi.org/10.2196/83075 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e83065 %T Acceptance of Men Living With HIV Toward Treatment-Supportive Mobile Apps Using the Unified Theory of Acceptance and Use of Technology: Cross-Sectional Study %A Kempen,Fabian %A Chandrakumar,Ranujan %A Esser,Stefan %A Jahre,Lisa Maria %A Teufel,Martin %A Bäuerle,Alexander %K HIV %K eHealth %K mobile health %K mHealth %K mobile app %K people living with HIV %K telemedicine %K Unified Theory of Acceptance and Use of Technology %K UTAUT %D 2026 %7 10.2.2026 %9 %J JMIR Form Res %G English %X Background: Despite a 40-year prevalence of HIV, the AIDS epidemic prevails. Effective AIDS treatment requires specialist care and high adherence often hindered by structural issues in care access. Innovative eHealth solutions like treatment-supportive mobile apps can help address these issues. Successful implementation depends on user acceptance. Acceptance can be operationalized as behavioral intention and measured through the Unified Theory of Acceptance and Use of Technology (UTAUT). Objective: This study examines the acceptance and its influencing factors of treatment-supportive mobile apps among men living with HIV. Methods: A cross-sectional study was conducted among 172 men living with HIV between September 2021 and April 2024. In addition to the collection of sociodemographic, medical, and eHealth-related data, acceptance and its influencing factors were assessed by applying the UTAUT model. A multiple hierarchical regression analysis was conducted. Results: High acceptance of treatment-supportive mobile apps in men living with HIV was reported by 45.3% (n=78) of the participants. Significant predictors of acceptance were age (β=−0.27; P<.001); health literacy regarding disease (β=0.11; P<.001); eHealth literacy (β=0.10; P=.001); internet anxiety (β=−0.18; P=.04); and the UTAUT predictors: effort expectancy (β=0.38; P<.001), performance expectancy (β=0.24; P<.001), and social influence (β=0.40; P<.001). The UTAUT model explained 72% of the variance in acceptance. Conclusions: Since the acceptance of eHealth services is a reliable indicator of the actual usage behavior, the results of this study are a promising basis for the successful implementation of eHealth offerings in the group of men living with HIV. %R 10.2196/83065 %U https://formative.jmir.org/2026/1/e83065 %U https://doi.org/10.2196/83065 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 14 %N %P e64860 %T Exploring Self-Management–Based Mobile Health User Typologies and Associations Between User Types and Satisfaction With Key Mobile Health Functions: Comparative Study of Various Fitness and Weight Management App User Types %A Wang,Tong %A Fan,Yiwen %A Li,Zheng %A Jiao,Xiaoyi %A Fang,Qichuan %A Ma,Junhao %A Lei,Jianbo %+ Institute of Advanced Clinical Medicine, Center for Medical Informatics, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China, 86 8280 5901, jblei@hsc.pku.edu.cn %K mHealth app %K user satisfaction %K self-management characteristics %K user profile %K unsupervised learning %D 2026 %7 10.2.2026 %9 Original Paper %J JMIR Med Inform %G English %X Background: Exploring user satisfaction is crucial for enhancing and ensuring the sustainable development of mobile health (mHealth) apps, particularly in the fitness and weight management sectors. Analyzing user types and developing user profiles are valuable for understanding differences in satisfaction. However, prior research lacks a classification of user types based on self-management characteristics and an analysis of satisfaction disparities among these types. Objective: This study analyzes user heterogeneity from a self-management perspective among fitness and weight management app users by identifying user types and constructing profiles. It further explores differences in satisfaction with the functional design of these mHealth apps across user types. Methods: First, 8 feature indicators were selected based on the Health Belief Model and the Behavior Change Wheel to evaluate users’ levels of health knowledge and beliefs, as well as self-regulation related to self-management. Existing research was integrated to categorize mHealth app functional design into 5 categories: health guidance, health education, health monitoring, social features, and gamification. Second, a questionnaire survey was used to collect data on users’ 8 health management characteristics and their satisfaction with the 5 functional design categories. A total of 2518 responses were collected, of which 1025 were included in the analysis. Cluster analysis was conducted to classify users into distinct types based on the 8 health management characteristics, and user profiles were constructed according to the distribution of these characteristics within each type. Finally, the Kruskal-Wallis test was used to analyze differences in satisfaction across user types with respect to the 5 functional design categories of mHealth apps. Results: Cluster analysis revealed that users could be categorized into 6 types based on the 8 self-management characteristics: positively proactive energizers, proactive intenders, negatively proactive energizers, low health management demanders, potential health management demanders, and passive attitude holders. Significant differences were observed across all 8 health management characteristics among the 6 user types (all P<.001). The Kruskal-Wallis test indicated significant variations in user satisfaction with the 5 functional designs of mHealth apps: H(4)=445.388, (P<.001). Overall, users reported the highest satisfaction with health guidance and health monitoring (median 4.00, IQR 1.00) and the lowest satisfaction with gamification (median 3.00, IQR 1.00). Positively proactive energizers, proactive intenders, and negatively proactive energizers demonstrated the highest satisfaction with health education and health guidance (median 4.00). Potential health management demanders, proactive intenders, positively proactive energizers, and negatively proactive energizers reported the highest satisfaction with health monitoring (median 4.00). Proactive intenders reported the highest satisfaction with social features and gamification (median 4.00). Conclusions: Users of mHealth apps exhibit diverse types, with significant differences in health management characteristics and satisfaction with the 5 functional designs of fitness and weight management apps. This study clarifies individual-level differences in user satisfaction with mHealth apps. %M 41666365 %R 10.2196/64860 %U https://medinform.jmir.org/2026/1/e64860 %U https://doi.org/10.2196/64860 %U http://www.ncbi.nlm.nih.gov/pubmed/41666365 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 14 %N %P e63340 %T Features of Mobile Health Apps for Tobacco Cessation That Appeal to Black Adults Who Use Tobacco Products: Focus Group Study %A Clark,Sonia A %A Philips,Remi %A Kistler,Christine E %A Goldstein,Adam O %A Enyioha,Chineme %K mHealth %K tobacco cessation %K preferred features %K mobile health app %K representation %K inclusivity %K African American %K Black adult tobacco users %K mobile health %D 2026 %7 6.2.2026 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions show promise in supporting tobacco cessation. However, Black adults who use tobacco products are not well represented in mHealth studies for tobacco cessation, and their preferred features of mHealth apps are not well known. Identifying types of mHealth app features for tobacco cessation preferred by Black adults is critical to developing a culturally adapted app, with increased uptake by the target population. Objective: The goal of this study was to explore culturally relevant preferences for features of smoking cessation mHealth apps among Black adults who use tobacco products. Methods: A comprehensive list of features of mHealth apps for tobacco cessation was developed based on previous research and a review of existing mHealth literature. Through a content analysis, this list was divided into subgroups and used to develop a focus group guide. We recruited participants from Instagram, a social media platform. Eligible focus group participants included people who reported current use of a tobacco product, identified as being African American or Black, were 21 years old or older, and had access to Wi-Fi or the internet. Participants had to indicate interest in the use of an mHealth app for tobacco cessation. Participants discussed their opinions about different app features, including what features they felt would increase the use of an app by Black adults. Recordings from the focus groups were transcribed and coded deductively and inductively. We conducted a thematic content analysis of the resulting transcripts. Results: Forty adults aged 21‐69 (mean 43, SD 13.6) years participated in 8 focus groups. Fifty-seven percent were female, and 88% endorsed current cigarette use. Four central themes that represented app features emerged. (1) Participants wanted representation and inclusivity through personalization and featuring people with similar lived experiences, including representative images and relevant health information. (2) Participants desired the app to feature a diversity of experiences such as testimonials from individuals from different backgrounds rather than solely focusing on racial identity or excessive targeting of the Black community. (3) Participants desired accountability through trusted connections with health care professionals and other support groups within the app, as well as app tracking capability. (4) Encouragement and motivation were more salient incentives than monetary rewards. Conclusions: Black adults who use tobacco products prefer a tobacco cessation app with features that are inclusive, relatable, supportive, and motivating. These findings can serve as the groundwork for the development of an mHealth app that will appeal to Black adults, potentially leading to increased app use, successful cessation, and health equity. %R 10.2196/63340 %U https://mhealth.jmir.org/2026/1/e63340 %U https://doi.org/10.2196/63340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e73435 %T The Feasibility of Smartwatch Micro–Ecological Momentary Assessment for Tracking Eating Patterns of Malaysian Children and Adolescents in the South-East Asian Community Observatory Child Health Update 2020: Cross-Sectional Study %A Lane,Richard %A Millard,Louise A C %A Salway,Ruth %A Stone,Chris J %A Skinner,Andy L %A Brady,Sophia M %A Mariapun,Jeevitha %A Rajakumar,Sutha %A Ramadas,Amutha %A Rizal,Hussein %A Johnson,Laura %A Su,Tin Tin %A Armstrong,Miranda Elaine Glynis %+ Jean Golding Institute, University of Bristol, Beacon House, Queen's Road, Bristol, BS8 1QU, United Kingdom, 44 117 928 9000, mh19137@bristol.ac.uk %K eating behavior %K ecological momentary assessment %K EMA %K Malaysia %K LMIC %K children %K adolescents %K micro-interaction EMA %K μEMA %K smartwatch %D 2026 %7 6.2.2026 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone ecological momentary assessment (EMA) methods are a well-established measure of eating and drinking behaviors, but compliance can be poor. Micro-EMA (μEMA), which collects information with a single tap response to brief questions on smartwatches, offers a novel application that may improve response rates. To our knowledge, there is no data evaluating μEMA to measure eating habits in children or in low-to-middle-income countries. Objective: In this study, we investigated the feasibility of micro-EMA to measure eating patterns in Malaysian children and adolescents. Methods: We invited 100 children and adolescents aged 7-18 years in Segamat, Malaysia, to participate in 2021-2022. Smartwatches were distributed to 83 children and adolescents who agreed to participate. Participants were asked to wear the smartwatch for 8 days and respond to 12 prompts per day, hourly, from 9AM to 8PM, asking for information on their meals, snacks, and drinks consumed. A questionnaire captured their experiences using the smartwatch and μEMA interface. Response rate (proportion of prompts responded to) assessed participants’ adherence. We explored associations between response rate with time of day, across days, age, and sex using multilevel binomial logistic regression modeling. Results: Eighty-two participants provided usable smartwatch data. The median number (IQR) of meals, drinks, and snacks per day was 2 (2-4), 3 (1-5), and 1 (0-2), respectively, on the first day of the study. The median response rate across the study was 68% (IQR 50-83). The response rate decreased across study days from 74% (68-78) on Day 1 to 40% (30-50) on Day 7 (odds ratio [OR] per study day 0.73, 95% CI 0.64-0.83). Response rate was lowest at the start of the day and highest between the hours of 12 PM and 2 PM. Female participants responded to more prompts than male participants (OR 1.72, 95% CI 1.03-2.86). There was no evidence of differential response by age (OR 0.73, 95% CI 0.41-1.28). Most participants (65%) rated their experience using the smartwatch positively, with 33% saying they were happy to participate in future studies using the smartwatch. For children that did not wear the smartwatch for the full study duration (n=22), discomfort was the most common complaint (41%). Conclusions: In this study of the feasibility of μEMA on smartwatches to measure eating in Malaysian children, we found the method was acceptable. However, response rates declined across study days, resulting in substantial missingness. Future studies (eg, through focus groups) should explore approaches to improving response to event prompts, trial alternative devices to increase children’s comfort, and evaluate revised protocols for reporting of intake events. %M 41649858 %R 10.2196/73435 %U https://www.jmir.org/2026/1/e73435 %U https://doi.org/10.2196/73435 %U http://www.ncbi.nlm.nih.gov/pubmed/41649858 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 14 %N %P e76862 %T Quality and Multifunctionality in Mobile Apps for Gestational Diabetes: Systematic App Review %A Zhao,Qimeng %A Cooke,Alison %A Huang,Lishan %A Tang,Yimin %A Dowding,Dawn %K diabetes, gestational %K pregnant woman %K smartphone %K mobile health %K mHealth %K app %K behaviour change %K mobile phone %D 2026 %7 5.2.2026 %9 %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile health (mHealth) apps can assist with the management of gestational diabetes (GDM). Although a number of studies have demonstrated their efficacy in improving maternal-fetal outcomes, opinions differ regarding their usability and overall quality. Poorly designed apps, with ill-conceived features or inappropriate content, may pose a threat to patient safety. Nevertheless, very few studies provide in-depth evaluations of app design quality, and the diversity of features and techniques used remains insufficiently explored. Objective: We aimed to evaluate the quality and multifunctionality of commercially available mHealth apps for GDM. Methods: This is a systematic app review guided by the TECH (target user, evaluation focus, connectedness, and health domain) framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist. Searches were conducted on the Apple App Store and Google Play. Apps were screened by name, description, and full navigation to identify inclusions. The quality of the apps was evaluated using the Mobile App Rating Scale and IMS Institute for Healthcare Informatics Functionality Score. Multifunctionality of the apps was evaluated using the GDM-adapted features and techniques list developed from the App Behavior Change Scale, NICE (National Institute for Health and Care Excellence) 2015 guidelines, and previous studies. The general features list, which contains instruction, data security, customization, and technical issues, was derived from previous studies. Results: The search (June 2024) identified 23 commercially available apps from UK app stores. The overall app quality was evaluated to be satisfactory (Mobile App Rating Scale: mean 4.0, SD 0.36; IMS Institute for Healthcare Informatics Functionality Score: mean 5.83, SD 3.03). The multifunctionality evaluation found that the apps had a mean of 17.95 and SD of 7.31 across all 45 items. Overall, our findings suggested that mHealth apps for GDM achieved a certain level of multifunctionality. However, their feature types and supporting digital techniques are relatively basic. The apps focused on education and managing blood glucose control rather than integrating other self-monitoring data and pregnancy-relevant management into their design. The digital techniques used to achieve these features included text and manual operation, rather than other automated features. Conclusions: This is the first app review to consider the relationship between app features and usability for women with GDM. Future app development should integrate a wide range of pregnancy-relevant information and more automated features and use advanced digital techniques to enable a holistic digital solution for women with GDM. %R 10.2196/76862 %U https://mhealth.jmir.org/2026/1/e76862 %U https://doi.org/10.2196/76862 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e82485 %T A Peer-Led, Narrative-Based, and Mobile-Supported Intervention in Opioid Use Disorder: Multiphase Qualitative and Longitudinal Observational Study %A Latimer,Maria C %A Gregg,Lydia %A Saheed,Mustapha %A Tobin,Karin E %A Kelly,Sharon M %A Agee,Tracy %A Steele,R Joshua %A Frankiewicz,Nicholas %A Verinumbe,Tarfa %A Latkin,Carl %A Falade-Nwulia,Oluwaseun %K opioid epidemic %K opioid use disorder %K substance use %K mobile health intervention %K mHealth %K mobile app %K graphic narrative %K graphic novel %K comics %K animation %K mobile health %D 2026 %7 5.2.2026 %9 %J JMIR Form Res %G English %X Background: The ongoing opioid epidemic has been associated with increases in emergency department visits and hospitalizations for drug overdose and injection-related infections. These encounters with the health care system provide an opportunity to offer drug treatment linkage and support for people with opioid use disorder (OUD). There is a need for interventions that enhance linkage to and engagement in treatment with medication for opioid use disorder (MOUD) for people with OUD identified in hospital settings as they transition back to community settings. Objective: The mTools4life (Johns Hopkins University) study aimed to develop and evaluate a peer-led intervention integrating narrative-based health communication into a mobile health (mHealth) app to increase posthospitalization engagement in MOUD and reduce substance use. Methods: The formative phase of the study consisted of semistructured interviews with people with OUD and clinicians who provide care to people with OUD. Interviews sought to identify salient content to include in visual narratives within the mHealth app and information that may increase motivations for behavior change related to MOUD engagement. The intervention was developed in accordance with the information-motivation-behavioral skills model, transportation theory, and the transtheoretical model. The pilot phase of mTools4Life (Johns Hopkins University) aimed to evaluate the acceptability and usability of the intervention. People with OUD were recruited from the Johns Hopkins Hospital Emergency Department and consented to receive the intervention for a 3-month period. Participants completed a study survey at baseline and a 3-month follow-up. Data on demographics, past 30-day substance use, MOUD, and intervention appropriateness and acceptability were obtained at both time points. Additional data on intervention uptake and frequency of use were collected at follow-up. Dependent samples 2-tailed t tests were conducted on continuous data, and Fisher exact tests were conducted on count data. Results: Twenty people with OUD piloted the intervention. The sample was mostly male (13/20, 65%) and non-Hispanic White (13/20, 65%) with a mean age of 41.1 (SD 8.7) years. Most participants (16/20, 80%) completed the 3-month follow-up. Fewer participants reported opioid use at follow-up (9/16, 56.3%) compared to baseline (20/20, 100%; P=.001, and mean days of opioid use out of the past 30 days declined from baseline (19.9, SD 11.7) to follow-up (8.3, SD 11.4; P=.002). MOUD treatment in the prior 3 months was reported by 65% (13/20) of participants at baseline and 81.3% (13/16) at follow-up (P=.46). Most participants used the app (11/16, 68.8%) or engaged with their peer navigator (10/16, 62.5%) during the intervention period. At follow-up, mean acceptability and appropriateness scores (scale 0‐5; higher score indicating greater acceptability or appropriateness) were 4.5 (SD 0.5) and 4.3 (SD 0.8), respectively. Conclusions: This study demonstrates the feasibility of the development and deployment of a narrative-based mHealth intervention to support OUD care engagement and preliminary data in support of the intervention’s acceptability, appropriateness, and effectiveness %R 10.2196/82485 %U https://formative.jmir.org/2026/1/e82485 %U https://doi.org/10.2196/82485 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e74375 %T Digital Health Tools Embedded in a Cancer Genetics Clinic: Observational Study %A Nagaraj,Sujay %A Rabinowicz,Ron %A Goodday,Sarah %A Brunga,Ledia %A Korenblum,Chana %A Villani,Anita %A Kim,Raymond %A Karlin,Emma %A Greer,Robert William %A Balaci,Hadrian %A Omran,Meis %A Goldenberg,Anna %A Malkin,David %A Friend,Stephen %+ Department of Computer Science, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada, 1 416 978 2011, s.nagaraj@mail.utoronto.ca %K digital health %K cancer %K wearables %K pediatrics %K engagement %D 2026 %7 2.2.2026 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital Health Tools (DHTs), including wearables and mobile apps, offer promising avenues for personalized care and real-time monitoring, but user engagement and clinical utility—especially in pediatric populations—remain unclear. Li-Fraumeni syndrome (LFS) is a genetic mutation in the TP53 tumor suppressor gene, predisposing individuals to cancer, requiring lifelong surveillance and associated psychological stress. Objective: We evaluated engagement with DHTs in a cancer genetics clinic for families affected by LFS and explored their utility for patients and clinicians. Our goal was to identify insights that could inform future integration of DHTs in chronic disease populations and contribute to research. Methods: We conducted an observational study (January-December 2022) involving patients with LFS and family members aged 5 years and older. Participants received an Empatica EmbracePlus smartwatch and a suite of self-report surveys assessing psychosocial well-being at varying frequencies (ie, daily, weekly, etc). We used survival analysis to characterize engagement over time across age, TP53 status, and previous cancer history. Generalized additive models were used to explore physiological patterns relative to cancer surveillance events. Semistructured interviews provided qualitative insight into user experiences and preferences. Results: We enrolled 9 children and 36 adults. Adults wore their smartwatches more often than children (mean 81%, SD 19% vs mean 56%, SD 26%; t10.1=2.72; P=.02) and were engaged in the study for a longer duration (median retention 153, IQR 119-179; 95% CI 133-177 vs median 77, IQR 36-151; 95% CI 17-171 days; log-rank χ21=4.4; P=.04). Daily wear time was similar between the 2 groups (mean 17.6, SD 3.1 hours vs mean 15.7, SD 2.9 hours; t13.2=1.70; P=.11). There were no differences in survey engagement between adults and children, nor were there differences in engagement across TP53 status or previous cancer history. Children reported greater psychosocial burden, with more depressive symptoms (PHQ-9 [Patient Health Questionnaire-9] score mean 10.0, SD 5.2 vs mean 4.2, SD 4.4; t7.8=2.8; P=.03), worse sleep (PROMIS SRI [patient-reported outcomes measurement information system sleep-related impairment] score mean 22.7, SD 5.9 vs mean 16.5, SD 5.5; t8.1=−2.58; P=.03), and increased frequency of stress (mean 36.3%, SD 19.9% vs mean 14.3%, SD 19.2%; t8.3=−2.7; P=.03) than adults. A suicide alert system was triggered in 5 participants (11%) and prompted timely clinical intervention. Generalized additive model analysis showed individualized yet consistent physiological patterns of stress associated with cancer surveillance. Qualitative feedback from participants identified perceived value in stress awareness, but highlighted challenges with device comfort, functionality, and personalization. Conclusions: DHTs are feasible and can capture clinically meaningful psychological and physiological data in high-risk pediatric and family populations with LFS. They enable timely detection of distress and facilitate targeted interventions. Our findings can inform best practices for patient-centered DHT integration into clinical care, with relevance to pediatric oncology and broader digital health contexts. %M 41627862 %R 10.2196/74375 %U https://formative.jmir.org/2026/1/e74375 %U https://doi.org/10.2196/74375 %U http://www.ncbi.nlm.nih.gov/pubmed/41627862 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e78717 %T Feasibility and User Experience of an AI-Supported mHealth Intervention for Remote Life Goal Setting Based on Flow Theory: Exploratory Within-Participant Study %A Yoshida,Ippei %+ Department of Occupational Therapy, Faculty of Health Sciences, Wakayama Professional University of Rehabilitation, 3-1 Minatohonmachi, Wakayama, Wakayama, 640-8222, Japan, 81 73 435 4888, ippe.i.yoshi@gmail.com %K mobile health %K mHealth %K artificial intelligence %K AI %K self-management %K motivation %K occupational therapy %K telemedicine %K health behavior %D 2026 %7 27.1.2026 %9 Original Paper %J JMIR Form Res %G English %X Background: Life goal setting contributes substantially to well-being and quality of life, particularly among middle-aged and older adults. However, delivering remote goal-setting support remains challenging due to limited professional resources and accessibility barriers. Recent advancements in mobile health (mHealth) technologies, telemedicine, and generative artificial intelligence (AI) present new opportunities for scalable, personalized health behavior interventions. Nevertheless, few studies have compared AI-driven life goal interventions with conventional human-facilitated approaches in real-world settings. Objective: This study aimed to evaluate the feasibility and user experience of an AI-supported mHealth intervention for remote life goal setting based on flow theory. We compared the AI-supported approach to occupational therapist (OT)–facilitated support and explored the differential characteristics of AI-guided and human-guided interventions for self-management and motivation enhancement. Methods: An exploratory, within-participant, 2-condition comparison with a counterbalanced order was conducted among 28 community-dwelling adults (aged between 20 and 76 years) who were smartphone users. Each participant selected 2 personal life goals and completed remote adjusting the challenge-skill balance (R-ACS) sessions, a structured telemedicine process based on flow theory. One goal was supported by an OT, while the other was facilitated by a generative AI chatbot integrated into an mHealth platform. Following each session, participants completed a 4-item rubric-based questionnaire (5-point Likert scale), assessing the quantity and quality of questions, appropriateness of suggestions, and perceived contribution to goal attainment. Free-text feedback was also collected. Quantitative data were analyzed using Wilcoxon signed-rank tests with effect size calculations and Benjamini-Hochberg correction for multiple comparisons. Qualitative differences were explored using text mining (term frequency–inverse document frequency analysis) and sentiment evaluation. Results: Both AI-supported and OT-facilitated R-ACS sessions were feasible and successfully delivered tailored suggestions for all participants. AI-supported sessions received higher scores on all rubric items than OT-facilitated sessions, with a statistically significant difference in suggestion appropriateness (z score=3.13; P=.002; r=0.418; false discovery rate–adjusted P=.008). Term frequency–inverse document frequency analysis of free-text comments revealed that AI-supported sessions emphasized actionability, motivation, and immediacy, while OT-facilitated sessions highlighted reflection, self-understanding, and emotional safety. Participants expressed high acceptance of both intervention types, with AI-supported interactions perceived as particularly accessible and conducive to health behavior change. Conclusions: AI-supported mHealth interventions for remote life goal setting based on flow theory are feasible, well accepted, and offer potential advantages in immediacy, motivation enhancement, and action-oriented support. OT-facilitated support provides complementary strengths by fostering reflection and psychological safety. A hybrid R-ACS model that integrates both AI and human expertise may optimize personalized, scalable self-management support for life goal setting. Future randomized controlled trials are warranted to further investigate the long-term impact of AI-driven mHealth interventions on health behavior, well-being, and quality of life. %M 41592315 %R 10.2196/78717 %U https://formative.jmir.org/2026/1/e78717 %U https://doi.org/10.2196/78717 %U http://www.ncbi.nlm.nih.gov/pubmed/41592315 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 13 %N %P e82668 %T Perspectives of Frontline Clinicians and End-Line Users on Smartphone-Based Photography for Assessing Traumatic Dental Injuries: Focus Group Interview Study and Thematic Analysis %A Schultz,Emily C %A Huang,Boyen %A Shenouda,Margaret %A Estai,Mohamed %A Ranjitkar,Sarbin %A Louie,Jeffrey P %A Pungchanchaikul,Patimaporn %+ Department of Primary Dental Care, University of Minnesota School of Dentistry, 515 Delaware Street SE, Minneapolis, MN, 55455, United States, 1 612 624 7848, huan2321@umn.edu %K acceptability %K dental trauma %K feasibility %K image quality %K mHealth %K teledentistry %K telediagnosis %K usability %K user perception %D 2026 %7 26.1.2026 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) is increasingly used in teledentistry for telediagnosis and other services; yet, the perceptions of frontline clinicians and end-line users regarding these technologies remain unexplored. Objective: This study examined the acceptability, feasibility, and usability of an mHealth model for telediagnosis from the perspectives of frontline clinicians and end-line users. Methods: A qualitative study using focus group interviews was conducted with 15 participants, including frontline clinicians and end-line users. Frontline clinicians captured dental images via a smartphone app, while end-line users assessed them through an mHealth platform. Interview transcriptions were thematically analyzed using consensus coding. Results: Thematic analysis identified 9 key themes: feasibility and perceived ease of use, perceived usefulness, compatibility, self-image and social influences, self-efficacy, voluntariness and behavior intention, anxiety, facilitating conditions, and attitudes toward a behavior. Participants considered smartphone-based photography acceptable and feasible for remote dental assessment. Facilitators and barriers to implementing the mHealth model were highlighted, and recommendations for improvements were proposed. Conclusions: Cyclical education and professional development are essential to enhancing user confidence and technology usability. Addressing patient and clinician resistance through targeted education, improved communication, and operational upgrades such as camera grids, system integration, and simplified login can support adoption. This study highlights mHealth’s potential in emergency dental assessment and screening, particularly for underserved populations, and underscores opportunities for interprofessional collaboration. Future research should explore broader clinical applications across oral health conditions. %M 41587769 %R 10.2196/82668 %U https://humanfactors.jmir.org/2026/1/e82668 %U https://doi.org/10.2196/82668 %U http://www.ncbi.nlm.nih.gov/pubmed/41587769 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e77510 %T Feasibility, Acceptability, and Perspectives Regarding the Use of Activity Tracking Wearable Devices Among Home Health Aides: Mixed Methods Study %A Solano-Kamaiko,Ian René %A Dicpinigaitis,Michael %A Tan,Melissa %A Yang,Irene %A Cheng,Kexin %A Peramsetty,Ronica %A Shum,Michelle %A Escamilla,Yanira %A Bayly,Jennifer %A Turchioe,Meghan Reading %A Avgar,Ariel %A Vashistha,Aditya %A Dell,Nicola %A Sterling,Madeline R %+ Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, NY, United States, 1 646 962 5029, mrs9012@med.cornell.edu %K home health aides and attendants %K home health care %K home care %K worker well-being %K frontline work %K low-wage work %K data governance %K data advocacy %K wearable activity trackers %K passive sensing %D 2026 %7 26.1.2026 %9 Original Paper %J J Med Internet Res %G English %X Background: Home health aides and attendants (HHAs) provide in-home care to the growing population of older adults who want to age in place. Despite their vital role in patient care, HHAs are an underserved and vulnerable population of health care professionals who often experience poor health themselves. Activity tracking devices offer a promising way to improve HHAs’ health-related awareness and promote health behavior change, particularly regarding physical activity and sleep quality, 2 areas in which the workforce struggles. Objective: This study aimed to understand how feasible it is for HHAs to use activity tracking devices and assess their perceptions of such devices for improving their health. Specifically, we conducted (1) a field study to assess the use, feasibility, and acceptability of these devices among HHAs and (2) a qualitative study to understand HHAs’ perspectives on and reactions to activity trackers on and off the job. Methods: We partnered with the 1199 Service Employees International Union Training and Employment Fund to conduct a field study with home care agency–employed HHAs working in New York City, New York. Participants wore activity tracking devices for 4 weeks that collected data on physical activity and sleep. The HHAs were subsequently interviewed on their experiences with and attitudes toward the devices and asked to reflect on personalized visualizations of their data to prompt them to think aloud. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using grounded theory. Results: A total of 17 HHAs participated; their mean age was 48.7 (SD 12.2) years, 15 (88%) were women, 11 (65%) identified as Black, 5 (29%) identified as Hispanic or Latinx, and they had worked as HHAs for a mean of 11.7 (SD 7.5) years. In total, 94% (n=16) of the HHAs wore their activity trackers for the full 28-day study period. Participants took a mean of 10,230 (SD 3586) daily steps during the study period and slept for a mean of 6.27 (SD 0.58) hours per night. Overall, 4 key themes emerged: (1) activity tracking devices enhanced participants’ health awareness by providing empirical data for self-reflection; (2) this increased awareness led to positive behavior changes, including setting and achieving health-related goals; (3) HHAs believed that these devices could improve not only their own health but also that of their patients through positive behavior changes; and (4) despite this optimism, participants emphasized that their ability to modify sleep and activity patterns was constrained by social and occupational determinants, with sleep improvements being particularly challenging. Conclusions: Our findings suggest that appropriately designed personal tracking interventions could offer a promising approach to supporting positive health-related changes in this historically overlooked workforce, potentially improving their well-being and the quality of care they provide to their patients. %M 41587444 %R 10.2196/77510 %U https://www.jmir.org/2026/1/e77510 %U https://doi.org/10.2196/77510 %U http://www.ncbi.nlm.nih.gov/pubmed/41587444 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e83995 %T Designing Electronic Problem-Solving Training for Individuals With Traumatic Brain Injury: Mixed Methods, Community-Based, Participatory Research Case Study %A Schmidt,Matthew %A Weng,Yueqi %A Juengst,Shannon %A Holland,Alexandra %K traumatic brain injury %K community-based participatory research %K user-centered design %K usability %K mHealth %K rehabilitation %K problem-solving training %D 2026 %7 20.1.2026 %9 %J J Med Internet Res %G English %X Background: Traditional rehabilitation research often excludes the voices of individuals with lived experience of traumatic brain injury (TBI), resulting in interventions that lack relevance, accessibility, and effectiveness. Community-based participatory research (CBPR) offers an alternative framework that emphasizes collaboration, power sharing, and sustained engagement with patients, caregivers, and clinicians. Objective: This study aimed to apply CBPR to guide front-end design (empathy interviews, empathy mapping, personas) and to evaluate the sociotechnical-pedagogical usability of the Electronic Problem-Solving Training (ePST) mobile health (mHealth) intervention with TBI partners. Methods: A multistep, mixed methods design case methodology was adopted, guided by CBPR principles and learning experience design. Participatory mechanisms included a 33-member Community Advisory Board and 10 Community Engagement Studios that engaged TBI survivors, caregivers, clinicians, and researchers throughout the Discover, Define, Develop, and Deliver phases of the Double Diamond model. Iterative activities included empathy interviews (n=14), persona development (n=10), rapid prototyping, and usability testing with 5 participants with TBI using think-aloud protocols and the Comprehensive Assessment of Usability for Learning Technologies instrument. Results: The co-design process successfully translated community feedback into an empathy-informed, user-centered prototype and systematically identified design considerations that single-partner approaches overlook. TBI-specific design requirements emerged, including the need for linear content progression over branching navigation, higher technical performance standards, and explicit content signaling with clarity prioritized over novel interface design. Think-aloud protocols revealed that participants struggled with mobile navigation and branching structures but excelled with sequential content progression. In addition, the input from individuals with TBI, caregivers, clinicians, and researchers led to practical refinements such as shorter microlearning lessons (5‐12 min), clearer voiceover tone, and simplified navigation, directly addressing the study’s objective of improving accessibility and emotional resonance. Overall usability was high, measured using the Comprehensive Assessment of Usability for Learning Technologies (CAUSLT), with an average score of 4.25 out of 5 (SD 0.72; 95% CI 3.36‐5.15; n=5). Knowledge accuracy was 80% (8/10 items; 95% CI 49%‐94%; n=5 participants; 2 items each), indicating that the system effectively supported learning and comprehension. Module completion was 100% (5/5; 95% CI 56.6%‐100%). Average time-on-task for 10 lesson completions was 11.47 (SD 5.28; range 4.6‐21.42) minutes per lesson, demonstrating strong task efficiency and engagement. Highest ratings were observed in the pedagogical usability domain, reflecting that the interface was clear, intuitive, and conducive to learning. Collectively, these findings suggest that applying CBPR across all design stages produced a technically sound, easy-to-use, and pedagogically meaningful mHealth tool specifically tailored for individuals with TBI. Conclusions: Sustained CBPR across full design and development cycles resulted in high usability for ePST for individuals with TBI. Ultimately, this study operationalized a full-cycle pipeline that links sustained community partnership to measured usability outcomes, producing community-informed design principles and a reproducible mixed methods approach for formative mHealth development for TBI. %R 10.2196/83995 %U https://www.jmir.org/2026/1/e83995 %U https://doi.org/10.2196/83995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e79510 %T Preferences for an Experience Sampling Method–Based Tool as an Adjunct to Usual Treatment in Patients With Problem Substance Use: Qualitative Study %A Kurilla,Adam %A Čavojská,Natália %A Ikegwuonu,Theresa %A Nemčíková,Marta %A Schulte-Strathaus,Julia CC %A Uyttebroek,Lotte %A Beames,Joanne R %A Breznoščáková,Dagmar %A Dančík,Daniel %A Hajdúk,Michal %A Heretik,Anton %A Izáková,Ľubomíra %A Katreniaková,Zuzana %A Myin-Germeys,Inez %A Pečeňák,Ján %A Reininghaus,Ulrich %A Schick,Anita %A Wolters,Maria %+ Department of Psychology, Faculty of Arts, Comenius University Bratislava, Gondova 2, Bratislava, 81102, Slovakia, 1 911201241, adam.kurilla@uniba.sk %K mHealth %K Experience Sampling Method %K Ecological Momentary Assessment %K digital mental health %K user preferences %K substance use %K qualitative research %D 2026 %7 15.1.2026 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health tools that use the Experience Sampling Method (ESM) appear to be a promising tool to streamline and improve the treatment of substance use disorders. However, patient involvement in the development of these tools is uncommon, and research on the preferences of people being treated for substance use disorders has been scarce. In the scope of the European Union IMMERSE (Implementing Mobile Mental health Recording Strategy for Europe) consortium, an ESM-based tool for Digital Mobile Mental Health (DMMH) was first codeveloped and later tested in 4 European countries. Objective: This study aimed to achieve an understanding of preferences for features of DMMH among mental health service users with problem substance use. Methods: In 4 European countries, service users were recruited for a semistructured qualitative interview, which started with the presentation of a prototype of the DMMH. Data analysis was performed through directed qualitative content analysis. Results: The analytical sample consisted of 12 (5 female, 6 male, and 1 nonbinary person) participants with problem substance use aged 18-50 years. There were 4 participants from Slovakia, 3 from Belgium, 4 from Germany, and 1 from Scotland. Patient preferences were classified into 7 categories: notifications, questions, user interface, functionality changes, visualizations, sharing data with clinicians, and sharing data with others. The proposed intensive notification schedule was deemed acceptable by service users as long as the questionnaire is short. Participants expressed a preference for open-text response options, Ecological Momentary Interventions, and options for individual customization of several elements of the tool. Data visualization was considered an important aid for communication with clinicians, with whom all participants wanted to share data obtained with DMMH. The possibility of sharing data with other people depended on the quality of the relationship with them. Conclusions: In the development of ESM-based mobile health tools for people with problem substance use, their preferences for content, functionality, and appearance of the tools should be considered so they match patients’ treatment needs. %M 41538792 %R 10.2196/79510 %U https://formative.jmir.org/2026/1/e79510 %U https://doi.org/10.2196/79510 %U http://www.ncbi.nlm.nih.gov/pubmed/41538792 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 12 %N %P e58823 %T New Technologies and Digital Health Tools in Patients With Solid Tumors and Hematological Malignancies: Cross-Sectional Multicenter Survey Study %A Lopez-Garcia,Alberto %A Diaz-Aizpun,Carola %A Gallego-Diaz,Beatriz %A Miranda-Castillo,Carolina %A Yuste-Platero,Maria %A Beltran-Alvarez,Pilar %A Carames-Sanchez,Cristina %A Garcia-Foncillas,Jesus %A Llamas-Sillero,Pilar %A del Olmo-Rodriguez,Marta %A Short-Apellaniz,Jorge %A Pfang,Bernadette %A Arcos-Campillo,Javier %A Cordoba,Raul %K eHealth %K oncohematology %K telemedicine %K survey %K digital health tools %K tumor %K hematological malignancies %K barrier %K cancer %K cancer care %K cross-sectional study %K cancer diagnosis %D 2026 %7 13.1.2026 %9 %J JMIR Cancer %G English %X Background: Barriers to eHealth use include lack of technological infrastructure, resistance to change, and inequities in access. However, patterns of access to and use of eHealth tools in people being treated for cancer have not been fully described in the literature. Objective: Our aim was to describe the patterns of access to and use of eHealth tools among outpatients receiving treatment for hematological malignancies and solid tumors. Methods: We conducted a cross-sectional multicenter study using a survey offered to patients aged over 18 years receiving outpatient treatment for hematological malignancies or solid tumors at 4 teaching hospitals in Madrid, Spain, between February 1, 2021, and November 30, 2021. The survey instrument featured questions about patients’ demographic and social characteristics, cancer diagnosis, use of information and communication technology (ICT), use and opinions of the Patient Portal, and changes in ICT use during the COVID-19 pandemic. To study the relationship between the different variables, 2-tailed Student t tests or ANOVA were used for variables with normal distribution, and the Mann-Whitney or Kruskal-Wallis tests were used for variables with nonnormal distribution. Statistical analyses were performed using SPSS (version 25; IBM Corp) for Windows. Results: In total, 200 patients were included in our study. Median age was 60 (range 21‐87) years. A total of 130 (65%) patients presented with hematological malignancies. Most (n=181, 90.5%) patients considered that eHealth tools might help to improve communication with the medical team during their treatment. Retired participants (28.6% vs 71.4%; P<.001), those older than 60 years (26% vs 74%; P<.001), and those without higher education (2.6% vs 97.4%; P<.001) showed significantly lower rates of internet use, with no observed sex-related differences. A total of 177 (88.5%) patients found the Patient Portal useful, and 140 (70%) reported increased use of ICT due to the COVID-19 pandemic. Conclusions: Most (177/200, 88.5%) patients viewed eHealth tools as useful and believed that it was helpful to improve communication with their care team. However, notable gaps in the use of eHealth were observed in certain groups of patients, with significant differences in use due to age, education, and employment status. Strategies to identify subgroups at risk for unequal access to digital health, as well as to facilitate access and use, are warranted. %R 10.2196/58823 %U https://cancer.jmir.org/2026/1/e58823 %U https://doi.org/10.2196/58823 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 10 %N %P e65067 %T Translation and Validation of the User Version of the Mobile Application Rating Scale Into the Polish Language: Cross-Sectional Methodological Study %A Glinkowski,Wojciech Michał %A Cedro,Tomasz %A Nowicka,Joanna %A Doniec,Rafał %A Michalak,Bartłomiej %A Glinkowska,Bożena %A Stoyanov,Stoyan %+ Center of Excellence TeleOrto for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Litewska 14/16, Warsaw, 00-581, Poland, 48 22 116 92 44, w.glinkowski@gmail.com %K translation %K validation %K Polish language %K mobile health %K mHealth %K User Version of the Mobile Application Rating Scale %K uMARS %D 2026 %7 12.1.2026 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) apps can innovatively diagnose, prevent, and treat many diseases. The increasing use of mHealth apps necessitates an appropriate assessment standard. Objective: This study aimed to translate the User Version of the Mobile Application Rating Scale (uMARS) into Polish, followed by validation, cultural adaptation, and examination of its reliability and validity. Methods: The Polish version of uMARS was adapted, translated, and validated based on the free STOP COVID ProteGO Safe app available for Android and iOS platforms. A total of 117 participants rated the app using the translated scale and rerated it 1 week later Results: The conceptual equivalence of all items and subscales of the original uMARS and its Polish version was confirmed. The translated uMARS scale exhibited high reliability (Cronbach α=0.95). The perceived test-retest reliability and total influence score were acceptable, with intraclass correlation coefficient values of 0.59 and 0.65, respectively Conclusions: The translated scale matched the reliability of the original scale. It can help users choose the best mHealth apps available in Poland and report their quality. The Polish version of uMARS was cross-culturally validated and was found to be as reliable as the original uMARS. The translated and validated uMARS tool can be used to evaluate mHealth apps in various aspects. App developers can reliably assess app components and determine areas that require further improvement and development to deliver higher-quality apps. The Polish version of the uMARS can become a standard tool for evaluating the quality of mHealth apps in Poland. %M 41525684 %R 10.2196/65067 %U https://formative.jmir.org/2026/1/e65067 %U https://doi.org/10.2196/65067 %U http://www.ncbi.nlm.nih.gov/pubmed/41525684 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 9 %N %P e79457 %T Experiences of Ageism in mHealth App Usage Among Older Adults: Interview Study Among Older Adults Based on Extended Unified Theory of Acceptance and Use of Technology and Risks of Ageism Models %A Sun,Jiayi %A Liu,Yawen %A Zhang,Chengrui %A Xing,Ying %A Zhou,Wanqiong %A Luan,Wei %K mHealth apps %K ageism %K technology use %K older adults %K healthy aging %D 2026 %7 7.1.2026 %9 %J JMIR Aging %G English %X Background: As the global aging population accelerates, mobile health (mHealth) apps have emerged as critical tools in the health management of older people. However, the promotion of mHealth apps has faced multiple obstacles, including insufficient technological adaptation to aging, digital resistance, and ageism. The impact of ageism on technology usage experiences among older adults is influenced by mechanisms such as stereotypes and biases. Notably, extant research has not adequately explored the subjective experiences of older adults in the context of mHealth app usage scenarios. Objectives: The present study was predicated on the extended unified theory of acceptance and use of technology model and the risks of ageism model to systematically explore and understand older adults’ ageism experiences in mHealth app usage. Our objectives were to provide a reference for optimizing age-friendly design and enhancing digital health management capabilities for older adults. Methods: This qualitative study utilized an interpretive phenomenological design and was conducted between February and April 2025. Purposive sampling was employed to select older adults with experience using mHealth apps in a Shanghai community for semistructured interviews. This study used Colaizzi’s phenomenological method to analyze and summarize older adults’ experiences and perceptions of ageism and to extract themes. Results: The study identified 3 core themes: (1) internalized age stereotypes, which manifest as technological uselessness and learning barriers; (2) anxiety and avoidance behaviors caused by stereotype threat; and (3) external unfair treatment (such as age-friendly design flaws and inadequate support systems), which inhibits usage. These experiences significantly impact older adults’ intention to use mHealth apps. Conclusions: Ageism profoundly affects the engagement of older adults with mHealth apps. It is advisable to execute systematic interventions to improve digital inclusion and health self-management capabilities, including strategies to challenge age stereotypes, optimize intergenerational support, refine age-friendly design, and establish strong social support networks. %R 10.2196/79457 %U https://aging.jmir.org/2026/1/e79457 %U https://doi.org/10.2196/79457 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e79942 %T MyPainPal, a Novel mHealth App to Improve Pain in Patients With Advanced Cancer: Single-Arm Pilot Study %A Azizoddin,Desiree R %A Hassett,Michael %A Anderson,Kris-Ann S %A Kessler,Daniela %A Wright,Alexi %A Gorra,Madeline %A Kematick,Benjamin %A Chua,Isaac %A Brandoff,Douglas %A Lally,Kate %A Nabati,Lida %A MacIsaac,Susan %A Tulsky,James A %A Enzinger,Andrea %+ Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02215, United States, 1 (617) 582 7335, andrea_enzinger@dfci.harvard.edu %K cancer %K mHealth %K mobile health %K pain management %K opioids %K constipation %K symptom management %D 2025 %7 30.12.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: Pain is common among patients with advanced cancer and is often inadequately controlled. Opioids are central to treatment; yet, self-management is challenging, and clinicians lack scalable tools to monitor and support patients between visits. Objective: This study aimed to evaluate the feasibility and acceptability of MyPainPal (Dana-Faber Cancer Institute), a novel mobile health app designed to optimize cancer pain management. MyPainPal combines daily surveys assessing symptoms and analgesic use, algorithmic self-management support, tailored psychoeducation, and clinician monitoring. Secondary objectives were to explore preliminary clinical impact and identify priorities for refinement. Methods: This single-arm pilot study enrolled adults with advanced malignancies using opioids for moderate-to-severe pain from an outpatient palliative care clinic at a comprehensive cancer center. Participants used MyPainPal for 28 days while nurses monitored symptom responses via a secure portal, and also completed structured surveys at end-of-study. Primary assessment of usability and acceptability included the System Usability Scale (SUS; range 0-100), the Acceptability E-Scale (range 6-30), and ratings of satisfaction using a 5-point Likert scale. Semistructured debriefing interviews explored user experience, perceived impact, and suggestions for optimization. Results: Twenty participants with advanced cancer enrolled, with a mean age of 57 (SD 12.3) years, 55% (11/20) female, 80% (16/20) non-Hispanic White, with mixed cancer types. Over the 28-day study, patients logged into MyPainPal a median of 14 (IQR 8-17) times, and completed a median of 8 (IQR 5-14) symptom surveys, reflecting mean of 36% (SD 20%) of eligible (out-of-hospital) days on study. Usability and acceptability ratings of MyPainPal were high (mean SUS 78.3, SD 16.2; mean Acceptability E-Scale 24.0, SD 4.4); 79% rated overall satisfaction of greater than or equal to 4/5. Twenty percent of surveys generated an alert, prompting nurse outreach. In response, 5 participants had symptom medications changed and 2 had medication errors corrected. In debriefing interviews, many participants described that the intervention reduced barriers to pain reporting and facilitated timely and constructive interactions with care teams for symptom management. Several noted that the intervention validated their pain experience, reduced stigma around opioid use, enabled constructive conversations with providers, and promoted self-management. Patients recommended several survey modifications, including reducing their frequency and enabling more nuanced pain assessments. Participants underused the educational resources and suggested that they be featured more prominently. Some patients suggested that the MyPainPal app should be introduced earlier in patients’ cancer pain trajectory when pain needs are higher and opioid management is novel. Conclusions: In this pilot study, MyPainPal demonstrated feasibility, acceptability, and preliminary evidence of potential clinical impact among patients with advanced cancer receiving palliative care. The app has been rebuilt and optimized with attention to patient feedback and in preparation for a future efficacy study. Trial Registration: ClinicalTrials.gov NCT03717402; https://clinicaltrials.gov/study/NCT03717402 %M 41468579 %R 10.2196/79942 %U https://cancer.jmir.org/2025/1/e79942 %U https://doi.org/10.2196/79942 %U http://www.ncbi.nlm.nih.gov/pubmed/41468579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e84393 %T Acceptability and Use of Digital Health and Artificial Intelligence–Enabled Chatbots for Sexual and Reproductive Health Among Lesbian, Bisexual, and Queer Women of Color in the United States: Cross-Sectional Survey Study %A Threats,Megan %A Gray,Morgan %K digital health %K artificial intelligence %K ethnic and racial minorities %K health equity %K sexual health %K reproductive health %K sexual and gender minorities %K mHealth %K women %K cervical cancer %D 2025 %7 29.12.2025 %9 %J J Med Internet Res %G English %X Background: Cisgender lesbian, bisexual, and queer (LBQ+) women of color experience barriers to accessing sexual and reproductive health (SRH) services in the United States. Barriers, including limited provider access and poor patient-provider communication, contribute to SRH service underutilization and poorer outcomes among these women than their heterosexual counterparts. Digital health modalities, including telemedicine, mobile health, and chatbots enabled by artificial intelligence (AI), offer potential to expand access to SRH information and services among these women. Objective: This study investigated the influencing factors, acceptability, and concerns regarding the use of digital health modalities (video calls, SMS text messaging, and mobile apps) and AI-enabled chatbots to support SRH information and service access among LBQ+ women of color in the United States. It also assessed their awareness and knowledge of human papillomavirus (HPV) and cervical cancer prevention, and attitudes toward HIV prevention medication. Methods: A self-administered online survey was conducted from November 2020 to March 2021 with 285 LBQ+ women of color (aged ≥18 years) residing in the United States. The 88-item survey assessed digital health use, SRH knowledge and awareness, and acceptability of and concerns about digital health use for SRH information and services. Data were analyzed using descriptive statistics, Fisher exact tests, multivariable logistic regression, and thematic analysis. Results: Most respondents (233/285, 81.8%) were comfortable using video calls to communicate with health care providers for SRH support. Respondents with a bachelor’s degree or higher (95% CI 0.00‐0.24), with health insurance (95% CI 56.1‐1025.7), and without a usual place of care (95% CI 0.07‐0.43) were significantly (P<.001) more likely to agree with using video calls. Respondents with a bachelor’s degree or higher (95% CI 0.23‐0.74), aged <45 years (95% CI 0.07‐0.25), and with health insurance (95% CI 3.23‐12.45) were significantly (P<.001) more likely to agree with using mobile apps. Respondents aged ≥45 years (95% CI 0.14‐0.53), without health insurance (95% CI 0.01‐0.06), and with an income of 3 months compared to 5.19 among new users (≤1 wk use of Paired), a trend supported by the longitudinal data. Of those who had used Paired for >1 month, 64.3% (330/513) agreed that their relationship felt stronger since using the app (95% CI 60.2%-68.4%), with no or minimal demographic differences. Regarding the app’s mechanisms of action, interview accounts demonstrated how it prompted and habituated meaningful communication between partners, both within and outside the app. Couples made regular times in their day to discuss the topics Paired raised. Daily questions were sometimes lighthearted and sometimes concerned topics that couples might find challenging to discuss (eg, money management). Interviewees valued the combination of fun and seriousness. It was easier to discuss challenging topics when they were raised by the “neutral” app, rather than during stressful circumstances or when broached by 1 partner. Engagement seemed to be enhanced by users’ experience of relationship benefits and by the app’s design. Conclusions: This study demonstrates proof of concept, showing that Paired may have the potential to improve relationship quality over a relatively short time frame. Positive relationship practices became embedded within couples’ daily routines, suggesting that relationship quality improvements might be sustained. Digital interventions can play an important role in the relationship care ecosystem. The mixed methods design enabled triangulation and integration, strengthening our findings. However, app users were self-selecting, and methodological choices impact our findings’ generalizability. %R 10.2196/55433 %U https://mhealth.jmir.org/2025/1/e55433 %U https://doi.org/10.2196/55433 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64350 %T Designing eHealth Interventions for Pediatric Emergency Departments: Protocol for a Usability Testing Study With Youth, Parent, and Clinician Participants %A Somerville,Mari %A Wozney,Lori %A Gallant,Allyson %A Curran,Janet A %+ IWK Health, 5980 University Avenue #5850, Halifax, NS, B3K 6R8, Canada, 1 902 470 3748, jacurran@dal.ca %K eHealth intervention %K emergency department %K usability testing %K youth %K health services %K parents %K pediatric %K digital health tools %K mixed methods %K quantitative surveys %D 2025 %7 14.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Usability tests provide important insight into user preferences, functional issues, and differences between target groups for health interventions and products. However, there is limited guidance on how to adapt the usability testing approach for a youth audience, especially for digital health interventions. Objective: This protocol paper outlines a novel approach for conducting usability tests with a diverse audience of youth, parents, and clinicians in the development of 2 digital health tools for the pediatric emergency department (ED) setting. Methods: This paper outlines a protocol for usability testing as part of a broader study aimed at co-designing ED discharge communication tools with youth, parents, and clinicians. The broader study involved co-designing 2 digital tools: one for asthma and one for concussions. A multimethods approach to usability testing was used to assess the functionality of these tools through 2 rounds of testing. A mix of youth, parents, and ED clinicians were invited to participate in each round of usability testing. Participants were asked to provide feedback on the tools through quantitative surveys and open-ended qualitative questions. The usability testing approach was adapted to suit each target group, such as including a youth in the data collection process, to enhance the quality of the data. The severity of usability problems was analyzed following the first round of testing, and each tool was refined based on this feedback. The second round of usability tests involved collecting both qualitative and quantitative feedback on the revised tools. Results: All usability data have been collected and are being analyzed. Outcomes will be disseminated through a subsequent publication. Results will include demographic characteristics from each user group from both rounds of testing, severity of usability scores, qualitative and quantitative feedback, and differences in test outcomes between each target group. Conclusions: This paper provides novel guidance for conducting usability tests with youth participants when designing digital health tools. By using a comprehensive co-design and usability testing approach, we anticipate that final tools will be highly relevant to the end users and will lead to better uptake and patient outcomes when pilot-tested in future studies. The outlined approach may be adapted to different health care contexts for other youth participants. Further research should continue to explore ways to design usability tests that are suitable for youth audiences, as there is still a significant gap in the literature around this topic. International Registered Report Identifier (IRRID): DERR1-10.2196/64350 %M 40228237 %R 10.2196/64350 %U https://www.researchprotocols.org/2025/1/e64350 %U https://doi.org/10.2196/64350 %U http://www.ncbi.nlm.nih.gov/pubmed/40228237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67275 %T Evaluating User Experience and Satisfaction in a Concussion Rehabilitation App: Usability Study %A Hutchison,Michael G %A Di Battista,Alex P %A Pyndiura,Kyla L %K mild traumatic brain injury %K recovery %K mHealth %K app %K digital health %K smartphone %K eHealth %K digital %K technology %K usability %K concussion rehabilitation %K brain injury %K rehabilitation protocols %K evidence-based exercise %K single-arm pilot study %K home-based rehabilitation %K user-friendly %K questionnaire %K telehealth %K telemedicine %D 2025 %7 11.4.2025 %9 %J JMIR Form Res %G English %X Background: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions. Objective: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions. Methods: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from “strongly agree” to “strongly disagree”. Results: Twenty-six participants consented and were enrolled in the study, with 23 participants (82%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100% positive responses, with no single question scoring below 83% positive responses. In the “ease of use and satisfaction” category, 100% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83%-96% (19-22) of users responded positively to the remaining four questions. In the “system information arrangement” category, 100% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87%-96% of users approving action acknowledgment, error recovery, and expected functions. Under the “usefulness” category, 96% (n=22) of users found the app beneficial for health and well-being, and 91% (n=21) users felt it effectively managed their health. For the five custom questions, 100% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations. Conclusions: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app’s potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience. %R 10.2196/67275 %U https://formative.jmir.org/2025/1/e67275 %U https://doi.org/10.2196/67275 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e54753 %T Sociodemographic Differences in Logins and Engagement With the Electronic Health Coach Messaging Feature of a Mobile App to Support Opioid and Stimulant Use Recovery: Results From a 1-Month Observational Study %A Filiatreau,Lindsey M %A Szlyk,Hannah %A Ramsey,Alex T %A Kasson,Erin %A Li,Xiao %A Zhang,Zhuoran %A Cavazos-Rehg,Patricia %+ Division of Infectious Diseases, School of Medicine, Washington University in St Louis, 620 S Taylor Ave, St Louis, MO, 63110, United States, 1 3142737579, flindsey@wustl.edu %K substance misuse %K substance use recovery %K opioid use disorder %K stimulant use disorder %K uptake %K engagement %K mHealth %K digital health intervention %K sociodemographic %K mobile app %K stimulant use %K observational study %K mobile health %K smartphone %K St. Louis %K eCoach messaging %K Wilcoxon rank-sum tests %K Pearson chi-square %K recovery %K app %D 2025 %7 10.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps can serve as a critical tool in supporting the overall health of uninsured and underinsured individuals and groups who have been historically marginalized by the medical community and may be hesitant to seek health care. However, data on uptake and engagement with specific app features (eg, in-app messaging) are often lacking, limiting our ability to understand nuanced patterns of app use. Objective: This study aims to characterize sociodemographic differences in uptake and engagement with a smartphone app (uMAT-R) to support recovery efforts in a sample of individuals with opioid and stimulant use disorders in the Greater St. Louis area. Methods: We enrolled individuals into the uMAT-R service program from facilities providing recovery support in the Greater St. Louis area between January 2020 and April 2022. Study participants were recruited from service project enrollees. We describe the number of logins and electronic health coach (eCoach) messages participants sent in the first 30 days following enrollment using medians and IQRs and counts and proportions of those who ever (vs never) logged in and sent their eCoach a message. We compare estimates across sociodemographic subgroups, by insurance status, and for those who did and did not participate in the research component of the project using Wilcoxon rank-sum tests and Pearson chi-square tests. Results: Of all 695 participants, 446 (64.2%) logged into uMAT-R at least once during the 30 days following enrollment (median 2, IQR 0-8 logins). Approximately half of those who logged in (227/446) used the eCoach messaging feature (median 1, IQR 0-3 messages). Research participants (n=498), who could receive incentives for app engagement, were more likely to log in and use the eCoach messaging feature compared to others (n=197). Younger individuals, those with higher educational attainment, and White, non-Hispanic individuals were more likely to log in at least once compared to their counterparts. The median number of logins was higher among women, and those who were younger, employed, and not on Medicaid compared to their counterparts. Among those who logged in at least once, younger individuals and those with lower educational attainment were more likely to send at least one eCoach message compared to others. Conclusions: Mobile apps are a viable tool for supporting individuals in recovery from opioid and stimulant use disorders. However, older individuals, racial and ethnic minorities, and those with lower educational attainment may need additional login support, or benefit from alternative mechanisms of recovery support. In addition, apps may need to be tailored to achieve sustained engagement (ie, repeat logins) among men, and individuals who are older, unemployed, or on Medicaid. Older individuals and those with higher educational attainment who may be less likely to use eCoach messaging features could benefit from features tailored to their preferences. %M 40210205 %R 10.2196/54753 %U https://mhealth.jmir.org/2025/1/e54753 %U https://doi.org/10.2196/54753 %U http://www.ncbi.nlm.nih.gov/pubmed/40210205 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64324 %T Patient-Related Barriers to Digital Technology Adoption in Alzheimer Disease: Systematic Review %A Panzavolta,Andrea %A Arighi,Andrea %A Guido,Emanuele %A Lavorgna,Luigi %A Di Lorenzo,Francesco %A Dodich,Alessandra %A Cerami,Chiara %K digital technology %K digital e-health %K accessibility %K user-friendliness %K neurocognitive disorders %K Alzheimer disease %K dementia %D 2025 %7 10.4.2025 %9 %J JMIR Aging %G English %X Background: Digital technology in dementia is an area of great development with varying experiences across countries. However, novel digital solutions often lack a patient-oriented perspective, and several relevant barriers prevent their use in clinics. Objective: In this study, we reviewed the existing literature on knowledge, familiarity, and competence in using digital technology and on attitude and experiences with digital tools in Alzheimer disease. The main research question is whether digital competence and attitudes of patients and caregivers may affect the adoption of digital technology. Methods: Following the PRISMA guidelines, a literature search was conducted by two researchers in the group. Inter-rater reliability was calculated with Cohen κ statistics. The risk of bias assessment was also recorded. Results: Of 597 initial records, only 18 papers were considered eligible. Analyses of inter-rater reliability showed good agreement levels. Significant heterogeneity in study design, sample features, and measurement tools emerged across studies. Quality assessment showed a middle-high overall quality of evidence. The main factors affecting the adoption of digital technology in patients and caregivers are severity of cognitive deficits, timing of adoption, and the availability of training and support. Additional factors are age, type of digital device, and ease of use of the digital solution. Conclusions: Adoption of digital technology in dementia is hampered by many patient-related barriers. Improving digital competence in patient-caregiver dyads and implementing systematic, patient-oriented strategies for the development and use of digital tools are needed for a successful incorporation of digital technology in memory clinics. %R 10.2196/64324 %U https://aging.jmir.org/2025/1/e64324 %U https://doi.org/10.2196/64324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64174 %T A New Mobile App to Train Attention Processes in People With Traumatic Brain Injury: Logical and Ecological Content Validation Study %A Laverdière,Roxanne %A Jackson,Philip L %A Banville,Frédéric %+ , Department of Health Sciences, Université du Québec à Rimouski, 300, allée des Ursulines, Rimouski, QC, G5L 3A1, Canada, 1 418 723 1986 ext 1931, frederic_banville@uqar.ca %K mobile app %K attention training %K cognitive remediation %K mindfulness %K psychometric properties %K content validation %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Attention is at the base of more complex cognitive processes, and its deficits can significantly impact safety and health. Attention can be impaired by neurodevelopmental and acquired disorders. One validated theoretical model to explain attention processes and their deficits is the hierarchical model of Sohlberg and Mateer. This model guides intervention development to improve attention following an acquired disorder. Another way to stimulate attention functions is to engage in the daily practice of mindfulness, a multicomponent concept that can be explained by the theoretical model of Baer and colleagues. Mobile apps offer great potential for practicing mindfulness daily as they can easily be used during daily routines, thus facilitating transfer. Laverdière and colleagues have developed such a mobile app called Focusing, which is aimed at attention training using mindfulness-inspired attentional exercises. However, this app has not been scientifically validated. Objective: This research aims to analyze the logical content validity and ecological content validity of the Focusing app. Methods: Logical content validation was performed by 7 experts in neuropsychology and mindfulness. Using an online questionnaire, they determined whether the content of the attention training app exercises is representative of selected constructs, namely the theoretical model of attention by Sohlberg and Mateer and the theoretical model of mindfulness by Baer and colleagues. A focus group was subsequently held with the experts to discuss items that did not reach consensus in order to change or remove them. Ecological content validation was performed with 10 healthy adults. Participants had to explore all sections of the app and assess the usability, relevance, satisfaction, quality, attractiveness, and cognitive load associated with each section of the app, using online questionnaires. Results: Logical content validation results demonstrated a high content validity index (CVI) of the attention training app. Excellent scores (CVI ≥0.78) in both the attention and mindfulness models were obtained for all exercises in the app, except 2 exercises. One of these exercises was subsequently modified to include expert feedback, and one was removed. Regarding ecological content validation, the results showed that workload, quality, user experience, satisfaction, and relevance of the app were adequate. The Mobile Application Rating Scale questionnaire showed an average quality rating between 3.75/5 (SD 0.41) (objective quality) and 3.65/5 (SD 0.36) (subjective quality), indicating acceptable quality. The mean global attractiveness rating from the AttrakDiff questionnaire was 2.36/3 (SD 0.57), which represents one of the strengths of the app.  Conclusions: Logical and ecological content validation showed that Focusing is theoretically valid, with a high level of agreement among experts and healthy participants. This tool can be tested to train attention processes after a neurological insult such as traumatic brain injury. %M 40202789 %R 10.2196/64174 %U https://formative.jmir.org/2025/1/e64174 %U https://doi.org/10.2196/64174 %U http://www.ncbi.nlm.nih.gov/pubmed/40202789 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62741 %T Anticipated Acceptability of Blended Learning Among Lay Health Care Workers in Malawi: Qualitative Analysis Guided by the Technology Acceptance Model %A Mbeya-Munkhondya,Tiwonge E %A Meek,Caroline J %A Mphande,Mtisunge %A Tembo,Tapiwa A %A Chitani,Mike J %A Jean-Baptiste,Milenka %A Kumbuyo,Caroline %A Vansia,Dhrutika %A Simon,Katherine R %A Rutstein,Sarah E %A Mwapasa,Victor %A Go,Vivian %A Kim,Maria H %A Rosenberg,Nora E %K blended learning %K technology acceptance model %K index case testing %K acceptability %K partner notification %K contact tracing %D 2025 %7 7.4.2025 %9 %J JMIR Form Res %G English %X Background: HIV index case testing (ICT) aims to identify people living with HIV and their contacts, engage them in HIV testing services, and link them to care. ICT implementation has faced challenges in Malawi due to limited counseling capacity among lay health care workers (HCWs). Enhancing capacity through centralized face-to-face training is logistically complex and expensive. A decentralized blended learning approach to HCW capacity-building, combining synchronous face-to-face and asynchronous digital modalities, may be an acceptable way to address this challenge. Objective: The objective of this analysis is to describe factors influencing HCW anticipated acceptability of blended learning using the Technology Acceptance Model (TAM). Methods: This formative qualitative study involved conducting 26 in-depth interviews with HCWs involved in the ICT program across 14 facilities in Machinga and Balaka, Malawi (November-December 2021). Results were analyzed thematically using TAM. Themes were grouped into factors affecting the 2 sets of TAM constructs: perceived usefulness and perceived ease of use. Results: A total of 2 factors influenced perceived usefulness. First, HCWs found the idea of self-guided digital learning appealing, as they believed it would allow for reinforcement, which would facilitate competence. They also articulated the need for opportunities to practice and receive feedback through face-to-face interactions in order to apply the digital components. In total, 5 factors influenced perceived ease of use. First, HCWs expressed a need for orientation to the digital technology given limited digital literacy. Second, they requested accessibility of devices provided by their employer, as many lacked personal devices. Third, they wished for adequate communication surrounding their training schedules, especially if they were going to be asynchronous. Fourth, they wished for support for logistical arrangements to avoid work interruptions. Finally, they wanted monetary compensation to motivate learning, a practice comparable with offsite trainings. Conclusions: A decentralized blended learning approach may be an acceptable method of enhancing ICT knowledge and skills among lay HCWs in Malawi, although a broad range of external factors need to be considered. Our next step is to integrate these findings into a blended learning package and examine perceived acceptability of the package in the context of a cluster randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-077706 %R 10.2196/62741 %U https://formative.jmir.org/2025/1/e62741 %U https://doi.org/10.2196/62741 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67997 %T A Remote Intervention Based on mHealth and Community Health Workers for Antiretroviral Therapy Adherence in People With HIV: Pilot Randomized Controlled Trial %A Shourya,Shivesh %A Liu,Jianfang %A McInerney,Sophia %A Casimir,Trinity %A Kenniff,James %A Kershaw,Trace %A Batey,David %A Schnall,Rebecca %+ Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, United States, 1 6503346176, shivesh.shourya@yale.edu %K HIV %K antiretroviral therapy adherence %K ART %K ART adherence %K mobile health technology %K mHealth technology %K community health workers %K CHWs %K smart pill bottle %K feasibility evaluation %K mobile health technology acceptance model %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the availability of antiretroviral therapy (ART), only 66% of people with HIV in the United States achieve viral suppression, largely due to suboptimal ART adherence. Barriers such as limited access to care and forgetfulness impact adherence rates, which must be maintained at ≥95% to prevent viral load rebound. Combination interventions leveraging community health worker (CHW) support and mobile health (mHealth) technologies have the potential to overcome previously identified barriers and provide cost-effective support for improving adherence and viral suppression outcomes in people with HIV. Objective: This pilot study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of remote delivery of the Community Health Worker and mHealth to Improve Viral Suppression (CHAMPS) intervention, combining the WiseApp, CHW support, and the CleverCap smart pill bottle. A secondary aim was to gather participants’ feedback on the usability of the app and pill bottle as well as to better understand their experiences with remote study procedures. Methods: This mixed methods pilot study involved 40 participants with HIV, who were randomly assigned to a control group (n=20, 50%) or the CHAMPS intervention (n=20, 50%) over 3 months. The intervention group participated in up to 12 sessions with CHWs and used the WiseApp, paired with a CleverCap smart pill bottle, to support ART adherence. Remote baseline and follow-up visits were conducted via Zoom and included surveys measuring adherence, self-efficacy, and usability (measured by Health Information Technology Usability Evaluation Scale [Health-ITUES] and Poststudy System Usability Questionnaire [PSSUQ]). Semistructured interviews explored participants’ experiences with the intervention. Thematic analysis was used to identify key facilitators and barriers based on the Mobile Health Technology Acceptance Model. Results: Remote delivery of the CHAMPS intervention was feasible, with high usability ratings for both the WiseApp and CleverCap (overall scores on Health-ITUES: mean 4.35, SD 0.58 and PSSUQ: mean 2.04, SD 1.03). In the intervention group, there were nonsignificant improvements in self-reported adherence scores (P=.29) and in self-efficacy scores (P=.07). The adjusted odds ratio for achieving undetectable viral load in the intervention group compared to the control group was 3.01 (95% CI –1.59 to 4.12), indicating a medium effect size in favor of the intervention. Overall study retention was 75% (30/40), with higher retention in the control group. Participants valued the flexibility of remote study procedures, particularly Zoom-based study visits and mailed blood sample kits. Qualitative feedback highlighted the intervention’s acceptability and ability to overcome logistical barriers. Conclusions: The remote CHAMPS pilot study demonstrated the feasibility and acceptability of combining mHealth tools with CHW support to promote medication adherence among people with HIV. While further optimization is needed to enhance its impact, this intervention shows potential for improving health outcomes in diverse underserved populations. Trial Registration: ClinicalTrials.gov NCT05938413; https://clinicaltrials.gov/study/NCT05938413 %M 40173448 %R 10.2196/67997 %U https://formative.jmir.org/2025/1/e67997 %U https://doi.org/10.2196/67997 %U http://www.ncbi.nlm.nih.gov/pubmed/40173448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56666 %T Insights Into How mHealth Applications Could Be Introduced Into Standard Hypertension Care in Germany: Qualitative Study With German Cardiologists and General Practitioners %A May,Susann %A Seifert,Frances %A Bruch,Dunja %A Heinze,Martin %A Spethmann,Sebastian %A Muehlensiepen,Felix %+ Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 3391 39 145 91, susann.may@mhb-fontane.de %K hypertension %K mHealth apps %K physicians %K qualitative study %K digitalization %K app %K application %K Germany %K blood pressure %K cardiologists %K thematic analysis %K general practitioner %K mobile phone %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps provide innovative solutions for improving treatment adherence, facilitating lifestyle modifications, and optimizing blood pressure control in patients with hypertension. Despite their potential benefits, the adoption and recommendation of mHealth apps by physicians in Germany remain limited. This reluctance may be due to a lack of understanding of the factors influencing physicians’ willingness to incorporate these digital tools into routine clinical practice. Understanding these factors is crucial for fostering greater integration of mHealth apps in hypertension care. Objective: The aim of this study was to explore the relationship between physicians’ information needs and acceptance factors, and how these elements can support the effective integration of mHealth apps into daily medical routines. Methods: We conducted a qualitative study involving 24 semistructured telephone interviews with physicians, including 14 cardiologists and 10 general practitioners, who are involved in the treatment of hypertensive patients. Participants were selected through purposive sampling to ensure a diverse range of perspectives. Thematic analysis was conducted using MAXQDA software (Verbi GmbH) to identify key themes and subthemes related to the acceptance and use of mHealth apps. Results: The analysis revealed significant variability in physicians’ information needs regarding mHealth apps, particularly concerning their functionalities, clinical benefits, and potential impact on patient outcomes. These informational gaps play a critical role in determining whether physicians are willing to recommend mHealth apps to their patients. Key determinants influencing acceptance were identified, including the availability of robust knowledge about the apps, high-quality and reliable data, generational shifts within the medical profession, solid evidence supporting the effectiveness of the mHealth apps, and clearly defined areas of application and responsibilities within the physician-patient relationship. The study found that acceptance of mHealth apps could be significantly increased through targeted educational initiatives, enhanced data quality, and better integration of these tools into existing clinical workflows. Furthermore, younger physicians, more familiar with digital technologies, demonstrated greater openness to using mHealth apps, suggesting that generational changes may drive future increases in adoption. Conclusions: The successful integration of mHealth apps into hypertension management requires a multifaceted approach that addresses both the informational and practical concerns of physicians. By disseminating comprehensive knowledge about the variety, functionality, and proven efficacy of hypertension-related mHealth apps, health care providers can be better equipped to use these tools effectively. This approach necessitates the implementation of various knowledge transfer strategies, such as targeted training programs, peer learning opportunities, and active engagement with digital health technologies. As physicians become more informed and confident in the use of mHealth apps, their acceptance and recommendation of these tools are likely to increase, leading to more widespread adoption. Overcoming current barriers related to information deficits and data quality is essential for ensuring that mHealth apps are optimally used in routine hypertension care, ultimately improving patient outcomes and enhancing the overall quality of care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 %M 40153776 %R 10.2196/56666 %U https://mhealth.jmir.org/2025/1/e56666 %U https://doi.org/10.2196/56666 %U http://www.ncbi.nlm.nih.gov/pubmed/40153776 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65269 %T Factors Influencing Health Care Technology Acceptance in Older Adults Based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology: Meta-Analysis %A Yang,Hyo Jun %A Lee,Ji-Hyun %A Lee,Wonjae %+ Graduate School of Culture Technology, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong District, Daejeon, 34141, Republic of Korea, 82 010 7341 4441, wnjlee@kaist.ac.kr %K technology adoption %K older adults %K health care technology %K technology acceptance model %K unified theory of acceptance and use of technology %K meta-analysis %D 2025 %7 28.3.2025 %9 Review %J J Med Internet Res %G English %X Background: The technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) are widely used to examine health care technology acceptance among older adults. However, existing literature exhibits considerable heterogeneity, making it difficult to determine consistent predictors of acceptance and behavior. Objective: We aimed to (1) determine the influence of perceived usefulness (PU), perceived ease of use (PEOU), and social influence (SI) on the behavioral intention (BI) to use health care technology among older adults and (2) assess the moderating effects of age, gender, geographic region, type of health care technology, and presence of visual demonstrations. Methods: A systematic search was conducted across Google Scholar, Web of Science, Scopus, IEEE Xplore, and ProQuest databases on March 15, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1167 initially identified studies, 41 studies (11,574 participants; mean age 67.58, SD 4.76 years; and female:male ratio=2.00) met the inclusion criteria. The studies comprised 12 mobile health, 12 online or telemedicine, 9 wearable, and 8 home or institution hardware investigations, with 23 studies from Asia, 7 from Europe, 7 from African-Islamic regions, and 4 from the United States. Studies were eligible if they used the TAM or UTAUT, examined health care technology adoption among older adults, and reported zero-order correlations. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, evaluating selection, comparability, and outcome assessment with 34% (14/41) of studies rated as good quality and 66% (27/41) as satisfactory. Results: Random-effects meta-analysis revealed significant positive correlations for PU-BI (r=0.607, 95% CI 0.543-0.665; P<.001), PEOU-BI (r=0.525, 95% CI 0.462-0.583; P<.001), and SI-BI (r=0.551, 95% CI 0.468-0.624; P<.001). High heterogeneity was observed across studies (I²=95.9%, 93.6%, and 95.3% for PU-BI, PEOU-BI, and SI-BI, respectively). Moderator analyses revealed significant differences based on geographic region for PEOU-BI (Q=8.27; P=.04), with strongest effects in Europe (r=0.628) and weakest in African-Islamic regions (r=0.480). Technology type significantly moderated PU-BI (Q=8.08; P=.04) and SI-BI (Q=14.75; P=.002), with home or institutional hardware showing the strongest effects (PU-BI: r=0.736; SI-BI: r=0.690). Visual demonstrations significantly enhanced PU-BI (r=0.706 vs r=0.554; Q=4.24; P=.04) and SI-BI relationships (r=0.670 vs r=0.492; Q=4.38; P=.04). Age and gender showed no significant moderating effects. Conclusions: The findings indicate that PU, PEOU, and SI significantly impact the acceptance of health care technology among older adults, with heterogeneity influenced by geographic region, type of technology, and presence of visual demonstrations. This suggests that tailored strategies for different types of technology and the use of visual demonstrations are important for enhancing adoption rates. Limitations include varying definitions of older adults across studies and the use of correlation coefficients rather than controlled effect sizes. Results should therefore be interpreted within specific contexts and populations. %M 40153796 %R 10.2196/65269 %U https://www.jmir.org/2025/1/e65269 %U https://doi.org/10.2196/65269 %U http://www.ncbi.nlm.nih.gov/pubmed/40153796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64384 %T User Experience With a Personalized mHealth Service for Physical Activity Promotion in University Students: Mixed Methods Study %A Wittmar,Silke %A Frankenstein,Tom %A Timm,Vincent %A Frei,Peter %A Kurpiers,Nicolas %A Wölwer,Stefan %A Schäfer,Axel Georg Meender %+ Faculty of Social Work and Health, HAWK University of Applied Sciences and Arts Hildesheim/Holzminden/Göttingen, Goschentor 1, Hildesheim, 31134, Germany, 49 5121881369, silke.wittmar@hawk.de %K usability testing %K health promotion %K exercise %K smartphone app %K mHealth %K physical activity %K user experience %K user %K university student %K undergraduate %K college %K student %K mixed methods %K physical fitness %K digital intervention %K mobile health %K promote %K engagement %K mobile phone %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular physical activity (PA) is known to offer substantial health benefits, including improved physical fitness, reduced risk of disease, enhanced psychological well-being, and better cognitive performance. Despite these benefits, many university students fail to meet recommended PA levels, risking long-term health consequences. Objective: This study evaluated the user experience (UX) of futur.move, a digital intervention aimed at promoting PA among university students. The service delivers personalized, evidence-based content to foster sustained engagement in PA. Methods: A mixed methods approach was used to evaluate the prototype of futur.move. UX assessments included on-site and online user tests, standardized questionnaires, and online focus groups. A total of 142 university students participated, with 23 joining additional focus groups. Each participant tested the service for 30 minutes. Quantitative data were collected using the User Experience Questionnaire and analyzed descriptively, followed by correlation analysis with variables such as PA level, age, gender, and experience with PA apps. Qualitative insights were gathered from transcribed focus group discussions and analyzed using content-structuring, qualitative content analysis. Quantitative findings were cross-validated with qualitative data. Results: The UX received positive ratings across 4 User Experience Questionnaire scales (range –3 to +3; higher numbers indicate positive UX): attractiveness (median 1.67, IQR 1.04-2.17), perspicuity (median 1.5, IQR 0.5-2), stimulation (median 1.5, IQR 1-2), and novelty (median 1.25, IQR 0.5-2). Weak correlations were found between adherence to World Health Organization guidelines for PA and the perspicuity subscale (η=0.232, P=.04), and between age and the perspicuity (Kendall τb=0.132, P=.03) and stimulation subscales (Kendall τb=0.144, P=.02), and a moderate correlation was found between gender and the novelty subscale (η=0.363, P=.004). Critical feedback from focus group discussions highlighted issues with manual data entry. Qualitative findings aligned with the quantitative results, emphasizing students’ appreciation for the personalized, diverse content and social networking features of futur.move. Conclusions: futur.move demonstrates favorable UX and aligns with student needs, particularly through its personalized content and social features. Improvements should focus on reducing manual data entry and enhancing feature clarity, particularly for the features “your condition” and “goal setting.” While correlations between UX ratings and demographic variables were weak to moderate, they warrant further investigation to better address the diverse target audience. The feedback from the students serves as a basis for further adapting the service to their needs and expectations. Future work will involve coding an advanced prototype and conducting a longitudinal study to assess its impact on PA behavior and sustained engagement. %M 40153787 %R 10.2196/64384 %U https://formative.jmir.org/2025/1/e64384 %U https://doi.org/10.2196/64384 %U http://www.ncbi.nlm.nih.gov/pubmed/40153787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63278 %T Bridging the Gap in Carbohydrate Counting With a Mobile App: Needs Assessment Survey %A Housni,Asmaa %A Katz,Alexandra %A Bergeron,Lucien Junior %A Simard,Alain %A Finkel,Ashley %A Roy-Fleming,Amélie %A Nakhla,Meranda %A Brazeau,Anne-Sophie %+ School of Human Nutrition, McGill University, 21111 Lakeshore Road, Montreal, QC, H9V 1X9, Canada, 1 5143987848, anne-sophie.brazeau@mcgill.ca %K type 1 diabetes %K carbohydrate counting %K mobile apps %K photo recognition %K diabetes management %K mHealth %K mobile health %K user-centered design %K Canadian survey %D 2025 %7 28.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Carbohydrate counting (CC) can be burdensome and difficulty with adherence has been reported. Automated CC through mobile apps offers innovative solutions to ease this burden. Objective: This cross-sectional web-based survey aims to identify (1) perceived barriers to CC by Canadians living with type 1 diabetes (T1D) and (2) app features that would help reduce these barriers. The secondary objective aims to compare apps used by participants with the suggested app features. Methods: People with T1D aged 14 years and older, living in Canada, were recruited through the BETTER Canadian registry, diabetes organizations, and social media. Participants completed a 39-question web-based survey (closed- and open-ended) to identify barriers in CC, preferred CC app features, and current app use. Respondents rated barriers and app features using a 5-point Likert scale. The features were cross-referenced in each app reported being used by participants. Descriptive statistics summarized barriers and app feature preferences, and statistical analyses identified differences by age, app use, and insulin modality. Mean scores (out of 5) were compared using 2-tailed t tests or nonparametric tests. Open-ended questions were analyzed using inductive thematic analysis. Results: Participants (N=196; woman: n=145, 74%; mean age 40 [SD 17] years; mean diabetes duration 22 (14) years; relied on CC to determine insulin doses at mealtimes: n=178, 90.8%) reported barriers related to carbohydrate identification, nutrient interaction, and insulin dose calculation, as well as psychosocial factors. Preferred app features included nutrient analysis (165/196, 84.2%), personalization (151/196, 77.1%), insulin bolus calculation (145/196, 74%), and health care professional support (135/196, 68.8%). Among the 16 apps used by participants, most (12/16, 75%) supported nutrient analysis but only one offered bolus calculations or health care professional support, and none offered personalization. Users on injections reported greater barriers to blood glucose monitoring for insulin adjustments compared to exclusive pump users (mean score of 3.87, SD 1.22 vs mean 3.30, SD 1.28; P=.001). They also expressed higher needs for meal logs in an electronic food journal (mean 4.06, SD 1.18 vs mean 3.69, SD 1.17; P=.01), bolus dose suggestions (mean 4.37, SD 0.98 vs mean 3.84, SD 1.26; P=.001), and app personalization (mean 4.47, SD 0.86 vs mean 3.93, SD 1.21; P<.001). No significant differences were observed based on age or app use. The thematic analysis revealed participants’ perceptions of suggested barriers and features, as well as new barriers such as calculation errors from unreliable food data and nutrition labels, fear of eating disorders, limited app reliability, and insufficient health care support, with suggestions for technology-based solutions. Conclusions: CC mobile apps currently used do not meet the needs of people with T1D. A novel CC app with app features such as photo recognition, reliable nutrient values, and personalized bolus calculations could reduce the CC burden. %M 40153793 %R 10.2196/63278 %U https://www.jmir.org/2025/1/e63278 %U https://doi.org/10.2196/63278 %U http://www.ncbi.nlm.nih.gov/pubmed/40153793 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e54312 %T Effectiveness of Augmented Reality in the Teaching of Health University Students: Quasi-Experimental Study %A Martín-Valero,Rocío %A Vega-Morales Sr,Alejandro %A Martín-Vega,Francisco Javier %A Rodriguez-Huguet,Manuel %A Rodríguez-Martínez,Maria Carmen %A Vinolo-Gil,Maria Jesus %K augmented reality %K qualifications %K usability %K university %K teaching %K education %K implementation %K academic performance %K quasi-experimental design %K control group %K applications %K experimental group %D 2025 %7 27.3.2025 %9 %J JMIR Serious Games %G English %X Background: The exponential growth of new technologies has resulted in the need for updating the field of education. From the educational point of view, there are some studies that have promoted the implementation of new technologies. These facts have raised the need to implement augmented reality in the university environment, especially among students of health sciences. The use of augmented reality can mean a new approach to teaching by teachers and better learning by students. Objective: We aimed to analyze the degree of usability of two augmented reality applications and to compare the academic performance between the control group and the experimental group at the Universities of Cádiz and Málaga. The students at the University of Málaga used the Zapworks augmented reality software, while those at the University of Cádiz used the Aumentaty augmented reality software for their respective experimental groups. The secondary objective was to measure the relationships between all the studied variables. Methods: This was a quasi-experimental design with a posttest as the only evaluation measure. We followed the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement and the ethical and legal aspects of the Principles of the Declaration of Helsinki. An intervention was carried out using two augmented reality applications on the subject of General Procedures in Physiotherapy II at the Universities of Málaga and Cádiz. Results: A total of 199 participants took part in the study. Demographic variables, ratings, and usability were assessed, followed by statistical analysis, with the results and their interpretation being described in the study. Significant differences (P<.001) were found in the ratings at both the universities. In addition, significant differences (P<.001) were found between the experimental group and the control group. Regarding the degree of usability in the univariate analysis, no significant differences were found (P=.049). A multiple regression analysis of the rating and usability was performed. The rating showed significant differences, with a beta of 1.4 (P<.001), and usability was also significant (P=.03) in favor of the Aumentaty group. Conclusions: Significant differences were observed in those who used augmented reality compared to the control group, with higher values observed in the University of Cádiz. There are no correlations between the variables of usability and qualifications. Trial Registration: ClinicalTrials.gov NCT05798468; https://clinicaltrials.gov/study/NCT05798468 %R 10.2196/54312 %U https://games.jmir.org/2025/1/e54312 %U https://doi.org/10.2196/54312 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66975 %T Stress and Hypertension Among African American Female Family Caregivers of Persons Living With Alzheimer Disease and Related Dementias: Protocol for a Pilot Internet-Based Randomized Controlled Trial %A Wright,Kathy D %A Richards Adams,Ingrid K %A Helsabeck,Nathan P %A Rose,Karen M %A Moss,Karen O %A Nemati,Donya %A Palmer,Navia %A Kim,Bohyun %A Pokhrel Bhattarai,Sunita %A Nguyen,Christopher %A Addison,Daniel %A Klatt,Maryanna D %+ The Ohio State University College of Nursing, 1577 Neil Avenue, Columbus, OH, 43210, United States, 1 6142920309, wright.2104@osu.edu %K African American women %K high blood pressure %K stress reactivity and resilience %K caregiving %K hypertension %K stress %K Alzheimer disease %K dementia %K lifestyle and healthy self-care behaviors %D 2025 %7 27.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Caregivers of persons with Alzheimer disease and related dementias (ADRD) neglect their health, including by ignoring stress levels. African American women are vulnerable and susceptible to hypertension. Chronic caregiving stress and hypertension place them at high risk for cardiovascular disease. Addressing stress reactivity or resilience is vital in lessening their caregiving stress, enhancing their quality of life (QOL), and fostering healthy blood pressure (BP) self-care behaviors. Objective: This pilot study aims to investigate the feasibility and acceptability of implementing the Mindfulness in Motion (MIM) plus the Dietary Approaches to Stop Hypertension (DASH) intervention in this population and to evaluate its effect on ADRD caregivers’ stress and QOL. Additionally, it explores the mediation of stress reactivity or resilience between interventions and self-care behaviors. Methods: A small randomized controlled trial pilot study will recruit 28 African American or Black female caregivers aged 40 years diagnosed with hypertension and on an antihypertensive medication. Participants will be randomly assigned to either the MIM DASH or the Alzheimer’s Association caregiver training group (attention control). Trained facilitators will deliver both interventions over 8 weeks through 1-hour, group, internet-based sessions, via video or telephone. After completion, both groups will receive coaching calls over 9 months, beginning with 8 weekly calls followed by 4 monthly calls to encourage use of the educational materials. Primary outcome measures include feasibility (recruitment and retention) and acceptability (attendance). Secondary measures assess caregiver stress (Perceived Stress Scale), QOL, and self-care behaviors (Food Frequency Questionnaire and self-reported physical activity). Data collection occurs at baseline, 3 months, and 9 months. Quantitative data will be analyzed using descriptive statistics, CIs, and mediation models. Results: This study was approved by the institutional review board in April 2022 and funded in May 2022. The first data were collected in January 2023, and the last data were collected in September 2024. The completion of all aims’ data analysis is anticipated in spring 2025. The participants’ mean age was 62.4 (SD 7.98) years, with a mean baseline systolic BP of 128 (SD 19) mm Hg and diastolic BP of 79 (SD 10) mm Hg. Participants reported that MIM DASH was acceptable (at a mean score of 59.08, SD 7.38, compared to 60.83, SD 5.56 for caregiver training). Regarding feasibility, as reflected in attendance, MIM DASH participants had a mean attendance of 6.3 (SD 2.3) sessions, and the caregiver training group had 4.9 (SD 2.9) sessions. Conclusions: This study’s findings demonstrate the feasibility of conducting an internet-based intervention (MIM DASH) for African American women with hypertension who also care for families living with ADRD. These results will inform the design of a larger randomized controlled trial to evaluate the intervention’s efficacy and scalability further. Trial Registration: ClinicalTrials.gov NCT05721482; https://clinicaltrials.gov/study/NCT05721482 International Registered Report Identifier (IRRID): DERR1-10.2196/66975 %M 40146982 %R 10.2196/66975 %U https://www.researchprotocols.org/2025/1/e66975 %U https://doi.org/10.2196/66975 %U http://www.ncbi.nlm.nih.gov/pubmed/40146982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66763 %T Mobile App-Based Interactive Care Plan for Migraine: Survey Study of Usability and Improvement Opportunities %A Young,Nathan P %A Stern,Jennifer I %A Steel,Stephanie J %A Ebbert,Jon O %K migraine %K remote monitoring %K mobile app %K mHealth %K patient-reported outcomes %K care plan %K digital health %K app %K smartphone %K eHealth %K technology %K survey study %K headache %K electronic health record %K remote assessment %K older adult %K adult %K electronic survey %K pain %K mobile phone %K telehealth %K telemedicine %D 2025 %7 26.3.2025 %9 %J JMIR Form Res %G English %X Background: We implemented a novel mobile app-based Migraine Interactive Care Plan (MICP) integrated with our electronic health records (EHRs). The MICP facilitates remote assessment of adult patients with migraine, educational content delivery, and care team communication. Feasibility of the MICP was demonstrated in a pilot implementation study. Objective: We aimed to assess the preferences and satisfaction of patients with migraine users of a mobile app-based care plan integrated with the EHR. Methods: An electronic survey was administered to a single cohort of MICP users between December 6, 2021, and December 30, 2021. The survey assessed patient preferences for which data to track, frequency of tracking, and satisfaction with the MICP. Survey responses were compared between subsets determined by patient-reported headache frequency and treatment with and without botulinum toxin and calcitonin gene-related peptide (CGRP) antagonist therapy. The Wilcoxon rank-sum test was used for continuous variables and the χ2 test or Fisher exact test for categorical variables. Results: The total sample size was 184 and the survey response rate was 30.4% (56/184). No significant differences in age (P=.26) or sex (P=.19) between respondents and nonrespondents were observed. Respondent median age was 42 (range 20‐72) years and 94.6% (53/56) were female. Headache frequency was (1) 0 to 8 days (26/56, 46.4%), (2) 9 to 14 days (12/56, 21.4%), and (3) 15 or more days (18/56, 32.1%). No difference was observed in any survey responses based on headache frequency or treatment. The majority of respondents preferred to track headache days weekly (30/56, 53.6%) or daily (15/56, 26.8%) and preferred to change the frequency of headache tracking reminders (42/56, 75%). Respondents were somewhat or very interested in daily tracking personal observations in free text (41/52, 78.8%), medication treatment (43/52, 82.7%) and treatment response (39/56, 69.6%), class of medication treatment (36/52, 69.2%), severity of functional impairment (39/56, 69.6%), type of functional impairment (35/53, 66%), headache day (40/54, 74.1%), and headache pain level on a scale of 1 to 10 (38/53, 71.7%). Respondents agreed or strongly agreed that the education content was useful (31/51, 60.8%) but lacked personalization (25/51, 49%). Most respondents agreed or strongly agreed that they were satisfied with the MICP (38/50, 76%) and that it helped them communicate with their care team (38/53, 71.7%). Conclusions: Most MICP users were motivated to track headache frequency, medication treatment with response, functional impairment, and pain intensity. Opportunities to improve the MICP include (1) allowing patients to change the frequency of assessments and notifications; (2) recording personal observations or comments through free text, which may include headache triggers; (3) assessment of headache severity using a 1 to 10 pain scale; and (4) tailoring headache education based on frequency and severity (episodic vs chronic migraine). These observations may be useful to improve the usability of the MICP and similar EHR-integrated migraine care platforms that others may develop. %R 10.2196/66763 %U https://formative.jmir.org/2025/1/e66763 %U https://doi.org/10.2196/66763 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e65747 %T Participant Evaluation of Blockchain-Enhanced Women’s Health Research Apps: Mixed Methods Experimental Study %A Ng,Madelena Y %A Halpern,Jodi %A Shane,Olivia %A Teng,Tina %A Nguyễn,Michael %A Alt,Casey Ryan %A Leite,Anaïs Barthe %A Moss-Pultz,Sean %A Lyles,Courtney R %A Cheshire,Coye %+ , School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94704, United States, 1 5106426000, madelena.ng@berkeley.edu %K blockchain technology %K privacy %K trust %K data control %K data ownership %K digital health study %K user-centered design %K user experience %K mHealth %K mobile health %K women’s health %K reproductive health %K data sharing %K research participation %K bioethics %D 2025 %7 25.3.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Blockchain technology has capabilities that can transform how sensitive personal health data are safeguarded, shared, and accessed in digital health research. Women’s health data are considered especially sensitive, given the privacy and safety risks associated with their unauthorized disclosure. These risks may affect research participation. Using a privacy-by-design approach, we developed 2 app-based women’s health research study prototypes for user evaluation and assessed how blockchain may impact participation. Objective: This study aims to seek the perspectives of women to understand whether applications of blockchain technology in app-based digital research would affect their decision to participate and contribute sensitive personal health data. Methods: A convergent, mixed methods, experimental design was used to evaluate participant perceptions and attitudes toward using 2 app-based women’s health research study prototypes with blockchain features. Prototype A was based on the status quo ResearchKit framework and had extensive electronic informed consent, while prototype B minimized study onboarding requirements and had no informed consent; the mechanisms of how the contributed data flowed and were made pseudonymous were the same. User evaluations were carried out in February and March 2021 and consisted of a think-aloud protocol, a perception survey, and a semistructured interview. Findings were mapped to the technology acceptance model to guide interpretation. Results: We recruited 16 representative female participants from 175 respondents. User evaluations revealed that while participants considered prototype B easier to use on intuitive navigation (theme 1) of specified tasks and comprehension (theme 2) of research procedures, prototype A trended toward being perceived more favorably than prototype B across most perception survey constructs, with an overall lower level of privacy concern (mean [SD]: 2.22 [1.10] vs 2.95 [1.29]) and perceived privacy risk (2.92 [1.46] vs 3.64 [1.73]) and higher level of perceived privacy (5.21 [1.26] vs 4.79 [1.47]), trust (5.46 [1.19] vs 4.76 [1.27]), and usability (67.81 [21.77] vs 64.84 [23.69]). Prototype B was perceived more favorably than prototype A with perceived control (4.92 [1.32] vs 4.89 [1.29]) and perceived ownership (5.18 [0.59] vs 5.01 [0.96]). These constructs, except for perceived ownership, were significantly correlated with behavioral intention to use the app (P<.05). Participants perceived the usefulness of these prototypes in relation to the value of research study to women’s health field (theme 3), the value of research study to self (theme 4), and the value of blockchain features for participation (theme 5). Conclusions: This study provides nuanced insights into how blockchain applications in app-based research remain secondary in value to participants’ expectations of health research, and hence their intention to participate and contribute data. However, with impending data privacy and security concerns, it remains prudent to understand how to best integrate blockchain technology in digital health research infrastructure. %M 40131317 %R 10.2196/65747 %U https://mhealth.jmir.org/2025/1/e65747 %U https://doi.org/10.2196/65747 %U http://www.ncbi.nlm.nih.gov/pubmed/40131317 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60936 %T Determinants of Telehealth Adoption Among Older Adults: Cross-Sectional Survey Study %A Tan,Siow-Hooi %A Yap,Yee-Yann %A Tan,Siow-Kian %A Wong,Chee-Kuan %+ , Faculty of Management, Multimedia University, Persiaran Multimedia, Cyberjaya, 63100, Malaysia, 60 38312 ext 5658, shtan@mmu.edu.my %K telehealth services adoption %K survey %K questionnaire %K telehealth %K older adult population %K subjective well-being %K transition cost %K technology acceptance model %K importance-performance map analysis %K IPMA %D 2025 %7 24.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The aging population and the accompanying rise in chronic diseases have intensified the need to study the adoption of telehealth services. However, the success of telehealth services depends not only on their ease and usefulness but also on addressing broader concerns. Despite being a substantial user group in traditional health services, older adults may encounter barriers to adopting telehealth services. Increasing the adoption of telehealth among the older adult population is crucial for enhancing their access to care and managing the challenges of aging effectively. Objective: We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs. Methods: A cross-sectional survey was conducted among 119 adults aged ≥60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable. Results: Of the 119 participants, 52 (43.7%) were women and 67 (56.3%) were men. The study found that subjective well-being (β=0.448; P<.001) was the most significant factor, followed by attitude (β=0.242; P<.001), transition cost (β=−0.163; P<.001), and perceived usefulness (β=0.100, P=.02) in influencing telehealth service intention. Furthermore, perceived ease of use (β=0.271; P<.001), availability (β=0.323; P<.001), subjective well-being (β=0.261; P<.001), and trust (β=0.156, P=.004) positively influenced perceived usefulness, while inertia (β=0.024, P=.22) did not. In addition, availability (β=0.420; P<.001) and subjective well-being (β=0.260; P<.001) were positively related to perceived ease of use, with inertia (β=−0.246; P<.001) having a negative impact. The importance-performance map analysis results showed that subjective well-being (importance=0.532) was the most crucial factor for older adult users, while availability (importance=70.735) had the highest performance in telehealth services. Conclusions: This research underscores the importance of catering to the subjective well-being of older adults and optimizing the availability of telehealth services to encourage adoption, ultimately advancing health care accessibility and quality for this vulnerable demographic. %M 40126531 %R 10.2196/60936 %U https://aging.jmir.org/2025/1/e60936 %U https://doi.org/10.2196/60936 %U http://www.ncbi.nlm.nih.gov/pubmed/40126531 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e54560 %T User Experience of a Bespoke Videoconferencing System for Web-Based Family Visitation for Patients in an Intensive Care Unit: 1-Year Cross-Sectional Survey of Nursing Staff %A Murray,Aoife %A Conroy,Irial %A Kirrane,Frank %A Cullen,Leonie %A Worlikar,Hemendra %A O'Keeffe,Derek T %K telemedicine %K health %K telehealth %K videoconferencing %K web-based %K usability %K intensive care %K critical care %K communication %K COVID-19 %K SARS-COV-2 %K intensive care unit %K ICU %K cross-sectional survey %K nursing %K transmission %K transmission risk %K usability questionnaire %K questionnaire %K reliability %K satisfaction %K usefulness %K family %D 2025 %7 21.3.2025 %9 %J JMIR Hum Factors %G English %X Background: During the COVID-19 pandemic, in-person visitation within hospitals was restricted and sometimes eliminated to reduce the risk of transmission of SARS-CoV-2. Many health care professionals created novel strategies that were deployed to maintain a patient-centered approach. Although pandemic-related restrictions have eased, these systems, including videoconferencing or web-based bedside visits, remain relevant for visitors who cannot be present due to other reasons (lack of access to transport, socioeconomic restraints, geographical distance, etc). Objective: The aims of this study were (1) to report the experience of intensive care nursing staff using a bespoke videoconferencing system called ICU FamilyLink; (2) to examine the scenarios in which the nursing staff used the system; and (3) to assess the future use of videoconferencing systems to enhance communication with families. Methods: A modified Telehealth Usability questionnaire was administered to the nursing staff (N=22) of an intensive care unit in a model 4 tertiary hospital in Ireland 1 year after implementing the bespoke videoconferencing system. Results: In total, 22 nurses working in the intensive care department at University Hospital Galway, Ireland, responded to the survey. A total of 23% (n=5) of participants were between the ages of 25 and 34 years, 54% (n=12) were between 35 and 44 years, and 23% (n=5) were between 45 and 54 years. Most (n=15, 68%) of the participants reported never using videoconferencing in the intensive care setting to communicate with family members before March 2020. The modified Telehealth Usability Questionnaire showed overall satisfaction scores for each subcategory of ease of use and learnability, interface quality, interaction quality, reliability, satisfaction and future use, and usefulness. In total, 21 (95%) participants agreed or strongly agreed with the statement, “I would use the ICU FamilyLink system in future circumstances in which family members cannot be physically present (ie, pandemics, abroad, inability to travel, etc),” and 1 participant responded neutrally. One participant highlighted a common scenario in intensive care settings in which a videoconferencing system can be used “Even without COVID, web-based communication is important when patients become unexpectedly ill and when families are abroad.” Conclusions: This study provides valuable insights into health care professionals’ experience using a videoconferencing system to facilitate web-based visits for families. We conclude that videoconferencing systems when appropriately tailored to the environment with the users in mind can be an acceptable solution to maintain communication with family members who cannot be physically present at the bedside. The bespoke videoconferencing system had an overall positive response from 22 nursing staff who interacted with the system at varying frequency levels. %R 10.2196/54560 %U https://humanfactors.jmir.org/2025/1/e54560 %U https://doi.org/10.2196/54560 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e63148 %T Preferences for Mobile Apps That Aim to Modify Alcohol Use: Thematic Content Analysis of User Reviews %A Kirouac,Megan %A Gillezeau,Christina %K alcohol mobile app %K mHealth %K alcohol use disorder %K user-centered design %K alcohol %K user-centered %K user %K reviews %K usefulness %K mobile health app %K content analysis %K drinking %K health tool %D 2025 %7 19.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Nearly one-third of adults in the United States will meet criteria for alcohol use disorder in their lifetime, yet fewer than 10% of individuals who meet for alcohol use disorder criteria will receive treatment for it. Mobile health (mHealth) applications (apps) have been suggested as a potential mechanism for closing this treatment gap, yet there is a wide variety of quality and integrity within these apps, leading to potential harms to users. Objectives: The aim of this paper is to systematically record and qualitatively examine user reviews or mHealth apps to identify features in the existing apps that may impact usefulness and adoption of them. Methods: The researchers used Apple App and Google Play stores to identify mHealth apps that were focused on modifying alcohol use and treating common comorbidities. Apps that were free without in-app purchases and provided multiple features for users were included. User reviews from the apps were downloaded and coded using content analysis. Results: A total of 425 unique apps were found in our search. Of these, the majority of apps (n=301) were excluded from the present analyses for not focusing on reducing alcohol-related concerns (eg, many apps were for purchasing alcohol). Eight apps were identified and had user reviews downloaded. The apps examined in this study were VetChange, SMART, DrinkCoach, SayingWhen, AlcoStat, Celebrate Recovery, TryDry, and Construction Industry Helpline. A total of 370 reviews were downloaded and 1353 phrases were coded from those reviews into a total of 11 codes. The 5 most common themes identified were praise (498 counts coded; 36.831%), tools (150 counts coded; 11.062%), suggestions for improvement (118 counts coded; 8.756%), criticism (105 counts coded; 7.768%), and tracking (104 counts coded; 7.724%). Conclusions: The current findings suggest that alcohol mobile app users broadly found the apps helpful in reducing their drinking or meeting their drinking goals. Users were able to identify features that they liked or found helpful in the apps, as well as provide concrete feedback about features that they would like included or improved. Specifically, flexible and expansive tracking features and comprehensive whole health tools were cited as valuable and desired. App developers and those looking to expand access to and uptake of alcohol reduction apps may find these user reviews helpful in guiding their app development. %R 10.2196/63148 %U https://mhealth.jmir.org/2025/1/e63148 %U https://doi.org/10.2196/63148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65794 %T Development of a Clinical Decision Support Tool to Implement Asthma Management Guidelines in Pediatric Primary Care: Qualitative Study %A Fedele,David A %A Ray,Jessica M %A Mallela,Jaya L %A Bian,Jiang %A Chen,Aokun %A Qin,Xiao %A Salloum,Ramzi G %A Kelly,Maria %A Gurka,Matthew J %A Hollenbach,Jessica %+ Center for Healthcare Delivery Science, Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32610, United States, 1 904 697 3600, david.fedele@nemours.org %K clinical decision support %K asthma %K primary care %K guidelines %K pediatric %K asthma care %K morbidity %K health information technology %K electronic health record %K EHR %K user-centered design %K inductive approach %K digital health %K health technology %D 2025 %7 18.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a longstanding gap between national asthma guidelines and their implementation in primary care. Primary care providers (PCPs) endorse numerous provider and practice or clinic-related barriers to providing guidelines-based asthma care. To reduce asthma morbidity in primary care, PCPs need access to tools that facilitate adherence to national guidelines, which can be delivered at the point of care, are minimally burdensome, and fit within the clinic workflow. Clinical decision support (CDS) tools are health IT systems that can be housed in the electronic health record (EHR) system. Objective: This study aimed to follow user-centered design principles and describe the formative qualitative work with target stakeholders (ie, PCPs and IT professionals) to inform our design of an EHR-embedded CDS tool that adheres to recent, significant changes in asthma management guidelines. Methods: Purposive sampling was used to recruit three separate subgroups of professionals (n=15) between (1) PCPs with previous experience using a paper-based CDS tool for asthma management, (2) PCPs without previous experience using CDS tools for asthma management, and (3) health care IT professionals. The PCP interview guide focused on their practice, familiarity with national asthma guidelines, and how a CDS tool embedded in the EHR might help them provide guideline-based care. The health care IT professional guide included questions on the design and implementation processes of CDS tools into the EHR. Qualitative data were audio-recorded, transcribed, and then analyzed using an inductive approach to develop themes. Results: Themes were organized into 2 domains, current practice and CDS tool development. The themes that emerged from PCPs included descriptions of assessments conducted to make an asthma diagnosis, previous attempts or opportunities to implement updated national asthma guidelines, and how a CDS tool could be implemented using the EHR and fit into the current asthma management workflow. The themes that emerged from health care IT professionals included processes used to design CDS tools and strategies to collect evidence that indicated a tool’s value to a practice and the broader health system. Conclusions: In this study, user-centered design principles were used to guide a qualitative study on perceived barriers and facilitators to a primary care–based, EHR-integrated asthma CDS tool. PCPs expressed their interest in adopting an asthma CDS tool that was low burden and efficient but could help them adhere to national asthma guidelines and improve clinic workflow. Similarly, health care IT professionals perceived an asthma CDS tool to be useful, if it adhered to EHR design standards. Implementation of a CDS tool to improve adherence of PCPs to recently updated national asthma guidelines could be beneficial in reducing pediatric asthma morbidity. %M 40100268 %R 10.2196/65794 %U https://formative.jmir.org/2025/1/e65794 %U https://doi.org/10.2196/65794 %U http://www.ncbi.nlm.nih.gov/pubmed/40100268 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e56053 %T Optimization of the Care4Today Digital Health Platform to Enhance Self-Reporting of Medication Adherence and Health Experiences in Patients With Coronary or Peripheral Artery Disease: Mixed Methods Study %A Juan,Stephanie %A Harxhi,Ante %A Kaul,Simrati %A Woods,Breeana %A Tran,Monica %A Geonnotti,Gabrielle %A Gupta,Archit %A Dean,Emily %A Saunders,Cassandra E %A Payne,Gloria %+ Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, United States, 1 609 732 5221, stphjuan@gmail.com %K app %K cardiovascular disease %K Care4Today %K coronary artery disease %K digital health %K health tracker %K medication reminder %K mobile health %K mHealth %K qualitative %K peripheral artery disease %D 2025 %7 17.3.2025 %9 Original Paper %J JMIR Cardio %G English %X Background: Care4Today is a digital health platform developed by Johnson & Johnson comprising a patient mobile app (Care4Today Connect), a health care provider (HCP) portal, and an educational website. It aims to improve medication adherence; enable self-reporting of health experiences; provide patient education; enhance connection with HCPs; and facilitate data and analytics learning across disease areas, including cardiovascular disease. Objective: This study aimed to gather patient feedback on Care4Today Connect, specifically the coronary artery disease (CAD) and peripheral artery disease (PAD) module, and to cocreate and validate features with patients to optimize the app experience for those with CAD, PAD, or both. Methods: We conducted 3 research engagements between November 2022 and May 2023. Participants were US-based adults recruited and consented through the sponsor’s Patient Engagement Research Council program. Participants self-reported a diagnosis of cardiovascular disease, and in some cases, specifically, CAD, PAD, or both. Part 1, internet survey, posed quantitative questions with Likert-scale answer options about existing app features. Part 2, virtual focus group, and part 3, virtual individual interviews, both used semistructured qualitative discussion to cocreate and validate new app enhancements. The quantitative data from part 1 was evaluated descriptively to categorize mobile health app use, confidence in the ability to use the app, and motivations for app use. The qualitative discussions from parts 2 and 3 were synthesized to understand participants’ app needs and preferences to inform an optimal app experience. Results: The response rate for part 1, internet survey, was 67% (37/55). Most participants felt at least somewhat confident using the app after seeing the newly added app tutorial (33/37, 89%), and at least somewhat confident in their ability to earn points for completing activities using app instructions (33/37, 89%). In part 2, virtual focus group (n=3), and part 3, virtual individual interviews (n=8), participants collectively preferred to enhance the app with (1) the ability to automatically add medication data for tracking and (2) the ability to receive relevant care team feedback on their self-reported health experiences. Participants would be willing to spend 10-15 minutes a day tracking 4-5 health experiences, especially those requested by their HCP. Conclusions: Participants prefer apps that can reduce user burden and provide information relevant to them. Care4Today Connect can optimize the user experience for patients with CAD, PAD, or both with the automatic addition of medication data for tracking and in-app care team feedback on patient self-reported health experiences. %M 40094792 %R 10.2196/56053 %U https://cardio.jmir.org/2025/1/e56053 %U https://doi.org/10.2196/56053 %U http://www.ncbi.nlm.nih.gov/pubmed/40094792 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65228 %T Digital Cognitive Behavioral Therapy–Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial %A Isaac,Fadia %A Klein,Britt %A Nguyen,Huy %A Watson,Shaun %A Kennedy,Gerard A %+ Institute of Health and Wellbeing, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia, 61 353276717, fadia.isaac@hotmail.com %K insomnia %K nightmares %K posttraumatic stress disorder %K PTSD %K wildfires %K cognitive behavioral therapy for insomnia %K CBTi %K exposure, relaxation, and rescripting therapy %K ERRT %K Sleep Best-i %K mobile health %K mHealth %K digital health %K computer %K eHealth %K bushfires %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes. Objective: This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States. Methods: Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ≥8 on the Insomnia Severity Index, a score of ≥3 on the Nightmare Disorder Index, or a score of ≥31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53%) or the waitlist control group (n=14, 47%) in a sequential manner. Participants’ ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63% (19/30) female and 37% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder–7, the Patient Health Questionnaire–9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis. Results: Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention’s effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition × time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire–9. No changes were detected on the Generalized Anxiety Disorder–7. The per-protocol analysis yielded comparable results for both the primary and secondary measures. Conclusions: The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054 %M 40085843 %R 10.2196/65228 %U https://humanfactors.jmir.org/2025/1/e65228 %U https://doi.org/10.2196/65228 %U http://www.ncbi.nlm.nih.gov/pubmed/40085843 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60156 %T Transcultural Adaptation, Validation, Psychometric Analysis, and Interpretation of the 22-Item Thai Senior Technology Acceptance Model for Mobile Health Apps: Cross-Sectional Study %A Buawangpong,Nida %A Siviroj,Penprapa %A Pinyopornpanish,Kanokporn %A Sirikul,Wachiranun %+ Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110 Intrawarorot road, Sriphum, Mueng, Chiang Mai, 50200, Thailand, 66 53935472, wachiranun.sir@cmu.ac.th %K STAM %K senior technology acceptance model %K validity %K reliability %K mHealth %K older adult %K technology acceptance %K mobile health %K app %K transcultural adaptation %K psychometric analysis %K geriatrics %K cross-sectional study %K Thai %K theory analysis %K Cronbach α %K McDonald ω %K quality of life %K well-being %K social media %K telehealth %K health informatics %K eHealth %K mobile phone %D 2025 %7 11.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The rapid advancement of technology has made mobile health (mHealth) a promising tool to mitigate health problems, particularly among older adults. Despite the numerous benefits of mHealth, assessing individual acceptance is required to address the specific needs of older people and promote their intention to use mHealth. Objective: This study aims to adapt and validate the senior technology acceptance model (STAM) questionnaire for assessing mHealth acceptance in the Thai context. Methods: In this cross-sectional study, we adapted the original, 38-item, English version of the STAM using a 10-point Likert scale for mHealth acceptability among the Thai population. We translated the mHealth STAM into Thai using forward and backward translation. A total of 15 older adults and experts completed the pilot questionnaire and were interviewed to assess its validity. The pilot items of the Thai mHealth STAM were then reworded and revised for better comprehension and cross-cultural compatibility. The construct validity of the Thai mHealth STAM was evaluated by a multidimensional approach, including exploratory and confirmatory factor analysis and nonparametric item response theory analysis. Discriminative indices consisting of sensitivity, specificity, and area under the receiver operating characteristic (AUROC) were used to determine appropriate banding and discriminant validity for the intention to use mHealth. Internal consistency was assessed using Cronbach α and McDonald ω coefficients. Results: Out of the 1100 participants with a mean age of 62.3 (SD 8.8) years, 360 (32.7%) were adults aged 45-59 years, and 740 (67.3%) were older adults aged 60 years and older. Of the 40-item pilot questionnaire, exploratory factor analysis identified 22 items with factor loadings >0.4 across 7 principal components, explaining 91.45% of the variance. Confirmatory factor analysis confirmed that 9-dimensional sets of 22 items had satisfactory fit indices (comparative fit index=0.976, Tucker-Lewis index=0.968, root mean square error of approximation=0.043, standardized root mean squared residual=0.044, and R2 for each item>0.30). The score banding D (low≤151, moderate 152-180, and high≥181) was preferred as the optimal 22-item Thai mHealth STAM cutoff score based on the highest sensitivity of 89% (95% CI 86.1%-91.5%) and AUROC of 72.4% (95% CI 70%-74.8%) for predicting the intention to use mHealth. The final Thai mHealth STAM, consisting of 22 items, exhibited remarkable internal consistency, as evidenced by a Cronbach α of 0.88 (95% CI 0.87-0.89) and a McDonald ω of 0.85 (95% CI 0.83-0.87). For all 22 items, the corrected item-total correlations ranged between 0.26 and 0.71. Conclusions: The 22-item Thai mHealth STAM demonstrated satisfactory psychometric properties in both validity and reliability. The questionnaire has the potential to serve as a practical questionnaire in assessing the acceptance and intention to use mHealth among pre-older and older adults. %M 40068149 %R 10.2196/60156 %U https://aging.jmir.org/2025/1/e60156 %U https://doi.org/10.2196/60156 %U http://www.ncbi.nlm.nih.gov/pubmed/40068149 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e52544 %T Benefits and Barriers to mHealth in Hypertension Care: Qualitative Study With German Health Care Professionals %A May,Susann %A Muehlensiepen,Felix %A Wengemuth,Eileen %A Seifert,Frances %A Heinze,Martin %A Bruch,Dunja %A Spethmann,Sebastian %+ Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Faculty of Health Sciences, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 3391 39 145 91, susann.may@mhb-fontane.de %K hypertension %K mHealth apps %K digital health %K physicians %K nurses %K HCP %K qualitative interviews %K health care professional %K cardiologists %K mHealth %K Germany %K general practitioners %K blood pressure monitoring %K qualitative study %K qualitative content analysis %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health technologies, particularly mobile health (mHealth) apps and wearable devices, have emerged as crucial assets in the battle against hypertension. By enabling lifestyle modifications, facilitating home blood pressure monitoring, and promoting treatment adherence, these technologies have significantly enhanced hypertension treatment. Objective: This study aims to explore the perspectives of health care professionals (HCPs) regarding the perceived benefits and barriers associated with the integration of mHealth apps into routine hypertension care. Additionally, strategies for overcoming these barriers will be identified. Methods: Through qualitative analysis via semistructured interviews, general practitioners (n=10), cardiologists (n=14), and nurses (n=3) were purposefully selected between October 2022 and March 2023. Verbatim transcripts were analyzed using qualitative content analysis. Results: The results unveiled 3 overarching themes highlighting the benefits of mHealth apps in hypertension care from the perspective of HCPs. First, these technologies possess the potential to enhance patient safety by facilitating continuous monitoring and early detection of abnormalities. Second, they can empower patients, fostering autonomy in managing their health conditions, thereby promoting active participation in their care. Lastly, mHealth apps may provide valuable support to medical care by offering real-time data that aids in decision-making and treatment adjustments. Despite these benefits, the study identified several barriers hindering the seamless integration of mHealth apps into hypertension care. Challenges predominantly revolved around data management, communication contexts, daily routines, and system handling. HCPs underscored the necessity for structural and procedural modifications in their daily practices to effectively address these challenges. Conclusions: In conclusion, the effective usage of digital tools such as mHealth apps necessitates overcoming various obstacles. This entails meeting the information needs of both HCPs and patients, tackling interoperability issues to ensure seamless data exchange between different systems, clarifying uncertainties surrounding reimbursement policies, and establishing the specific clinical benefits of these technologies. Active engagement of users throughout the design and implementation phases is crucial for ensuring the usability and acceptance of mHealth apps. Moreover, enhancing knowledge accessibility through the provision of easily understandable information about mHealth apps is essential for eliminating barriers and fostering their widespread adoption in hypertension care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 %M 40063928 %R 10.2196/52544 %U https://humanfactors.jmir.org/2025/1/e52544 %U https://doi.org/10.2196/52544 %U http://www.ncbi.nlm.nih.gov/pubmed/40063928 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e63607 %T Factors Associated With the Intention to Use mHealth Among Thai Middle-Aged Adults and Older Adults: Cross-Sectional Study %A Buawangpong,Nida %A Sirikul,Wachiranun %A Siviroj,Penprapa %K mHealth %K mobile healthcare %K older adults %K elderly %K aging %K questionnaire %K smartphone %K mHealth usage %K intention to use %D 2025 %7 7.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Mobile health care (mHealth) apps are emerging worldwide as a vital component of internet health care, but there are issues, especially among older adults. Objective: We aim to investigate the factors influencing the intention to use (ITU) mHealth apps, focusing on those with and without prior mHealth experience. Methods: A cross-sectional study conducted from August 2022 to July 2023 included Thai citizens aged 45 years or older. Self-reported questionnaires collected data on sociodemographic information, health conditions, smartphone or tablet ownership, and mHealth usage experience. The Thai mHealth Senior Technology Acceptance Model questionnaires with a 10-point Likert scale evaluated mHealth acceptance. A multivariable logistic regression analysis, adjusted for age, gender, education, income, and living area, was performed for 2 subgroups: those who used ITU mHealth apps and those who did not. Results: Of 1100 participants, 537 (48.8%) intended to use mHealth apps, while 563 (51.2%) did not. The ITU group had a younger average age, higher education levels, higher income, and fewer underlying diseases compared to those who did not intend to use mHealth apps. For those who had never used mHealth apps, having a smartphone was strongly associated with higher odds of ITU (adjusted odds ratio 2.81, 95% CI 1.6 to 4.93; P<.001), while having any underlying disease was associated with lower odds of ITU (adjusted odds ratio 0.63, 95% CI 0.42 to 0.97; P=.034). Higher acceptance levels, characterized by a positive attitude toward mHealth and lower fear of making mistakes, were also associated with higher ITU. For those with prior mHealth experience, acceptance in areas such as perceived ease of use, gerontechnology anxiety, and facilitating conditions was significantly associated with ITU. Conclusions: Among inexperienced users, a positive attitude toward mHealth significantly enhanced ITU. Conversely, having an underlying disease decreased ITU, indicating a need for tailored mHealth apps. For experienced users, acceptance levels in areas such as ease of use and gerontechnology anxiety were crucial. Future research should explore specific mHealth apps for more targeted insights. %R 10.2196/63607 %U https://humanfactors.jmir.org/2025/1/e63607 %U https://doi.org/10.2196/63607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72477 %T Authors’ Reply: Advancing Digital Health Integration in Oncology %A Lee,Yura %A Park,Ye-Eun %+ Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 1498, haepary@amc.seoul.kr %K mHealth %K user experience %K cancer %K technology acceptance model %K structural equation modeling %K health care app %K mixed-method study %K medical care %K digital health care %K cancer survivors %K disparities %K health status %K behavioral intervention %K clinician %D 2025 %7 7.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40053760 %R 10.2196/72477 %U https://www.jmir.org/2025/1/e72477 %U https://doi.org/10.2196/72477 %U http://www.ncbi.nlm.nih.gov/pubmed/40053760 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70316 %T Advancing Digital Health Integration in Oncology %A Khan,Rai Muhammad Umar %A Tariq,Hassan %+ Punjab Medical College, Faisalabad Medical University, Sargodha Road, Faisalabad, 38800, Pakistan, 92 41 9210080, raimumerkhan@gmail.com %K mHealth %K user experience %K cancer %K technology acceptance model %K structural equation modeling %K health care app %K mixed-method study %K medical care %K digital health care %K cancer survivors %K disparities %K health status %K behavioral intervention %K clinician %D 2025 %7 7.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40053796 %R 10.2196/70316 %U https://www.jmir.org/2025/1/e70316 %U https://doi.org/10.2196/70316 %U http://www.ncbi.nlm.nih.gov/pubmed/40053796 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e63805 %T An Actor-Partner Interdependence Mediation Model for Assessing the Association Between Health Literacy and mHealth Use Intention in Dyads of Patients With Chronic Heart Failure and Their Caregivers: Cross-Sectional Study %A Jin,Xiaorong %A Zhang,Yimei %A Zhou,Min %A Mei,Qian %A Bai,Yangjuan %A Hu,Qiulan %A Wei,Wei %A Zhang,Xiong %A Ma,Fang %K chronic heart failure %K caregivers %K health literacy %K mHealth %K actor-partner interdependence mediation model %K mobile health %D 2025 %7 6.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Chronic heart failure (CHF) has become a serious threat to the health of the global population. Self-management is the key to treating CHF, and the emergence of mobile health (mHealth) has provided new ideas for the self-management of CHF. Despite the many potential benefits of mHealth, public utilization of mHealth apps is low, and poor health literacy (HL) is a key barrier to mHealth use. However, the mechanism of the influence is unclear. Objective: The aim of this study is to explore the dyadic associations between HL and mHealth usage intentions in dyads of patients with CHF and their caregivers, and the mediating role of mHealth perceived usefulness and perceived ease of use in these associations. Methods: This study had a cross-sectional research design, with a sample of 312 dyads of patients with CHF who had been hospitalized in the cardiology departments of 2 tertiary care hospitals in China from March to October 2023 and their caregivers. A general information questionnaire, the Chinese version of the Heart Failure-Specific Health Literacy Scale, and the mHealth Intention to Use Scale were used to conduct the survey; the data were analyzed using the actor-partner interdependence mediation model. Results: The results of the actor-partner interdependent mediation analysis of HL, perceived usefulness of mHealth, and mHealth use intention among patients with CHF and their caregivers showed that all of the model’s actor effects were valid (β=.26‐0.45; P<.001), the partner effects were partially valid (β=.08‐0.20; P<.05), and the mediation effects were valid (β=.002‐0.242, 95% CI 0.003‐0.321; P<.05). Actor-partner interdependent mediation analyses of HL, perceived ease of use of mHealth, and mHealth use intention among patients with CHF and caregivers showed that the model’s actor effect partially held (β=.17‐0.71; P<.01), the partner effect partially held (β=.15; P<.01), and the mediation effect partially held (β=.355‐0.584, 95% CI 0.234‐0.764; P<.001). Conclusions: Our study proposes that the HL of patients with CHF and their caregivers positively contributes to their own intention to use mHealth, suggesting that the use of mHealth by patients with CHF can be promoted by improving the HL of patients and caregivers. Our findings also suggest that the perceived usefulness of patients with CHF and caregivers affects patients’ mHealth use intention, and therefore patients with CHF and their caregivers should be involved throughout the mHealth development process to improve the usability of mHealth for both patients and caregivers. This study emphasizes the key role of patients’ perception that mHealth is easy to use in facilitating their use of mHealth. Therefore, it is recommended that the development of mHealth should focus on simplifying operational procedures and providing relevant operational training according to the needs of the patients when necessary. %R 10.2196/63805 %U https://mhealth.jmir.org/2025/1/e63805 %U https://doi.org/10.2196/63805 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58867 %T Patient Adoption of Digital Use Cases in Family Medicine and a Nuanced Implementation Approach for Family Doctors: Quantitative Web-Based Survey Study %A Beerbaum,Julian %A Robens,Sibylle %A Fehring,Leonard %A Mortsiefer,Achim %A Meister,Sven %+ Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Pferdebachstr. 11, Witten, 58448, Germany, 49 230292678629, sven.meister@uni-wh.de %K technology acceptance %K UTAUT %K family doctor %K digital health %K eHealth %K video consultation %K electronic health records %K digital anamnesis %K online appointment scheduling %D 2025 %7 5.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital use cases describe the application of technology to achieve specific outcomes. Several studies in health care have examined patients’ overall attitudes toward digitalization and specific use cases. However, these studies have failed to provide a comparison of patient acceptance criteria between inherently different digital use cases in family medicine. Objective: To address this research gap, this paper aimed to assist family doctors in selecting digital use cases by comparing the underlying patient adoption factors and in driving usage of these use cases by presenting a differentiated implementation approach. Methods: Adapting an established Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire to 4 digital use cases in family medicine, we surveyed a large cross-sectional sample of adults living in Germany. The results of the web-based survey were then analyzed via descriptive statistics, ANOVA, and hierarchical regression models to compare the effects of sociodemographic and technology acceptance factors on the intention to use a specific use case. Results: Our web-based survey included 1880 participants. Of these 1880 participants, only 304 (16.2%) agreed that the degree of digitalization is important when selecting a family practice. However, more digitally literate participants attributed greater importance to this criterion (B=0.226, SE 0.023; β=.223; P<.001), and digital literacy was found to be dependent on age (Welch F3,968.29=53.441; P<.001). Regarding sociodemographic characteristics, only digital literacy demonstrated a significant effect on the intention to use for all use cases, particularly scheduling doctor appointments online (B=0.322, SE 0.033; β=.408; P<.001). Furthermore, performance expectancy was the strongest predictor of the intention to use for all use cases, while further effects of technology acceptance factors depended on the use case (receiving medical consultations via video: B=0.603, SE 0.049; β=.527; P<.001; scheduling doctor appointments online: B=0.566, SE 0.043; β=.513; P<.001; storing personal medical information via electronic health records: B=0.405, SE 0.047; β=.348; P<.001; and providing personal information before consultation digitally [digital anamnesis]: B=0.434, SE 0.048; β=.410; P<.001). To illustrate, perceived privacy and security had an effect on the intention to use electronic health records (B=0.284, SE 0.040; β=.243; P<.001) but no effect on the intention to use video consultations (B=0.068, SE 0.042; β=.053; P=.10). Conclusions: In the selection and implementation of digital use cases, family doctors should always prioritize the perceived value of the digital use case for the patient, and further criteria might depend on the digital use case. Practice owners should therefore always harmonize the introduction of digital use cases with their own patient care strategies. Not every digital innovation fits every strategy and therefore every practice. %M 40053731 %R 10.2196/58867 %U https://formative.jmir.org/2025/1/e58867 %U https://doi.org/10.2196/58867 %U http://www.ncbi.nlm.nih.gov/pubmed/40053731 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55592 %T Utilization and Experiences of Using Quit Now, a Nicotine and Tobacco Smoking Cessation Website: Thematic Analysis %A Salaheddin,Tala %A Sharma,Ramona H %A Fajardo,Marcela %A Panter,Cameron %A De Souza,Lauren %A Matano,Sheila Kanyevu %A Struik,Laura %+ Doctor of Medicine Program, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada, 1 6048222211, talasala@student.ubc.ca %K smoking cessation %K user experiences %K nicotine %K vaping %K web-based %K Google Analytics %K thematic analysis %K digital health %K nicotine replacement therapy %K quit attempts %K tobacco %K British Columbia %K behavioral support %K pharmacotherapy %K qualitative interview %K cessation support %K QuitNow %K mobile health %K mHealth %K intervention %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: British Columbia residents have access to a program called QuitNow that provides behavioral support and information about pharmacotherapy to nicotine and tobacco users. Web- or computer-based smoking cessation programs have been shown to yield an abstinence rate about 1.5 times higher when compared to a control. Although quantitative evidence reveals significant promise for web-based services like QuitNow, there is very little qualitative evidence available. Understanding website utilization and the experiences of end users is key to contextualizing the effectiveness of web-based cessation services and providing directions for enhancing these services. Objective: This qualitative interview study aims to delve into users’ utilization and experiences of QuitNow, which is supplemented by Google Analytics data. Methods: We interviewed 10 QuitNow users using semistructured interviews to understand what they liked the most and the least about QuitNow. We transcribed these interviews and conducted an inductive thematic analysis using NVivo (QSR International) software to extract common themes about user experiences. We also gathered utilization metrics via Google Analytics (n=13,856 users) to understand which aspects of QuitNow were used the most and which were used the least during the study period. Results: Thematic analysis yielded four major themes: (1) barriers to information access reduce opportunities to take action, (2) lack of clarity around pharmacological options is discouraging, (3) hearing from others is an important part of the journey, and (4) recognizing own agency throughout the quit process. These themes provided context and support for the Google Analytics data, which showed that end user activity, measured by indicators such as page views and average time spent on each page, was highest on pages about how to quit (10,393 page views), pharmacology information (1999 page views), and the community forum (11,560 page views). Conclusions: Results of this study point to several important implications for improving the website, as well as directions for enhancing cessation support services in general. %M 40053769 %R 10.2196/55592 %U https://www.jmir.org/2025/1/e55592 %U https://doi.org/10.2196/55592 %U http://www.ncbi.nlm.nih.gov/pubmed/40053769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58266 %T App- and Wearable-Based Remote Monitoring for Patients With Myasthenia Gravis and Its Specialists: Feasibility and Usability Study %A Stein,Maike %A Stegherr,Regina %A Narayanaswami,Pushpa %A Legg,David %A Herdick,Meret %A Meisel,Andreas %A Gerischer,Lea %A Lehnerer,Sophie %K myasthenia gravis %K myasthenia %K remote monitoring %K PROMs %K digital platform %K wearables %K telemedicine %K spirometry %K app %K usability %K feasibility %K autoimmune disorder %K web-based portal %K activity tracker %K communication %K wearable data %K digital tool %K mobile phone %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Myasthenia gravis (MG) is rare, chronic autoimmune disorder of the neuromuscular junction that requires specialized care and often lifelong treatment, facing challenges due to its rarity and the limited availability of specialists. Telemedical solutions in specialized centers hold considerable promise in bridging this gap by increasing access to this care to a broader patient population in a timely manner. However, there is no research regarding interventional remote care solutions in the field of MG to date. Objective: This study aimed to assess the feasibility and usability among patients with MG and specialists of a telemedicine platform, tailored to patients with MG and designed to facilitate remote monitoring, treated in a specialized center. Methods: The telemedicine platform consisted of an app for patients and a web-based portal for physicians. Over a period of 3 months, 30 patients continuously monitored their vital parameters through external devices, including a digital spirometer and a wearable (activity tracker). Furthermore, patients completed 7 different patient-reported outcome measures (PROMs) through the app at predefined intervals. Specialists could review this monitoring data and adjust therapy as necessary. In addition, communication between patients and physicians was facilitated through a chat module. Feasibility was evaluated by total adherence rates for completing PROMs within the app, alongside the collection of spirometry and wearable data. Furthermore, user satisfaction was assessed among both patients with MG and physicians at the end of study. Results: Total adherence rates ranged from 74.3% (1830/2464) to 97.9% (327/334) across all data types, with the highest adherence observed for PROMs (1139/1179, 96.6%), followed by spirometry (293/334, 87.7%) and wearables (1830/2261, 80.9%). Notably, patients wore the wearable longer than required by protocol and conducted a higher number of spirometry measurements during the study than required per protocol (median 20 h/d [IQR 15-24] vs 14 h/d and median 49 [IQR 15-59] measurements vs 11 measurements, respectively). Technical issues and discomfort with wearables were factors affecting lower adherence in some patients. The System Usability Scale yielded a median score of 85 indicating “excellent usability.” In addition, results from a more detailed user evaluation questionnaire showed high levels of user satisfaction among both patients and health care professionals across diverse categories, including their experience of the care program, communication, and evaluation of the program. Conclusions: Remote monitoring of patients with MG through the telemedical platform demonstrated good feasibility and acceptability, as evidenced by above-average adherence rates and user satisfaction for both patients and physicians. The majority of patients wanted to continue using the app. These findings highlight the potential for user-friendly digital tools to enhance care for patients with MG, although addressing technical challenges and ensuring patient comfort with wearables are essential for optimal implementation. Further research involving larger cohorts and longer study duration is warranted to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029907; https://drks.de/search/en/trial/DRKS00029907 %R 10.2196/58266 %U https://formative.jmir.org/2025/1/e58266 %U https://doi.org/10.2196/58266 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e48370 %T Development and Testing of the Kids Hurt App, a Web-Based, Pain Self-Report App for First Nations Youths: Mixed Methods Study %A Francis,Karlee %A Francis,Julie %A Latimer,Margot %A Gould,Hayley %A Blackmore,Shante %A MacLeod,Emily %K app %K eHealth %K pain %K Indigenous %K First Nations %K children %K youths %K mobile phone %D 2025 %7 3.3.2025 %9 %J JMIR Hum Factors %G English %X Background: First Nations children and youths may have unique ways to convey their health needs that have not been recognized by health providers. This may contribute to the disparity between high rates of mental health and physical pain and low rates of treatment for the conditions they experience. Evidence suggests that a colonial history has resulted in poor experiences with the health care system, lack of trust with health providers, and miscommunication between clinicians and patients. Contemporary ways, using both Indigenous and Western knowledge, are needed to bridge the gap in communicating pain. Objective: The aim of this qualitative study was to test the usability and clinical feasibility of the Kids Hurt App with First Nations youths and clinicians working with youths. Methods: Using a Two-Eyed Seeing approach, the Kids Hurt App was developed using concepts from validated mood and pain assessment apps combined with community-based research that gathered First Nations youths and clinicians perspectives on quality, intensity, and location of pain and hurt. The Kids Hurt App contains 16 screens accessible on any web-based device. Results: In total, 3 rounds of low-fidelity testing (n=19), 2 rounds of high-fidelity testing (n=20), and 2 rounds of clinical feasibility testing (n=10) were conducted with First Nations youths (10‐19 years) to determine the relevance, validity, and usability of the Kids Hurt App. High-fidelity testing was also conducted with 15 clinicians after completing the high-fidelity youth sessions. Youths had constructive suggestions that were used to improve the app in subsequent rounds of version testing. There was one main discrepancy between youths and clinicians related to preference for how best to visually convey pain. The youth’s preference was maintained in the app. Conclusions: All youths in all rounds of testing indicated that they would use the Kids Hurt App if it was available to them in a health care setting, with most clinicians noting that the app would be useful in practice. %R 10.2196/48370 %U https://humanfactors.jmir.org/2025/1/e48370 %U https://doi.org/10.2196/48370 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64661 %T Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool %A Connelly,Jenni %A Swingler,Kevin %A Rodriguez-Sanchez,Nidia %A Whittaker,Anna C %+ Faculty of Health Sciences and Sport, University of Stirling, 3a74a Cottrell Building, Stirling, FK9 4LA, United Kingdom, 44 1786 466399, jenni.connelly1@stir.ac.uk %K ageing %K digital technology %K dietary measurement %K care homes %K co-design %K dietary intake %K food diary %D 2025 %7 3.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Malnutrition is a challenge among older adults and can result in serious health consequences. However, the dietary intake monitoring needed to identify malnutrition for early intervention is affected by issues such as difficulty remembering or needing a dietitian to interpret the results. Objective: This study aims to co-design a tool using automated food classification to monitor dietary intake and food preferences, as well as food-related symptoms and mood and hunger ratings, for use in care homes. Methods: Participants were 2 separate advisory groups and 2 separate sets of prototype testers. The testers for the first prototype were 10 community-dwelling older adults based in the Stirlingshire area in Scotland who noted their feedback on the tool over 2 weeks in a food diary. The second set of testers consisted of 14 individuals (staff: n=8, 57%; and residents: n=6, 43%) based in 4 care homes in Scotland who provided feedback via interview after testing the tool for a minimum of 3 days. In addition, 130 care home staff across the United Kingdom completed the web-based survey on the tool’s needs and potential routes to pay for it; 2 care home managers took part in follow-up interviews. Data were collected through food diaries, a web-based survey, audio recordings and transcriptions of focus groups and interviews, and research notes. Systematic text condensation was used to describe themes across the different types of data. Results: Key features identified included ratings of hunger, mood, and gastrointestinal symptoms that could be associated with eating specific foods, as well as a traffic light system to indicate risk. Issues included staff time, Wi-Fi connectivity, and the accurate recognition of pureed food and fortified meals. Different models for potential use and commercialization were identified, including peer support among residents to assist those considered less able, staff-only use of the tool, care home–personalized database menus for easy meal photo selection, and targeted monitoring of residents considered to be at the highest risk using the traffic light system. Conclusions: The tool was deemed useful for monitoring dietary habits and associated symptoms, but necessary design improvements were identified. These should be incorporated before formal evaluation of the tool as an intervention in this setting. Co-design was vital to help make the tool fit for the intended setting and users. %M 40053797 %R 10.2196/64661 %U https://aging.jmir.org/2025/1/e64661 %U https://doi.org/10.2196/64661 %U http://www.ncbi.nlm.nih.gov/pubmed/40053797 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e59780 %T The mChoice App, an mHealth Tool for the Monitoring of Preexposure Prophylaxis Adherence and Sexual Behaviors in Young Men Who Have Sex With Men: Usability Evaluation %A Dos Santos,Fabiana Cristina %A Brin,Maeve %A Tanner,Mary R %A Galindo,Carla A %A Schnall,Rebecca %K HIV prevention %K data visualization %K patient-reported health information %K mHealth %K digital health %K usability %K human immunodeficiency virus %K preexposure prophylaxis %K men who have sex with men %K apps %K HIV %K PrEP %D 2025 %7 28.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) apps provide easy and quick access for end users to monitor their health-related activities. Features such as medication reminders help end users adhere to their medication schedules and automatically record these actions, thereby helping manage their overall health. Due to insufficient mHealth tools tailored for HIV preventive care in young men who have sex with men (MSM), our study evaluated the usability of the mChoice app, a tool designed to enhance preexposure prophylaxis (PrEP) adherence and promote sexual health (eg, encouraging the use of condoms and being aware of the partner’s HIV status and PrEP use). Objective: This study aimed to apply systematic usability evaluations to test the mChoice app and to refine the visualizations to better capture and display patient-reported health information. Methods: Usability testing involved heuristic evaluations conducted with 5 experts in informatics and user testing with 20 young MSM who were taking or were eligible to take PrEP. Results: End users demonstrated satisfaction with the appearance of the mChoice app, reporting that the app has an intuitive interface to track PrEP adherence. However, participants highlighted areas needing improvement, including chart titles and the inclusion of “undo” and “edit” buttons to improve user control when recording PrEP use. Conclusions: Usability evaluations involving heuristic experts and end users provided valuable insights into the mChoice app’s design. Areas for improvement were identified, such as enhancing chart readability and providing additional user controls. These findings will guide iterative refinements, ensuring that future versions of the app better address the needs of its target audience and effectively support HIV prevention. %R 10.2196/59780 %U https://humanfactors.jmir.org/2025/1/e59780 %U https://doi.org/10.2196/59780 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64867 %T Provider Perspectives on the Use of Mental Health Apps, and the BritePath App in Particular, With Adolescents at Risk for Suicidal Behavior: Qualitative Study %A Lynch,Frances %A Cavese,Julie %A Fulton,Lucy %A Vuckovic,Nancy %A Brent,David %+ , Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, United States, 1 503 335 2400, frances.lynch@kpchr.org %K depression %K adolescent %K suicidality %K safety plan %K mental health %K apps %K suicide %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Many youth with significant mental health concerns face limited access to mental health services. Digital programs, such as mobile apps designed to address mental health issues, have the potential to expand access to strategies for managing these conditions. However, few mental health apps are specifically designed for youth experiencing severe concerns, such as suicidal ideation. BritePath is a new app developed to enhance communication and interaction between providers and youth at risk for suicidal behavior. Objective: This study aims to explore health care providers’ opinions and concerns regarding the use of mental health apps for youth at significant risk of suicidal behavior. Methods: We conducted individual semistructured interviews with 17 providers across 7 states. Interviews were conducted via video, recorded, and transcribed. Codes were developed using a team-based approach, with discrepancies resolved through team discussions. Results: Most providers were aware of mental health apps in general and expressed interest in trying the BritePath app with patients experiencing depression, suicidality, or both. Analyses identified 4 key themes related to mental health apps: (1) almost all providers viewed mental health apps as an adjunct to, rather than a replacement for, psychotherapy visits; (2) most providers were concerned about the cost of apps and youth access to them; (3) providers noted the challenge of maintaining patient engagement with apps over time; and (4) providers were concerned about patient privacy, in terms of both data shared with app developers and data privacy within families. Analyses of providers’ opinions specifically about the BritePath app identified 4 additional themes: (1) providers believed that access to safety plans within BritePath could be beneficial for youth at risk for suicidal behavior; (2) providers reported that BritePath’s interactive features could enhance communication between providers and youth; (3) providers appreciated BritePath’s flexibility and the ability for both youth and providers to tailor its content to individual needs; and (4) providers expressed concerns about integrating BritePath into clinical workflows within health systems. Conclusions: The use of mental health apps is expanding, yet there is limited understanding of how to effectively integrate these tools into mental health treatment. Providers are increasingly referring patients to mental health apps, and most expressed interest in trying the BritePath app for patients with depression, suicidality, or both. However, providers also identified several concerns, particularly regarding privacy and safety. %M 40009843 %R 10.2196/64867 %U https://humanfactors.jmir.org/2025/1/e64867 %U https://doi.org/10.2196/64867 %U http://www.ncbi.nlm.nih.gov/pubmed/40009843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60699 %T Perceptions, Experiences, and Beliefs About Patient Portals Among Women With Limited English Proficiency: Multicultural Qualitative Interview Study %A Han,Hae-Ra %A Chepkorir,Joyline %A Kim,Tina %A Zamora,Martha %A Huang,Emma %+ Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 614 2669, hhan3@jhu.edu %K patient portal %K limited English proficiency %K immigrant %K women %K mobile phone %D 2025 %7 26.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals in the United States with limited English proficiency (LEP) experience a disproportionate disease burden. Patient portals provide patient education, outreach, and linkage to preventive health services. While patient portals have been found to be effective in facilitating the use of preventive services, they have predominantly engaged well-educated, English-speaking, White populations. There is limited research investigating experiences and beliefs about patient portals among populations with LEP. Objective: This study aims to explore perceptions, experiences, and beliefs about patient portals among women with LEP. Methods: We used a qualitative semistructured interview design and recruited a purposive sample of women through diverse methods. The interview guide covered topics including experiences with patient portals, the perceived feasibility and relevance of patient portals, and perceptions of patient portals targeted toward women with LEP for health promotion. The interviews were audio recorded for verbatim transcription and analysis. Each bilingual interviewer reached data saturation after interviewing 12 (43%), 9 (32%), and 7 (25%) Korean-, Spanish-, and Swahili-speaking women, respectively, yielding a total of 28 women in the study. Results: We identified 4 main themes that were common across all linguistic groups: perceived benefits of patient portals, perceived facilitators of patient portal use, perceived barriers to patient portal use, and preferred features and suggested improvements. Perceived benefits of patient portals had 5 subthemes: easier communication with health care providers and health systems, getting connected and staying connected with health systems, easier and efficient access to one’s health records over time, staying informed of and engaged with one’s health and health management, and better patient engagement in medical visits. Subthemes for perceived facilitators of patient portal use were availability of time, widespread use and availability of smartphones and the internet in the United States, family support, and parenthood. Subthemes for perceived barriers to patient portal use were limited digital literacy and limited access to technology, LEP, lack of awareness and knowledge about patient portals, and illiteracy. Finally, subthemes for preferred features and suggested improvements were expanded language access to accommodate non-English speakers, improved accessibility to health information using graphics and patient education materials, and user onboarding education and technical support. Of note, while most subthemes were shared across all 3 groups, the widespread use and availability of smartphones and the internet in the United States and illiteracy subthemes were unique to Swahili-speaking women. Conclusions: Women with LEP recognized multiple benefits of patient portals; however, several barriers were also identified. These included limited digital literacy, restricted access to technology, LEP, and illiteracy. Barriers to patient portal use were closely tied to social determinants of health, which are commonly experienced by women with LEP. To expedite the attainment of health equity, it is important to promote access to health resources such as patient portals. %M 40009438 %R 10.2196/60699 %U https://www.jmir.org/2025/1/e60699 %U https://doi.org/10.2196/60699 %U http://www.ncbi.nlm.nih.gov/pubmed/40009438 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67962 %T Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study %A Midgett,Aida %A Doumas,Diana M %A Peralta,Claudia %A Peck,Matt %A Reilly,Blaine %A Buller,Mary K %+ Boise State University, 301 University Drive, Boise, ID, 83706, United States, 1 426 1214, AidaMidgett@boisestate.edu %K technology-based bullying intervention %K STAC-T %K usability testing %K middle school %K rural %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48% school personnel; n=11, 52% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90% (9/10) rated the program with 4 or 5 stars. Among students, 91% (10/11) stated they would recommend the program to others, and 100% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. %M 39984169 %R 10.2196/67962 %U https://humanfactors.jmir.org/2025/1/e67962 %U https://doi.org/10.2196/67962 %U http://www.ncbi.nlm.nih.gov/pubmed/39984169 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65302 %T Digital Solution to Support Medication Adherence and Self-Management in Patients with Cancer (SAMSON): Pilot Randomized Controlled Trial %A Dang,Thu Ha %A Wickramasinghe,Nilmini %A Jayaraman,Prem Prakash %A Burbury,Kate %A Alexander,Marliese %A Whitechurch,Ashley %A Dyer,Mitchell %A Quinn,Stephen %A Forkan,Abdur Rahim Mohammad %A Schofield,Penelope %+ Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Melbourne, 3122, Australia, 61 422703347, thuhadang@swin.edu.au %K home-based cancer treatment %K smartphone app %K oral chemotherapy %K patient safety %K SAMSON %K mobile phone %K digital solution %K medication adherence %K self-management %K cancer %K randomized controlled trial %K RCT %K pilot study %K oncology %K mobile health %K mHealth %K quality of life %K eHealth %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication nonadherence is a serious problem in cancer, potentially impacts patients’ health outcomes and health care costs. Although technology-based medication adherence (MA) interventions have emerged, evidence supporting their quality and effectiveness remains limited. Objective: This study tested the acceptability, feasibility, and potential effects of Safety and Adherence to Medications and Self-care Advice in Oncology (SAMSON), a digital solution designed to support MA and self-management in cancer. Methods: A 12-week, 2-arm, unblinded, pragmatic pilot randomized controlled trial was conducted. Adults with hematological malignancies who started oral cancer medicines within the last 12 months were recruited from a metropolitan specialized hospital and randomized 1:1 to SAMSON or control (usual care). The SAMSON solution included a smartphone app with tailored alerts and real-time self-care advice, a web-based dashboard for health care professionals (HCPs) to monitor patients’ adherence and symptoms, and motivational interviewing (MI) teleconsultations delivered by oncology nurses and pharmacists at baseline and weeks 1, 4, 8, and 12. Primary outcomes were the patients’ acceptance of SAMSON, measured by the Unified Theory of Acceptance and Use of Technology at 12 weeks, and study feasibility, measured by predefined rates of recruitment, randomization, retention, intervention adherence, and outcome assessment completion. Secondary outcomes were comparison of MA and clinical self-assessments through online questionnaires, including adherence, toxicity self-management, anxiety and depression symptoms, and quality of life, measured at baseline and 12 weeks between the 2 arms. Data retrieved from the SAMSON app (Swinburne University of Technology) was analysed for task completion. Results: A total of 33 patients (79% of those who were approached) consented to participate in the trial. Of those, 31/33 (94%) completed baseline surveys and were randomized to SAMSON (15/31) and control arms (16/31). Of 31 patients, 28 (90%) completed the 12-week surveys (12 SAMSON and 16 control). Overall, patients rated the SAMSON solution as highly acceptable (13/15, 87% app usage; 14/15, 93% MI teleconsultation delivery). They reported that SAMSON was easy to use (10/12, 83%) and helpful in improving their MA (6/12, 50%). All study HCPs reported the SAMSON solution was helpful in supporting patients’ MA. Patients completed an average of 99 tasks over the 12-week study period (71% of scheduled tasks). Most patients (10/12, 83%) completed all 5 scheduled consultations. All study feasibility measures were higher than the predefined upper thresholds, except the rate of patients’ responses to medication reminders. Conclusions: The results demonstrated that the SAMSON solution is acceptable, usable, and useful for oncology HCPs and patients with cancer. The SAMSON solution is feasible in real-life oncology settings. Our next steps involve refining the SAMSON solution based on participants’ feedback, conducting a large-scale randomized controlled trial to evaluate its clinical and economic effectiveness, and exploring potential commercialization. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000472673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385728 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-079122 %M 39969972 %R 10.2196/65302 %U https://formative.jmir.org/2025/1/e65302 %U https://doi.org/10.2196/65302 %U http://www.ncbi.nlm.nih.gov/pubmed/39969972 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e64145 %T Development and Implementation of a Personal Virtual Assistant for Patient Engagement and Communication in Postsurgical Cancer Care: Feasibility Cohort Study %A Bargas-Ochoa,Miguel %A Zulbaran-Rojas,Alejandro %A Finco,M G %A Costales,Anthony B %A Flores-Camargo,Areli %A Bara,Rasha O %A Pacheco,Manuel %A Phan,Tina %A Khichi,Aleena %A Najafi,Bijan %K digital health %K personal virtual assistant %K remote patient monitoring %K surgical oncology %K posthospital discharge %K postoperative support %K medication adherence postsurgery %K patient engagement %K mHealth %K mobile health %D 2025 %7 18.2.2025 %9 %J JMIR Cancer %G English %X Background: Cancer-care complexity heightens communication challenges between health care providers and patients, impacting their treatment adherence. This is especially evident upon hospital discharge in patients undergoing surgical procedures. Digital health tools offer potential solutions to address communication challenges seen in current discharge protocols. We aim to explore the usability and acceptability of an interactive health platform among discharged patients who underwent oncology-related procedures. Methods: A 4-week exploratory cohort study was conducted. Following hospital discharge, a tablet equipped with an integrated Personal Virtual Assistant (PVA) system was provided to patients who underwent oncology-related procedures. The PVA encompasses automated features that provide personalized care plans, developed through collaboration among clinicians, researchers, and engineers from various disciplines. These plans include guidance on daily specific assignments that were divided into 4 categories: medication intake, exercise, symptom surveys, and postprocedural specific tasks. The aim was to explore the acceptability of the PVA by quantification of dropout rate and assessing adherence to each care plan category throughout the study duration. The secondary aim assessed acceptability of the PVA through a technology acceptance model (TAM) questionnaire that examined ease of use, usefulness, attitude toward use, and privacy concerns. Results: In total, 17 patients were enrolled. However, 1 (5.8%) patient dropped out from the study after 3 days due to health deterioration, leaving 16/17 (94.2%) completing the study (mean age 54.5, SD 12.7, years; n=9, 52% Caucasian; n=14, 82% with a gynecological disease; n=3, 18% with a hepatobiliary disease). At the study end point, adherence to care plan categories were 78% (SD 25%) for medications, 81% (SD 24%) for exercises, 61% (SD 30%) for surveys, and 58% (SD 44%) for specific tasks such as following step-by step wound care instructions, managing drains, administering injectable medications independently, and performing pelvic baths as instructed. There was an 80% patient endorsement (strongly agree or agree) across all TAM categories. Conclusion: This study suggests the potential acceptability of the PVA among patients discharged after oncology-related procedures, with a dropout rate of less than 6% and fair-to-good adherence to tasks such as medication intake and exercise. However, these findings are preliminary due to the small sample size and highlight the need for further research with larger cohorts to validate and refine the system. %R 10.2196/64145 %U https://cancer.jmir.org/2025/1/e64145 %U https://doi.org/10.2196/64145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54608 %T Relative Preference for In-Person, Telehealth, Digital, and Pharmacologic Mental Health Care After the COVID-19 Pandemic: Cross-Sectional Questionnaire Study %A Parsons,E Marie %A Figueroa,Zoë G %A Hiserodt,Michele %A Cornelius,Talea %A Otto,Michael W %+ Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA, 02115, United States, 1 617 353 9610, mariepar@bu.edu %K stigma %K digital CBT %K age %K generalized anxiety disorder %K insomnia %K adult %K telehealth %K digital health %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Most adults and children in the United States fail to receive timely care for mental health symptoms, with even worse rates of care access for individuals who belong to racial and ethnic minority groups. Digital (ie, app-based) care has proven to be an efficacious and empirically supported treatment option with the potential to address low rates of care and reduce care disparities, yet little is known about the relative preference for such treatment. Furthermore, the rapid adoption of telehealth care during the COVID-19 pandemic may have shifted care preferences. Objective: This study aimed to examine relative treatment preferences for 4 different types of mental health care: in-person psychological care, telehealth psychological care, digital treatment, or pharmacologic care. Care preferences were also examined relative to potential predictors of care use (ie, gender, race, age, stigma, discrimination, and level of shame). Methods: In this cross-sectional online survey study of adults (N=237, mean age 35 years, range 19-68 years), we ranked 4 mental health care modalities based on care preference: (1) in-person care, (2) telehealth care, (3) digital care, and (4) pharmacologic care. Preference for treatment modality was assessed based on vignette presentation for generalized anxiety disorder and insomnia. In addition, participants completed self-report questionnaires for demographics, symptom severity, and psychological and stigma-related variables. Results: We found no difference in overall preference for in-person versus both telehealth and digital care. For both generalized anxiety disorder and insomnia, participants preferred in-person care to telehealth care, although this finding was attenuated amongst older participants for insomnia treatment. Participants’ depressed mood was associated with a greater relative preference for pharmacologic care. There was no evidence of differential preference for digital care according to demographics, symptom severity, or psychological and stigma-related variables. Conclusions: These results indicate that digital care now competes well in terms of treatment preference with in-person, telehealth, and pharmacologic treatment options. %M 39946715 %R 10.2196/54608 %U https://www.jmir.org/2025/1/e54608 %U https://doi.org/10.2196/54608 %U http://www.ncbi.nlm.nih.gov/pubmed/39946715 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63166 %T Smartphone Application–Based Voice and Speech Training Program for Parkinson Disease: Feasibility and Satisfaction Study With a Preliminary Rater-Blinded Single-Arm Pretest and Posttest Design %A Lee,Sol-Hee %A Kim,Jiae %A Kim,Han-Joon %+ Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 10 7279 7883, movement@snu.ac.kr %K Parkinson disease %K speech therapy %K mHealth %K home-based training %K self-delivered %K digital health care %K app %K feasibility %K voice therapy %K mobile phone %K satisfaction %K effectiveness %K smartphone %K apps %K single-arm study %K mobility %K mobile health %K acoustic analysis %K self-training %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Up to 75% of patients with Parkinson disease (PD) experience voice and speech impairments, such as breathy phonation and low speech volume, which worsen over time and negatively impact the quality of life. However, given their increasingly limited mobility, face-to-face speech therapy is often inaccessible. Mobile health (mHealth) apps offer accessible and cost-effective alternatives; yet, their application in PD-specific, self-delivered voice therapy remains underexplored. Objective: This study aimed to evaluate the feasibility, adherence, and satisfaction of a self-delivered smartphone app for voice therapy in patients with PD, designed to minimize speech-language pathologist involvement while promoting patient independence. In addition, it seeks to assess the preliminary therapeutic effectiveness of the app in addressing voice and speech problems in this population. Methods: A single-arm, rater-blinded, and pretest and posttest study was conducted between September to November 2023. Patients with PD with voice and speech problems who have no problem with using Android (Google) smartphones were recruited. Participants downloaded the researcher-developed mHealth app on their smartphone and participated in a patient-tailored 5-week home-based speech training program. Each session included 5 stages: breathing, oral motor exercises, loudness, prosody, and functional speaking. The training program consisted of 20 sessions, with participants completing 1 session per day, 4 days per week. Each session lasted approximately 20-30 minutes. Adherence was monitored through app logs, satisfaction was assessed through a phone survey, and therapeutic effectiveness was evaluated using acoustic analysis and auditory-perceptual assessments. Results: Out of 30 patients were initially recruited, but 2 of them withdrew. Out of 25 participants completed all the training sessions while 3 dropped out. The adherence was above 90% in 20 participants (80%, 20/25), 70% to 90% in 4 (16%, 4/25), and below 70% in 4 (16%, 4/25). Satisfaction was 75% (18/24) among the 24 people who participated in the survey. Significant improvements were observed in all acoustic measures: the maximum phonation time increased from 11.15 (SD 5.38) seconds to 14.01 (SD 5.64) seconds (P=.003), and vocal intensity increased from 71.59 (SD 4.39) dB to 73.81 (SD 3.48) dB (P<.001) across both sustained phonation and reading tasks. Voice quality scores on the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale improved significantly (all components P<.001). Furthermore, 58.3% (14/24) of participants reported subjective improvements in their voice. Conclusions: This study demonstrates that home-based, self-training speech therapy delivered through a mHealth app is a feasible solution for patients with PD, suggesting that mHealth apps can serve as a convenient and effective alternative to face-to-face therapy by enhancing accessibility and empowering patients to actively manage their condition. %M 39946689 %R 10.2196/63166 %U https://www.jmir.org/2025/1/e63166 %U https://doi.org/10.2196/63166 %U http://www.ncbi.nlm.nih.gov/pubmed/39946689 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65923 %T An Explainable AI Application (AF’fective) to Support Monitoring of Patients With Atrial Fibrillation After Catheter Ablation: Qualitative Focus Group, Design Session, and Interview Study %A She,Wan Jou %A Siriaraya,Panote %A Iwakoshi,Hibiki %A Kuwahara,Noriaki %A Senoo,Keitaro %+ Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Hirokoji, Kawaramachi-dori, Kamigyo-ku Kyoto, Kyoto, 602-8566, Japan, 81 75 251 5511, k-senoo@koto.kpu-m.ac.jp %K atrial fibrillation %K explainable artificial intelligence %K explainable AI %K user-centered design %K prevention %K postablation monitoring %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The opaque nature of artificial intelligence (AI) algorithms has led to distrust in medical contexts, particularly in the treatment and monitoring of atrial fibrillation. Although previous studies in explainable AI have demonstrated potential to address this issue, they often focus solely on electrocardiography graphs and lack real-world field insights. Objective: We addressed this gap by incorporating standardized clinical interpretation of electrocardiography graphs into the system and collaborating with cardiologists to co-design and evaluate this approach using real-world patient cases and data. Methods: We conducted a 3-stage iterative design process with 23 cardiologists to co-design, evaluate, and pilot an explainable AI application. In the first stage, we identified 4 physician personas and 7 explainability strategies, which were reviewed in the second stage. A total of 4 strategies were deemed highly effective and feasible for pilot deployment. On the basis of these strategies, we developed a progressive web application and tested it with cardiologists in the third stage. Results: The final progressive web application prototype received above-average user experience evaluations and effectively motivated physicians to adopt it owing to its ease of use, reliable information, and explainable functionality. In addition, we gathered in-depth field insights from cardiologists who used the system in clinical contexts. Conclusions: Our study identified effective explainability strategies, emphasized the importance of curating actionable features and setting accurate expectations, and suggested that many of these insights could apply to other disease care contexts, paving the way for future real-world clinical evaluations. %M 39946707 %R 10.2196/65923 %U https://humanfactors.jmir.org/2025/1/e65923 %U https://doi.org/10.2196/65923 %U http://www.ncbi.nlm.nih.gov/pubmed/39946707 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59386 %T Involving End Users in the Development and Usability Testing of a Smartphone App Designed for Individuals With Prediabetes: Mixed-Methods Focus Group Study %A Grieve,Natalie %A Braaten,Kyra %A MacPherson,Megan %A Liu,Sam %A Jung,Mary E %K usability evaluation %K mHealth %K usability testing %K app %K end-user %K focus group %K participant %K survey %K diabetes %K user-centered %K cognitive walkthrough %K cognitive walkthroughs %K questionnaire %K mobile phone %K digital health %K prediabetes %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X Background: Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. Objective: A focus group with 7 participants was conducted to examine the app’s usability and collect feedback for future iterations. Methods: Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Results: Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. Conclusions: These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client’s preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes’ program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals. %R 10.2196/59386 %U https://formative.jmir.org/2025/1/e59386 %U https://doi.org/10.2196/59386 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54156 %T Understanding Providers’ Attitude Toward AI in India’s Informal Health Care Sector: Survey Study %A Kumar,Sumeet %A Rayal,Snehil %A Bommaraju,Raghuram %A Varasala,Navya Pratyusha %A Papineni,Sirisha %A Deo,Sarang %K artificial intelligence %K tuberculosis %K health care providers %K cross-sectional studies %K trust %K x-rays %K India %D 2025 %7 10.2.2025 %9 %J JMIR Form Res %G English %X Background: Tuberculosis (TB) is a major global health concern, causing 1.5 million deaths in 2020. Diagnostic tests for TB are often inaccurate, expensive, and inaccessible, making chest x-rays augmented with artificial intelligence (AI) a promising solution. However, whether providers are willing to adopt AI is not apparent. Objective: The study seeks to understand the attitude of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) and informal health care providers, who we jointly call AIPs, toward adopting AI for TB diagnosis. We chose to study these providers as they are the first point of contact for a majority of TB patients in India. Methods: We conducted a cross-sectional survey of 406 AIPs across the states of Jharkhand (162 participants) and Gujarat (244 participants) in India. We designed the survey questionnaire to assess the AIPs’ confidence in treating presumptive TB patients, their trust in local radiologists’ reading of the chest x-ray images, their beliefs regarding the diagnostic capabilities of AI, and their willingness to adopt AI for TB diagnosis. Results: We found that 93.7% (270/288) of AIPs believed that AI could improve the accuracy of TB diagnosis, and for those who believed in AI, 71.9% (194/270) were willing to try AI. Among all AIPs, 69.4% (200/288) were willing to try AI. However, we found significant differences in AIPs’ willingness to try AI across the 2 states. Specifically, in Gujarat, a state with better and more accessible health care infrastructure, 73.4% (155/211) were willing to try AI, and in Jharkhand, 58.4% (45/77) were willing to try AI. Moreover, AIPs in Gujarat who showed higher trust in the local radiologists were less likely to try AI (odds ratio [OR] 0.15, 95% CI 0.03‐0.69; P=.02). In contrast, in Jharkhand, those who showed higher trust in the local radiologists were more likely to try AI (OR 2.11, 95% CI 0.9‐4.93; P=.09). Conclusions: While most AIPs believed in the potential benefits of AI-based TB diagnoses, many did not intend to try AI, indicating that the expected benefits of AI measured in terms of technological superiority may not directly translate to impact on the ground. Improving beliefs among AIPs with poor access to radiology services or those who are less confident of diagnosing TB is likely to result in a greater impact of AI on the ground. Additionally, tailored interventions addressing regional and infrastructural differences may facilitate AI adoption in India’s informal health care sector. %R 10.2196/54156 %U https://formative.jmir.org/2025/1/e54156 %U https://doi.org/10.2196/54156 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62915 %T Women Empowered to Connect With Addiction Resources and Engage in Evidence-Based Treatment (WE-CARE)—an mHealth Application for the Universal Screening of Alcohol, Substance Use, Depression, and Anxiety: Usability and Feasibility Study %A Isaacs,Krystyna %A Shifflett,Autumn %A Patel,Kajal %A Karpisek,Lacey %A Cui,Yi %A Lawental,Maayan %A Tzilos Wernette,Golfo %A Borsari,Brian %A Chang,Katie %A Ma,Tony %+ Benten Technologies, 9408 Grant Ave, Unit 206, Manassas, VA, 20110, United States, 1 7036625858, krysisaacs@gmail.com %K service linkage %K digital health %K education %K mental health %K substance use disorder %K SUD %K alcohol use disorder %K chatbot %K childbearing women %K women %K alcohol %K substance use %K empowerment %K evidence-based treatment %K usability %K feasibility %K mobile health %K mhealth %K app %K depression %K anxiety %K screening %K e-screening %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Women of childbearing age (aged 18-44 years) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with women of childbearing age and linkage to care after an anonymous assessment. Objective: In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments through mobile phones for alcohol and substance use, as well as depression and anxiety, for women of childbearing age. Methods: We used agile development principles based on previous formative research to test WE-CARE mobile health app with women of childbearing age (N=30) who resided in 1 of 6 counties in central Florida. WE-CARE included screening instruments (for alcohol, substance use, depression, and anxiety), a moderated discussion forum, educational microlearning videos, a frequently asked questions section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listserves, and a commercial human subject recruiting company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale to evaluate the mobile health app’s usability and acceptability. Postpilot semistructured interviews (n=4) were conducted to further explore the women’s reactions to the app. Results: A total of 77 women downloaded the application and 30 completed testing. Women of childbearing age gave the WE-CARE app an excellent System Usability Scale score of 86.7 (SD 12.43). Our results indicate elevated risk for substance use in 18 of the 30 (60%) participants, 9/18 (50%) also had an elevated risk for anxiety or depression, and 11/18 (61%) had an elevated risk for substance use, anxiety, or depression. Participants reported that WE-CARE was easy to navigate and use but they would have liked to see more screening questions and more educational content. Linkage to care was an issue; however, as none of the women identified as “at-risk” for substance use disorders contacted the free treatment clinic for further evaluation. Conclusions: The mobile health app was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the app. The linkage to care design features was likely insufficient to encourage them to seek treatment. The next version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared with their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on enhancing engagement to improve change behaviors and assess readiness for change. %M 39918861 %R 10.2196/62915 %U https://formative.jmir.org/2025/1/e62915 %U https://doi.org/10.2196/62915 %U http://www.ncbi.nlm.nih.gov/pubmed/39918861 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64847 %T Implications of Public Disclosure of Personal Information in a Mobile Alert App for People Living With Dementia Who Go Missing: Qualitative Descriptive Study %A Adekoya,Adebusola %A Daum,Christine %A Neubauer,Noelannah %A Miguel-Cruz,Antonio %A Liu,Lili %+ , School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, lili.liu@uwaterloo.ca %K alert systems %K technology %K missing persons %K dementia %K autonomy %K privacy %K stigmatization %K consent %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: People living with dementia are at risk of getting lost and going missing due to memory loss, confusion, and disorientation. Missing person incidents involving people living with dementia are increasing. Alert systems such as Community ASAP can promote community engagement in locating missing persons with dementia and aid in search and rescue efforts. However, the implications of public disclosure of personal information such as name, age, sex, and physical description within such alert systems have yet to be explored. Objective: This study aimed to identify and discuss the implications of public disclosure of personal information in Community ASAP for people living with dementia at risk of going missing. Methods: This study used a qualitative descriptive research design drawing from naturalistic inquiry. A total of 19 participants including people living with dementia, care partners, first responders, and service providers were recruited from Ontario, Alberta, and British Columbia, Canada. Semistructured interviews were used to explore participants’ perspectives on the perceived implications of the release of personal information when using Community ASAP. NVivo (version 12) was used to manage data, and conventional content analysis was conducted to identify key themes of the implications of public disclosure of personal information in Community ASAP. Results: In total, 10/19 (53%) of the participants were women and 9/19 (47%) were men. Of the 19 participants, 3 (16%) were people living with dementia, 5 (26%) were care partners, 4 (21%) were first responders, and 7 (37%) were service providers. In total, 4 key themes were identified as implications of public disclosure of personal information in Community ASAP: right to autonomy, safety versus privacy, informed and knowledgeable consent, and stigmatization. Participants discussed how the public disclosure of personal information in Community ASAP could undermine a person’s choice not to be found and contribute to stigmatization. Participants emphasized a need to balance safety and privacy concerns. Informed and knowledgeable consent is important when using an alert system to locate missing persons with dementia. Conclusions: Community ASAP can promote community engagement in locating missing persons with dementia. However, the public disclosure of personal information in alert systems has implications. Users’ right to autonomy, a balance between safety and privacy, informed and knowledgeable consent, and risks of stigmatization are perceived impacts of disclosure of personal information in alert systems. %M 39918846 %R 10.2196/64847 %U https://aging.jmir.org/2025/1/e64847 %U https://doi.org/10.2196/64847 %U http://www.ncbi.nlm.nih.gov/pubmed/39918846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59817 %T Perspectives of Hispanic and Latinx Community Members on AI-Enabled mHealth Tools: Qualitative Focus Group Study %A Kraft,Stephanie A %A Chopra,Shaan %A Duran,Miriana C %A Rojina,Janet A %A Beretta,Abril %A López,Katherine I %A Javan,Russell %A Wilfond,Benjamin S %A Rosenfeld,Margaret %A Fogarty,James %A Ko,Linda K %+ Department of Bioethics and Decision Sciences, Geisinger College of Health Sciences, 100 N. Academy Ave., Danville, PA, 17822, United States, 1 5702140506, skraft1@geisinger.edu %K wearable electronic devices %K qualitative research %K mobile health %K mHealth %K digital health %K privacy %K data sharing %K artificial intelligence %K AI %K community %K chronic conditions %K chronic disease %D 2025 %7 6.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) tools have the potential to reduce the burden of chronic conditions that disproportionately affect Hispanic and Latinx communities; however, digital divides in the access to and use of health technology suggest that mHealth has the potential to exacerbate, rather than reduce, these disparities. Objective: A key step toward developing health technology that is accessible and usable is to understand community member perspectives and needs so that technology is culturally relevant and appropriately contextualized. In this study, we aimed to examine the perspectives of Hispanic and Latinx community members in Washington State about mHealth. Methods: We recruited English- and Spanish-speaking Hispanic or Latinx adults to participate in web-based focus groups through existing community-based networks across rural and urban regions of Washington State. Focus groups included a presentation of narrative slideshow materials developed by the research team depicting mHealth use case examples of asthma in children and fall risk in older adults. Focus group questions asked participants to respond to the case examples and to further explore mHealth use preferences, benefits, barriers, and concerns. Focus group recordings were professionally transcribed, and Spanish transcripts were translated into English. We developed a qualitative codebook using deductive and inductive methods and then coded deidentified transcripts using the constant comparison method. The analysis team proposed themes based on review of coded data, which were validated through member checking with a community advisory board serving Latino individuals in the region and finalized through discussion with the entire research team. Results: Between May and September 2023, we conducted 8 focus groups in English or Spanish with 48 participants. Focus groups were stratified by language and region and included the following: 3 (n=18, 38% participants) Spanish urban groups, 2 (n=14, 29% participants) Spanish rural groups, 1 (n=6, 13% participants) English urban group, and 2 (n=10, 21% participants) English rural groups. We identified the following seven themes: (1) mHealth is seen as beneficial for promoting health and peace of mind; (2) some are unaware of, unfamiliar with, or uncomfortable with technology and may benefit from individualized support; (3) financial barriers limit access to mHealth; (4) practical considerations create barriers to using mHealth in daily life; (5) mHealth raises concern for overreliance on technology; (6) automated mHealth features are perceived as valuable but fallible, requiring human input to ensure accuracy; and (7) data sharing is seen as valuable for limited uses but raises privacy concerns. These themes illustrate key barriers to the benefits of mHealth that communities may face, provide insights into the role of mHealth within families, and examine the appropriate balance of data sharing and privacy protections. Conclusions: These findings offer important insights that can help advance the development of mHealth that responds to community values and priorities. %M 39912577 %R 10.2196/59817 %U https://www.jmir.org/2025/1/e59817 %U https://doi.org/10.2196/59817 %U http://www.ncbi.nlm.nih.gov/pubmed/39912577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68619 %T Users’ Perspectives of Direct-to-Consumer Telemedicine Services: Survey Study %A Churruca,Kate %A Foo,Darran %A Turner,Andrew %A Crameri,Emily %A Saba,Maree %A Spanos,Samantha %A Vickers,Matthew %A Braithwaite,Jeffrey %A Ellis,Louise A %K telemedicine %K digital health technology %K direct-to-consumer %K digital tools %K telehealth %K consumer experience %D 2025 %7 3.2.2025 %9 %J JMIR Form Res %G English %X Background: Commercially run direct-to-consumer (DTC) telemedicine services are on the rise in countries such as Australia and the United States. These include DTC services that are web-based, largely asynchronous, and offer targeted treatment pathways for specific health issues (eg, weight loss or sexual function). It has been argued that DTC telemedicine improves access to health care and promotes patient empowerment. Despite research examining quality and safety issues, little is known about users’ reasons for accessing DTC telemedicine services or their perceptions of them. Objective: In this study, we aimed to examine the perspectives of Australian users accessing DTC telemedicine services, including the reasons for use, perceived benefits, and concerns, in addition to their usage and interaction with traditional general practice services. Methods: A web-based cross-sectional survey including questions on demographics, published and validated scales, and author-developed closed- and open-response questions was administered via REDCap in 2023 to Australian adults accessing DTC telemedicine services. Results: Among the 151 respondents, most (136/151, 90.1%) had seen a general practitioner (GP) in the previous 12 months and were somewhat or very satisfied (118/136, 86.8%) with the care, just over half found it easy to get an appointment with their GP (76/151, 50.3%), and a quarter found it difficult (38/151, 25.2%). Among the 136 respondents who had seen a GP, more than half either “never” (55/136, 40.4%) or “rarely” (23/136, 16.9%) discussed the information and treatment received from DTC telemedicine service with their GP. The majority of respondents were using a DTC telemedicine service offering prescription skin care (92/151, 60.9%), had received treatment in the previous 6 months (123/151, 81.5%), and had self-initiated care (128/151, 84.8%). The most frequently cited reasons for using DTC telemedicine were related to convenience (97/121, 80.2%) and flexibility (71/121, 58.7%), while approximately a third of the sample selected that it was difficult to see traditional health care provider in their preferred time frame (44/121, 36.4%) and that the use of DTC telemedicine allowed them to gain access to services otherwise unavailable through traditional health care (39/121, 32.2%). Most participants felt “more in control” (106/128, 82.9%) and “in charge” of their health concern (102/130, 78.5%) when using DTC telemedicine services, in addition to having “more correct knowledge” (92/128, 71.9%) and “feeling better informed as a patient” (94/131, 71.8%). “Costs of services” (40/115, 34.8%) and “privacy” (31/115, 27%) were the most frequently reported concerns with using digital health care technologies such as DTC telemedicine. Conclusions: We report that most users perceive DTC telemedicine services as offering ease of access and convenience, and that their use contributes to a greater sense of empowerment over their health. Concerns were related to data privacy and the costs of utilizing the services. Responses suggest that DTC telemedicine may be tapping into a previously unmet need, rather than complementing traditional health care provided by a GP. %R 10.2196/68619 %U https://formative.jmir.org/2025/1/e68619 %U https://doi.org/10.2196/68619 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62738 %T Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study %A Pupong,Kittiwara %A Hunsrisakhun,Jaranya %A Pithpornchaiyakul,Samerchit %A Naorungroj,Supawadee %K chatbot %K conversational agents %K tele-dentistry %K oral health behavior %K in-person toothbrushing %K hands-on %K children %K covid-19 %K oral health education %K development. %D 2025 %7 3.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention. Objective: This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months. Methods: The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3‐5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest). Results: The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4% at baseline to 93.1% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot’s content quality, empathetic communication, and multimedia design, but noted the intervention’s lengthy duration and messaging system as limitations. Conclusions: The 30-Day FunDee chatbot effectively enhanced caregivers’ perceptions of oral health care and improved tooth-brushing practices for children aged 6‐36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials. Trial Registration: Thai Clinical Trials Registry Tctr20210927004; https://www.thaiclinicaltrials.org/show/Tctr20210927004 %R 10.2196/62738 %U https://pediatrics.jmir.org/2025/1/e62738 %U https://doi.org/10.2196/62738 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53306 %T Reconstructing Risk Dimensions in Telemedicine: Investigating Technology Adoption and Barriers During the COVID-19 Pandemic in Taiwan %A Wu,Tzu-Chi %A Ho,Chien-Ta %+ Department of Emergency Medicine, Show Chwan Memorial Hospital, 542, Sec 1, Zhongshan Rd., Changhua, 500009, Taiwan, 886 958352193, j10062008@hotmail.com %K telemedicine %K perceived risk %K technology acceptance model %K risk %K performance risk %D 2025 %7 3.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has shifted health care toward virtual and online models, impacting both users and providers. Numerous user concerns and perceived risks related to telemedicine are continually evolving and adjusting in response to the pandemic. In many countries, there has been a substantial increase in the use of virtual health care visits, which offers a unique opportunity for researchers to explore these user concerns. Objective: This study aimed to first reconstruct the risk dimensions associated with telemedicine, then identify the risk factors affecting users’ adoption, and finally propose effective solutions to mitigate these concerns. By integrating the newly constructed perceived risk with the technology acceptance model (TAM), we scrutinized various dimensions of perceived risk and their influence on users’ perceptions of ease of use, perceived usefulness, and use intention (UI). Methods: Our target population consists of adults aged ≥18 years who have used or may use telemedicine services, recruited through an anonymous, voluntary, open, web-based survey. We collected responses and used part of them to reconstruct risk dimensions using exploratory factor analysis. Subsequently, we analyzed the intricate relationship between perceived risk, the TAM, and the acceptance of telemedicine using structural equation modeling with another part of the responses. Results: A total of 1600 valid responses were collected. Eight distinct risk dimensions were reconstructed, revealing a substantial negative impact of performance risk on UI. The psychological and social risk was the strongest barrier to the ease of using telemedicine. Time risk, provider risk, and privacy risk were not statistically significant to the TAM. The resulting model elucidates a remarkable 66% variance in UI for telemedicine services. Conclusions: This study substantially advances the field of telemedicine research by reconstructing and redefining 8 risk dimensions and confirming the statistical significance of 5 perceived risks on the adoption of telemedicine services. These insights are poised to facilitate the promotion and enhancement of telemedicine services in the health care sector. %M 39899842 %R 10.2196/53306 %U https://www.jmir.org/2025/1/e53306 %U https://doi.org/10.2196/53306 %U http://www.ncbi.nlm.nih.gov/pubmed/39899842 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66132 %T Human-Centered Design of an mHealth Tool for Optimizing HIV Index Testing in Wartime Ukraine: Formative Research Case Study %A Puttkammer,Nancy %A Dunbar,Elizabeth %A Germanovych,Myroslava %A Rosol,Mariia %A Golden,Matthew %A Hubashova,Anna %A Fedorchenko,Vladyslav %A Hetman,Larisa %A Legkostup,Liudmyla %A Flowers,Jan %A Nesterova,Olena %+ Digital Initiatives Group at I-TECH, Department of Global Health, University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, United States, 1 206 898 5892, nputt@uw.edu %K human-centered design %K mobile health %K mHealth %K Ukraine %K HIV testing %K war and humanitarian settings %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Assisted partner services (APSs; sometimes called index testing) are now being brought to scale as a high-yield HIV testing strategy in many nations. However, the success of APSs is often hampered by low levels of partner elicitation. The Computer-Assisted Self-Interview (CASI)–Plus study sought to develop and test a mobile health (mHealth) tool to increase the elicitation of sexual and needle-sharing partners among persons with newly diagnosed HIV. CASI-Plus provides client-facing information on APS methods and uses a standardized, self-guided questionnaire with nonjudgmental language for clients to list partners who would benefit from HIV testing. The tool also enables health care workers (HCWs) to see summarized data to facilitate partner tracking. Objective: The formative research phase of the CASI-Plus study aimed to gather client and HCW input on the design of the CASI-Plus tool to ensure its acceptability, feasibility, and usability. Methods: This study gathered input to prioritize features and tested the usability of CASI-Plus with HCWs and clients receiving HIV services in public health clinics in wartime Ukraine. The CASI-Plus study’s formative phase, carried out from May 2023 to July 2024, adapted human-centered design (HCD) methods grounded in principles of empathy, iteration, and creative ideation. The study involved 3 steps: formative HCD, including in-depth individual interviews with clients, such as men who have sex with men and people who inject drugs, and internet-based design workshops with HCWs from rural and urban HIV clinics in Chernihiv and Dnipro; software platform assessment and heuristic evaluation, including assessment of open-source mHealth platforms against CASI-Plus requirements, prototype development, and testing of the REDCap (Research Electronic Data Capture) prototype based on usability heuristics; and usability walk-throughs, including simulated cases with HCWs and clients. Results: The formative phase of the CASI-Plus study included in-depth individual interviews with 10 clients and 3 workshops with 22 HCWs. This study demonstrated how simplified HCD methods, adapted to the wartime context, gathered rich input on prioritized features and tool design. The CASI-Plus design reflected features that are both culturally sensitive and in alignment with the constraints of Ukraine’s wartime setting. Prioritized features included information about the benefits of HIV index testing; a nonjudgmental, self-guided questionnaire to report partners; client stories; and bright images to accompany the text. Two-way SMS text messaging between clients and HCWs was deemed impractical based on risks of privacy breaches, national patient privacy regulations, and HCW workload. Conclusions: It was feasible to conduct HCD research in Ukraine in a wartime setting. The CASI-Plus mHealth tool was acceptable to both HCWs and clients. The next step for this research is a randomized clinical trial of the effect of the REDCap-based CASI-Plus tool on the number of partners named and the rate of partners completing HIV testing. %M 39883930 %R 10.2196/66132 %U https://formative.jmir.org/2025/1/e66132 %U https://doi.org/10.2196/66132 %U http://www.ncbi.nlm.nih.gov/pubmed/39883930 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54216 %T Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study %A Steyn,Sherrie %A Slabbert,Meggan %+ Vimbo Health SA (Pty) Ltd, 20 Riverclub Mews, 7 Sycamore Avenue, Riverclub, Sandton, 2191, South Africa, 27 63 861 6780, sherrie@vimbohealth.com %K treatment gap %K mental health %K health %K depression %K anxiety %K South Africa %K CBT %K cognitive behavioral therapy %K app-based intervention %K mobile health %K mental health app %K smartphone %K mobile phone %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited. Objective: This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy–based digital intervention for common mental health difficulties developed for the South African context. Methods: This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period. Results: A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as “unemployed but seeking employment” (χ24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30% (SD 29.473%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills. Conclusions: Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa. %M 39883938 %R 10.2196/54216 %U https://formative.jmir.org/2025/1/e54216 %U https://doi.org/10.2196/54216 %U http://www.ncbi.nlm.nih.gov/pubmed/39883938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59414 %T A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan %A Saleem,Maham %A Zafar,Shamsa %A Klein,Thomas %A Koesters,Markus %A Bashir,Adnan %A Fuhr,Daniela C %A Sikander,Siham %A Zeeb,Hajo %+ Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstraße 30, Bremen, 28359, Germany, 49 421 218 ext 56760, saleem@leibniz-bips.de %K digital mental health %K digital technology %K digital intervention %K Problem Management Plus %K lay health worker programme %K common mental health disorders %K low- and middle-income countries %K co-production %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization–endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. Objective: We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for "lady health workers" (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. Methods: A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Results: Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Conclusions: Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants. %M 39874072 %R 10.2196/59414 %U https://formative.jmir.org/2025/1/e59414 %U https://doi.org/10.2196/59414 %U http://www.ncbi.nlm.nih.gov/pubmed/39874072 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63348 %T Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study %A Daniels,Kim %A Vonck,Sharona %A Robijns,Jolien %A Quadflieg,Kirsten %A Bergs,Jochen %A Spooren,Annemie %A Hansen,Dominique %A Bonnechère,Bruno %+ , Centre of Expertise in Care Innovation, Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Guffenslaan 39, Hasselt, 3500, Belgium, 32 485763451, kim.daniels@pxl.be %K mobile health %K mHealth %K feasibility %K physical activity %K older adults %K health promotion %K usability %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app’s workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515 %M 39869906 %R 10.2196/63348 %U https://aging.jmir.org/2025/1/e63348 %U https://doi.org/10.2196/63348 %U http://www.ncbi.nlm.nih.gov/pubmed/39869906 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e58183 %T Medical Students’ Acceptance of Tailored e–Mental Health Apps to Foster Their Mental Health: Cross-Sectional Study %A Grüneberg,Catharina %A Bäuerle,Alexander %A Karunakaran,Sophia %A Darici,Dogus %A Dörrie,Nora %A Teufel,Martin %A Benson,Sven %A Robitzsch,Anita %K eHealth %K medical education %K medical students %K tailored interventions %K UTAUT %K intention to use %K e–mental health apps %K app %K foster %K cross-sectional study %K mental health problems %K physician %K well-being %K mobile apps %K acceptance %K assessment %K mental health apps %D 2025 %7 24.1.2025 %9 %J JMIR Med Educ %G English %X Background: Despite the high prevalence of mental health problems among medical students and physicians, help-seeking remains low. Digital mental health approaches offer beneficial opportunities to increase well-being, for example, via mobile apps. Objective: This study aimed to assess the acceptance, and its underlying predictors, of tailored e–mental health apps among medical students by focusing on stress management and the promotion of personal skills. Methods: From November 2022 to July 2023, a cross-sectional study was conducted with 245 medical students at the University of Duisburg-Essen, Germany. Sociodemographic, mental health, and eHealth-related data were assessed. The Unified Theory of Acceptance and Use of Technology (UTAUT) was applied. Differences in acceptance were examined and a multiple hierarchical regression analysis was conducted. Results: The general acceptance of tailored e–mental health apps among medical students was high (mean 3.72, SD 0.92). Students with a job besides medical school reported higher acceptance (t107.3=–2.16; P=.03; Padj=.027; Cohen d=4.13) as well as students with higher loads of anxiety symptoms (t92.4=2.36; P=.02; Padj=.03; Cohen d=0.35). The t values were estimated using a 2-tailed t test. Regression analysis revealed that acceptance was significantly predicted by anxiety symptoms (β=.11; P=.045), depressive symptoms (β=–.11; P=.05), internet anxiety (β=–.12; P=.01), digital overload (β=.1; P=.03), and the 3 UTAUT core predictors—performance expectancy (β=.24; P<.001), effort expectancy (β=.26; P<.001), and social influence (β=.43; P<.001). Conclusions: The high acceptance of e–mental health apps among medical students and its predictors lay a valuable basis for the development and implementation of tailored e–mental health apps within medical education to foster their mental health. More research using validated measures is needed to replicate our findings and to further investigate medical students’ specific needs and demands regarding the framework of tailored e–mental health apps. %R 10.2196/58183 %U https://mededu.jmir.org/2025/1/e58183 %U https://doi.org/10.2196/58183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60843 %T Characterizing Telehealth Barriers and Preferences to Promote Acceptable Implementation Strategies in Central Uganda: Multilevel Formative Evaluation %A Kizito,Michael %A Mugabi,Erina Nabunjo %A Ford,Sabrina %A Holtz,Bree %A Hirko,Kelly %K telehealth %K telemedicine %K health care %K disparities %K technology %K barriers %K resource-limited %K preferences %K Uganda %K Africa %K barrier %K formative evaluation %K health service provider %K primary care %K satisfaction %K Sub-Saharan Africa %K survey %K utility %D 2025 %7 23.1.2025 %9 %J JMIR Form Res %G English %X Background: Telehealth approaches can address health care access barriers and improve care delivery in resource-limited settings around the globe. Yet, telehealth adoption in Africa has been limited, due in part to an insufficient understanding of effective strategies for implementation. Objective: This study aimed to conduct a multi-level formative evaluation identifying barriers and facilitators for implementing telehealth among health service providers and patients in Central Uganda. Methods: We collected surveys characterizing telehealth perceptions, barriers, and preferences from health care providers and patients seeking primary care in the Central Region of Uganda from January 2022 to July 2022. Survey development was informed by the technology acceptance model and evaluated predictors of technology acceptance (ie, perceived usefulness, ease of use, and attitudes). We used descriptive statistics to characterize telehealth perceptions and examined differences according to provider and patient characteristics using Student t tests. Results: Nearly 79% (n=48) of 61 providers surveyed had used telehealth, and perceptions were generally favorable. While 93.4% (n=57) reported that telehealth adds value to clinical practice, less than half (n=30, 49.2%) felt telehealth was more efficient than in-person visits. Provider-reported barriers to telehealth included technology challenges for the patient (34/132, 26%), low patient engagement (25/132, 19%), and lack of implementation support (24/132, 18%). Telehealth use was lower among the 91 surveyed patients, with only 19.8% (n=18) having used telehealth. Although 89% (n=81) of patients reported saving time with telehealth approaches, 33.3% (n=30) of patients reported that telehealth made them feel uncomfortable, and 43.8% (n=39) reported concerns about confidentiality. Over 72% (n=66) of patients who had used telehealth previously reported satisfaction with the telehealth services they received. Several differences in perceptions of telehealth according to patient’s self-reported health status were observed. Conclusions: Perceptions of telehealth were generally favorable, although higher among providers than patients. Barriers impeding telehealth use include technology challenges and the lack of infrastructure and implementation support. Findings from this study can inform the implementation of acceptable telehealth approaches to address disparities propagated by health care access barriers in Sub-Saharan Africa. %R 10.2196/60843 %U https://formative.jmir.org/2025/1/e60843 %U https://doi.org/10.2196/60843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63349 %T Factors Influencing Informed Consent Preferences in Digital Health Research: Survey Study of Prospective Participants %A McInnis,Brian J %A Pindus,Ramona %A Kareem,Daniah %A Vital,Daniela G %A Hekler,Eric B %A Nebeker,Camille %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr MC 0811, La Jolla, CA, 92093-0811, United States, 1 6195182875, nebeker@health.ucsd.edu %K digital health %K research ethics %K informed consent %K readability %K health literacy %K human-centered approach %K consent communication %K text snippet %K qualitative analysis %K effectiveness %K health information %K health informatics %D 2025 %7 23.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Readability is important to consider when developing informed consent communications for prospective research participants, but not the most important consideration. Other factors to consider relate to learning preferences and literacy needs of people recruited to participate in research, as these factors can influence understanding of consent communications. To promote understanding among prospective participants, researchers should take a human-centered approach to develop consent communications. Objective: This study aims to explore how factors related to readability, topic, and participant demographic characteristics play into preferences for digital health research consent material. These factors are important to consider as not attending to some details that matter to a specific subgroup of prospective participants may systematically exclude people from research. Methods: People eligible to participate in a digital health study were recruited to review 31 paragraph length sections of a consent form, referred to as “text snippets,” for an existing institutional review board–approved digital health study. Participants (N=79) were surveyed and asked to choose between 2 variations of the text snippets, either indicating a preference for the institutional review board–approved original or a version that was modified to improve readability. Results: A slim majority of participants provided feedback about the snippets (n=44; 55%). Our qualitative analysis of the feedback found that participants preferred shorter snippets, in general, but the snippets also elicited new questions not addressed by the original consent material. This observation is supported by our quantitative analysis, which found that when the character length of the original was longer, participants were less likely to prefer the original (P<.001) and more likely to prefer the modified text by a factor of 1.20 times (P=.04), and particularly for snippets explaining study risks (P=.03). Our analysis also found significant differences in participant demographic characteristics. For example, older participants tended to prefer the original more than younger participants, by a factor of 1.95 times (P=.004). The results present illustrative examples of how factors related to sex, age, physical activity, and ethnicity all play into preference for consent communication. Conclusions: The findings point toward new ways of evaluating informed consent communication: (1) for responsiveness to specific prospective participant populations, and (2) effectiveness at eliciting informed questions from people considering participation. We discuss how creating partnerships with prospective participants to prototype informed consent materials, specifically study procedures and risks, can be a way to identify those details before launching a study. Furthermore, future research should go beyond “readability” to explore alternate measures of evaluating consent materials, such as the likelihood that the consent material and communication procedures will elicit “informed questions” for the research team. %M 39847412 %R 10.2196/63349 %U https://www.jmir.org/2025/1/e63349 %U https://doi.org/10.2196/63349 %U http://www.ncbi.nlm.nih.gov/pubmed/39847412 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56310 %T Attitudes of German General Practitioners Toward eHealth Apps for Dementia Risk Reduction: Qualitative Interview Study %A Schultz,Adrian %A Luppa,Melanie %A Bleckwenn,Markus %A Riedel-Heller,Steffi G %A Zuelke,Andrea %+ Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Philipp Rosenthal Str. 55, Leipzig, 04103, Germany, 49 03419715483, andrea.zuelke@medizin.uni-leipzig.de %K eHealth %K dementia %K primary care %K lifestyle %K risk factor %K older adults %K prevention %K brain health %D 2025 %7 22.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth interventions constitute a promising approach to disease prevention, particularly because of their ability to facilitate lifestyle changes. Although a rather recent development, eHealth interventions might be able to promote brain health and reduce dementia risk in older adults. Objective: This study aimed to explore the perspective of general practitioners (GPs) on the potentials and barriers of eHealth interventions for brain health. Understanding the perspective of GPs allows us to identify chances and challenges for implementing eHealth apps for dementia risk reduction. Methods: We conducted semistructured expert interviews with 9 GPs working in an outpatient setting in and near Leipzig, Germany. Data were fully transcribed and analyzed using a process model of qualitative content analysis with codes and categories being constructed inductively and deductively. Results: We found generally favorable but balanced views of eHealth apps for brain health. Eight themes were identified and elaborated on in the data as follows: “addressing dementia,” “knowledge about dementia,” “need for information,” “potential for prevention,” “chances for apps for prevention,” “development of apps for prevention,” and “barriers of apps for prevention.” GPs talked mostly about how and when to address dementia and the requirements for their use of eHealth apps for dementia prevention. GPs stated that they only addressed dementia once abnormalities were already present or less frequently when a patient or relative expressed a direct wish, while individual dementia risk or standardized diagnostic during routine check-ups were mentioned much less frequently. According to GPs, knowledge about dementia in patients was low; therefore, patients expressed little need for information on dementia risk factors and prevention in GP practices. Most patients wished for quick information regarding diagnostics, treatment options, and progression of the disease. GPs mentioned a lack of overview of the available eHealth apps and their content. They also expressed a fear of inducing health anxiety when talking to patients about risk factors and prevention. Conclusions: GPs want patients to receive relevant and individualized information. Prerequisites for the use of eHealth apps for dementia prevention were app characteristics related to design and content. GPs need to address dementia more routinely, assess relevant risk factors, and aid patients in a preventive role. Concerns were expressed over limited effectiveness, overwhelming patients, limited use in clinical practice, and only targeting patients with an already low risk of dementia. %M 39841983 %R 10.2196/56310 %U https://formative.jmir.org/2025/1/e56310 %U https://doi.org/10.2196/56310 %U http://www.ncbi.nlm.nih.gov/pubmed/39841983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56523 %T Public Understanding and Expectations of Digital Health Evidence Generation: Focus Group Study %A Bondaronek,Paulina %A Li,Jingfeng %A Potts,Henry W W %K mobile apps %K digital health %K public expectations %K evidence of effectiveness %K health risk perception %K effectiveness %K health risk %K health app %K public health %K well-being %K public trust %K diagnostic tools %K safety %K mobile phone %D 2025 %7 20.1.2025 %9 %J JMIR Form Res %G English %X Background: The rapid proliferation of health apps has not been matched by a comparable growth in scientific evaluations of their effectiveness, particularly for apps available to the public. This gap has prompted ongoing debate about the types of evidence necessary to validate health apps, especially as the perceived risk level varies from wellness tools to diagnostic aids. The perspectives of the general public, who are direct stakeholders, are notably underrepresented in discussions on digital health evidence generation. Objective: This study aimed to explore public understanding and expectations regarding the evidence required to demonstrate health apps’ effectiveness, including at varying levels of health risk. Methods: A total of 4 focus group discussions were held with UK residents aged 18 years and older, recruited through targeted advertisements to ensure demographic diversity. Participants discussed their views on evidence requirements for 5 hypothetical health apps, ranging from low-risk wellness apps to high-risk diagnostic tools. Focus groups were moderated using a structured guide, and data were analyzed using reflexive thematic analysis to extract common themes. Results: A total of 5 key themes were established: personal needs, app functionality, social approval, expectations of testing, and authority. Participants relied on personal experiences and social endorsements when judging the effectiveness of low-risk digital health interventions, while making minimal reference to traditional scientific evidence. However, as the perceived risk of an app increased, there was a noticeable shift toward preferring evidence from authoritative sources, such as government or National Health Service endorsements. Conclusions: The public have a preference for evidence that resonates on a personal level, but also show a heightened demand for authoritative guidance as the potential risk of digital health interventions increases. These perspectives should guide developers, regulators, and policy makers as they balance how to achieve innovation, safety, and public trust in the digital health landscape. Engaging the public in evidence-generation processes and ensuring transparency in app functionality and testing can bridge the gap between public expectations and regulatory standards, fostering trust in digital health technologies. %R 10.2196/56523 %U https://formative.jmir.org/2025/1/e56523 %U https://doi.org/10.2196/56523 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64427 %T Feasibility, User Acceptance, and Outcomes of Using a Cancer Prehabilitation App for Exercise: Pilot Cohort Study %A Zhang,Fuquan %A Bang,Deepali %A Visperas,Christine Alejandro %A Tun,Mon Hnin %A Tay,San San %K cancer prehabilitation %K mobile app %K technology %K feasibility %K acceptance %K cancer %K prehabilitation %K mHealth %K exercise %K application %K app %K mobile application %K reliability %K smartphone app %K sustainability %K effectiveness %K older patients %K older adults %K elderly %D 2025 %7 20.1.2025 %9 %J JMIR Form Res %G English %X Background: The efficacy of cancer prehabilitation programs is supported by international reviews and meta-analyses. Technology has been deployed in cancer prehabilitation to address challenges such as access or limited resources. This study evaluated the feasibility, user acceptance, safety, and program outcomes of a newly developed mobile app for cancer prehabilitation. The app integrates with Singapore’s existing health care mobile app, Health Buddy, and provides instructional videos for prescribed exercises. Objective: The objectives of this study were to investigate the feasibility, user experience, safety, and outcomes of a mobile app for cancer prehabilitation within a hospital-associated, home-based, multimodal cancer prehabilitation program. Methods: This retrospective study analyzed the records of patients enrolled in the cancer prehabilitation program from September 1, 2022, to March 30, 2023. Patients who participated in the prehabilitation program (n=63) were categorized into 2 groups: those prescribed the app (n=41) and those who were not (n=22). There was further subgroup analysis of those who were prescribed: app users (n=25) versus those who were non-app users (n=16). Demographics, Fried Frailty Phenotype, prehabilitation duration, app use, and functional outcome measures (6-minute walk test [6MWT], 30-second sit-to-stand test [STS], timed up and go test [TUG], and Hospital Anxiety and Depression Scale [HADS]) were collected. Compliance was determined by the completion of prescribed exercises and the accuracy of executing these exercises, with a high compliance rate considered to be at 80% or more. Baseline characteristics and preoperative outcomes were compared between the groups. User satisfaction was assessed through surveys among app users (n=25). Results: Among 63 patients, 41 (65.1%) patients were prescribed the app, of which 22 (34.9%) patients were users. No significant differences in preoperative functional improvements were observed between app users and nonusers (6MWT: P=.60; STS: P=.81; TUG: P=.53; HADS: P=.36), or between those prescribed and not prescribed the app (6MWT: P=.94; STS: P=.26; TUG: P=.39; HADS: P=.62). However, high compliance rates (80%) were observed among app users. Patient satisfaction with the app was high (>90%), with positive feedback on ease of use and technical reliability. Baseline measures revealed significantly lower functional scores and higher mean frailty scores in the nonprescribed group. Conclusions: This preliminary study demonstrates the acceptability, feasibility, and safety of Singapore’s first smartphone app for exercise prescription in cancer prehabilitation. Lower baseline functional outcome measures and a higher mean frailty score in the unprescribed group have implications for the selection process and patient participation. Further studies should include strategies to enhance patients’ readiness for technology, sustainability, and effectiveness in older patients. %R 10.2196/64427 %U https://formative.jmir.org/2025/1/e64427 %U https://doi.org/10.2196/64427 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55586 %T Patient-Centered mHealth Intervention to Improve Self-Care in Patients With Chronic Heart Failure: Phase 1 Randomized Controlled Trial %A Kitsiou,Spyros %A Gerber,Ben S %A Buchholz,Susan W %A Kansal,Mayank M %A Sun,Jiehuan %A Pressler,Susan J %+ University of Illinois Chicago, 1919 W Taylor Street, MC 530, Chicago, IL, 60612, United States, 1 312 355 3519, skitsiou@uic.edu %K mHealth %K app %K digital health %K telehealth %K text messaging %K smartphone %K wearable electronic devices %K heart failure %K self-care %K self-management %K randomized controlled trial %K cardiology %K SMS %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Heart failure (HF) is one of the most common causes of hospital readmission in the United States. These hospitalizations are often driven by insufficient self-care. Commercial mobile health (mHealth) technologies, such as consumer-grade apps and wearable devices, offer opportunities for improving HF self-care, but their efficacy remains largely underexplored. Objective: The objective of this study was to examine the feasibility, acceptability, safety, and preliminary efficacy of a patient-centered mHealth intervention (iCardia4HF) that integrates 3 consumer mHealth apps and devices (Heart Failure Health Storylines, Fitbit, and Withings) with a program of individually tailored SMS text messages to improve HF self-care. Methods: We conducted a phase 1 randomized controlled trial. Eligible patients had stage C HF, were aged ≥40 years, and had New York Heart Association (NYHA) class I, II, or III HF. Patients were randomly assigned to either iCardia4HF plus usual care or to usual care only and were observed for 8 weeks. Key feasibility measures were recruitment and retention rates. The primary efficacy outcome was change in HF self-care subscale scores (maintenance, symptom perception, and self-care management) at 8 weeks, assessed with the Self-Care Heart Failure Index (SCHFI; version 7.2). Key secondary outcomes were modifiable behaviors targeted by the intervention (health beliefs, self-efficacy, and HF knowledge), health status, and adherence to daily self-monitoring of 2 core vital signs (body weight and blood pressure). Results: A total of 27 patients were enrolled in the study and randomly assigned to iCardia4HF (n=13, 48%) or usual care (n=14, 52%). Of these 27 patients, 11 (41%) in the intervention group (iCardia4HF) and 14 (52%) in the usual care group started their assigned care and were included in the full analysis. Patients’ mean age was 56 (SD 8.3) years, 44% (11/25) were female, 92% (23/25) self-reported race as Black, 76% (19/25) had NYHA class II or III HF, and 60% (15/25) had HF with reduced left ventricular ejection fraction. Participant retention, completion of study visits, and adherence to using the mHealth apps and devices for daily self-monitoring were high (>80%). At 8 weeks, the mean group differences in changes in the SCHFI subscale scores favored the intervention over the control group: maintenance (Cohen d=0.19, 95% CI –0.65 to 1.02), symptom perception (Cohen d=0.33, 95% CI –0.51 to 1.17), and self-care management (Cohen d=0.25, 95% CI –0.55 to 1.04). The greatest improvements in terms of effect size were observed in self-efficacy (Cohen d=0.68) and health beliefs about medication adherence (Cohen d=0.63) and self-monitoring adherence (Cohen d=0.94). There were no adverse events due to the intervention. Conclusions: iCardia4HF was found to be feasible, acceptable, and safe. A larger trial with a longer follow-up duration is warranted to examine its efficacy among patients with HF. Trial Registration: ClinicalTrials.gov NCT03642275; https://clinicaltrials.gov/study/NCT03642275 %M 39813671 %R 10.2196/55586 %U https://www.jmir.org/2025/1/e55586 %U https://doi.org/10.2196/55586 %U http://www.ncbi.nlm.nih.gov/pubmed/39813671 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 8 %N %P e58878 %T A Patient-Oriented Implementation Strategy for a Perioperative mHealth Intervention: Feasibility Cohort Study %A Toben,Daan %A de Wind,Astrid %A van der Meij,Eva %A Huirne,Judith A F %A Anema,Johannes R %+ Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands, 31 647861694, d.j.toben@amsterdamumc.nl %K perioperative care %K recovery %K feasibility %K convalescence %K patient-oriented %K surgery %K perioperative %K eHealth %K mHealth %K tailor %K customize %K patient care %K digital intervention %K health intervention %K patient education %K surgical care %K hospital care %K digital health %K perioperative medicine %K elective surgery %K technology %K caregiver %K mobile app %K digital care %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Day surgery is being increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effectively manage their convalescence. The mHealth application ikHerstel is one such tool, but although it administers its functions in the home, its implementation hinges on health care professionals within the hospital. Objective: We conducted a feasibility study of an additional patient-oriented implementation strategy for ikHerstel. This strategy aimed to empower patients to access and use ikHerstel independently, in contrast to implementation as usual, which hinges on the health care professional acting as gatekeeper. Our research question was “How well are patients able to use ikHerstel independently of their health care professional?” Methods: We investigated the implementation strategy in terms of its recruitment, reach, dose delivered, dose received, and fidelity. Patients with a recent or prospective elective surgery were recruited using a wide array of materials to simulate patient-oriented dissemination of ikHerstel. Data were collected through web-based surveys. Descriptive analysis and open coding were used to analyze the data. Results: Recruitment yielded 213 registrations, with 55 patients ultimately included in the study. The sample was characterized by patients undergoing abdominal surgery, with high literacy and above average digital health literacy, and included an overrepresentation of women (48/55, 87%). The implementation strategy had a reach of 81% (63/78), with 87% (55/67) of patients creating a recovery plan. Patients were satisfied with their independent use of ikHerstel, rating it an average 7.0 (SD 1.9) of 10, and 54% (29/54) of patients explicitly reported no difficulties in using it. A major concern of the implementation strategy was conflicts in recommendations between ikHerstel and the health care professionals, as well as the resulting feelings of insecurity experienced by patients. Conclusions: In this small feasibility study, most patients were satisfied with the patient-oriented implementation strategy. However, the lack of involvement of health care professionals due to the strategy contributed to patient concerns regarding conflicting recommendations between ikHerstel and health care professionals. %R 10.2196/58878 %U https://periop.jmir.org/2025/1/e58878 %U https://doi.org/10.2196/58878 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e53850 %T A Mobile App–Based Gratitude Intervention’s Effect on Mental Well-Being in University Students: Randomized Controlled Trial %A Fuller,Chloë %A Marin-Dragu,Silvia %A Iyer,Ravishankar Subramani %A Meier,Sandra Melanie %K gratitude intervention %K smartphone app %K gratitude exercises %K psychological well-being %K mobile phone %D 2025 %7 14.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Gratitude interventions are used to cultivate a sense of gratitude for life and others. There have been mixed results of the efficacy of gratitude interventions’ effect on psychological well-being with a variety of populations and methodologies. Objectives: The objective of our study was to test the effectiveness of a gratitude intervention smartphone app on university students’ psychological well-being. Methods: We used a randomized experimental design to test our objective. Participants were recruited undergraduate students from a web-based university study recruitment system. Participants completed 90 web-based survey questions on their emotional well-being and personality traits at the beginning and end of the 3-week research period. Their depression, anxiety, and stress levels were measured with the Depression, Anxiety, and Stress Scale (DASS-21). After the baseline survey, participants were randomly assigned to either the control or the intervention. Participants in the intervention group used both a fully automated mobile sensing app and a gratitude intervention mobile iOS smartphone app designed for youth users and based on previous gratitude interventions and exercises. The gratitude intervention app prompted users to complete daily gratitude exercises on the app including a gratitude journal, a gratitude photo book, an imagine exercise, a speech exercise, and meditation. Participants in the control group used only the mobile sensing app, which passively collected smartphone sensory data on mobility, screen time, sleep, and social interactions. Results: A total of 120 participants met the inclusion criteria, and 27 were lost to follow-up for a total of 41 participants in the intervention group and 52 in the control group providing complete data. Based on clinical cutoffs from the baseline assessment, 56 out of 120 participants were identified as being in a subsample with at least moderate baseline symptomatology. Participants in the subsample with at least moderate baseline symptomatology reported significantly lower symptoms of depression, anxiety, and stress postintervention (Cohen d=−0.68; P=.04) but not in the full sample with low baseline symptomatology (Cohen d=0.16; P=.46). The number of times the app was accessed was not correlated with changes in either the subsample (r=0.01; P=.98) or the full sample (r=−0.04; P=.79). Conclusions: University students experiencing moderate to severe distress can benefit from a gratitude intervention smartphone app to improve symptoms of depression, anxiety, and stress. The number of times the gratitude intervention app was used is not related to well-being outcomes. Clinicians could look at incorporating gratitude apps with other mental health treatments or for those waitlisted as a cost-effective and minimally guided option for university students experiencing psychological distress. Trial Registration: Clinicaltrials.gov NCT06621745; http://clinicaltrials.gov/ct2/show/NCT06621745 %R 10.2196/53850 %U https://mhealth.jmir.org/2025/1/e53850 %U https://doi.org/10.2196/53850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55042 %T The Combined Effect of Multisensory Stimulation and Therapist Support on Physical and Mental Health of Older Adults Living in Nursing Homes: Pilot Randomized Controlled Trial %A Khatib,Sewar %A Palgi,Yuval %A Ashar,Yoni K %A Polyvyannaya,Natalya %A Goldstein,Pavel %+ School of Public Health, University of Haifa, 199 Aba Khoushy Avenue, Mount Carmel, Haifa, 3103301, Israel, 972 48240519, pavelg@stat.haifa.ac.il %K Snoezelen room %K mental health %K sensory stimulation environment %K social support %K nursing homes %K older adults %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing life expectancy has led to a rise in nursing home admissions, a context in which older adults often experience chronic physical and mental health conditions, chronic pain, and reduced well-being. Nonpharmacological approaches are especially important for managing older adults’ chronic pain, mental health conditions (such as anxiety and depression), and overall well-being, including sensory stimulation (SS) and therapist support (TS). However, the combined effects of SS and TS have not been investigated. Objective: This randomized controlled trial examines the specific and combined effects of brief SS and TS interventions on older adults’ physical and mental health and pain intensity levels, among individuals living in nursing homes. Methods: A total of 96 patients aged 65-99 years from a nursing home were randomly assigned to 3 groups: SS, TS, and combined SS+TS interventions, each delivered as four 20-minute sessions. SS was implemented using a multisensory Snoezelen room. Pain intensity levels (per a Visual Analog Scale), blood pressure, heart rate, blood oxygen saturation, and hand grip strength (using a Jamar hand dynamometer) were measured before and after each of the 4 weekly therapeutic sessions. In addition, life satisfaction (per the Satisfaction with Life Scale) and anxiety (per the 7-item General Anxiety Disorder Scale) were evaluated before and after the whole intervention. Mixed model analyses tested the relative efficacy of the 3 interventions, applying simple slope analysis with Tukey correction. Study rationale and analytical plans were preregistered. Results: The combined intervention of SS and TS (SS+TS) resulted in reduced pain levels compared with SS (B=0.209, P=.006) and TS alone (B=0.23, P=.002) over 4 sessions (F6,266=2.62; P=.017; R2=0.23). Further, the combined SS+TS intervention resulted in reduced systolic blood pressure versus SS (B=0.09, P=.01) and TS alone (B=0.016, P<.001) groups (F6,272=5.42; P<.001; R2=0.29). In addition, the combined SS+TS intervention resulted in an increased grip strength versus SS (B=–0.35, P=.003) and TS alone (B=–0.032, P=.008) groups (F6,273=2.25; P=.04; R2=0.19). Moreover, combined SS+TS resulted in an improvement in life satisfaction (B=–4.29, P<.0001) compared with SS (B=–2.38, P=.0042) and TS alone (B=–1.20, P=.13) groups (F2,39=3.47; P=.04). Finally, SS+TS demonstrated greater improvement in symptoms of general anxiety disorder (B=10.64, P<.0001) compared with SS (B=3.30 P=.01) and TS alone (B=1.13, P=.37) (F2,38=13.5; P<.001) groups. No differences between the interventions were shown for blood oxygen saturation (F6,273=2.06; P=.06), diastolic blood pressure (F6,272=1.12; P=.35), and heart rate (F6,273=1.33; P=.23). Conclusions: The combined intervention of SS and TS showed therapeutic benefits for pain management and physical and mental health of older adults living in nursing homes, relative to each therapeutic component in isolation. This brief intervention can be readily implemented to improve well-being and optimize therapeutic resources in nursing home settings. Trial Registration: ClinicalTrials.gov NCT05394389; https://clinicaltrials.gov/ct2/show/NCT05394389 %M 39808474 %R 10.2196/55042 %U https://www.jmir.org/2025/1/e55042 %U https://doi.org/10.2196/55042 %U http://www.ncbi.nlm.nih.gov/pubmed/39808474 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e37083 %T Eliciting Preferences for the Uptake of Smoking Cessation Apps: Discrete Choice Experiment %A Szinay,Dorothy %A Cameron,Rory A %A Jones,Andy %A Whitty,Jennifer A %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Research Park, Norwich, NR4 7TJ, United Kingdom, 44 01603456161, dorothy.szinay@uea.ac.uk %K discrete choice experiment %K uptake, engagement %K mHealth %K smartphone app %K smoking cessation %K health app %K behavior change %K TDF %K theoretical domains framework %K mobile phone %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: If the most evidence-based and effective smoking cessation apps are not selected by smokers wanting to quit, their potential to support cessation is limited. Objective: This study sought to determine the attributes that influence smoking cessation app uptake and understand their relative importance to support future efforts to present evidence-based apps more effectively to maximize uptake. Methods: Adult smokers from the United Kingdom were invited to participate in a discrete choice experiment. Participants made 12 choices between two hypothetical smoking cessation app alternatives, with five predefined attributes reflecting domains from the theoretical domains framework: (1) monthly price of the app (environmental resources), (2) credible source as app developer (social influence), (3) social proof as star rating (social influence), (4) app description type (beliefs about consequences), and (5) images shown (beliefs about consequences); or opting out (choosing neither app). Preferences and the relative importance of attributes were estimated using mixed logit modeling. Willingness to pay and predicted uptake of the most and least preferred app were also calculated. Results: A total of 337 adult smokers completed the survey (n=168, 49.8% female; mean age 35, SD 11 years). Participants selected a smoking cessation app rather than opting out for 90% of the choices. Relative to other attributes, a 4.8-star user rating, representing social proof, was the strongest driver of app selection (mean preference parameter 2.27, SD 1.55; 95% CI 1.95-2.59). Participants preferred an app developed by health care–orientated trusted organization (credible source) over a hypothetical company (mean preference parameter 0.93, SD 1.23; 95% CI 0.72-1.15), with a logo and screenshots over logo only (mean preference parameter 0.39, SD 0.96; 95% CI 0.19-0.59), and with a lower monthly cost (mean preference parameter –0.38, SD 0.33; 95% CI –0.44 to –0.32). App description did not influence preferences. The uptake estimate for the best hypothetical app was 93% and for the worst, 3%. Participants were willing to pay a single payment of up to an additional US $6.96 (UK £5.49) for 4.8-star ratings, US $3.58 (UK £2.82) for 4-star ratings, and US $2.61(UK £2.06) for an app developed by a trusted organization. Conclusions: On average, social proof appeared to be the most influential factor in app uptake, followed by credible source, one perceived as most likely to provide evidence-based apps. These attributes may support the selection of evidence-based apps. %M 39808479 %R 10.2196/37083 %U https://www.jmir.org/2025/1/e37083 %U https://doi.org/10.2196/37083 %U http://www.ncbi.nlm.nih.gov/pubmed/39808479 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e53748 %T Cultural Adaptation of an Aboriginal and Torres Strait Islanders Maternal and Child mHealth Intervention: Protocol for a Co-Design and Adaptation Research Study %A Ishaque,Sana %A Ela,Ola %A Rissel,Chris %A Canuto,Karla %A Hall,Kerry %A Bidargaddi,Niranjan %A Briley,Annette %A Roberts,Claire T %A Perkes,Sarah Jane %A Dowling,Anna %A Bonevski,Billie %+ College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, 5042, Australia, 61 882013911, isha0018@flinders.edu.au %K Aboriginal %K co-design %K mHealth %K maternal %K child health %K digital health %K children %K women %K female %K cultural adaptation %K Torres Strait %K research study %K Indigenous %K digital health intervention %K diversity %K South Australia %K pregnant %K health professional %K adaption %K focus group %K pretesting %K usability %K app %K health disparities %K information %K technology %K mobile phone %D 2025 %7 10.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is limited evidence of high-quality, accessible, culturally safe, and effective digital health interventions for Indigenous mothers and babies. Like any other intervention, the feasibility and efficacy of digital health interventions depend on how well they are co-designed with Indigenous communities and their adaptability to intracultural diversity. Objective: This study aims to adapt an existing co-designed mobile health (mHealth) intervention app with health professionals and Aboriginal and/or Torres Strait Islander mothers living in South Australia. Methods: Potential participants include Aboriginal and/or Torres Strait Islander pregnant women and mothers of children aged 0-5 years, non-Aboriginal and/or Torres Strait Islander women who are mothers of Aboriginal and/or Torres Strait Islander babies, and health professionals who predominantly care for Aboriginal and/or Torres Strait Islander mothers and babies. Participants will be recruited from multiple Aboriginal and/or Torres Strait Islander–specific health services under the local health networks around metropolitan South Australia. In this study, data collection will be carried out via culturally safe, and family-friendly yarning circles, facilitated by Aboriginal research staff to collect feedback on the existing mHealth app from approximately 20 women and 10 health professionals, with the aim to achieve data saturation. This will inform the changes required to the mHealth app. All focus groups and interviews will be audio recorded and transcribed verbatim. Data will be inductively analyzed using realist epistemology via NVivo software (Lumivero). Themes about the mHealth app’s cultural acceptability, usability, and appropriateness will be used to inform the changes applied to the app. Results: With the feedback received from participating women and health professionals, changes in the smartphone app will be made to ensure the intervention is supportive and meets the needs of Aboriginal and/or Torres Strait Islander mothers and families in South Australia. Participation of community members will promote ownership, community engagement, and implementation. Conclusions: A co-designed, culturally sensitive, and effective digital health intervention is likely to support Indigenous mothers and their children facing health disparities due to the disruption of Indigenous culture by colaying a foundation for a potential clinical trial and wider implementation. International Registered Report Identifier (IRRID): PRR1-10.2196/53748 %M 39793001 %R 10.2196/53748 %U https://www.researchprotocols.org/2025/1/e53748 %U https://doi.org/10.2196/53748 %U http://www.ncbi.nlm.nih.gov/pubmed/39793001 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e53045 %T Tongue Muscle Training App for Middle-Aged and Older Adults Incorporating Flow-Based Gameplay: Design and Feasibility Pilot Study %A Su,Kuan-Chu %A Wu,Ko-Chiu %A Chou,Kuei-Ru %A Huang,Chia-Hsu %K exergame %K mobile app %K flow %K self-care %K feasibility %K older adults %K dysphagia %K tongue exercises %D 2025 %7 9.1.2025 %9 %J JMIR Serious Games %G English %X Background: Complications due to dysphagia are increasingly prevalent among older adults; however, the tediousness and complexity of conventional tongue rehabilitation treatments affect their willingness to rehabilitate. It is unclear whether integrating gameplay into a tongue training app is a feasible approach to rehabilitation. Objective: Tongue training has been proven helpful for dysphagia treatment. Following the development of a tongue training app, a feasibility trial aimed to identify physiological and psychological factors that affect user and flow experience and explored whether training specialized muscles could produce a flow experience for optimal immersion. We aimed to provide a useful tool for medical rehabilitation so that older adults could retain tongue muscle flexibility. Methods: After consulting professional nurses, we developed a mobile gaming app for middle-aged and older adults to train their tongue muscles. This pilot study used an image recognition system to detect the tongue movements of 32 healthy middle-aged and older adults (7 males, 21.9%; 25 females, 78.1%) during 3 game training tasks, each requiring different reaction speeds. Their physiological and psychological signals, as well as the results of the Flow State Scale 2 (FSS2) questionnaire, were used for correlation analysis regarding relevant flow experiences to establish and evaluate the feasibility of our method. Results: Through exploratory factor analyses, a 2-factor (operation and immersion) structure was confirmed to have an adequate model fit (χ²36=448.478; P<.001; Kaiser-Meyer-Olkin=0.757) and internal consistency reliability (Cronbach α=0.802). The slow, medium, and fast levels all significantly affected the FSS2 score for operation (P=.001), the National Aeronautics and Space Administration Task Load Index (P<.001), and flow distance (P<.001). K-means clustering revealed that participants could be further categorized into 3 groups. Through the analysis of changes in the participants’ physiological and psychological signals for each given task, Pearson correlation indicated that changes were primarily related to flow distance. For the 12 indicators measured in this study, the low, medium, and high operation groups showed significance in 58% (7/12), 50% (6/12), and 25% (3/12) of the indicators, respectively. Similarly, the low, medium, and high immersion groups had changes in 50% (6/12), 33% (4/12), and 17% (2/12) of indicators, respectively. Conclusions: Our research supports the further development of a gaming app to aid older adults with tongue muscle training and measure flow using physiological and psychological signals to enhance training accuracy and feasibility. Next, we aim to conduct a randomized pilot trial, improve app functions, offer alternative rehabilitation options, and encourage long-term participation. Future goals include enhancing long-term efficacy, diversifying training modes, and adding a multiuser interactive option for an added challenge. %R 10.2196/53045 %U https://games.jmir.org/2025/1/e53045 %U https://doi.org/10.2196/53045 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58479 %T Using a Mobile Health App (ColonClean) to Enhance the Effectiveness of Bowel Preparation: Development and Usability Study %A Chen,Hui-Yu %A Tu,Ming-Hsiang %A Chen,Miao-Yen %K mobile health app %K bowel preparation %K nursing guidance %K technology acceptance model %K mHealth %K mobile health %D 2025 %7 8.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Colonoscopy is the standard diagnostic method for colorectal cancer. Patients usually receive written and verbal instructions for bowel preparation (BP) before the procedure. Failure to understand the importance of BP can lead to inadequate BP in 25%-30% of patients. The quality of BP impacts the success of colonoscopy in diagnostic yield and adenoma detection. We developed the “ColonClean” mobile health (mHealth) app for Android devices. It incorporates visual representations of dietary guidelines, steps for using bowel cleansing agents, and observations of the last bowel movement. We used the Technology Acceptance Model to investigate whether the use of the ColonClean mHealth app can improve users’ attitudes and behaviors toward BP. Objective: This study aims to validate the effectiveness of the ColonClean app in enhancing user behavior and improving BP, providing safe and cost-effective outpatient colonoscopy guidance. Methods: This study uses a structured questionnaire to assess perceived usefulness, perceived ease of use, and users’ attitudes and behaviors toward BP regarding the ColonClean mHealth app. A total of 40 outpatients who were physically and mentally healthy and proficient in Chinese were randomly chosen for this study. The data were analyzed using SPSS 25.0, and we used Pearson product-moment correlation and simple regression analysis to predict the perception of ColonClean. Results: The results showed that 75% (30/40) of participants achieved an “excellent” or “good” level of BP according to the Aronchick Bowel Preparation Scale. Perceived usefulness and perceived ease of use of the ColonClean mHealth app were positively correlated with users’ attitudes and behaviors (P<.05). Conclusions: The ColonClean mHealth app serves as an educational reference and enhances the effectiveness of BP. Users expressed their willingness to use the app again in the future and recommend it to family and friends, highlighting its effectiveness as an educational guide for BP. %R 10.2196/58479 %U https://humanfactors.jmir.org/2025/1/e58479 %U https://doi.org/10.2196/58479 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63703 %T Patients’ Experienced Usability and Satisfaction With Digital Health Solutions in a Home Setting: Instrument Validation Study %A Oudbier,Susan J %A Smets,Ellen M A %A Nieuwkerk,Pythia T %A Neal,David P %A Nurmohamed,S Azam %A Meij,Hans J %A Dusseljee-Peute,Linda W %K digital health solutions %K questionnaire development %K usability instruments %K self-management %K home setting %K validation %K reliability %D 2025 %7 8.1.2025 %9 %J JMIR Med Inform %G English %X Background: The field of digital health solutions (DHS) has grown tremendously over the past years. DHS include tools for self-management, which support individuals to take charge of their own health. The usability of DHS, as experienced by patients, is pivotal to adoption. However, well-known questionnaires that evaluate usability and satisfaction use complex terminology derived from human-computer interaction and are therefore not well suited to assess experienced usability of patients using DHS in a home setting. Objective: This study aimed to develop, validate, and assess an instrument that measures experienced usability and satisfaction of patients using DHS in a home setting. Methods: The development of the “Experienced Usability and Satisfaction with Self-monitoring in the Home Setting” (GEMS) questionnaire followed several steps. Step I consisted of assessing the content validity, by conducting a literature review on current usability and satisfaction questionnaires, collecting statements and discussing these in an expert meeting, and translating each statement and adjusting it to the language level of the general population. This phase resulted in a draft version of the GEMS. Step II comprised assessing its face validity by pilot testing with Amsterdam University Medical Center’s patient panel. In step III, psychometric analysis was conducted and the GEMS was assessed for reliability. Results: A total of 14 items were included for psychometric analysis and resulted in 4 reliable scales: convenience of use, perceived value, efficiency of use, and satisfaction. Conclusions: Overall, the GEMS questionnaire demonstrated its reliability and validity in assessing experienced usability and satisfaction of DHS in a home setting. Further refinement of the instrument is necessary to confirm its applicability in other patient populations in order to promote the development of a steering mechanism that can be applied longitudinally throughout implementation, and can be used as a benchmarking instrument. %R 10.2196/63703 %U https://medinform.jmir.org/2025/1/e63703 %U https://doi.org/10.2196/63703 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e59181 %T The MyGuide Web-Based Self-Management Tool for Concussion Rehabilitation: Mixed Methods Cross-Sectional Study %A Turcott,Alyssa %A Kang,Ruthine %A Yao,Christopher %A O'Melinn,Colleen %A Mahoney,Patricia %A Barlow,Susan %A Schmidt,Julia %+ Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health, G.F. Strong Rehabilitation Centre, 4255 Laurel St., Vancouver, BC, V5Z2G9, Canada, 1 604 737 6311, julia.schmidt@ubc.ca %K concussion %K self-management %K health information technology %K perceptions %K concussion recovery %K concussion management %K concussion rehabilitation %K rehabilitation %K self-management tool %K perception %K digital health %K e-health %K mobile app %K mhealth %K web-based tool %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population. Objective: This study aimed to investigate the perceptions and acceptance of clinicians and adults with concussions using MyGuide Concussion (Vancouver Coastal Health), a web-based concussion self-management tool. Methods: Using a mixed methods sequential explanatory design, a convenience sample of 8 adults with concussions and 8 clinicians who used MyGuide Concussion over a 2-year period were interviewed, and their responses were analyzed. Results: Participants reported two key benefits of using the web-based self-management tool: (1) the tool’s emphasis on the interconnectedness of physical and psychological symptoms, and (2) the ability to provide reassurance that symptom being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions and believed the content was useful for increasing clients’ independence in managing their own recovery. Conclusions: Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for adults with concussions who require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use. %M 39773679 %R 10.2196/59181 %U https://rehab.jmir.org/2025/1/e59181 %U https://doi.org/10.2196/59181 %U http://www.ncbi.nlm.nih.gov/pubmed/39773679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e49585 %T Differences in eHealth Access, Use, and Perceived Benefit Between Different Socioeconomic Groups in the Dutch Context: Secondary Cross-Sectional Study %A Standaar,Lucille %A van Tuyl,Lilian %A Suijkerbuijk,Anita %A Brabers,Anne %A Friele,Roland %+ Department of Population Health and Health Services Research, Centre for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, PO Box 1, Bilthoven, 3723 BA, Netherlands, 31 302743243, lucille.standaar@rivm.nl %K eHealth %K digital divide %K socioeconomic factors %K education %K income %K neighborhood %K health disparities %K cross-sectional studies %K digital health care %K health equity %K Netherlands %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing concern that digital health care may exacerbate existing health disparities. Digital health care or eHealth encompasses the digital apps that are used in health care. Differences in access, use, and perceived benefits of digital technology among socioeconomic groups are commonly referred to as the digital divide. Current research shows that people in lower socioeconomic positions (SEPs) use eHealth less frequently. Objective: This study aims to (1) investigate the association between SEP and eHealth access to, use of, and perceived benefit within the adult Dutch population and (2) evaluate disparities in eHealth access, use, and perceived benefit through three socioeconomic variables—education, standardized income, and the socioeconomic status of the neighborhood. Methods: A secondary analysis was conducted on data from the Nivel Dutch Health Care Consumer Panel (response rate 57%, 849/1500), to assess access to, use of, and perceived benefits from eHealth. These data were collected to monitor eHealth developments in the Netherlands. eHealth was examined through two concepts: (1) eHealth in general and (2) websites, apps, and wearables. Results were stratified into 9 SEP populations based on 3 indicators—education, standardized income, and socioeconomic status level of the neighborhood. Logistic regression analyses were performed to evaluate whether the outcomes varied significantly across different SEP groups. Age was included as a covariate to control for confounding. Results: This study confirms the association between eHealth and SEP and shows that low SEP respondents have less access (odds ratio [OR] 5.72, 95% CI 3.06-10.72) and use (OR 4.96, 95% CI 2.66-9.24) of eHealth compared to medium or high SEP respondents. Differences were most profound when stratifying for levels of education. Conclusions: The access to and use of eHealth has a socioeconomic gradient and emphasizes that SEP indicators cannot be used interchangeably to assess eHealth access and use. The results underline the importance of activities and policies aimed at improving eHealth accessibility and usage among low SEP groups to mitigate disparities in health between different socioeconomic groups. %R 10.2196/49585 %U https://formative.jmir.org/2025/1/e49585 %U https://doi.org/10.2196/49585 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e68243 %T Enhancing Methodological Rigor in Mobile Health Care Research %A Tang,Shuhan %K letter to the editor %K health care professionals %K mobile health care %K technical training %K cross-sectional survey %K mobile %K China %K web-based questionnaire %K logistic regression %K mhealth %K mobile health %D 2025 %7 3.1.2025 %9 %J JMIR Hum Factors %G English %X %R 10.2196/68243 %U https://humanfactors.jmir.org/2025/1/e68243 %U https://doi.org/10.2196/68243 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60042 %T Factors Affecting Usability and Acceptability of an Online Platform Used by Caregivers in Child and Adolescent Mental Health Services: Mixed Methods Study %A Radley,Jessica %A Penhallow,Jessica %A Wickersham,Alice %A Morris,Anna %A Colling,Craig %A Downs,Johnny %K child mental health %K caregivers %K digital technology %K digital health %K technology use %K digital skill %K digital literacy %K digital divides %K online systems %K online survey %K pediatric %K mental health %K usability %K platform %K survey %K questionnaire %K children %K youth %K adolescent %K informal care %K family care %K acceptability %K System Usability Scale %K SUS %K mobile phone %D 2024 %7 26.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Young people and families endure protracted waits for specialist mental health support in the United Kingdom. Staff shortages and limited resources have led many organizations to develop digital platforms to improve access to support. myHealthE is a digital platform used by families referred to Child and Adolescent Mental Health Services in South London. It was initially designed to improve the collection of routine outcome measures and subsequently the “virtual waiting room” module was added, which includes information about child and adolescent mental health as well as signposting to supportive services. However, little is known about the acceptability or use of digital resources, such as myHealthE, or about sociodemographic inequalities affecting access to these resources. Objective: This study aimed to assess the usability and acceptability of myHealthE as well as investigating whether any digital divides existed among its userbase in terms of sociodemographic characteristics. Methods: A survey was sent to all myHealthE users (N=7337) in May 2023. Caregivers were asked about their usage of myHealthE, their levels of comfort with technology and the internet. They completed the System Usability Scale and gave open-ended feedback on their experiences of using myHealthE. Results: A total of 680 caregivers responded, of whom 45% (n=306) were from a Black, Asian, or a minority ethnic background. Most (n=666, 98%) used a mobile phone to access myHealthE, and many had not accessed the platform’s full functionality, including the new “virtual waiting room” module. Household income was a significant predictor of caregivers’ levels of comfort using technology; caregivers were 13% more likely to be comfortable using technology with each increasing income bracket (adjusted odds ratio 1.13, 95% CI 1.00‐1.29). Themes generated from caregivers’ feedback highlight strengths of digital innovation as well as ideas for improvement, such as making digital platforms more personalized and tailored toward an individual’s needs. Conclusions: Technology can bring many benefits to health care; however, sole reliance on technology may result in many individuals being excluded. To enhance engagement, clinical services must ensure that digital platforms are mobile friendly, personalized, that users are alerted and directed to their full functionality, and that efforts are made to bridge digital divides. Enhancing dissemination practices and improving accessibility to informative resources on the internet is critical to provide fair access to all using Child and Adolescent Mental Health Services. %R 10.2196/60042 %U https://pediatrics.jmir.org/2024/1/e60042 %U https://doi.org/10.2196/60042 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e67992 %T The CareVirtue Digital Journal for Family and Friend Caregivers of People Living With Alzheimer Disease and Related Dementias: Exploratory Topic Modeling and User Engagement Study %A Pickett,Andrew C %A Valdez,Danny %A White,Lillian A %A Loganathar,Priya %A Linden,Anna %A Boutilier,Justin J %A Caldwell,Clover %A Elliott,Christian %A Zuraw,Matthew %A Werner,Nicole E %+ Department of Health & Wellness Design, School of Public Health- Bloomington, Indiana University, 2719 E 10th Street, Bloomington, IN, 47408, United States, 1 812 856 1710, picketac@iu.edu %K caregiving %K dementia %K social support %K technology %K intervention %K Alzheimer disease %K family %K care network %K elder %K CareVirtue %K open text %K online platform %K digital journaling tool %K computational informatics %K thematic analysis %K topic modeling %K neurodegeneration %K gerontology %K sentiment analysis %D 2024 %7 24.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: As Alzheimer disease (AD) and AD-related dementias (ADRD) progress, individuals increasingly require assistance from unpaid, informal caregivers to support them in activities of daily living. These caregivers may experience high levels of financial, mental, and physical strain associated with providing care. CareVirtue is a web-based tool created to connect and support multiple individuals across a care network to coordinate care activities and share important information, thereby reducing care burden. Objective: This study aims to use a computational informatics approach to thematically analyze open text written by AD/ADRD caregivers in the CareVirtue platform. We then explore relationships between identified themes and use patterns. Methods: We analyzed journal posts (n=1555 posts; 170,212 words) generated by 51 unique users of the CareVirtue platform. Latent themes were identified using a neural network approach to topic modeling. We calculated a sentiment score for each post using the Valence Aware Dictionary and Sentiment Reasoner. We then examined relationships between identified topics; semantic sentiment; and use-related data, including post word count and self-reported mood. Results: We identified 5 primary topics in users’ journal posts, including descriptions of specific events, professional and medical care, routine daily activities, nighttime symptoms, and bathroom/toileting issues. This 5-topic model demonstrated adequate fit to the data, having the highest coherence score (0.41) among those tested. We observed group differences across these topics in both word count and semantic sentiment. Further, posts made in the evening were both longer and more semantically positive than other times of the day. Conclusions: Users of the CareVirtue platform journaled about a variety of different topics, including generalized experiences and specific behavioral symptomology of AD/ADRD, suggesting a desire to record and share broadly across the care network. Posts were the most positive in the early evening when the tool was used habitually, rather than when writing about acute events or symptomology. We discuss the value of embedding informatics-based tools into digital interventions to facilitate real-time content delivery. %M 39719081 %R 10.2196/67992 %U https://aging.jmir.org/2024/1/e67992 %U https://doi.org/10.2196/67992 %U http://www.ncbi.nlm.nih.gov/pubmed/39719081 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48170 %T Prototype of an App Designed to Support Self-Management for Health Behaviors and Weight in Women Living With Breast Cancer: Qualitative User Experience Study %A Lally,Phillippa %A May,Christine N %A Mitchell,E Siobhan %A McCallum,Meaghan %A Michaelides,Andreas %A Fisher,Abigail %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20276791722, abigail.fisher@ucl.ac.uk %K breast cancer %K self-management %K app %K health behaviors %K weight %K prototype %K user experience %K development %K application %K coaching %K peer support %K oncology %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Accessible self-management interventions are required to support people living with breast cancer. Objective: This was an industry-academic partnership study that aimed to collect qualitative user experience data of a prototype app with built-in peer and coach support designed to support the management of health behaviors and weight in women living with breast cancer. Methods: Participants were aged ≥18 years, were diagnosed with breast cancer of any stage within the last 5 years, had completed active treatment, and were prescribed oral hormone therapy. Participants completed demographic surveys and were asked to use the app for 4 weeks. Following this, they took part in in-depth qualitative interviews about their experiences. These were analyzed using thematic analysis. Results: Eight participants (mean age, 45 years; mean time since diagnosis, 32 months) were included. Of the 8 participants, 7 (88%) were white, 6 (75%) had a graduate degree or above, and 6 (75%) had stage I-III breast cancer. Four overarching themes were identified: (1) Support for providing an app earlier in the care pathway; (2) Desire for more weight-focused content tailored to the breast cancer experience; (3) Tracking of health behaviors that are generally popular; and (4) High value of in-app social support. Conclusions: This early user experience work showed that women with breast cancer found an app with integrated social and psychological support appealing to receive support for behavior change and weight management or self-management. However, many features were recommended for further development. This work is the first step in an academic-industry collaboration that would ultimately aim to develop and empirically test a supportive app that could be integrated into the cancer care pathway. %M 39705674 %R 10.2196/48170 %U https://cancer.jmir.org/2024/1/e48170 %U https://doi.org/10.2196/48170 %U http://www.ncbi.nlm.nih.gov/pubmed/39705674 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e59381 %T A Narrative-Gamified Mental Health App (Kuamsha) for Adolescents in Uganda: Mixed Methods Feasibility and Acceptability Study %A R Pozuelo,Julia %A Nabulumba,Christine %A Sikoti,Doreen %A Davis,Meghan %A Gumikiriza-Onoria,Joy Louise %A Kinyanda,Eugene %A Moffett,Bianca %A van Heerden,Alastair %A O'Mahen,Heather A %A Craske,Michelle %A , %A Sulaiman,Munshi %A Stein,Alan %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Headington, Oxford, OX3 7JX, United Kingdom, 44 01865618200, julia_ruizpozuelo@hms.harvard.edu %K adolescents %K mental health %K Uganda %K gamified app %K digital interventions %K mobile phone %K user-centered design %K low- and middle-income countries %D 2024 %7 19.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Many adolescents in Uganda are affected by common mental disorders, but only a few affordable treatment options are available. Digital mental health interventions offer promising opportunities to reduce these large treatment gaps, but interventions specifically tailored for Ugandan adolescents are limited. Objective: This study aimed to determine the feasibility and acceptability of the Kuamsha program, an intervention delivered through a gamified app with low-intensity telephonic guidance, as a way to promote mental health among adolescents from the general population in Uganda. Methods: A 3-month pre-post single-arm trial was conducted with adolescents aged between 15 and 19 years living in Wakiso District, Central Uganda. The intervention was coproduced with adolescents from the study site to ensure that it was culturally acceptable. The feasibility and acceptability of the intervention were evaluated using an explanatory sequential mixed methods approach. Feasibility was assessed by collecting data on trial retention rates and treatment adherence rates. Acceptability was assessed through a questionnaire and in-depth interviews with participants following the conclusion of the intervention period. As a secondary objective, we explored the changes in participants’ mental health before and after the intervention. Results: A total of 31 adolescents were recruited for the study. Results from the study showed high levels of feasibility and acceptability. Trial retention rates exceeded 90%, and treatment adherence was ≥80%. These results, evaluated against our predefined trial progression criteria, indicate a successful feasibility study, with all criteria exceeding the thresholds necessary to progress to a larger trial. App engagement metrics, such as time spent on the app and modules completed, exceeded existing literature benchmarks, and many adolescents continued to use the app after the intervention. In-depth interviews and questionnaire responses revealed high acceptability levels. Depressive symptoms trended toward reduction (mean difference: 1.41, 95% CI –0.60 to 3.42, Cohen d=0.30), although this was not statistically significant (P=.16). Supporting this trend, we also observed a reduction in the proportion of participants with moderate depressive symptoms from 32% (10/31) to 17% (5/29) after the intervention, but this change was also not significant (P=.10). Conclusions: This study presents evidence to support the Kuamsha program as a feasible and acceptable digital mental health program for adolescents in Uganda. A fully powered randomized controlled trial is needed to assess its effectiveness in improving adolescents’ mental health. %M 39700489 %R 10.2196/59381 %U https://games.jmir.org/2024/1/e59381 %U https://doi.org/10.2196/59381 %U http://www.ncbi.nlm.nih.gov/pubmed/39700489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55176 %T User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study %A Park,Ye-Eun %A Tak,Yae Won %A Kim,Inhye %A Lee,Hui Jeong %A Lee,Jung Bok %A Lee,Jong Won %A Lee,Yura %+ Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 1498, haepary@amc.seoul.kr %K mHealth %K user experience %K cancer %K technology acceptance model %K structural equation modeling %K health care app %K mixed-method study %K medical care %K digital health care %K cancer survivors %K disparities %K health status %K behavioral intervention %K clinician %D 2024 %7 18.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The shift in medical care toward prediction and prevention has led to the emergence of digital health care as a valuable tool for managing health issues. Aiding long-term follow-up care for cancer survivors and contributing to improved survival rates. However, potential barriers to mobile health usage, including age-related disparities and challenges in user retention for commercial health apps, highlight the need to assess the impact of patients’ abilities and health status on the adoption of these interventions. Objective: This study aims to investigate the app adherence and user experience of commercial health care apps among cancer survivors using an extended technology acceptance model (TAM). Methods: The study enrolled 264 cancer survivors. We collected survey results from May to August 2022 and app usage records from the app companies. The survey questions were created based on the TAM. Results: We categorized 264 participants into 3 clusters based on their app usage behavior: short use (n=77), medium use (n=101), and long use (n=86). The mean usage days were 9 (SD 11) days, 58 (SD 20) days, and 84 (SD 176) days, respectively. Analysis revealed significant differences in perceived usefulness (P=.01), interface satisfaction (P<.01), equity (P<.01), and utility (P=.01) among the clusters. Structural equation modeling indicated that perceived ease-of-use significantly influenced perceived usefulness (β=0.387, P<.01), and both perceived usefulness and attitude significantly affected behavioral intention and actual usage. Conclusions: This study showed the importance of positive user experience and clinician recommendations in facilitating the effective usage of digital health care tools among cancer survivors and contributing to the evolving landscape of medical care. %M 39693615 %R 10.2196/55176 %U https://www.jmir.org/2024/1/e55176 %U https://doi.org/10.2196/55176 %U http://www.ncbi.nlm.nih.gov/pubmed/39693615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63680 %T Exploring Individuals’ Views and Feedback on a Nutritional Screening Mobile App: Qualitative Focus Group Study %A Jones,Debra %A Sowerbutts,Anne Marie %A Burden,Sorrel %+ School of Health Sciences, University of Manchester, Jean McFarlane Building, 5th Floor, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613061508, debra.jones@manchester.ac.uk %K malnutrition %K malnutrition risk %K malnutrition screening %K MUST %K mobile application %K mHealth app %K malnutrition universal screening tool %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Malnutrition is a major global health challenge. Worldwide, approximately 390 million adults are underweight, while 2.5 billion are overweight. The Malnutrition Universal Screening Tool (MUST) has been implemented successfully in the United Kingdom to assess the nutritional status of patients in health care settings. Currently, MUST is available as a web-based tool or as a paper-based version, However, the paper tool can lead to calculation errors, and web-based tools require internet access, limiting use in some communities. The MUST app uses clear and simple navigation and processes information precisely, so could potentially improve the accuracy and accessibility of malnutrition screening for health care professionals (HCP) in all settings. Objective: This study aimed to explore the views of HCPs on the content, functionality, and usability of a newly developed mobile app for MUST. Methods: We performed a qualitative study using deductive and inductive framework analysis. A series of online focus groups (~1 hour each) were conducted, exploring potential users’ views on the app’s content design, functionality, and usefulness, which was set in demonstration mode and not available for direct use with patients. Each focus group used a semistructured approach and predefined topic guide. Participants were recruited consecutively and United Kingdom–wide using advertisements through emails, newsletters, and on social media across appropriate local and national networks. Participants had the opportunity to look at the app on their phones before giving feedback and an on-screen demonstration of the app was provided during the focus group. Data were analyzed using deductive and inductive framework analysis. Results: In total, 8 online focus groups were conducted between August 2022 and January 2023. Participants (n=32) were dietetic and nutrition HCPs or educators with experience in using MUST in clinical or community settings. Data analysis revealed three broad themes: (1) improving the app for better use in practice, (2) user experience of design, and (3) barriers and facilitators in different settings. Overall feedback for the app was positive with potential users considering it to be very useful for improving routine and accurate screening, particularly in the community, and mainly because of the automatic calculation feature, which may help with improving discrepancies. Participants generally considered the app to be for professional use only, stating that patients may find it too clinical or technical. Participants also made suggestions for app sustainability and improvements, such as incentives to complete the demographics section or the option to skip questions, and the addition of more subjective measures and instructions on measuring ulna length. Conclusions: The MUST app was positively evaluated by potential users, who reported it was user-friendly and an accessible way to screen for malnutrition risk, whilst improving the accuracy of screening and availability in community settings. %M 39693128 %R 10.2196/63680 %U https://formative.jmir.org/2024/1/e63680 %U https://doi.org/10.2196/63680 %U http://www.ncbi.nlm.nih.gov/pubmed/39693128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63041 %T Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study %A Grewal,Karl S %A Gowda-Sookochoff,Rory %A Peacock,Shelley %A Cammer,Allison %A McWilliams,Lachlan A %A Spiteri,Raymond J %A Haase,Kristen R %A Harrison,Mary %A Holtslander,Lorraine %A MacRae,Rhoda %A Michael,Joanne %A Green,Shoshana %A O'Connell,Megan E %+ Department of Psychology and Health Studies, College of Arts and Science, University of Saskatchewan, 9 Campus Drive, Sasktoon, SK, S7N 5A5, Canada, 1 3069662496, karl.grewal@usask.ca %K care partner %K caregiving %K dementia %K technology %K content analysis %K mobile phone %K technology adoption %K assistive technology %K support %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Examining ways to support persons with dementia and their caregivers to help minimize the disease’s impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes). Objective: Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner’s everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia. Methods: We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis. Results: Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic. Conclusions: The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners’ relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners’ reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology. %M 39671589 %R 10.2196/63041 %U https://formative.jmir.org/2024/1/e63041 %U https://doi.org/10.2196/63041 %U http://www.ncbi.nlm.nih.gov/pubmed/39671589 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60461 %T Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study %A Golsong,Konstanze %A Kaufmann,Luisa %A Baldofski,Sabrina %A Kohls,Elisabeth %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Haus 13, Semmelweisstraße 10, Leipzig, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K mental health %K eHealth %K app %K health care %K app-based support %K psychiatric symptoms %K mobile phone %K COVID-19 %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment–like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment–like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt “definitely” or “rather” encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=–0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. %M 39630503 %R 10.2196/60461 %U https://formative.jmir.org/2024/1/e60461 %U https://doi.org/10.2196/60461 %U http://www.ncbi.nlm.nih.gov/pubmed/39630503 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52715 %T Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study %A Härkönen,Henna %A Myllykangas,Kirsi %A Kärppä,Mikko %A Rasmus,Kirsi Maaria %A Gomes,Julius Francis %A Immonen,Milla %A Hyvämäki,Piia %A Jansson,Miia %+ Research Unit of Health Sciences and Technology (HST), University of Oulu, PO BOX 8000, Oulu, FI-90014, Finland, 358 504689544, henna.harkonen@oulu.fi %K cerebrovascular disease %K stroke %K digitalization %K interventions %K health care professional %K client %K patient %K mHealth %K mobile health %K application %K digital health %K smartphones %K health system %K qualitative %K descriptive study %K brain %K blood vessel disease %K cerebrovascular disorder %K Finland %K interviews %K efficiency %K information %K quality %K accountability %K neurology %K neuroscience %K brain injury %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements. Objective: This study aims to identify opportunities for DHIs from clients’ and health care professionals’ perspectives to address health system challenges and improve CVD care. Methods: This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis. Results: Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange. Conclusions: The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care. %M 39622027 %R 10.2196/52715 %U https://www.jmir.org/2024/1/e52715 %U https://doi.org/10.2196/52715 %U http://www.ncbi.nlm.nih.gov/pubmed/39622027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58682 %T An Image-Recognition Dietary Assessment App for Adolescents With Obesity: Pilot Randomized Controlled Trial %A Oei,Krista %A Choi,Elizabeth EY %A Bar-Dayan,Alisa %A Stinson,Jennifer N %A Palmert,Mark R %A Alfonsi,Jeffrey E %A Hamilton,Jill %+ Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada, 1 4168131500, krista.oei@sickkids.ca %K obesity %K weight management %K dietary assessment %K nutrition %K adolescent %K digital health app %K mHealth %K mobile health %K image recognition %K teens %K weight %K youth %K diet %K dietary %K dietary app %K usability %K feasibility %K pilot randomized controlled trial %K obesity management %K nutritional %K user %K patient engagement %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a period of increased susceptibility to developing obesity-related health issues due to poor eating patterns and increased sedentary behaviors. Recommendations for pediatric obesity management include dietary assessments. However, adolescents often avoid food logging through traditional methods. The use of image-recognition dietary assessment apps in adolescents with obesity is not well studied. Eating for Wellness (E4W) is a mobile app that determines the nutritional content of meals from photos and incorporates nutritional goal setting. Nutritional data can be displayed for health care providers (HCPs) via the Clinician Portal, while the data are presented to the user in a manner that minimizes the focus on calorie counting. Objective: This study aims to evaluate the usability and feasibility of E4W, a mobile health app designed to improve dietary intake in adolescents with obesity attending an obesity clinic, using a phased approach. Methods: The overall study was conducted in 2 phases to refine and evaluate E4W. In Phase 1, usability was tested through 3 iterative cycles of patient interviews. A total of 14 patient participants, aged 12-18 years with a BMI≥97th percentile, were included. Participants performed standardized scenario-based tasks in E4W and provided feedback on the app. Two iterative cycles were conducted for HCPs (n=4). Refinements were made during each cycle based on issues encountered and feedback provided. In Phase 2, a pilot randomized controlled trial of 32 adolescents (16 adolescents enrolled in the experimental group for 1 month, and 16 controls enrolled for 1 month) was completed. Both groups met with their dietitian at baseline, midstudy, and 1 month following their baseline visit to discuss goals and eating patterns. The control group was instructed to take photos of all intake using their default phone camera, without access to E4W, while those in the experimental group received full access to E4W. The primary outcome was the feasibility of implementation. Secondary outcomes examined overall change in dietary intake and achievement of nutritional goals. Results: Usability testing demonstrated that E4W and the Clinician Portal were easy to use, efficient, and well-liked by patients and HCPs. Feasibility testing revealed high patient acceptability scores. However, significant technical challenges were encountered. Although the use of E4W did not significantly impact patient engagement (control: mean 0.9, SD 0.7; experimental: mean 1.7, SD 1.9; P=.14), there were outliers in the experimental group with very high engagement and improved self-reported efficacy. Overall, there was no improvement in dietary intake, although assessment was hindered by poor adherence to traditional methods of food logging. Conclusions: E4W and the Clinician Portal were well-received by patients and HCPs. Further research is warranted and planned to determine if E4W can improve dietary intake and achievement of nutritional goals in adolescents with obesity. Trial Registration: ClinicalTrials.gov NCT05548868; https://clinicaltrials.gov/study/NCT05548868 %M 39621405 %R 10.2196/58682 %U https://formative.jmir.org/2024/1/e58682 %U https://doi.org/10.2196/58682 %U http://www.ncbi.nlm.nih.gov/pubmed/39621405 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50835 %T Understanding Morning Emotions by Analyzing Daily Wake-Up Alarm Usage: Longitudinal Observational Study %A Oh,Kyue Taek %A Ko,Jisu %A ­Jin,Nayoung %A Han,Sangbin %A Yoon,Chan Yul %A Shin,Jaemyung %A Ko,Minsam %+ Department of Human-Computer Interaction, University of Hanyang, ERICA Campus, 55 Hanyangdeahak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, Republic of Korea, 82 31 400 1071, minsam@hanyang.ac.kr %K morning emotion %K wake-up alarm usage %K morning context %K emotion monitoring %K longitudinal observational study %D 2024 %7 29.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Morning emotions can significantly affect daily wellness. While many studies have analyzed daily survey responses to identify factors influencing morning emotions, these methods require additional time and effort from individuals for emotional monitoring. Objective: This study aims to identify daily alarm usage patterns related to morning emotions. Methods: We recruited 373 users of the Alarmy app (DelightRoom) in the United States and South Korea and surveyed their demographics and usual behaviors related to morning emotions. Participants described their morning emotions over a 2-week period, during which we collected daily alarm app logs. We used a generalized estimating equation (GEE) method to identify factors affecting morning emotions. Results: The findings indicate that varied alarm usage is related to morning emotions. Alarm set time was positively associated with feelings of peacefulness and refreshment in the morning, while task-based alarms were related to nervousness. The time taken to deactivate the alarm after it rang was negatively correlated with happiness. In addition, usual behaviors and demographic factors were found to be related to morning emotions, consistent with previous studies. Conclusions: The study reveals that daily alarm usage is related to morning emotions, suggesting that daily alarm logs can supplement survey methods to facilitate daily emotion monitoring. %M 39612499 %R 10.2196/50835 %U https://humanfactors.jmir.org/2024/1/e50835 %U https://doi.org/10.2196/50835 %U http://www.ncbi.nlm.nih.gov/pubmed/39612499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64380 %T Public Perception on Artificial Intelligence–Driven Mental Health Interventions: Survey Research %A Varghese,Mahima Anna %A Sharma,Poonam %A Patwardhan,Maitreyee %+ Department of Social Science and Language, Vellore Institute of Technology, Vellore Campus, Tiruvalam Road, Vellore, 632014, India, 91 9702872251, poonam.sharma@vit.ac.in %K public perception %K artificial intelligence %K AI %K AI-driven %K human-driven %K mental health inteventions %K mental health stigma %K trust in AI %K public perception %K digital health %K India %K mobile phone %D 2024 %7 28.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) has become increasingly important in health care, generating both curiosity and concern. With a doctor-patient ratio of 1:834 in India, AI has the potential to alleviate a significant health care burden. Public perception plays a crucial role in shaping attitudes that can facilitate the adoption of new technologies. Similarly, the acceptance of AI-driven mental health interventions is crucial in determining their effectiveness and widespread adoption. Therefore, it is essential to study public perceptions and usage of existing AI-driven mental health interventions by exploring user experiences and opinions on their future applicability, particularly in comparison to traditional, human-based interventions. Objective: This study aims to explore the use, perception, and acceptance of AI-driven mental health interventions in comparison to traditional, human-based interventions. Methods: A total of 466 adult participants from India voluntarily completed a 30-item web-based survey on the use and perception of AI-based mental health interventions between November and December 2023. Results: Of the 466 respondents, only 163 (35%) had ever consulted a mental health professional. Additionally, 305 (65.5%) reported very low knowledge of AI-driven interventions. In terms of trust, 247 (53%) expressed a moderate level of Trust in AI-Driven Mental Health Interventions, while only 24 (5.2%) reported a high level of trust. By contrast, 114 (24.5%) reported high trust and 309 (66.3%) reported moderate Trust in Human-Based Mental Health Interventions; 242 (51.9%) participants reported a high level of stigma associated with using human-based interventions, compared with only 50 (10.7%) who expressed concerns about stigma related to AI-driven interventions. Additionally, 162 (34.8%) expressed a positive outlook toward the future use and social acceptance of AI-based interventions. The majority of respondents indicated that AI could be a useful option for providing general mental health tips and conducting initial assessments. The key benefits of AI highlighted by participants were accessibility, cost-effectiveness, 24/7 availability, and reduced stigma. Major concerns included data privacy, security, the lack of human touch, and the potential for misdiagnosis. Conclusions: There is a general lack of awareness about AI-driven mental health interventions. However, AI shows potential as a viable option for prevention, primary assessment, and ongoing mental health maintenance. Currently, people tend to trust traditional mental health practices more. Stigma remains a significant barrier to accessing traditional mental health services. Currently, the human touch remains an indispensable aspect of human-based mental health care, one that AI cannot replace. However, integrating AI with human mental health professionals is seen as a compelling model. AI is positively perceived in terms of accessibility, availability, and destigmatization. Knowledge and perceived trustworthiness are key factors influencing the acceptance and effectiveness of AI-driven mental health interventions. %M 39607994 %R 10.2196/64380 %U https://formative.jmir.org/2024/1/e64380 %U https://doi.org/10.2196/64380 %U http://www.ncbi.nlm.nih.gov/pubmed/39607994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48914 %T Preliminary Screening for Hereditary Breast and Ovarian Cancer Using an AI Chatbot as a Genetic Counselor: Clinical Study %A Sato,Ann %A Haneda,Eri %A Hiroshima,Yukihiko %A Narimatsu,Hiroto %+ Department of Genetic Medicine, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan, 81 045 520 2222, hiroto-narimatsu@umin.org %K hereditary cancer %K familial cancer %K IBM Watson %K family history %K medical history %K cancer %K feasibility %K social network %K screening %K breast cancer %K ovarian cancer %K artificial intelligence %K AI %K chatbot %K genetic %K counselling %K oncology %K conversational agent %K implementation %K usability %K acceptability %D 2024 %7 27.11.2024 %9 Research Letter %J J Med Internet Res %G English %X Background: Hereditary breast and ovarian cancer (HBOC) is a major type of hereditary cancer. Establishing effective screening to identify high-risk individuals for HBOC remains a challenge. We developed a prototype of a chatbot system that uses artificial intelligence (AI) for preliminary HBOC screening to determine whether individuals meet the National Comprehensive Cancer Network BRCA1/2 testing criteria. Objective: This study’s objective was to validate the feasibility of this chatbot in a clinical setting by using it on a patient population that visited a hospital. Methods: We validated the medical accuracy of the chatbot system by performing a test on patients who consecutively visited the Kanagawa Cancer Center. The participants completed a preoperation questionnaire to understand their background, including information technology literacy. After the operation, qualitative interviews were conducted to collect data on the usability and acceptability of the system and examine points needing improvement. Results: A total of 11 participants were enrolled between October and December 2020. All of the participants were women, and among them, 10 (91%) had cancer. According to the questionnaire, 6 (54%) participants had never heard of a chatbot, while 7 (64%) had never used one. All participants were able to complete the chatbot operation, and the average time required for the operation was 18.0 (SD 5.44) minutes. The determinations by the chatbot of whether the participants met the BRCA1/2 testing criteria based on their medical and family history were consistent with those by certified genetic counselors (CGCs). We compared the medical histories obtained from the participants by the CGCs with those by the chatbot. Of the 11 participants, 3 (27%) entered information different from that obtained by the CGCs. These discrepancies were caused by the participant’s omissions or communication errors with the chatbot. Regarding the family histories, the chatbot provided new information for 3 (27%) of the 11 participants and complemented information for the family members of 5 (45%) participants not interviewed by the CGCs. The chatbot could not obtain some information on the family history of 6 (54%) participants due to several reasons, such as being outside of the scope of the chatbot’s interview questions, the participant’s omissions, and communication errors with the chatbot. Interview data were classified into the following: (1) features, (2) appearance, (3) usability and preferences, (4) concerns, (5) benefits, and (6) implementation. Favorable comments on implementation feasibility and comments on improvements were also obtained. Conclusions: This study demonstrated that the preliminary screening system for HBOC using an AI chatbot was feasible for real patients. %M 39602801 %R 10.2196/48914 %U https://www.jmir.org/2024/1/e48914 %U https://doi.org/10.2196/48914 %U http://www.ncbi.nlm.nih.gov/pubmed/39602801 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49443 %T An Evaluation of the Effect of App-Based Exercise Prescription Using Reinforcement Learning on Satisfaction and Exercise Intensity: Randomized Crossover Trial %A Doherty,Cailbhe %A Lambe,Rory %A O’Grady,Ben %A O’Reilly-Morgan,Diarmuid %A Smyth,Barry %A Lawlor,Aonghus %A Hurley,Neil %A Tragos,Elias %K reinforcement learning %K exercise therapy %K personal satisfaction %K satisfaction %K physiotherapy %K physical therapy %K exercise intensity %K mobile apps %K randomized controlled trial %K crossover trial %K apps %K exercise %K physical activity %K mobile phone %D 2024 %7 26.11.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: The increasing prevalence of sedentary lifestyles has prompted the development of innovative public health interventions, such as smartphone apps that deliver personalized exercise programs. The widespread availability of mobile technologies (eg, smartphone apps and wearable activity trackers) provides a cost-effective, scalable way to remotely deliver personalized exercise programs to users. Using machine learning (ML), specifically reinforcement learning (RL), may enhance user engagement and effectiveness of these programs by tailoring them to individual preferences and needs. Objective: The primary aim was to investigate the impact of the Samsung-developed i80 BPM app, implementing ML for exercise prescription, on user satisfaction and exercise intensity among the general population. The secondary objective was to assess the effectiveness of ML-generated exercise programs for remote prescription of exercise to members of the public. Methods: Participants were randomized to complete 3 exercise sessions per week for 12 weeks using the i80 BPM mobile app, crossing over weekly between intervention and control conditions. The intervention condition involved individualizing exercise sessions using RL, based on user preferences such as exercise difficulty, selection, and intensity, whereas under the control condition, exercise sessions were not individualized. Exercise intensity (measured by the 10-item Borg scale) and user satisfaction (measured by the 8-item version of the Physical Activity Enjoyment Scale) were recorded after the session. Results: In total, 62 participants (27 male and 42 female participants; mean age 43, SD 13 years) completed 559 exercise sessions over 12 weeks (9 sessions per participant). Generalized estimating equations showed that participants were more likely to exercise at a higher intensity (intervention: mean intensity 5.82, 95% CI 5.59‐6.05 and control: mean intensity 5.19, 95% CI 4.97‐5.41) and report higher satisfaction (RL: mean satisfaction 4, 95% CI 3.9-4.1 and baseline: mean satisfaction 3.73, 95% CI 3.6-3.8) in the RL model condition. Conclusions: The findings suggest that RL can effectively increase both the intensity with which people exercise and their enjoyment of the sessions, highlighting the potential of ML to enhance remote exercise interventions. This study underscores the benefits of personalized exercise prescriptions in increasing adherence and satisfaction, which are crucial for the long-term effectiveness of fitness programs. Further research is warranted to explore the long-term impacts and potential scalability of RL-enhanced exercise apps in diverse populations. This study contributes to the understanding of digital health interventions in exercise science, suggesting that personalized, app-based exercise prescriptions may be more effective than traditional, nonpersonalized methods. The integration of RL into exercise apps could significantly impact public health, particularly in enhancing engagement and reducing the global burden of physical inactivity. Trial Registration: ClinicalTrials.gov NCT06653049; https://clinicaltrials.gov/study/NCT06653049 %R 10.2196/49443 %U https://mhealth.jmir.org/2024/1/e49443 %U https://doi.org/10.2196/49443 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57579 %T Feasibility of a Web-Based and Mobile-Supported Follow-Up Treatment Pathway for Adult Patients With Orthopedic Trauma in the Netherlands: Concurrent Mixed Methods Study %A Willinge,Gijs J A %A Spierings,Jelle F %A Romijnders,Kim A G J %A Mathijssen,Elke G E %A Twigt,Bas A %A Goslings,J Carel %A van Veen,Ruben N %K musculoskeletal extremity injury %K patient portal %K follow-up treatment %K healthcare utilization %K patient experience %K feasibility %K orthopedics %K trauma %K Netherlands %K mixed methods %K resource utilization %K electronic patient records %K thematic analysis %K qualitative data %K digital treatment %K mobile phone %D 2024 %7 26.11.2024 %9 %J JMIR Form Res %G English %X Background: Orthopedic trauma care encounters challenges in follow-up treatment due to limited patient information provision, treatment variation, and the chaotic settings in which it is provided. Additionally, pressure on health care resources is rising worldwide. In response, digital follow-up treatment pathways were implemented for patients with orthopedic trauma, aiming to optimize health care resource use and enhance patient experiences. Objective: We aim to assess digital follow-up treatment pathway feasibility from the patient’s perspective and its impact on health care resource use. Methods: A concurrent mixed methods study was conducted parallel to implementation of digital follow-up treatment pathways in an urban level-2 trauma center. Inclusion criteria were (1) minimum age of 18 years, (2) an active web-based patient portal account, (3) ability to read and write in Dutch, and (4) no cognitive or preexisting motor impairment. Data were collected via electronic patient records, and surveys at three time points: day 1‐3, 4‐6 weeks, and 10‐12 weeks after an initial emergency department visit. Semistructured interviews were performed at 10‐12 weeks post injury. Anonymous data from a pre-existing database were used to compare health care resource use between the digital treatment pathways and traditional treatment. Quantitative data were reported descriptively. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited efficacy. Results: Sixty-six patients were included for quantitative data collection. Survey response rates were 100% (66/66) at day 1‐3, 92% (61/66) at 4‐6 weeks, and 79% (52/66) at 10‐12 weeks. For qualitative data collection, 15 semistructured interviews were performed. Patients reported median satisfaction scores of 7 (IQR 6‐8) with digital treatment pathways and 8 (IQR 7‐9) for overall treatment, reflecting positive experiences regarding functionality, actual and intended use, and treatment safety. Digital treatment pathways reduced secondary health care use, with fewer follow-up appointments by phone (median 0, IQR 0‐0) versus the control group (median 1, IQR 0‐1; P<.001). Consequently, fewer physicians were involved in follow-up treatment for the intervention group (median 2, IQR 1‐2) than for the control group (median 2, IQR 1‐3; P<.001). Fewer radiographs were performed for the intervention group (median 1, IQR 0-1) than for the control group (P=.01). Qualitative data highlighted positive experiences with functionalities, intended use, and safety, but also identified areas for improvement, including managing patient expectations, platform usability, and protocol adherence. Conclusions: Use of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reducing health care resource use. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for health care professionals. These insights can guide clinicians and policy makers in effectively integrating similar tools into clinical practice. %R 10.2196/57579 %U https://formative.jmir.org/2024/1/e57579 %U https://doi.org/10.2196/57579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60918 %T Evaluating an App-Based Intervention for Preventing Firearm Violence and Substance Use in Young Black Boys and Men: Usability Evaluation Study %A Emezue,Chuka %A Dan-Irabor,Dale %A Froilan,Andrew %A Dunlap,Aaron %A Zamora,Pablo %A Negron,Sarah %A Simmons,Janiya %A Watkins,Jayla %A Julion,Wrenetha A %A Karnik,Niranjan S %+ Department of Women, Children and Family Nursing, Rush University Medical Center, 600 S Paulina St AAC Suite 1064A, Armour Academic Center, Chicago, IL, 60612, United States, 1 312 942 6151, chuka_emezue@rush.edu %K telemedicine %K mobile app %K adolescent %K violence %K substance-related disorder %K African American %K user-computer interface %K software validation %K software development %K mobile phone %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young Black male individuals are 24 times more likely to be impacted by firearm injuries and homicides but encounter significant barriers to care and service disengagement, even in program-rich cities across the United States, leaving them worryingly underserved. Existing community-based interventions focus on secondary and tertiary prevention after firearm violence has occurred and are typically deployed in emergency settings. To address these service and uptake issues, we developed BrotherlyACT—a nurse-led, culturally tailored, multicomponent app—to reduce the risk and effects of firearm injuries and homicides and to improve access to precrisis and mental health resources for young Black male individuals (aged 15-24 years) in low-resource and high-violence settings. Grounded in Acceptance and Commitment Therapy, the app provides life skills coaching, safety planning, artificial intelligence–powered talk therapy, and zip code–based service connections directly to young Black male individuals at risk for violence and substance use. Objective: The primary aim of this study is to evaluate the usability, engagement, and satisfaction of BrotherlyACT among target young Black male users and mobile health (mHealth) experts, using a combination of formative usability testing (UT) and heuristic evaluation (HE). Methods: Using a convergent mixed methods approach, we evaluated the BrotherlyACT app using HE by 8 mHealth specialists and conducted UT with 23 participants, comprising 15 young Black male users (aged 15-24 years), alongside 4 adult internal team testers and 4 high school students who were part of our youth advisory board. UT included the System Usability Scale and thematic analysis of think-aloud interviews and cognitive walkthroughs. HE involved mHealth experts applying the Nielsen severity rating scale (score 0-3, with 3 indicating a major issue). All testing was conducted via REDCap (Research Electronic Data Capture) and Zoom or in person. Results: Qualitative usability issues were categorized into 8 thematic groups, revealing only minor usability concerns. The app achieved an average System Usability Scale score of 79, equivalent to an A-minus grade and placing it in the 85th percentile, indicating near-excellent usability. Similarly, the HE by testers identified minor and cosmetic usability issues, with a median severity score of 1 across various heuristics (on a scale of 0-3), indicating minimal impact on user experience. Overall, minor adjustments were recommended to enhance navigation, customization, and guidance for app users, while the app’s visual and functional design was generally well received. Conclusions: BrotherlyACT was considered highly usable and acceptable. Testers in the UT stage gave the app a positive overall rating and emphasized that several key improvements were made. Findings from our UT prompted revisions to the app prototype. Moving forward, a pilot study with a pretest-posttest design will evaluate the app’s efficacy in community health and emergency care settings. International Registered Report Identifier (IRRID): RR2-10.2196/43842 %M 39589765 %R 10.2196/60918 %U https://formative.jmir.org/2024/1/e60918 %U https://doi.org/10.2196/60918 %U http://www.ncbi.nlm.nih.gov/pubmed/39589765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62742 %T Assessing the Usability and Effectiveness of an AI-Powered Telehealth Platform: Mixed Methods Study on the Perspectives of Patients and Providers %A Jain,Ekta %A Gupta,Srishti %A Yadav,Vandana %A Kachnowski,Stan %+ Healthcare Innovation and Technology Lab, Lasker Hall, 3960 Broadway, Room 501, New York, NY, 10032, United States, 1 (212) 543 0100, vyadav@hitlab.org %K usability study %K telemedicine %K web platform %K patient-provider feedback %K artificial intelligence %K AI triage %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine has revolutionized health care by significantly enhancing accessibility and convenience, yet barriers remain, such as providers’ challenges with technology use. With advancements in telemedicine technologies, understanding the viewpoints of patients and providers is crucial for an effective and acceptable telemedicine service. This study reports the findings on the usability and effectiveness of the HelixVM artificial intelligence powered platform, analyzing key aspetcs like asynchronous health care, access, time efficiency, productivity, data exchange, security, privacy, and quality of care from patient and provider perspectives. Objective: This study aims to assess the usability and effectiveness of the HelixVM marketplace platform. Methods: We recruited 102 patients and 12 providers in a mixed methods study design involving surveys and in-depth structured interviews with a subset of the providers. The survey questionnaires are a modified version of the Telehealth Usability Questionnaire. We analyzed patient data using descriptive statistics and exploratory factor analysis to identify latent demographic patterns. For provider data, we used a deductive thematic analysis approach to identify key themes from the interviews and interpreted overall sentiments of the providers as negative, neutral, or positive. We also calculated percentages of different provider responses from the survey and interviews, where applicable. Results: Overall, 86.3% (88/102) of the patients reported satisfaction with HelixVM, and 89.2% (91/102) indicated that they would use the services again. A total of 91.1% (93/102) of the patients agreed that HelixVM improves access to health care and is an acceptable way to receive health care, and 98% (100/102) agreed it saves time. Chi-square tests demonstrated statistical significance for all survey questions (P<.001). The results from factor analysis show a higher propensity of middle-aged women, who had a fast-track encounter type, who self-reported a medium level of technology savviness, and who are residing in the South region of the United States rating the platform more positively. With regard to the providers, the thematic analysis identified themes of asynchronous medicine in terms of the accessibility and quality of care, time and productivity, integration within the workflow, data exchange, and artificial intelligence triage. Certain challenges regarding incomplete data in patient charts and its impact on provider time were cited. Suggestions for improvements included options to ensure the completeness of patient charts and better screening to ensure that only asynchronous, qualified patients are able to reach the provider. Conclusions: Overall, our study findings indicate a positive experience for patients and providers. The use of fast-track prescription was considered favorable compared to traditional telemedicine. Some concerns on data completeness, gaps, and accuracy exist. Suggestions are provided for improvement. This study adds to the knowledge base of existing literature and provides a detailed analysis of the real-world implementation of a telemedicine market-place platform. %M 39418632 %R 10.2196/62742 %U https://formative.jmir.org/2024/1/e62742 %U https://doi.org/10.2196/62742 %U http://www.ncbi.nlm.nih.gov/pubmed/39418632 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58441 %T A Remote Patient Monitoring System With Feedback Mechanisms Using a Smartwatch: Concept, Implementation, and Evaluation Based on the activeDCM Randomized Controlled Trial %A Wettstein,Reto %A Sedaghat-Hamedani,Farbod %A Heinze,Oliver %A Amr,Ali %A Reich,Christoph %A Betz,Theresa %A Kayvanpour,Elham %A Merzweiler,Angela %A Büsch,Christopher %A Mohr,Isabell %A Friedmann-Bette,Birgit %A Frey,Norbert %A Dugas,Martin %A Meder,Benjamin %+ Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 62215636617, reto.wettstein@med.uni-heidelberg.de %K wearable %K consumer device %K mobile phone %K mobile health %K telemedicine %K remote patient monitoring %K usability %K Health Level 7 Fast Healthcare Interoperability Resources %K HL7 FHIR %K cardiology %K heart failure %K dilated cardiomyopathy %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological advances allow for recording and sharing health-related data in a patient-centric way using smartphones and wearables. Secure sharing of such patient-generated data with physicians would enable close management of individual health trajectories, monitoring of risk factors, and asynchronous feedback. However, most remote patient monitoring (RPM) systems currently available are not fully integrated into hospital IT systems or lack a patient-centric design. Objective: The objective of this study was to conceptualize and implement a user-friendly, reusable, interoperable, and secure RPM system incorporating asynchronous feedback mechanisms using a broadly available consumer wearable (Apple Watch). In addition, this study sought to evaluate factors influencing patient acceptance of such systems. Methods: The RPM system requirements were established through focus group sessions. Subsequently, a system concept was designed and implemented using an iterative approach ensuring technical feasibility from the beginning. To assess clinical feasibility, the system was used as part of the activeDCM prospective randomized interventional study focusing on dilated cardiomyopathy. Each patient used the system for at least 12 months. The System Usability Scale was used to measure usability from a subjective patient perspective. In addition, an evaluation was conducted on the objective wearable interaction frequency as well as the completeness of transmitted data classified into sensor-based health data (SHD) and patient-reported outcome measures (PROMs). Descriptive statistics using box plots and bootstrapped multiple linear regression with 95% CIs were used for evaluation analyzing the influence of age, sex, device experience, and intervention group membership. Results: The RPM system comprised 4 interoperable components: patient devices, a data server, a data viewer, and a notification service. The system was evaluated with 95 consecutive patients with dilated cardiomyopathy (28/95, 29% female; mean age 50, SD 12 y) who completed the activeDCM study protocol. The system’s app achieved a mean System Usability Scale score of 78 (SD 17), which was most influenced by device experience. In total, 87% (83/95) of the patients could integrate the use of the app well or very well into their daily routine, and 71% (67/95) saw a benefit of the RPM system for management of their health condition. On average, patients interacted with the wearable on 61% (SD 26%) of days enrolled in the study. SHD were available on average for 78% (SD 23%) of days, and PROM data were available on 64% (SD 27%) of weeks enrolled in the study. Wearable interaction frequency, SHD, and PROM completeness were most influenced by intervention group membership. Conclusions: Our results mark a first step toward integrating RPM systems based on a consumer wearable device for primary patient input into standardized clinical workflows. They can serve as a blueprint for creating a user-friendly, reusable, interoperable, and secure RPM system that can be integrated into patients’ daily routines. %M 39365164 %R 10.2196/58441 %U https://mhealth.jmir.org/2024/1/e58441 %U https://doi.org/10.2196/58441 %U http://www.ncbi.nlm.nih.gov/pubmed/39365164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56553 %T An Educational Digital Tool to Improve the Implementation of Switching to a Biosimilar (Rapid Switch Trainer): Tool Development and Validation Study %A Marras,Carlos %A Labarga,María %A Ginard,Daniel %A Carrascosa,Jose Manuel %A Escudero-Contreras,Alejandro %A Collantes-Estevez,Eduardo %A de Mora,Fernando %A Robles,Tamara %A Romero,Elisa %A Martínez,Rafael %K consumer health information %K treatment switching %K biosimilar pharmaceuticals %K immune-mediated diseases %K education %K qualitative research %K training %K nocebo %K digital tool %K implementation %D 2024 %7 21.11.2024 %9 %J JMIR Form Res %G English %X Background: Switching to biosimilars is an effective and safe practice in treating inflammatory diseases; however, a nocebo effect may arise as a result of the way in which the switch is communicated to a given patient. Objective: We aimed to design a gaming-based digital educational tool (including a discussion algorithm) to support the training of health care professionals in efficiently communicating the switch to biosimilars, minimizing the generation of a nocebo effect and thus serving as an implementation strategy for the recommended switch. Methods: The tool was developed based on interviews and focus group discussions with key stakeholders, both patients and health care professionals. Messages likely to either generate trust or to trigger a nocebo effect were generated on the basis of the interviews and focus group discussions. Results: A total 7 clinicians and 4 nurses specializing in rheumatology, gastroenterology, and dermatology, with balanced levels of responsibility and experience, as well as balance between geographic regions, participated in the structured direct interviews and provided a list of arguments they commonly used, or saw used, to justify the switching, and objections given by the patients they attended. Patients with immune-mediated inflammatory diseases who were taking biologic drugs with (n=4) and without (n=5) experience in switching attended the focus groups and interviews. Major topics of discussion were the reason for the change, the nature of biosimilars, and their quality, safety, efficacy, and cost. Based on these discussions, a list of objections and of potential arguments was produced. Patients and health care professionals rated the arguments for their potential to evoke trust or a nocebo effect. Two sets of arguments, related to savings and sustainability, showed discrepant ratings between patients and health care professionals. Objections and arguments were organized by categories and incorporated into the tool as algorithms. The educators then developed additional arguments (with inadequate answers) to complement the valid ones worked on in the focus groups. The tool was then developed as a collection of clinical situations or vignettes that appear randomly to the user, who then has to choose an argument to counteract the given objections. After each interaction, the tool provides feedback. The tool was further supported by accredited medical training on biosimilars and switching. Conclusions: We have developed a digital training tool to improve communication on switching to biosimilars in the clinic and prevent a nocebo effect based on broad and in-depth experiences of patients and health care professionals. The validation of this implementation strategy is ongoing. %R 10.2196/56553 %U https://formative.jmir.org/2024/1/e56553 %U https://doi.org/10.2196/56553 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57771 %T German Version of the Telehealth Usability Questionnaire and Derived Short Questionnaires for Usability and Perceived Usefulness in Health Care Assessment in Telehealth and Digital Therapeutics: Instrument Validation Study %A Zimmermann,Jannik %A Morf,Harriet %A Scharf,Florian %A Knitza,Johannes %A Moeller,Heidi %A Muehlensiepen,Felix %A Nathrath,Michaela %A Orlemann,Till %A Voelker,Thomas %A Deckers,Merlin %+ Palliative Care Team for Children Kassel, Mönchebergstr. 41-43, Kassel, 34125, Germany, 49 56198017558, merlin.deckers@kleine-riesen-nordhessen.de %K mHealth %K mobile health %K telehealth %K usability %K questionnaire validation %K technology acceptance model %K validity %K questionnaire translation %K Net Promoter Scale %K NPS %K usefulness %K autoimmune chronic diseases %K questionnaire %K German %K digital therapeutics %K therapeutics %K feasibility %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The exponential growth of telehealth is revolutionizing health care delivery, but its evaluation has not matched the pace of its uptake. Various forms of assessment, from single-item to more extensive questionnaires, have been used to assess telehealth and digital therapeutics and their usability. The most frequently used questionnaire is the “Telehealth Usability Questionnaire” (TUQ). The use of the TUQ is limited by its restricted availability in languages other than English and its feasibility. Objective: The aims of this study were to create a translated German TUQ version and to derive a short questionnaire for patients—“Telehealth Usability and Perceived Usefulness Short Questionnaire for patients” (TUUSQ). Methods: As a first step, the original 21-item TUQ was forward and back-translated twice. In the second step, 13 TUQ items were selected for their suitability for the general evaluation of telehealth on the basis of expert opinion. These 13 items were surveyed between July 2022 and September 2023 in 4 studies with patients and family members of palliative care, as well as patients with chronic autoimmune diseases, evaluating 13 health care apps, including digital therapeutics and a telehealth system (n1=128, n2=220, n3=30, and n4=12). Psychometric exploratory factor analysis was conducted. Results: The analysis revealed that a parsimonious factor structure with 2 factors (“perceived usefulness in health care” and “usability”) is sufficient to describe the patient’s perception. Consequently, the questionnaire could be shortened to 6 items without compromising its informativeness. Conclusions: We provide a linguistically precise German version of the TUQ for assessing the usability and perceived usefulness of telehealth. Beyond that, we supply a highly feasible shortened version that is versatile for general use in telehealth, mobile health, and digital therapeutics, which distinguishes between the 2 factors “perceived usefulness in health care” and “usability” in patients. Trial Registration: German Clinical Trials Register DRKS00030546; https://drks.de/search/de/trial/DRKS00030546 %M 39571151 %R 10.2196/57771 %U https://humanfactors.jmir.org/2024/1/e57771 %U https://doi.org/10.2196/57771 %U http://www.ncbi.nlm.nih.gov/pubmed/39571151 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e64681 %T Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach %A Park,Jinyoung %A Lee,Jungeun %A Noh,Dabok %+ College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13135, Republic of Korea, 82 31 740 7415, daboknoh@eulji.ac.kr %K out-of-home youth %K mental health intervention %K mobile app %K intervention mapping %K youth %K mental health %K mHealth %K mobile health %K app %K interview %K need %K focus group %K emotion %K emotional %K young adult %K independent living %K emotional support %K tool %K emotion regulation %K user %K app usage %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app’s adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app’s impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app’s effectiveness in real-world settings and refine it continuously based on user input. %M 39571152 %R 10.2196/64681 %U https://humanfactors.jmir.org/2024/1/e64681 %U https://doi.org/10.2196/64681 %U http://www.ncbi.nlm.nih.gov/pubmed/39571152 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60037 %T An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study %A Alnooh,Ghadah %A AlTamimi,Jozaa Z %A Williams,Elizabeth A %A Hawley,Mark S %+ Centre for Assistive Technology and Connected Healthcare, School of Medicine and Population Health, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 1142222000, mark.hawley@sheffield.ac.uk %K hypertension %K blood pressure %K Dietary Approaches to Stop Hypertension %K DASH diet %K self-efficacy %K mobile health %K mHealth %K Saudi Arabia %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals’ and patients’ preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app’s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. %M 39561360 %R 10.2196/60037 %U https://formative.jmir.org/2024/1/e60037 %U https://doi.org/10.2196/60037 %U http://www.ncbi.nlm.nih.gov/pubmed/39561360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60865 %T Understanding Patients’ Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study %A Liu,Jianyi %A Giannone,Alyssa %A Wang,Hailing %A Wetherall,Lucy %A Juarascio,Adrienne %+ Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Philadelphia, PA, 19104, United States, 1 2158951895, jl4528@drexel.edu %K bulimia nervosa %K binge eating %K digital intervention %K deterioration prevention %K eating disorder %K bulimia %K digital health %K deterioration %K maintenance %K mHealth %K mobile health app %K interviews %K qualitative %K user-centered design %K psychotherapy %K CBT %K cognitive behavioral therapy %K needs %K preferences %K mobile phone %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Deterioration rates after enhanced cognitive behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high, and decreased posttreatment skill use might be a particularly relevant contributor. Digital interventions could be an ideal option to improve skill use after treatment ends but they have yet to be investigated for BN-EDs. Objective: This study used a user-centered design approach to explore patients’ interest in a digital intervention to prevent deterioration after CBT-E and their desired features. Methods: A total of 12 participants who previously received CBT-E for BN-EDs and experienced at least a partial response to treatment completed a qualitative interview asking about their interests and needs for an app designed to prevent deterioration after treatment ended. Participants were also presented with features commonly used in digital interventions for EDs and were asked to provide feedback. Results: All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. In total, 11 participants thought the proposed feature of setting a goal focusing on skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals related to specific triggers because they would know what skills to use in high-risk situations. A total of 10 participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels. Participants also reported wanting to track mood (n=6) and food intake (n=5) besides the proposed tracking feature. A total of 10 participants reported wanting knowledge-based content in the app, including instructions on skill practice (n=6), general mental health strategies outside of EDs (n=4), guided mindfulness exercises (n=3), and nutrition recommendations (n=3). Eight participants reported a desire for the app to send targeted push notifications, including reminders of skill use (n=7) and inspirational quotes for encouragement (n=3). Finally, 8 participants reported wanting a human connection in the app, 6 participants wishing to interact with other users to support and learn from each other, and 4 participants wanting to connect with professionals as needed. Overall, participants thought that having an app targeting skill use could provide continued support and improve self-accountability, thus lowering the risk of decreased skill use after treatment ended. Conclusions: Insights from participants highlighted the perceived importance of continued support for continued skill use after treatment ended. This study also provided valuable design implications regarding potential features focusing on facilitating posttreatment skill use to include in digital deterioration prevention programs. Future research should examine the optimal approaches to deliver the core features identified in this study that could lead to higher continued skill use and a lower risk of deterioration in the long term. %M 39556809 %R 10.2196/60865 %U https://formative.jmir.org/2024/1/e60865 %U https://doi.org/10.2196/60865 %U http://www.ncbi.nlm.nih.gov/pubmed/39556809 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59831 %T Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study %A Miller,Michael J %A Eberhart,Lindsay G %A Heliste,Jennifer L %A Tripuraneni,Bhaskara R %+ Mid-Atlantic Permanente Research Institute (MAPRI), 700 2nd St NE, 5th Floor, Washington, DC, 20002, United States, 1 202 317 0618, Michael.J1.Miller@kp.org %K digital mental health applications %K DMHA %K mobile health %K mHealth %K mobile phone %K smartphone %K user experience %K engagement %K implementation %K Kaiser Permanente %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. Objective: This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Methods: Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Results: Of the 119 patients e-mailed a survey link, 58 (48.7%) completed the survey and 44 (37%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66%); 73% (32/44) of the respondents were female, 73% (32/44) of the respondents had at least a 4-year college degree, 41% (18/44) of the respondents were Black or African American, and 39% (17/44) of the respondents were White. Moreover, 27% (12/44) of the respondents screened positive for anxiety symptoms, and 23% (10/44) of the respondents screened positive for depression. Overall, 61% (27/44) of the respondents reported DMHA use for ≤6 months since referral, 36% (16/44) reported use within the past 30 days, and 43% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83%). Of the 12 HCPs, 7 (58%) were physicians and 5 (42%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described “typical patients” referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Conclusions: Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use. %M 39546791 %R 10.2196/59831 %U https://formative.jmir.org/2024/1/e59831 %U https://doi.org/10.2196/59831 %U http://www.ncbi.nlm.nih.gov/pubmed/39546791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57628 %T Human Factors, Human-Centered Design, and Usability of Sensor-Based Digital Health Technologies: Scoping Review %A Tandon,Animesh %A Cobb,Bryan %A Centra,Jacob %A Izmailova,Elena %A Manyakov,Nikolay V %A McClenahan,Samantha %A Patel,Smit %A Sezgin,Emre %A Vairavan,Srinivasan %A Vrijens,Bernard %A Bakker,Jessie P %A , %+ Digital Medicine Society, 90 Canal Street, 4th Floor, Boston, MA, 02114, United States, 1 6175833777, jessie.bakker@dimesociety.org %K digital health %K remote %K decentralized %K sensors %K connected care %K usability %K ergonomics %K human-centered design %K user experience %K systematic scoping review %K human factors %K screening %K clinicians %K wearable %K mobile phone %D 2024 %7 15.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Increasing adoption of sensor-based digital health technologies (sDHTs) in recent years has cast light on the many challenges in implementing these tools into clinical trials and patient care at scale across diverse patient populations; however, the methodological approaches taken toward sDHT usability evaluation have varied markedly. Objective: This review aims to explore the current landscape of studies reporting data related to sDHT human factors, human-centered design, and usability, to inform our concurrent work on developing an evaluation framework for sDHT usability. Methods: We conducted a scoping review of studies published between 2013 and 2023 and indexed in PubMed, in which data related to sDHT human factors, human-centered design, and usability were reported. Following a systematic screening process, we extracted the study design, participant sample, the sDHT or sDHTs used, the methods of data capture, and the types of usability-related data captured. Results: Our literature search returned 442 papers, of which 85 papers were found to be eligible and 83 papers were available for data extraction and not under embargo. In total, 164 sDHTs were evaluated; 141 (86%) sDHTs were wearable tools while the remaining 23 (14%) sDHTs were ambient tools. The majority of studies (55/83, 66%) reported summative evaluations of final-design sDHTs. Almost all studies (82/83, 99%) captured data from targeted end users, but only 18 (22%) out of 83 studies captured data from additional users such as care partners or clinicians. User satisfaction and ease of use were evaluated for 83% (136/164) and 91% (150/164) of sDHTs, respectively; however, learnability, efficiency, and memorability were reported for only 11 (7%), 4 (2%), and 2 (1%) out of 164 sDHTs, respectively. A total of 14 (9%) out of 164 sDHTs were evaluated according to the extent to which users were able to understand the clinical data or other information presented to them (understandability) or the actions or tasks they should complete in response (actionability). Notable gaps in reporting included the absence of a sample size rationale (reported for 21/83, 25% of all studies and 17/55, 31% of summative studies) and incomplete sociodemographic descriptive data (complete age, sex/gender, and race/ethnicity reported for 14/83, 17% of studies). Conclusions: Based on our findings, we suggest four actionable recommendations for future studies that will help to advance the implementation of sDHTs: (1) consider an in-depth assessment of technology usability beyond user satisfaction and ease of use, (2) expand recruitment to include important user groups such as clinicians and care partners, (3) report the rationale for key study design considerations including the sample size, and (4) provide rich descriptive statistics regarding the study sample to allow a complete understanding of generalizability to other patient populations and contexts of use. %M 39546781 %R 10.2196/57628 %U https://www.jmir.org/2024/1/e57628 %U https://doi.org/10.2196/57628 %U http://www.ncbi.nlm.nih.gov/pubmed/39546781 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63298 %T Cultural Adaptation and User Satisfaction of an Internet-Delivered Cognitive Behavioral Program for Depression and Anxiety Among College Students in Two Latin American Countries: Focus Group Study With Potential Users and a Cross-Sectional Questionnaire Study With Actual Users %A Albor,Yesica %A González,Noé %A Benjet,Corina %A Salamanca-Sanabria,Alicia %A Hernández-de la Rosa,Cristiny %A Eslava-Torres,Viridiana %A García-Alfaro,María Carolina %A Melchor-Audirac,Andrés %A Montoya-Montero,Laura Itzel %A Suárez,Karla %+ Center for Research in Global Mental Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, Mexico City, 14370, Mexico, 52 5541605332, cbenjet@gmail.com %K culturally competent care %K mental health %K digital health %K student health services %K Colombia %K Mexico %K SilverCloud %K anxiety %K depression %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To scale up mental health care in low-resource settings, digital interventions must consider cultural fit. Despite the findings that culturally adapted digital interventions have greater effectiveness, there is a lack of empirical evidence of interventions that have been culturally adapted or their adaptation documented. Objective: This study aimed to document the cultural adaptation of the SilverCloud Health Space from Depression and Anxiety program for university students in Colombia and Mexico and evaluate user satisfaction with the adapted program. Methods: A mixed methods process was based on Cultural Sensitivity and Ecological Validity frameworks. In phase 1, the research team added culturally relevant content (eg, expressions, personal stories, photos) for the target population to the intervention. In phase 2, potential users (9 university students) first evaluated the vignettes and photos used throughout the program. We calculated median and modal responses. They then participated in focus groups to evaluate and assess the cultural appropriateness of the materials. Their comments were coded into the 8 dimensions of the Ecological Validity Framework. Phase 3 consisted of choosing the vignettes most highly rated by the potential users and making modifications to the materials based on the student feedback. In the final phase, 765 actual users then engaged with the culturally adapted program and rated their satisfaction with the program. We calculated the percentage of users who agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them attain their goals. Results: The potential users perceived the original vignettes as moderately genuine, or true, which were given median scores between 2.5 and 3 (out of a possible 4) and somewhat identified with the situations presented in the vignettes given median scores between 1.5 and 3. The majority of comments or suggestions for modification concerned language (126/218, 57.5%), followed by concepts (50/218, 22.8%). Much less concerned methods (22/218, 10%), persons (9/218, 4.1%), context (5/218, 2.3%), or content (2/218, 0.9%). There were no comments about metaphors or goals. Intervention materials were modified based on these results. Of the actual users who engaged with the adapted version of the program, 87.7%-96.2% of them agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them to attain their goals. Conclusions: We conclude that the adapted version is satisfactory for this population based on the focus group discussions and the satisfaction scores. Conducting and documenting such cultural adaptations and involving the users in the cultural adaptation process will likely improve the effectiveness of digital mental health interventions in low- and middle-income countries and culturally diverse contexts. %M 39546799 %R 10.2196/63298 %U https://formative.jmir.org/2024/1/e63298 %U https://doi.org/10.2196/63298 %U http://www.ncbi.nlm.nih.gov/pubmed/39546799 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53340 %T Survey of Citizens’ Preferences for Combined Contact Tracing App Features During a Pandemic: Conjoint Analysis %A Bito,Seiji %A Hayashi,Yachie %A Fujita,Takanori %A Takahashi,Ikuo %A Arai,Hiromi %A Yonemura,Shigeto %+ National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 1528602, Japan, 81 334113130, bitoseiji@gmail.com %K digital contact tracing apps %K infectious disease %K conjoint analysis %K user attitudes %K public preferences %K citizen values %K attitude to health %K COVID-19 %K contact tracing %K privacy %K questionnaires %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns. Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future. Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public’s intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data. Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors. Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use. %M 39541579 %R 10.2196/53340 %U https://publichealth.jmir.org/2024/1/e53340 %U https://doi.org/10.2196/53340 %U http://www.ncbi.nlm.nih.gov/pubmed/39541579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57390 %T The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design %A Shojaei,Fereshtehossadat %A Shojaei,Fatemehalsadat %A Desai,Archita P %A Long,Emily %A Mehta,Jade %A Fowler,Nicole R %A Holden,Richard J %A Orman,Eric S %A Boustani,Malaz %+ Luddy School of Informatics, Computing, and Engineering, Indiana University Bloomington, 700 N Woodlawn Ave, Bloomington, IN, 47408, United States, 1 8128565754, fshojaei@iu.edu %K AgileNudge+ %K agile %K nudge strategy %K nudging interventions %K agile implementation %K human behavior %K software design %K human-computer interaction %K user experience design %K usability testing %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In today’s digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. “AgileNudge+” (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions. Objective: This paper aimed to outline the design process, methodologies, and usefulness of “AgileNudge+” for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software’s interface usability and usefulness for creating and testing nudge interventions. Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science–based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software’s ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool’s usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project’s sphere. Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software. Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users’ needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process. %M 39302134 %R 10.2196/57390 %U https://formative.jmir.org/2024/1/e57390 %U https://doi.org/10.2196/57390 %U http://www.ncbi.nlm.nih.gov/pubmed/39302134 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56320 %T Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England %A KC,Sukriti %A Papoutsi,Chrysanthi %A Reidy,Claire %A Gudgin,Bernard %A Powell,John %A Majeed,Azeem %A Greaves,Felix %A Laverty,Anthony A %+ Imperial College London, School of Public Health, South Kensington, London, SW7 2BX, United Kingdom, 44 2075945312, a.laverty@imperial.ac.uk %K digital health %K patient portals %K technological health divide %K eHealth %K inequality %K observational %K ecological %K England %K app %K patient portal %K disparities %K deprivation %K demographics %K long-term health care %K negative binomial regression model %K intervention %K patient support %K general practice %K digital technology %K patient %K youth %K %D 2024 %7 13.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population. Objective: This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories. Methods: We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices). Results: We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=–34%, log-ins=–34.9%, appointments booked=–39.7%, medical record views=–32.3%, and prescriptions ordered=–9.9%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=–7.1%, log-in=–10.4%, and appointments booked=–36.4%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2%, log-ins=11.7%, appointments booked=73.4%, medical record views=23.9%, and prescriptions ordered=20.7%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9%, log-ins=9.1%, appointments booked=14.1%, medical record views=28.7%, and prescriptions ordered=130.4%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=–3.6%, appointments booked=–20%, and medical record views=6%; P≤.001). Conclusions: This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived areas. Tailored interventions and patient support are required to ensure that any benefits from the NHS App are spread equally throughout the population. %M 39536310 %R 10.2196/56320 %U https://www.jmir.org/2024/1/e56320 %U https://doi.org/10.2196/56320 %U http://www.ncbi.nlm.nih.gov/pubmed/39536310 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52788 %T Acceptance and Use of eHealth in Support and Psychological Therapy for People With Intellectual Disabilities: Two Cross-Sectional Studies of Health Care Professionals %A Oudshoorn,Cathelijn %A Frielink,Noud %A Riper,Heleen %A Embregts,Petri %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, 5037 DB, Tilburg, Netherlands, 31 0134662969, c.e.m.oudshoorn@tilburguniversity.edu %K acceptance %K health care professionals %K intellectual disabilities %K eHealth %K disability %K psychological therapy %K support %K cross-sectional survey %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals’ acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID). Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID. Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants’ characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used. Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach α=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R2=0.47; F5,305=54.885; P<.001) and in 2021 (R2=0.43; F5,320=49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth. Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID. %M 39531275 %R 10.2196/52788 %U https://formative.jmir.org/2024/1/e52788 %U https://doi.org/10.2196/52788 %U http://www.ncbi.nlm.nih.gov/pubmed/39531275 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59908 %T A New Research Model for Artificial Intelligence–Based Well-Being Chatbot Engagement: Survey Study %A Yang,Yanrong %A Tavares,Jorge %A Oliveira,Tiago %+ NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Campus de Campolide, Lisboa, 1070-312, Portugal, 351 213 828 610, 20220021@NOVAIMS.UNL.PT %K artificial intelligence–based chatbot %K AI-based chatbot %K mental well-being %K intention to engage %K engagement behavior %K theoretical models %K mobile phone %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI)–based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being. Objective: This study aimed to identify the factors that impact individuals’ intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness. Methods: We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach. Results: The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (β=.201; P=.002), social factors (β=.184; P=.007), and compatibility (β=.149; P=.03) were statistically significant for the intention to engage. Habit (β=.154; P=.01), trust (β=.253; P<.001), and intention to engage (β=.464; P<.001) were statistically significant for engagement behavior. Conclusions: The new extended model provides a theoretical basis for studying users’ AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users. %M 39527812 %R 10.2196/59908 %U https://humanfactors.jmir.org/2024/1/e59908 %U https://doi.org/10.2196/59908 %U http://www.ncbi.nlm.nih.gov/pubmed/39527812 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58641 %T Older Adults’ Perspectives and Experiences With Digital Health in Singapore: Qualitative Study %A Leong,Qiao Ying %A Lee,V Vien %A Ng,Wei Ying %A Vijayakumar,Smrithi %A Lau,Ni Yin %A Mauritzon,Ingela %A Blasiak,Agata %A Ho,Dean %+ The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore, 65 6601 7515, biedh@nus.edu.sg %K digital health %K gerontology %K geriatrics %K elder %K aging %K Singapore %K qualitative %K mHealth %K mobile health %K experience %K technology use %K interview %K perspective %K acceptance %K technology adoption %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Technology use among older adults is increasingly common. Even though there is potential in leveraging technology to help them manage their health, only a small fraction of them use it for health-related purposes. Objective: This study seeks to understand the perspectives of and experiences with digital health (DH) among older adults in Singapore. Methods: A total of 16 participants (age range 60-80 years; n=11, 69% female) were interviewed for approximately an hour (range 27-64 minutes) about their health, DH use, and DH experiences. The interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Five main themes emerged from the interview: support in developing DH literacy, credibility, cost and benefit considerations, intrinsic drive to be healthy, and telehealth. Older adults need support in familiarizing themselves with DH. When considering DH options, older adults often relied on credible sources and preferred DH to be free. Monetary incentives were brought up as motivators. The intrinsic drive to live longer and healthily was expressed to be a huge encouragement to use DH to help obtain health-related knowledge and achieve healthy living goals. The idea of telehealth was also appealing among older adults but was seen to be more suited for individuals who have issues accessing a physical clinic. Conclusions: Our findings offer insights into the various aspects that matter to older adults in the adoption of DH, which in turn can help reshape their health-seeking behavior and lifestyle. As such, policy makers and DH implementors are encouraged to take these into consideration and align their strategies accordingly. %M 39527787 %R 10.2196/58641 %U https://humanfactors.jmir.org/2024/1/e58641 %U https://doi.org/10.2196/58641 %U http://www.ncbi.nlm.nih.gov/pubmed/39527787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53299 %T Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study %A Perme,Natalie %A Reid,Endia %A Eluagu,Macdonald Chinwenwa %A Thompson,John %A Hebert,Courtney %A Gabbe,Steven %A Swoboda,Christine Marie %+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Suite 4101, 700 Ackerman Rd., Columbus, OH, 43210, United States, 1 13157612701, swoboda.2@osu.edu %K health resources %K pregnancy %K patient engagement %K mHealth %K maternal %K mobile health %K app %K focus group %K landscape analysis %K birth %K preterm %K premature %K mortality %K death %K pediatric %K infant %K neonatal %K design %K development %K obstetric %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app’s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. %M 39514852 %R 10.2196/53299 %U https://formative.jmir.org/2024/1/e53299 %U https://doi.org/10.2196/53299 %U http://www.ncbi.nlm.nih.gov/pubmed/39514852 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60787 %T Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review %A Wang,Tzu %A Huang,Yen-Ming %A Chan,Hsun-Yu %+ Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S Rd, Zhongzheng Dist, Taipei City, 100025, Taiwan, 886 33668784, yenming927@ntu.edu.tw %K Asia %K adherence %K application %K feature %K medication %K mobile %D 2024 %7 8.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. Objective: We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. Methods: We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included “Asia,” “chronic disease,” “app,” “application,” “survey,” “experiment,” “questionnaire,” “group,” “medical adherence,” “medication adherence,” “case-control,” “cohort study,” “randomized controlled trial,” “clinical trial,” “observational study,” “qualitative research,” “mixed methods,” and “analysis,” combined using logical operators “OR” and “AND.” The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. Results: The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. Conclusions: This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence. %M 39514859 %R 10.2196/60787 %U https://www.jmir.org/2024/1/e60787 %U https://doi.org/10.2196/60787 %U http://www.ncbi.nlm.nih.gov/pubmed/39514859 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56437 %T Virtual Coach–Guided Online Acceptance and Commitment Therapy for Chronic Pain: Pilot Feasibility Randomized Controlled Trial %A Reilly,Erin D %A Kelly,Megan M %A Grigorian,Hannah L %A Waring,Molly E %A Quigley,Karen S %A Hogan,Timothy P %A Heapy,Alicia A %A Drebing,Charles E %A Volonte,Matias %A Kathawalla,Ummul-Kiram %A Robins,Hannah E %A Bernice,Katarina %A Bickmore,Timothy %+ Mental Illness Research, Education, and Clinical Center, Veteran Affairs Bedford Healthcare System, Department of Veteran Affairs, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 4191, erin.reilly@va.gov %K chronic pain %K randomized controlled trial %K usability %K acceptance and commitment therapy %K embodied conversational agent %K veterans %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47%-56%) and a 40% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home. Objective: This study aims to evaluate the virtual coach–guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes. Methods: Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group. Results: Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03). Conclusions: VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain—chronic pain acceptance—after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132 International Registered Report Identifier (IRRID): RR2-10.2196/45887 %M 39514264 %R 10.2196/56437 %U https://formative.jmir.org/2024/1/e56437 %U https://doi.org/10.2196/56437 %U http://www.ncbi.nlm.nih.gov/pubmed/39514264 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51865 %T Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders %A Lange-Drenth,Lukas %A Schulz,Holger %A Suck,Isabell %A Bleich,Christiane %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 07410 56811, l.lange-drenth@uke.de %K telerehabilitation %K rehabilitation %K eHealth development %K value specification %K stakeholder participation %K occupational injuries %K vocational rehabilitation %K aftercare %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients’ lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. %M 39514260 %R 10.2196/51865 %U https://formative.jmir.org/2024/1/e51865 %U https://doi.org/10.2196/51865 %U http://www.ncbi.nlm.nih.gov/pubmed/39514260 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63814 %T Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study %A Gordon,Nancy P %A Yin,Chelsea %A Lo,Joan C %+ Kaiser Permanente Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Pleasanton, CA, 94588, United States, 1 5109107992, nancypgordon@yahoo.com %K patient portal use %K video visit use %K older adults %K racial and ethnic differences %K telehealth %K mobile phone %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults. Objective: This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources. Methods: This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ≥1 message to a clinician in 2019 or 2020 and viewing ≥1 laboratory test result in 2020), and having ≥1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults. Results: Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults’ use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults. Conclusions: Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity. %M 39509698 %R 10.2196/63814 %U https://aging.jmir.org/2024/1/e63814 %U https://doi.org/10.2196/63814 %U http://www.ncbi.nlm.nih.gov/pubmed/39509698 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56201 %T Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial %A Yatziv,Shai-Lee %A Pedrelli,Paola %A Baror,Shira %A DeCaro,Sydney Ann %A Shachar,Noam %A Sofer,Bar %A Hull,Sunday %A Curtiss,Joshua %A Bar,Moshe %+ The Leslie and Susan Gonda Brain Science Center, Bar- Ilan University Building number 901, Ramat-Gan, 5290002, Israel, 972 35317795, moshe.bar@biu.ac.il %K depression %K cognitive neuroscience %K facilitating thought progression %K FTP %K mobile phone %K digital health %K gamification %K depression symptoms %K randomized controlled trial %K RCT %K app %K depressive disorder %K web-based platforms %K effectiveness %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health–based intervention designed to systematically facilitate thought progression would substantially alleviate depression. Objective: The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was designed as an easy-to-use gamified app specifically aimed to facilitate thought progression through intense practicing of associative, semantically broad, fast, and creative thought patterns. Methods: A randomized clinical trial was conducted, comparing changes in depression symptoms between participants who used the app in the intervention group (n=74) and waitlist control group (n=27) over the course of 8 weeks. All participants filled out a battery of clinical questionnaires to assess the severity of depression at baseline and 4 and 8 weeks after starting the study. These primarily included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 as well as the Positive Affect Negative Affect Scale-Negative Affect Score, Ruminative Response Scale, and Symptoms of Depression Questionnaire. Additional questionnaires were implemented to assess anxiety, positive affect, anhedonia, and quality of life. Results: The results indicate that across multiple clinical measurements, participants in the intervention group who played the gamified app showed greater and faster improvement in depressive symptoms compared with their waitlist control counterparts. The difference between the groups in MADRS improvement was –7.01 points (95% CI –10.72 to –3.29; P<.001; Cohen d=0.67). Furthermore, the difference in improvement between groups persisted up to 4 weeks posttrial (MADRS differences at week 12: F49,2=6.62; P=.003; ηp2=0.21). At the end of the trial, participants who played the app showed high interest in continuing using the app. Conclusions: The results demonstrate that a gamified app designed to facilitate thought progression is associated with improvement in depressive symptoms. Given its innovative and accessibility features, this gamified method aiming to facilitate thought progression may successfully complement traditional treatments for depression in the future, providing a safe and impactful way to enhance the lives of individuals experiencing depression and anxiety. Trial Registration: ClinicalTrials.gov NCT05685758; https://clinicaltrials.gov/study/NCT05685758 %M 39350528 %R 10.2196/56201 %U https://www.jmir.org/2024/1/e56201 %U https://doi.org/10.2196/56201 %U http://www.ncbi.nlm.nih.gov/pubmed/39350528 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59897 %T Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach %A Berger,Mathilde %A Deblock-Bellamy,Anne %A Chèze,Laurence %A Robert,Thomas %A Desrosiers,Julie J %A Christe,Guillaume %A Bertrand,Anne Martine %+ Department of Occupational Therapy, University of Applied Sciences and Arts Western Switzerland (HETSL | HES-SO), Chemin des Abeilles 14, Lausanne, 1010, Switzerland, 41 (0)216510330, mathilde.berger@hetsl.ch %K chronic low back pain %K needs %K self-management %K physical activity %K mobile health %K mHealth %K user-centered design %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. %M 39509701 %R 10.2196/59897 %U https://humanfactors.jmir.org/2024/1/e59897 %U https://doi.org/10.2196/59897 %U http://www.ncbi.nlm.nih.gov/pubmed/39509701 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54171 %T Assessment of Acceptability, Usage, and Impact on Caregivers of Children With Autism’s Stress and Mindfulness: Multiple-Method Feasibility Study of the 5Minutes4Myself App’s Mindfulness Module %A Larson,Elizabeth %A Mattie,Rebecca L %A Riffkin,Sophia A %K autism %K caregiver %K activities %K mindfulness %K mobile application %K stress %K wellness %K app %K application %K usage %K children %K developmental disability %K usability %K acceptability %K meditation %K wellness application %D 2024 %7 31.10.2024 %9 %J JMIR Hum Factors %G English %X Background: Caregiver wellness programs need to be easily accessible to address caregivers’ constraints to participation. Objective: We aimed to assess the feasibility of 5Minutes4Myself app’s mindfulness module (usability, usage, and impact on caregivers’ levels of mindfulness and perceived stress). Methods: Before and after participation in the 5Minutes4Myself program, 15 participants were asked to complete the Perceived Stress Scale (PSS) and Five Facet Mindfulness Questionnaire (FFMQ). Data on the usage of app-delivered meditations were collected electronically via the app, and app usability was rated on the Modified System Usability Scale. Analyses assessed participants’ frequency of use of app-delivered meditations, app usability, and changes in participants’ stress and mindfulness post intervention. Results: Overall, participants completed 10.9 minutes of mindfulness meditations per week and rated the app 76.7, indicating above-average usability. Related samples t tests (2-tailed) found that group PSS (t10=1.20, P=.26) and FFMQ (t10=−1.57, P=.15) pre- or postintervention mean scores were not significantly different. However, a visualization of pre- and post-PSS and mindfulness scores suggested there was a group of responders who had decreased stress with increased mindfulness. This was confirmed via an individual change analysis. The effect size of the FFMQ scores (d=0.47) suggests there may be treatment effects with a larger sample. A hierarchical multiple regression analysis examined the degree mindfulness impacted perceived stress; 20% of the variance in participants’ perceived stress could be attributed to increases in self-rated mindfulness (P=.04) when controlling for preintervention stress levels. Conclusions: Caregivers found the app highly usable and on average used low-dose levels of mindfulness meditations (10 min/wk). For responders, increased mindfulness was related to stress reduction to population-based levels. Trial Registration: ClinicalTrials.gov NCT03771001; https://clinicaltrials.gov/study/NCT03771001 %R 10.2196/54171 %U https://humanfactors.jmir.org/2024/1/e54171 %U https://doi.org/10.2196/54171 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57115 %T Experiences With mHealth Use Among Patient-Caregiver Dyads With Chronic Heart Failure: Qualitative Study %A Jin,Xiaorong %A Zhang,Yimei %A Zhou,Min %A Zhang,Xiong %A Mei,Qian %A Bai,Yangjuan %A Wei,Wei %A Ma,Fang %+ Department of Nursing, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua District, Kunming City, 650032, China, 86 65324888, rebeccamalei@126.com %K chronic heart failure %K informal caregiver %K mHealth %K experience %K dyad %D 2024 %7 31.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic heart failure has become a serious threat to the health of the global population, and self-management is key to treating chronic heart failure. The emergence of mobile health (mHealth) provides new ideas for the self-management of chronic heart failure in which the informal caregiver plays an important role. Current research has mainly studied the experiences with using mHealth among patients with chronic heart failure from the perspective of individual patients, and there is a lack of research from the dichotomous perspective. Objective: The aim of this study was to explore the experiences with mHealth use among patients with chronic heart failure and their informal caregivers from a dichotomous perspective. Methods: This descriptive phenomenological study from a post-positivist perspective used a dyadic interview method, and face-to-face semistructured interviews were conducted with patients with chronic heart failure and their informal caregivers. Data were collected and managed using NVivo 12 software, and data analysis used thematic analysis to identify and interpret participants’ experiences and perspectives. The thematic analysis included familiarizing ourselves with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Results: A total of 14 dyads of patients with chronic heart failure and their informal caregivers (13 men and 15 women) participated in this study, including 3 couples and 11 parent-child pairs. We constructed 4 key themes and their subthemes related to the experiences with mHealth use: (1) opposing experiences with mHealth as human interaction or trauma (great experience with mHealth use; trauma), (2) supplement instead of replacement (it is useful but better as a reference; offline is unavoidable sometimes), (3) both agreement and disagreement over who should be the adopter of mHealth (achieving consensus regarding who should adopt mHealth; conflict occurs when considering patients as the adopter of mHealth), (4) for better mHealth (applying mHealth with caution; suggestions for improved mHealth). Conclusions: This study reported that the experiences with mHealth use among patients with chronic heart failure and their informal caregivers were mixed, and it highlighted the human touch of mHealth and the importance of network security. These results featured mHealth as a complement to offline hospitals rather than a replacement. In the context of modern or changing Chinese culture, we encourage patients to use mHealth by themselves and their informal caregivers to provide help when necessary. In addition, we need to use mHealth carefully, and future mHealth designs should focus more on ease of use and be oriented more toward older adults. %M 39481106 %R 10.2196/57115 %U https://www.jmir.org/2024/1/e57115 %U https://doi.org/10.2196/57115 %U http://www.ncbi.nlm.nih.gov/pubmed/39481106 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57839 %T Evaluating the Impact of a Game (Inner Dragon) on User Engagement Within a Leading Smartphone App for Smoking Cessation: Randomized Controlled Trial %A White,Justin S %A Toussaert,Séverine %A Raiff,Bethany R %A Salem,Marie K %A Chiang,Amy Yunyu %A Crane,David %A Warrender,Edward %A Lyles,Courtney R %A Abroms,Lorien C %A Westmaas,J Lee %A Thrul,Johannes %+ Department of Health Law, Policy and Management, Boston University School of Public Health, Talbot Building - 249W, 715 Albany Street, Boston, MA, 02118, United States, 1 617 358 1916, juswhite@bu.edu %K smoking cessation %K mobile app %K games for health %K gamification %K engagement %K randomized controlled trial %K mobile phone %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps are a convenient, low-cost approach to delivering smoking cessation support to large numbers of individuals. Yet, the apps are susceptible to low rates of user engagement and retention. Objective: This study aims to test the effects of a new game module (called Inner Dragon) integrated into Smoke Free (23 Limited), a leading smoking cessation app with established efficacy. The primary outcomes measured user engagement with the app. Methods: A 2-arm, parallel-group, randomized controlled trial was conducted in the United States with an 8-week follow-up. Adult individuals who smoked ≥1 cigarettes daily and planned to quit smoking within 7 days were recruited and randomized (N=500), with equal allocation. Both groups received free access to the original Smoke Free app with “core” features of its smoking cessation program (eg, a diary and craving log). The treated group received additional access to the integrated Inner Dragon game that incorporated several game mechanics designed to increase user engagement. User engagement outcomes were the number of unique app sessions, average minutes per session, days with a session, and program adherence. Self-reported and verified smoking abstinence and app satisfaction were also assessed. The main analysis estimated the intention-to-treat effect of access to Inner Dragon on each outcome. Further analyses assessed effect modification by participant characteristics and the association of intensity of game use with program adherence and abstinence. Results: Overall, user engagement was greater for treated versus control participants: they had 5.3 more sessions of Smoke Free (mean 29.6, SD 36.5 sessions vs mean 24.3, SD 37.9 sessions; P=.06), 0.8 more minutes per session (mean 6.9, SD 5.4 min vs mean 6.1, SD 5.2 min; P=.047), and 3.4 more days with a session (mean 14.3, SD 15.3 days vs mean 11.9, SD 14.3 days; P=.03). Program adherence, based on the number of times core features of the original Smoke Free app were used, was higher for treated versus control participants (mean 29.4, SD 41.3 times vs mean 22.6, SD 35.6 times; P=.03). Self-reported 7-day and 30-day point-prevalence abstinence and verified 7-day point-prevalence abstinence at 8 weeks did not significantly differ by study group. The mean repeated 1-day prevalence of quitting was higher among the treated group versus the control group (mean 17.3%, SD 25.6 vs mean 12.4%, SD 21.3; P=.01). App satisfaction and the motivation to (stay) quit did not differ by study group. Higher intensity of game use was associated with increased program adherence and self-reported abstinence. Conclusions: Findings suggest that the Inner Dragon game increased user engagement and program adherence. Additional refinements to the game design may clarify whether the game increases abstinence rates. Overall, it is feasible to deploy games and gamification to enhance user engagement in existing smoking cessation interventions. Trial Registration: ClinicalTrials.gov NCT05227027; https://clinicaltrials.gov/study/NCT05227027 %M 39475840 %R 10.2196/57839 %U https://www.jmir.org/2024/1/e57839 %U https://doi.org/10.2196/57839 %U http://www.ncbi.nlm.nih.gov/pubmed/39475840 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55239 %T Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study %A Zhou,Shuo %A Brunetta,Paul %A Silvasstar,Joshva %A Feldman,Greg %A Oromi,Nicolas %A Bull,Sheana %+ Department of Communication Studies, School of Communication and System Health Lab, Hong Kong Baptist University, 913, No. 5 Hereford Rd, KL, Hong Kong, China (Hong Kong), 852 34118230, shuozhou@hkbu.edu.hk %K smoking cessation %K tobacco %K mobile phone app %K mHealth %K mobile health %K iterative design %K feasibility %K acceptability %K engagement %K efficacy %K mobile phone %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. Objective: This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers’ preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Methods: Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants’ app use was tracked and analyzed. The primary outcome measures were participants’ 7-day point prevalence abstinence at 6 and 12 weeks. Results: Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included “quit plan,” “tracking,” “reminders and notifications,” “MOtalks,” and “motivational quotes.” The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58% at 6 weeks and 52% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5% (odds ratio [OR] 1.05, 95% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95% CI 1.25-7.75) and 12 weeks (OR 4.65, 95% CI 1.83-11.76), compared with those who earned <5000 points. Conclusions: Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed. %M 39471372 %R 10.2196/55239 %U https://mhealth.jmir.org/2024/1/e55239 %U https://doi.org/10.2196/55239 %U http://www.ncbi.nlm.nih.gov/pubmed/39471372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59016 %T Development of the Happy Hands Self-Management App for People with Hand Osteoarthritis: Feasibility Study %A Tveter,Anne Therese %A Varsi,Cecilie %A Maarnes,Marit Kristin %A Pedersen,Stein Jarle %A Christensen,Barbara S %A Blanck,Thale Beate %A Nyheim,Sissel B %A Pelle,Tim %A Kjeken,Ingvild %+ Health Service Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Diakonveien 12, Oslo, 0319, Norway, 47 22451500, a.t.tveter@medisin.uio.no %K Osteoarthritis %K hand exercises %K home exercise %K first-line treatment %K mHealth %K eHealth %K self-management %K app development %K design %K usefulness %K satisfaction %K activity performance %K social cognitive theory %K behavior change %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient education, hand exercises, and the use of assistive devices are recommended as first-line treatments for individuals with hand osteoarthritis (OA). However, the quality of care services for this patient group is suboptimal in primary care. Objective: The overarching goal was to develop and evaluate feasibility of an app-based self-management intervention for people with hand OA. This feasibility study aims to assess self-reported usability and satisfaction, change in outcomes and quality-of-care, exercise adherence and patients’ experiences using the app. Methods: The development and feasibility testing followed the first 2 phases of the Medical Research Council framework for the development and evaluation of complex interventions and were conducted in close collaboration with patient research partners (PRPs). A 3-month pre-post mixed methods design was used to evaluate feasibility. Men and women over 40 years of age diagnosed with painful, symptomatic hand OA were recruited. Usability was assessed using the System Usability Scale (0-100), while satisfaction, usefulness, pain, and stiffness were evaluated using a numeric rating scale (NRS score from 0 to 10). The activity performance of the hand was measured using the Measure of Activity Performance of the Hand (MAP-Hand) (1-4), grip strength was assessed with a Jamar dynamometer (kg), and self-reported quality of care was evaluated using the Osteoarthritis Quality Indicator questionnaire (0-100). Participants were deemed adherent if they completed at least 2 exercise sessions per week for a minimum of 8 weeks. Focus groups were conducted to explore participants’ experiences using the app. Changes were analyzed using a paired sample t test (mean change and 95% CI), with the significance level set at P<.05. Results: The first version of the Happy Hands app was developed based on the needs and requirements of the PRPs, evidence-based treatment recommendations, and the experiences of individuals living with hand OA. The app was designed to guide participants through a series of informational videos, exercise videos, questionnaires, quizzes, and customized feedback over a 3-month period. The feasibility study included 71 participants (mean age 64 years, SD 8; n=61, 86%, women), of whom 57 (80%) completed the assessment after 3 months. Usability (mean 91.5 points, SD 9.2 points), usefulness (median 8, IQR 7-10), and satisfaction (median 8, IQR 7-10) were high. Significant improvements were observed in self-reported quality of care (36.4 points, 95% CI 29.7-43.1, P<.001), grip strength (right: 2.9 kg, 95% CI 1.7-4.1; left: 3.2 kg, 95% CI 1.9-4.6, P<.001), activity performance (0.18 points, 95% CI 0.11-0.25, P<.001), pain (1.7 points, 95% CI 1.2-2.2, P<.001), and stiffness (1.9 points, 95% CI 1.3-2.4, P=.001) after 3 months. Of the 71 participants, 53 (75%) were adherent to the exercise program. The focus groups supported these results and led to the implementation of several enhancements in the second version of the app. Conclusions: The app-based self-management intervention was deemed highly usable and useful by patients. The results further indicated that the intervention may improve quality of care, grip strength, activity performance, pain, and stiffness. However, definitive conclusions need to be confirmed in a powered randomized controlled trial. Trial Registration: NCT05150171 %M 39470716 %R 10.2196/59016 %U https://formative.jmir.org/2024/1/e59016 %U https://doi.org/10.2196/59016 %U http://www.ncbi.nlm.nih.gov/pubmed/39470716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52609 %T Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review %A Lau,Carrie K Y %A Saad,Anthony %A Camara,Bettina %A Rahman,Dia %A Bolea-Alamanac,Blanca %+ Department of Psychiatry, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 647 331 2707, Blanca.BoleaAlamanac@wchospital.ca %K acceptability %K mental health %K depression %K anxiety %K mobile app %K internet %K mobile phone %K mobile health %K mHealth %K digital health %D 2024 %7 28.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Depression and anxiety disorders are common, and treatment often includes psychological interventions. Digital health interventions, delivered through technologies such as web-based programs and mobile apps, are increasingly used in mental health treatment. Acceptability, the extent to which an intervention is viewed positively, has been identified as contributing to patient adherence and engagement with digital health interventions. Acceptability, therefore, impacts the benefit derived from using digital health interventions in treatment. Understanding the acceptability of digital mental health interventions among patients with depression or anxiety disorders is essential to maximize the effectiveness of their treatment. Objective: This review investigated the acceptability of technology-based interventions among patients with depression or anxiety disorders. Methods: A systematic review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines. We searched PubMed, Web of Science, and Ovid in May 2022. Studies were included if they evaluated digital interventions for the treatment of depression or anxiety disorders and investigated their acceptability among adult patients. Studies were excluded if they targeted only specific populations (eg, those with specific physical health conditions), investigated acceptability in healthy individuals or patients under the age of 18 years, involved no direct interaction between patients and technologies, used technology only as a platform for traditional care (eg, videoconferencing), had patients using technologies only in clinical or laboratory settings, or involved virtual reality technologies. Acceptability outcome data were narratively synthesized by the direction of acceptability using vote counting. Included studies were evaluated using levels of evidence from the Oxford Centre for Evidence-Based Medicine. The risk of bias was assessed using a tool designed for this review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Results: A total of 143 articles met the inclusion criteria, comprising 67 (47%) articles on interventions for depression, 65 (45%) articles on interventions for anxiety disorders, and 11 (8%) articles on interventions for both. Overall, 90 (63%) were randomized controlled trials, 50 (35%) were other quantitative studies, and 3 (2%) were qualitative studies. Interventions used web-based programs, mobile apps, and computer programs. Cognitive behavioral therapy was the basis of 71% (102/143) of the interventions. Digital mental health interventions were generally acceptable among patients with depression or anxiety disorders, with 88% (126/143) indicating positive acceptability, 8% (11/143) mixed results, and 4% (6/143) insufficient information to categorize the direction of acceptability. The available research evidence was of moderate quality. Conclusions: Digital mental health interventions seem to be acceptable to patients with depression or anxiety disorders. Consistent use of validated measures for acceptability would enhance the quality of evidence. Careful design of acceptability as an evaluation outcome can further improve the quality of evidence and reduce the risk of bias. Trial Registration: Open Science Framework Y7MJ4; https://doi.org/10.17605/OSF.IO/SPR8M %M 39466300 %R 10.2196/52609 %U https://www.jmir.org/2024/1/e52609 %U https://doi.org/10.2196/52609 %U http://www.ncbi.nlm.nih.gov/pubmed/39466300 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54673 %T Factors Related to mHealth App Use Among Japanese Workers: Cross-Sectional Survey %A Ozaki,Itsuko %A Nishijima,Mariko %A Shibata,Eiji %A Zako,Yuri %A Chiang,Chifa %+ Graduate School of Nursing, Nagoya City University, 1-4-7 Aoi, Higashi-ku, Nagoya, 461-0004, Japan, 81 52 982 7343, itsuko@med.nagoya-cu.ac.jp %K mHealth %K mobile health %K mobile health apps %K prevalence %K health promotion %K health management %K Japanese worker %K Japan %K cross-sectional survey %K disease management %K app users %K physical activity %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health care providers can make health guidance more effective by using mobile health technologies such as health apps. Although health care providers need to know who uses health apps, existing studies have yielded inconsistent results. Objective: The aim of the study was (1) to clarify the prevalence and patterns of health app use to improve health behaviors for preventing lifestyle-related diseases among Japanese workers and (2) to identify the associations among demographic characteristics, health behavior, and internet use and health app use by gender. Methods: Data were collected from a cross-sectional internet survey in 2023. In total, 2200 participants were included, with an even distribution of men and women in each age group aged 20 to 60 years. The participants were workers with smartphones and reported their gender, age, residence area, marital status, education, employment status, occupation, work pattern, diseases under treatment, health checkups, health guidance, health behaviors, internet use duration, and number of devices used. We asked about current and previous health app use for 1 month. A multivariate logistic regression analysis was conducted by gender. Results: Of the participants, 472 (21.5%) and 189 (8.6%) were current and previous health app users, respectively. Most current and previous health app users used features that record and track their physical activity and other health behaviors. Health app users—both men and women—were more likely to have health checkups (odds ratio [OR] 1.53, 95% CI 1.12-2.11 and OR 1.51, 95% CI 1.10-2.07, respectively), receive health guidance (OR 2.01, 95% CI 1.47-2.74 and OR 1.86, 95% CI 1.32-2.62, respectively), engage in regular physical activity (OR 2.57, 95% CI 1.91-3.47 and OR 1.94, 95% CI 1.41-2.67, respectively), use the internet for 120-179 minutes per day (OR 1.76, 95% CI 1.13-2.75 and OR 1.70, 95% CI 1.12-2.57, respectively), and were less likely to be older (50-59 years: OR 0.54, 95% CI 0.33-0.88 and OR 0.40, 95% CI 0.25-0.6, respectively, and 60-69 years: OR 0.37, 95% CI 0.22-0.62 and OR 0.47, 95% CI 0.28-0.77, respectively). According to gender, male health app users were more likely to be married (OR 1.69, 95% CI 1.23-2.33) and less likely to work in the security, agriculture, forestry, fishing, manufacturing, or transportation industries (OR 0.62, 95% CI 0.41-0.95). Female health app users were more likely to have a university education or higher (OR 1.55, 95% CI 1.061-2.26), maintain an appropriate body weight (OR 1.52, 95% CI 1.10-2.11), and use 3 or more devices (OR 2.13, 95% CI 1.41-3.23). Conclusions: Physical activity and health guidance are strong predictors of app use. Health care providers should assess the target populations’ preferences for app use based on their characteristics, support their app use, and enhance the effectiveness of health guidance. %M 39454195 %R 10.2196/54673 %U https://humanfactors.jmir.org/2024/1/e54673 %U https://doi.org/10.2196/54673 %U http://www.ncbi.nlm.nih.gov/pubmed/39454195 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59153 %T The Use of Mobile Health Care Among Medical Professionals in the Sichuan-Chongqing Region: Cross-Sectional Survey Study %A Tang,Yan %A Yang,Juan %A Wang,Ni %A Wang,Xin %A Hu,Wenli %K health care professionals %K mobile health care %K technical training %K cross-sectional survey %K utilization %K mobile %K usage %K China %K web-based questionnaire %K logistic regression %K training %K support %D 2024 %7 24.10.2024 %9 %J JMIR Hum Factors %G English %X Background: The emergence and integration of mobile health care technology have fundamentally transformed the health care industry, providing unprecedented opportunities to improve health care services and professional practice. Despite its immense potential, the adoption of mobile health care technology among health care professionals remains uneven, particularly in resource-limited regions. Objective: This study aims to explore the use and influencing factors of mobile health care among health care professionals in the Sichuan-Chongqing region of China and make recommendations. Methods: Convenience sampling was used in a cross-sectional study conducted from November 8 to November 14, 2023, to survey frontline clinical health care professionals at 5 district-level secondary public hospitals in the Sichuan-Chongqing region. A web-based questionnaire was used to investigate the use of mobile health care and its influencing factors among the participants. Descriptive analysis and logistic regression analysis were used in the study. Results: A total of 550 valid questionnaires were completed. Among the surveyed health care professionals, only 18.7% (103/550) used mobile health care, with a satisfaction rate of only 50.5% (52/103). Around 81.3% (447/550) did not use any form of mobile health care. The age group of 30‐39 years was found to be a significant factor influencing the use of mobile health care by health care professionals (P=.03). The main reasons for not using mobile health care among health care professionals were lack of appropriate technical training and support (266/447, 59.5%), lack of suitable management-specific apps (204/447, 45.6%), and concerns about increased workload (180/447, 40.3%). There were significant differences in the single-factor analysis of the reasons for the nonuse of mobile health care among health care professionals from different specialties (P=.04). Logistic regression analysis indicated that age was the only significant factor influencing the use of mobile health care by health care professionals (P=.04). Conclusions: The utilization rate of mobile health care among health care professionals in the Sichuan-Chongqing region is low. Age is a significant factor that influences whether health care professionals use mobile health care. Providing appropriate technical training and support may help improve the enthusiasm of health care professionals in using mobile health care. %R 10.2196/59153 %U https://humanfactors.jmir.org/2024/1/e59153 %U https://doi.org/10.2196/59153 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e63776 %T French Version of the User Mobile Application Rating Scale: Adaptation and Validation Study %A Saliasi,Ina %A Lan,Romain %A Rhanoui,Maryem %A Fraticelli,Laurie %A Viennot,Stéphane %A Tardivo,Delphine %A Clément,Céline %A du Sartz de Vigneulles,Benjamin %A Bernard,Sandie %A Darlington-Bernard,Adeline %A Dussart,Claude %A Bourgeois,Denis %A Carrouel,Florence %K mHealth %K mobile health %K mobile health apps %K eHealth %K Mobile Application Rating Scale, user version %K mobile apps %K quality assessment tool %K uMARS %D 2024 %7 24.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Managing noncommunicable diseases effectively requires continuous coordination and monitoring, often facilitated by eHealth technologies like mobile health (mHealth) apps. The end-user version of the Mobile Application Rating Scale is a valuable tool for assessing the quality of mHealth apps from the user perspective. However, the absence of a French version restricts its use in French-speaking countries, where the evaluation and regulation of mHealth apps are still lacking, despite the increasing number of apps and their strong relevance in health care. Objective: This study aims to translate and culturally adapt a French version of the user Mobile Application Rating Scale (uMARS-F) and to test its overall and internal reliability. Methods: Cross-cultural adaptation and translation followed the universalist approach. The uMARS-F was evaluated as part through a cohort study using the French mHealth app “MonSherpa” (Qare). Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical limitations. They assessed the app using the uMARS-F twice (T1 and T2) 1 week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test and presented as mean (SD), and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using intraclass correlation coefficients and internal reliability using Cronbach α. Concordance between the 3 subscales (objective quality, subjective quality, and perceived impact), 4 sections, and 26 items at T1 and T2 was evaluated using the paired t test (2-tailed) and Pearson correlation. Results: In total, 167 participants assessed the app at both T1 and T2 (100% compliance). Among them, 49.7% (n=83) were female, and 50.3% (n=84) were male, with a mean age of 43 (SD 16) years. The uMARS-F intraclass correlation coefficients were excellent for objective quality (0.959), excellent for subjective quality (0.993), and moderate for perceived impact (0.624). Cronbach α was good for objective quality (0.881), acceptable for subjective quality (0.701), and excellent for perceived impact (0.936). The paired t tests (2-tailed) demonstrated similar scores between the 2 assessments (P>.05), and the Pearson correlation coefficient indicated high consistency in each subscale, section, and item (r>0.76 and P<.001). The reliability and validity of the measures were similar to those found in the original English version as well as in the Spanish, Japanese, Italian, Greek, and Turkish versions that have already been translated and validated. Conclusions: The uMARS-F is a valid tool for end users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the French version of the Mobile Application Rating Scale could enable health care professionals and public health authorities to identify reliable, high-quality, and valid apps for patients and should be part of French health care education programs. %R 10.2196/63776 %U https://mhealth.jmir.org/2024/1/e63776 %U https://doi.org/10.2196/63776 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50457 %T Facilitators of and Barriers to Teachers’ Engagement With Consumer Technologies for Stress Management: Qualitative Study %A Manning,Julia B %A Blandford,Ann %A Edbrooke-Childs,Julian %+ UCL Interaction Centre, Department of Computer Science, University College London, 66-72 Gower Street, London, WC1E 6EA, United Kingdom, 44 02076792000, julia.manning@ucl.ac.uk %K teachers %K stress %K workplace %K self-management %K digital health %K technology %K qualitative %K context %K high schools %K wearables %K apps %K human-computer interaction %K HCI %K personal informatics %D 2024 %7 22.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Consumer technology is increasingly being adopted to support personal stress management, including by teachers. Multidisciplinary research has contributed some knowledge of design and features that can help detect and manage workplace stress. However, there is less understanding of what facilitates engagement with ubiquitous “off the shelf” technologies, particularly in a specific occupational setting. An understanding of features that facilitate or inhibit technology use, and the influences of contexts on the manner of interaction, could improve teachers’ stress-management opportunities. Objective: The aim of the study was to investigate the interaction features that facilitated or inhibited engagement with 4 consumer technologies chosen by teachers for stress management, as well as the influence of the educational contexts on their engagement. We also examined how use of well-being technology could be better supported in the school. Methods: The choice of consumer technologies was categorized in a taxonomy for English secondary school teachers according to stress-management strategies and digital features. Due to the COVID-19 pandemic, we adapted the study so that working from home in the summer could be contrasted with being back in school. Thus, a longitudinal study intended for 6 weeks in the summer term (in 2020) was extended into the autumn term, lasting up to 27 weeks. Teachers chose to use either a Withings smartwatch or Wysa, Daylio, or Teacher Tapp apps. Two semistructured interviews and web-based surveys were conducted with 8 teachers in England in the summer term, and 6 (75%) of them took part in a third interview in the autumn term. Interviews were analyzed using reflexive thematic analysis informed by interpretive phenomenological analysis. Results: Technology elements and characteristics such as passive data collation, brevity of interaction, discreet appearance, reminders, and data visualization were described by teachers as facilitators. Lack of instructions and information on features, connectivity, extended interaction requirements, and nondifferentiation of activity and exercise data were described as barriers. Mesocontextual barriers to engagement were also reported, particularly when teachers were back on school premises, including temporal constraints, social stigma, and lack of private space to de-stress. Teachers had ideas for feature improvements and how educational leadership normalizing teachers’ stress management with consumer technologies could benefit the school culture. Conclusions: Having preselected their stress-management strategies, teachers were able to harness design features to support themselves over an extended period. There could be an important role for digital interventions as part of teachers’ stress management, which the school leadership would need to leverage to maximize their potential. The findings add to the holistic understanding of situated self-care and should inform developers’ considerations for occupational digital stress support. %M 39437381 %R 10.2196/50457 %U https://www.jmir.org/2024/1/e50457 %U https://doi.org/10.2196/50457 %U http://www.ncbi.nlm.nih.gov/pubmed/39437381 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52128 %T An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Beta Stage Usability Study %A Mueller,Emily L %A Cochrane,Anneli R %A Campbell,Madison E %A Nikkhah,Sarah %A Holden,Richard J %A Miller,Andrew D %+ Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN, 46202, United States, 1 3123990245, elmuelle@iu.edu %K oncology %K supportive care %K mHealth %K children %K caregivers %K mobile phones %D 2024 %7 17.10.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Previous research demonstrated that caregivers of children with cancer desired a mobile health (mHealth) tool to aid them in the medical management of their child. Prototyping and alpha testing of the Cope 360 app (Commissioning Agents, Inc) resulted in improvements in the ability to track symptoms, manage medications, and prepare for urgent medical needs. Objective: This study aims to engage caregivers of children with cancer in beta testing of a smartphone app for the medical management of children with cancer, assess acceptance, identify caregivers’ perceptions and areas for improvement, and validate the app’s design concepts and use cases. Methods: In this pilot, study caregivers of children with cancer used the Cope 360 mHealth app for 1 week, with the goal of daily logging. Demographics and a technology acceptance survey were obtained from each participant. Recorded semistructured interviews were transcribed and analyzed iteratively using NVivo (version 12, QSR International) and analyzed for information on usage, perceptions, and suggestions for improvement. Results: A total of 10 caregivers participated in beta testing, primarily women (n=8, 80%), married, with some college education, and non-Hispanic White (n=10, 100%). The majority of participants (n=7, 70%) had children with acute lymphocytic leukemia who were being treated with chemotherapy only (n=8, 80%). Overall, participants had a favorable opinion of Cope 360. Almost all participants (n=9, 90%) believed that using the app would improve their ability to manage their child’s medical needs at home. All participants reported that Cope 360 was easy to use, and most would use the app if given the opportunity (n=8, 80%). These values indicate that the app had a high perceived ease of use with well-perceived usefulness and behavioral intention to use. Key topics for improvement were identified including items that were within the scope of change and others that were added to a future wish list. Changes that were made based on caregiver feedback included tracking or editing all oral and subcutaneous medications and the ability to change the time of a symptom tracked or medication administered if unable to do so immediately. Wish list items included adding a notes section, monitoring skin changes, weight and nutrition tracking, and mental health tracking. Conclusions: The Cope 360 app was well received by caregivers of children with cancer. Our validation testing suggests that the Cope 360 app is ready for testing in a randomized controlled trial to assess outcome improvements. %M 39419493 %R 10.2196/52128 %U https://cancer.jmir.org/2024/1/e52128 %U https://doi.org/10.2196/52128 %U http://www.ncbi.nlm.nih.gov/pubmed/39419493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62762 %T WhatsApp Versus SMS for 2-Way, Text-Based Follow-Up After Voluntary Medical Male Circumcision in South Africa: Exploration of Messaging Platform Choice %A Fabens,Isabella %A Makhele,Calsile %A Igaba,Nelson Kibiribiri %A Hlongwane,Sizwe %A Phohole,Motshana %A Waweru,Evelyn %A Oni,Femi %A Khwepeya,Madalitso %A Sardini,Maria %A Moyo,Khumbulani %A Tweya,Hannock %A Wafula,Mourice Barasa %A Pienaar,Jacqueline %A Ndebele,Felex %A Setswe,Geoffrey %A Dong,Tracy Qi %A Feldacker,Caryl %+ International Training and Education Center for Health (I-TECH), Departments of Global Health and Medicine, University of Washington, 13th Floor, 908 Jefferson Street, Seattle, WA, 98104, United States, 1 206 221 4970, cfeld@uw.edu %K 2-way texting %K text messages %K WhatsApp %K digital health innovations %K male circumcision %K South Africa %K quality improvement %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth is growing, especially in areas where access to health facilities is difficult. We previously used 2-way texting (2wT) via SMS to improve the quality of postoperative care after voluntary medical male circumcision in South Africa. In this study, we offered males aged 15 years and older WhatsApp or SMS as their message delivery and interaction platform to explore user preferences and behaviors. Objective: The objectives of this process evaluation embedded within a larger 2wT expansion trial were to (1) explore 2wT client preferences, including client satisfaction, with WhatsApp or SMS; (2) examine response rates (participation) by SMS and WhatsApp; and (3) gather feedback from the 2wT implementation team on the WhatsApp approach. Methods: Males aged 15 years and older undergoing voluntary medical male circumcision in program sites could choose their follow-up approach, selecting 2wT via SMS or WhatsApp or routine care (in-person postoperative visits). The 2wT system provided 1-way educational messages and an open 2-way communication channel between providers and clients. We analyzed quantitative data from the 2wT database on message delivery platforms (WhatsApp vs SMS), response rates, and user behaviors using chi-square tests, z tests, and t tests. The team conducted short phone calls with WhatsApp and SMS clients about their perceptions of this 2wT platform using a short, structured interview guide. We consider informal reflections from the technical team members on the use of WhatsApp. We applied an implementation science lens using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to focus results on practice and policy improvement. Results: Over a 2-month period—from August to October, 2023—337 males enrolled in 2wT and were offered WhatsApp or SMS and were included in the analysis. For 2wT reach, 177 (53%) participants chose WhatsApp as their platform (P=.38). Mean client age was 30 years, and 253 (75%) participants chose English for automated messages. From quality assurance calls, almost all respondents (87/89, 98%) were happy with the way they were followed up. For effectiveness, on average for the days on which responses were requested, 58 (33%) WhatsApp clients and 44 (28%) SMS clients responded (P=.50). All 2wT team members believed WhatsApp limited the automated message content, language choices, and inclusivity as compared with the SMS-based 2wT approach. Conclusions: When presented with a choice of 2wT communication platform, clients appear evenly split between SMS and WhatsApp. However, WhatsApp requires a smartphone and data plan, potentially reducing reach at scale. Clients using both platforms responded to 2wT interactive prompts, demonstrating similar effectiveness in engaging clients in follow-up. For telehealth interventions, digital health designers should maintain an SMS-based platform and carefully consider adding WhatsApp as an option for clients, using an implementation science approach to present evidence that guides the best implementation approach for their setting. %M 39412842 %R 10.2196/62762 %U https://formative.jmir.org/2024/1/e62762 %U https://doi.org/10.2196/62762 %U http://www.ncbi.nlm.nih.gov/pubmed/39412842 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50745 %T Feasibility, Acceptability, Satisfaction, and Challenges of an mHealth App (e-ASCov) for Community-Based COVID-19 Screening by Community Health Workers in Rwanda: Mixed Methods Study %A Omorou,Abdou Y %A Ndishimye,Pacifique %A Hoen,Bruno %A Mutesa,Léon %A Karame,Prosper %A Nshimiyimana,Ladislas %A Galmiche,Simon %A Mugabo,Hassan %A Murayire,Janvier %A Mugisha,Muco %A Umulisa,Marie Michele %A Uwera,Yvonne Delphine Nsaba %A Musanagabanwa,Clarisse %A Bigirimana,Noella %A Nsanzimana,Sabin %A Guillemin,Francis %A Rwabihama,Jean Paul %K community health workers %K COVID-19 screening tool %K COVID-19 %K SARS-CoV-2 %K screening %K acceptability %K feasibility %K satisfaction %K community based %K LMIC %K Africa %K challenges %K barriers %K smartphone %K proof-of-concept %K mHealth %K mobile health %K apps %K COVID-19 screening %D 2024 %7 14.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Although at the base of the pyramid-shaped organization of the Rwandan health system, community health workers (CHWs) are central to the community-based management of disease outbreaks. Objective: This mixed methods study aimed to explore the feasibility, acceptability, satisfaction, and challenges of a mobile health (mHealth) tool for community-based COVID-19 screening in Rwanda. Methods: Two urban (Gasabo and Nyarugenge) and 2 rural (Rusizi and Kirehe) districts in Rwanda participated in the project (smartphone app for COVID-19 screening). A mixed methods approach was used to inform the feasibility (awareness and expectation), acceptability (use and perceived benefits), satisfaction, and challenges of the mHealth intervention. At the end of the project, CHWs were asked to complete a quantitative questionnaire on the use of and satisfaction with the app. Then, in-depth interviews and focus group discussions were organized with CHWs. A content analysis was performed on the transcripts. Results: Overall, 383 CHWs were recruited and trained; 378 CHWs participated in the study. The mean age of CHWs was 36.7 (SD 6.6) to 45.3 (SD 9.9) years and most were women (237/378, 62.7%). More than 7000 people were registered with the use of the app and 20% were referred to a local COVID-19 testing facility. According to CHW reporting, the median number of people screened by each CHW ranged from 152 (IQR 70-276) for Nyarugenge to 24 (IQR 16-90) for Rusizi. COVID-19 positivity rates were higher in urban than rural districts: more than half of the CHWs in Gasabo reported a confirmed positive case versus only 2.4% for Kirehe and 15.4% for Rusizi. Despite the app being a novel tool, CHWs were well aware of the use of such a tool and had appropriate expectations. Acceptability and satisfaction were very high, with differences between urban and rural districts. Satisfaction was higher in Nyarugenge (72.8/100) and Gasabo (80.7/100) than in Kirehe (61.6/100) and Rusizi (64.5/100). More than 80% of the CHWs were willing to continue using the e-ASCov app, with the exception of CHWs in Kirehe (56.7%). The app was perceived as a tool to generate information on COVID-19, inform on the status of the pandemic, and help curb the spread of the pandemic in Rwanda. CHWs were satisfied with the app at all stages of its implementation in their districts. Conclusions: In this proof-of-concept study, a smartphone app for screening COVID-19 was useful as an mHealth tool to be used by CHWs, with the potential to increase health system efficiency in an epidemic context. The context should be analyzed for generalization on a country-wide scale, both in case of an epidemic and to take into account certain conditions at the community level. Information is needed on the conditions of generalization and transferability of this type of app to other health conditions so that CHWs can be given their full place in a pyramidal health system. %R 10.2196/50745 %U https://mhealth.jmir.org/2024/1/e50745 %U https://doi.org/10.2196/50745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53146 %T Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study %A Hong,Minji %A Rajaguru,Vasuki %A Kim,KyungYi %A Jang,Suk-Yong %A Lee,Sang Gyu %+ Department of Preventive Medicine, College of Medicine, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 02 2228 1500, Leevan@yuhs.ac %K menstruation %K dysmenorrhea %K period tracker app, menstrual cycle management, health care application, millennial %K Gen Z %K mobile phone %D 2024 %7 10.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance. Objective: This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women. Methods: A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews. Results: In total, 431 (62.3%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level. Conclusions: Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users’ needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health. %M 39388687 %R 10.2196/53146 %U https://www.jmir.org/2024/1/e53146 %U https://doi.org/10.2196/53146 %U http://www.ncbi.nlm.nih.gov/pubmed/39388687 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52424 %T Nutrition-Related Mobile Apps in the Spanish App Stores: Quality and Content Analysis %A Fernandez-Lazaro,Cesar I %A Santamaría,Gema %A Fernandez Milano,Annika %A Martin-Vergel,Maria I %A Fernandez-Lazaro,Diego %K mobile apps %K mHealth %K mobile health %K app %K nutritional %K nutrition %K dietary %K eating %K diet %K food %K lifestyle %K Spain %K Spanish %K chronic diseases %K chronic %K review %K quality %K MARS %K Mobile App Rating Scale %K uMARS %K user version of the Mobile App Rating Scale %K assessment %K mobile phone %D 2024 %7 4.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps represent accessible and cost-effective tools to improve nutrition and prevent chronic diseases. However, most of these apps have been characterized as having limited functionality, raising concerns about their effectiveness, acceptability, and efficacy. Objective: The aims of the study were to assess the quality of popular nutrition-related app platforms in Spain and to describe their characteristics and functionalities. Methods: We screened apps providing information on dietary advice, food advice, and nutritional content in the Apple App Store and Google Play Store in Spain from March 2 to March 16, 2024. Apps with a star rating of ≥4 (of 5 stars), those available in Spanish, those that were free of charge, those last updated after January 2022, those with >500 reviews, and those with >500,000 downloads were included. The quality of apps was assessed using the user version of the Mobile App Rating Scale (uMARS). General characteristics and nutritional, health, and market-related functionalities of the nutrition-related apps were described. Correlations among total and uMARS sections, star ratings, and number of reviews and downloads were evaluated. Results: Among the 1460 apps identified in the search, 42 apps met the criteria. The majority of these (n=20, 48%) aimed at recording and analyzing food intake, followed by those providing nutritional plans or diets (n=9, 21%), advising on healthy habits (n=7, 17%), and offering recipes (n=6, 14%). The most prevalent nutritional functionalities offered were recording and monitoring body measurements (n=30, 71%), food tracking (n=26, 62%), and dietary analysis (n=25, 60%), whereas nutrition education was less common (n=16, 38%). Among market-related functionalities, advertisements were the most common among the study apps (n=30, 71%), followed by the option of sharing on social media (n=29, 69%) and customizable reminders (n=26, 62%). Sharing the recorded information in the app with health professionals was infrequent (n=1, 2%). The mean (SD) total uMARS score (maximum 5 points) was 3.78 (0.35), while the mean (SD) uMARS scores for functionality, aesthetics, engagement, and information were 4.21 (0.38), 3.94 (0.54), 3.51 (0.46), and 3.48 (0.44), respectively. Lower mean scores were observed for the subjective quality (mean 2.65, SD 0.56) and perceived impact (mean 3.06, SD 0.67). Moderate to strong positive significant correlations were mostly observed between total uMARS and section-specific uMARS scores, while the correlations between the uMARS section scores were mostly moderate positive. Total uMARS scores were very weakly correlated with user rating, number of reviews, and number of downloads. Conclusions: The quality of popular nutrition-related app platforms in Spain was acceptable, with observed remarkable differences between sections. The majority of the apps were appealing due to their user-friendly interfaces. Only a few apps, however, provided dietary structure analysis or nutritional education. Further research is needed to assess the long-term impact of these apps on users. %R 10.2196/52424 %U https://mhealth.jmir.org/2024/1/e52424 %U https://doi.org/10.2196/52424 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49449 %T Usability Assessment Methods for Mobile Apps for Physical Rehabilitation: Umbrella Review %A Hach,Sylvia %A Alder,Gemma %A Stavric,Verna %A Taylor,Denise %A Signal,Nada %+ Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 2108184489, sylvia.hach@googlemail.com %K usability %K quality evaluation %K mobile health %K physical exercise %K rehabilitation %K overview %K umbrella review %K psychometrics %D 2024 %7 4.10.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Usability has been touted as one determiner of success of mobile health (mHealth) interventions. Multiple systematic reviews of usability assessment approaches for different mHealth solutions for physical rehabilitation are available. However, there is a lack of synthesis in this portion of the literature, which results in clinicians and developers devoting a significant amount of time and effort in analyzing and summarizing a large body of systematic reviews. Objective: This study aims to summarize systematic reviews examining usability assessment instruments, or measurements tools, in mHealth interventions including physical rehabilitation. Methods: An umbrella review was conducted according to a published registered protocol. A topic-based search of PubMed, Cochrane, IEEE Xplore, Epistemonikos, Web of Science, and CINAHL Complete was conducted from January 2015 to April 2023 for systematic reviews investigating usability assessment instruments in mHealth interventions including physical exercise rehabilitation. Eligibility screening included date, language, participant, and article type. Data extraction and assessment of the methodological quality (AMSTAR 2 [A Measurement Tool to Assess Systematic Reviews 2]) was completed and tabulated for synthesis. Results: A total of 12 systematic reviews were included, of which 3 (25%) did not refer to any theoretical usability framework and the remaining (n=9, 75%) most commonly referenced the ISO framework. The sample referenced a total of 32 usability assessment instruments and 66 custom-made, as well as hybrid, instruments. Information on psychometric properties was included for 9 (28%) instruments with satisfactory internal consistency and structural validity. A lack of reliability, responsiveness, and cross-cultural validity data was found. The methodological quality of the systematic reviews was limited, with 8 (67%) studies displaying 2 or more critical weaknesses. Conclusions: There is significant diversity in the usability assessment of mHealth for rehabilitation, and a link to theoretical models is often lacking. There is widespread use of custom-made instruments, and preexisting instruments often do not display sufficient psychometric strength. As a result, existing mHealth usability evaluations are difficult to compare. It is proposed that multimethod usability assessment is used and that, in the selection of usability assessment instruments, there is a focus on explicit reference to their theoretical underpinning and acceptable psychometric properties. This could be facilitated by a closer collaboration between researchers, developers, and clinicians throughout the phases of mHealth tool development. Trial Registration: PROSPERO CRD42022338785; https://www.crd.york.ac.uk/prospero/#recordDetails %M 39365988 %R 10.2196/49449 %U https://mhealth.jmir.org/2024/1/e49449 %U https://doi.org/10.2196/49449 %U http://www.ncbi.nlm.nih.gov/pubmed/39365988 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54405 %T Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review %A Suresh Kumar,Sagar %A Connolly,Patricia %A Maier,Anja %+ Department of Design, Manufacturing and Engineering Management (DMEM), University of Strathclyde, James Weir Building, 75 Montrose Street, Glasgow, G1 1XJ, United Kingdom, 44 1415482091, sagar.suresh-kumar@strath.ac.uk %K atrial fibrillation %K wearable devices %K lifestyle modification %K user experience %K design for behavior change %K systems thinking %K cardiac disease %K stroke %K heart disease %K complication %K mobile health %K systematic review %K usability %K mHealth %K intervention %D 2024 %7 4.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users. Objective: This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation. Methods: Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used. Results: A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC’s guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions. Conclusions: In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research. %M 39365991 %R 10.2196/54405 %U https://www.jmir.org/2024/1/e54405 %U https://doi.org/10.2196/54405 %U http://www.ncbi.nlm.nih.gov/pubmed/39365991 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e50364 %T Mobile Apps for Vaccination Services: Content Analysis and Quality Assessment %A Zhang,Chenchen %A Guo,Xing %A Zhu,Rui %A Hou,Wenjie %A Wang,Lingmeng %A Wang,Fuzhi %A Zhang,Li %A Luo,Dan %+ School of Health Administration, Bengbu Medical College, 2600 Donghai Blvd, Longzihu District, Bengbu, 233030, China, 86 13865073216, luodan1981@bbmc.edu.cn %K vaccination service app %K Mobile Application Rating Scale %K MARS %K quality evaluation %K app %K apps %K application %K applications %K quality %K evaluation %K rating %K mHealth %K mobile health %K service %K services %K service content %K user evaluation %K vaccine %K vaccines %K public health %D 2024 %7 3.10.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Vaccination services are increasingly in demand by the public, and mobile apps are an effective tool to meet that demand. However, the characteristics and quality of these apps are unknown. Objective: Commonly used vaccination service apps on the market were surveyed with regard to quality, service content, and user experience to evaluate and guide users. Methods: The Qimai Data mobile app data analytics platform was used to search for common vaccination service apps by keyword, and the WeChat and Alipay platforms were searched for apps. The apps included in the study were independently evaluated by two reviewers using the Mobile Application Rating Scale, and the service content and user experience of the apps were analyzed. The intragroup correlation coefficient between raters was used to measure interrater reliability. Results: In the app stores of the four major Android platforms and the iOS app store, 1092 and 207 apps were found, respectively; 189 WeChat applets and 30 Alipay applets were also found. A total of 29 apps was ultimately included in this study according to the inclusion criteria, including 21 independent apps, 4 WeChat applets, and 4 Alipay applets. Significant differences were found between independent apps and applets in terms of the quality score (t449.57=–5.301; P<.001) and the subjective quality score (z=–4.753; P<.001). No significant differences were found between iOS and Android platforms in terms of the quality score (t1404=–2.55; P=.80) and the subjective quality score (z=–0.137; P=.89). There was good intragroup consistency among the raters. Conclusions: In this study, independent apps and nonindependent apps that rely on social and payment platforms for implementation were included in the vaccination services category. The overall quality of these apps was acceptable. Nonindependent running apps were found to have slightly lower scores and showed room for improvement, and scores for the participatory apps were found to be generally low overall. %M 39361418 %R 10.2196/50364 %U https://ojphi.jmir.org/2024/1/e50364 %U https://doi.org/10.2196/50364 %U http://www.ncbi.nlm.nih.gov/pubmed/39361418 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58079 %T Italian Version of the mHealth App Usability Questionnaire (Ita-MAUQ): Translation and Validation Study in People With Multiple Sclerosis %A Podda,Jessica %A Grange,Erica %A Susini,Alessia %A Tacchino,Andrea %A Di Antonio,Federica %A Pedullà,Ludovico %A Brichetto,Giampaolo %A Ponzio,Michela %K mHealth %K multiple sclerosis %K cognitive assessment %K questionnaire validation %K usability %K mHealth app %K mHealth application %K validation study %K MAUQ %K app usability %K telemedicine %K disability %K usability questionnaire %K mobile health %D 2024 %7 30.9.2024 %9 %J JMIR Hum Factors %G English %X Background: Telemedicine and mobile health (mHealth) apps have emerged as powerful tools in health care, offering convenient access to services and empowering participants in managing their health. Among populations with chronic and progressive disease such as multiple sclerosis (MS), mHealth apps hold promise for enhancing self-management and care. To be used in clinical practice, the validity and usability of mHealth tools should be tested. The most commonly used method for assessing the usability of electronic technologies are questionnaires. Objective: This study aimed to translate and validate the English version of the mHealth App Usability Questionnaire into Italian (ita-MAUQ) in a sample of people with MS. Methods: The 18-item mHealth App Usability Questionnaire was forward- and back-translated from English into Italian by an expert panel, following scientific guidelines for translation and cross-cultural adaptation. The ita-MAUQ (patient version for stand-alone apps) comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. After interacting with DIGICOG-MS (Digital Assessment of Cognitive Impairment in Multiple Sclerosis), a novel mHealth app for cognitive self-assessment in MS, people completed the ita-MAUQ and the System Usability Scale, included to test construct validity of the translated questionnaire. Confirmatory factor analysis, internal consistency, test-retest reliability, and construct validity were assessed. Known-groups validity was examined based on disability levels as indicated by the Expanded Disability Status Scale (EDSS) score and gender. Results: In total, 116 people with MS (female n=74; mean age 47.2, SD 14 years; mean EDSS 3.32, SD 1.72) were enrolled. The ita-MAUQ demonstrated acceptable model fit, good internal consistency (Cronbach α=0.92), and moderate test-retest reliability (intraclass coefficient correlation 0.84). Spearman coefficients revealed significant correlations between the ita-MAUQ total score; the ease of use (5 items), interface and satisfaction (7 items), and usefulness subscales; and the System Usability Scale (all P values <.05). Known-group analysis found no difference between people with MS with mild and moderate EDSS (all P values >.05), suggesting that ambulation ability, mainly detected by the EDSS, did not affect the ita-MAUQ scores. Interestingly, a statistical difference between female and male participants concerning the ease of use ita-MAUQ subscale was found (P=.02). Conclusions: The ita-MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility, and acceptability of mHealth apps in people with MS. %R 10.2196/58079 %U https://humanfactors.jmir.org/2024/1/e58079 %U https://doi.org/10.2196/58079 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55350 %T Health Maintenance Organization–mHealth Versus Face-to-Face Interaction for Health Care in Israel: Cross-Sectional Web-Based Survey Study %A Zigdon,Avi %A Zwilling,Moti %A Zigdon,Ofek %A Reges,Orna %+ Department of Health Systems Management, School of Health Sciences, Ariel University, Science Park, POB 3, Ariel, 40700, Israel, 972 74 7288070, aviz@ariel.ac.il %K HMO-mHealth %K mHealth %K face-to-face %K digital health %K digital health apps %K eHealth %K HMO-mHealth adoption %K health care %K mHealth adoption %K mobile phone %K HMO %K health maintenance organization %D 2024 %7 30.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health maintenance organization–mobile health (HMO-mHealth) services have a direct impact on patients’ daily lives, and HMOs regularly expand their range of mHealth services. HMO-mHealth apps are saving HMOs time and money, as services are becoming more accessible to patients. However, the willingness to use mHealth apps depends on user perception. Although mHealth apps can change the relationship dynamic between HMOs and patients, patients prefer to use them to facilitate face-to-face interactions rather than replace them. Objective: This study aims to examine the extent to which Israeli adults prefer adopting health care services using HMO-mHealth as a replacement for face-to-face interaction. Methods: Israeli adults aged ≥18 years completed an electronic questionnaire. Data were collected from December 2020 to February 2021. All services in the main HMO-mHealth apps of the 4 Israeli HMOs were mapped. The 29 health care services used in this study were identical in all 4 HMO-mHealth apps in Israel. The association between sociodemographic characteristics and health condition with preference for HMO-mHealth or face-to-face interaction was analyzed separately for each health service by using a logistic model. Results: A total of 6321 respondents completed the questionnaire (female: 4296/6321, 68%; male: 2025/6321, 32%). Approximately 80.9% (5115/6321) to 88.2% (5578/6321) of the respondents preferred using HMO-mHealth apps for administrative matters. However, 55.3% (3498/6321), 52.2% (3301/6321), and 46.9% (2969/6321) preferred face-to-face meetings for the initial medical diagnosis, medical treatment, and medical diagnosis results, respectively. Seven main variables were found to be associated with HMO-mHealth adoption, including gender, age, education, marital status, religious affiliation, and subjective health condition. Female respondents were more likely than male respondents to prefer HMO-mHealth apps for administrative matters and face-to-face interaction for personal medical diagnosis and treatment (odds ratio [OR] 0.74, 95% CI 0.67-0.83; P<.001 and OR 0.82, 95% CI 0.74-0.92; P<.001, respectively). Married individuals preferred using HMO-mHealth apps over face-to-face meetings for a new medical diagnosis (OR 1.31, 95% CI 1.15-1.49; P<.001) or treatment (OR 1.34, 95% CI 1.18-1.52; P<.001). Improved health perception was associated with higher preference for HMO-mHealth apps across all health care services in this study (OR 1.11, 95% CI 1.02-1.22; P<.02 to OR 1.38, 95% CI 1.25-1.53; P<.001). No significant association was found between the presence of a chronic disease and the preferred mode of interaction for most services. Conclusions: HMO-mHealth is proving to be a robust and efficient tool for health care service delivery. However, there are barriers that affect vulnerable populations when adopting HMO-mHealth. Therefore, it is important to tailor HMO-mHealth apps for older adults, the chronically ill, and minorities in society, as these groups have a greater need for these services. Future studies should focus on identifying the barriers that affect the utilization of HMO-mHealth in these groups. %M 39348674 %R 10.2196/55350 %U https://www.jmir.org/2024/1/e55350 %U https://doi.org/10.2196/55350 %U http://www.ncbi.nlm.nih.gov/pubmed/39348674 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52563 %T Examining the Feasibility, Acceptability, and Preliminary Efficacy of an Immersive Virtual Reality–Assisted Lower Limb Strength Training for Knee Osteoarthritis: Mixed Methods Pilot Randomized Controlled Trial %A Lo,Hermione Hin Man %A Ng,Marques %A Fong,Pak Yiu Hugo %A Lai,Harmony Hoi Ki %A Wang,Bo %A Wong,Samuel Yeung-shan %A Sit,Regina Wing Shan %K virtual reality %K VR %K immersive %K knee %K joint %K arthritis %K arthritic %K osteoarthritis %K knee osteoarthritis %K gerontology %K geriatric %K older adult %K elder %K elderly %K older person %K older people %K aging %K pain %K function %K acceptability %K user experience %K RCT %K randomized %K controlled trial %K limb %K strength %K muscle %K muscular %K physiotherapy %D 2024 %7 27.9.2024 %9 %J JMIR Serious Games %G English %X Background: Knee osteoarthritis prevalently causes significant pain, activity limitations, psychological distress, and reduced quality of life. Despite lower limb strength training being a core treatment for knee osteoarthritis, adherence remains a challenge, prompting the exploration of virtual reality (VR) to improve exercise compliance. Recent research suggests the potential of VR in providing enhanced pain management and functional outcomes for knee osteoarthritis, necessitating further exploration of immersive VR technology. Objective: We aimed to study the feasibility, acceptability, and preliminary efficacy of an immersive VR-assisted lower limb strength training for knee osteoarthritis (VRiKnee). Methods: A convergent, parallel, mixed methods study was conducted in 30 participants with knee osteoarthritis. After 1:1 randomization, the VRiKnee group (n=15) was assigned to perform repetitive concentric quadriceps and isometric vastus medialis oblique exercise in an immersive environment using a head-mounted display for 12 weeks. The control group (n=15) completed the same exercises without VRiKnee. VRiKnee participants were interviewed at week 12 to study VRiKnee acceptability and user experience. Quantitative data included feasibility outcomes such as recruitment, dropout, and exercise adherence rates, and effectiveness outcomes such as the numeric rating scale, the Western Ontario and McMaster Universities Osteoarthritis Index (100 points) pain and function subscales, and objective physical activity measured by metabolic equivalents of task using an ActivPAL accelerometer. Qualitative data were analyzed by thematic analysis, followed by integration with quantitative data using joint displays. Results: The recruitment rate was 100% (N=30), with enrollment of 30 participants in 7.57 weeks. The median age was 63.5 (IQR 61.8‐66.3) years, with 76% (n=23) being female. The response rates were 80% and 93% for the VRiKnee and control groups. Dropout rates were 13% for VRiKnee and 7% for the control group. Median exercise adherence was 77% (IQR 37-104%) for VRiKnee and 62% (IQR 40-166%) for the control group, respectively, with adherence reduction over this study’s period and no significant intergroup differences (P=.82). No statistically significant differences were observed in primary and secondary outcomes, though positive trends were observed in pain and stiffness. Cybersickness was reported by 5 (33%) participants in the VRiKnee group. In the qualitative analysis, 4 themes, 11 subthemes, and 16 quotes were generated, identifying facilitators and barriers with practical suggestions to enhance the usability of VRiKnee. Conclusions: VRiKnee demonstrated feasibility, acceptability, and potential efficacy in managing knee osteoarthritis. Future trials of larger sample sizes and better VR designs will confirm its role in clinical practice. Trial Registration: Chinese Clinical Trial Registry CHiCTR2100046313; https://www.chictr.org.cn/showprojEN.html?proj=125404 %R 10.2196/52563 %U https://games.jmir.org/2024/1/e52563 %U https://doi.org/10.2196/52563 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59191 %T Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study %A Delaney,Tessa %A Jackson,Jacklyn K %A Brown,Alison L %A Lecathelinais,Christophe %A Wolfenden,Luke %A Hudson,Nayerra %A Young,Sarah %A Groombridge,Daniel %A Pinfold,Jessica %A Craven,Paul David %A Redman,Sinead %A Wiggers,John %A Kingsland,Melanie %A Hayes,Margaret %A Sutherland,Rachel %+ Hunter New England Local Health District, Lookout Road, New Lambton, 2306, Australia, 61 249246499, Rachel.Sutherland@health.nsw.gov.au %K maternal %K postnatal %K postpartum %K acceptability %K technology %K digital health %K first 2000 days %K child health %K experience %K experiences %K attitude %K attitudes %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K cross sectional %K survey %K surveys %K questionnaire %K questionnaires %K pediatric %K pediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K nurse %K nurses %K nursing %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. Objective: This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. Methods: A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. Results: A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child’s birth. The majority of women (n=282-315, 82%-92%) “strongly agreed or agreed” that receiving information from CFHN via technology would be acceptable, and most (n=308) women “strongly agreed or agreed” with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). Conclusions: Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days. %M 39316424 %R 10.2196/59191 %U https://pediatrics.jmir.org/2024/1/e59191 %U https://doi.org/10.2196/59191 %U http://www.ncbi.nlm.nih.gov/pubmed/39316424 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55324 %T Design and Psychometric Evaluation of Nurses’ Mobile Health Device Acceptance Scale (NMHDA-Scale): Application of the Expectation-Confirmation Theory %A Mirabootalebi,Narjes %A Meidani,Zahra %A Akbari,Hossein %A Rangraz Jeddi,Fatemeh %A Tagharrobi,Zahra %A Swoboda,Walter %A Holl,Felix %+ Trauma Nursing Research Centre, Kashan University of Medical Sciences, Isfahan Province, Kashan, 2C74+M7F, Iran, 98 9131613899, Tagharrobi_z@kaums.ac.ir %K mobile health %K acceptance %K psychometric evaluation %K nursing %K Expectation-Confirmation Theory %K smartphone %D 2024 %7 17.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of mobile tools in nursing care is indispensable. Given the importance of nurses’ acceptance of these tools in delivering effective care, this issue requires greater attention. Objective: This study aims to design the Mobile Health Tool Acceptance Scale for Nurses based on the Expectation-Confirmation Theory and to evaluate it psychometrically. Methods: Using a Waltz-based approach grounded in existing tools and the constructs of the Expectation-Confirmation Theory, the initial version of the scale was designed and evaluated for face and content validity. Construct validity was examined through exploratory factor analysis, concurrent validity, and known-group comparison. Reliability was assessed using measures of internal consistency and stability. Results: The initial version of the scale consisted of 33 items. During the qualitative and quantitative content validity stage, 1 item was added and 1 item was removed. Exploratory factor analysis, retaining 33 items, identified 5 factors that explained 70.53% of the variance. A significant positive correlation was found between the scores of the designed tool and nurses’ attitudes toward using mobile-based apps in nursing care (r=0.655, P<.001). The intraclass correlation coefficient, Cronbach α, and ω coefficient were 0.938, 0.953, and 0.907, respectively. Conclusions: The 33-item scale developed is a valid and reliable instrument for measuring nurses’ acceptance of mobile health tools. %M 39288375 %R 10.2196/55324 %U https://humanfactors.jmir.org/2024/1/e55324 %U https://doi.org/10.2196/55324 %U http://www.ncbi.nlm.nih.gov/pubmed/39288375 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e54116 %T Usage, Attitudes, Facilitators, and Barriers Toward Digital Health Technologies in Musculoskeletal Care: Survey Among Primary Care Physiotherapists in Norway %A Martinsen,Lars %A Østerås,Nina %A Moseng,Tuva %A Tveter,Anne Therese %+ Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Diakonveien 12, Oslo, 0370, Norway, 47 22451500, lars.martinsen@diakonsyk.no %K physiotherapy %K physiotherapist %K physiotherapists %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K ehealth %K telemedicine %K tele-medicine %K family medicine %K primary care %K primary health care %K musculoskeletal %K musculoskeletal care %K muscle %K skeleton %K musculoskeletal disorders %K MSD %K MSDs %K internet survey %K internet surveys %K online survey %K online surveys %K web-based survey %K web-based surveys %K survey %K surveys %K mobile phone %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Work burden increases for physiotherapists in the primary health care sector as the prevalence of musculoskeletal disorders (MSDs) increases. Digital health technologies (DHTs) are proposed as a viable solution to secure the sustainability of the health care system and have shown promising results in a range of conditions. However, little is known about use of DHTs among physiotherapists in the primary health care sector in Norway. Objective: This study aimed to investigate the use of and attitudes toward DHTs among physiotherapists treating patients with MSDs in primary care, and potential facilitators or barriers for adopting DHTs in clinical practice. Methods: An author-developed web-based questionnaire was distributed to physiotherapists in all Norwegian municipalities in March 2023. The questionnaire included items regarding use of technologies, attitudes, suitability, and factors influencing adoption of DHT. Suitability and agreement on statements were scored on an 11-point numeric rating scale (0=very unsuitable or strongly disagree, 10=very suitable or strongly agree). Differences across employment sites and users versus nonusers of DHT were analyzed using the χ2 test, Fisher exact test, Student t test, and Mann-Whitney U test. Results: Approximately 5000 physiotherapists were invited to participate, of which 6.8% (338) completed the questionnaire. A total of 46.2% (156/338) offered DHTs in their practice, of which 53.2% (83/156) used it on a weekly basis, mostly telephone consultations (105/156, 67.3%). A higher proportion of physiotherapists in private practice offered DHT compared with those employed by municipalities (95/170, 55.9% vs 61/168, 36.3%; P<.001). A majority (272/335, 81.2%) were positive about recommending DHTs to their patients. Suitability of DHTs in physiotherapy was rated an average of 6 (SD 2.1). Apps for smartphones or tablets were rated most suitable (mean rating 6.8, SD 2.4). The most frequently reported advantages were flexibility in how physiotherapy is offered (278/338, 82.3%) and reduced travel time for the patient (235/338, 70%). The highest rated disadvantages were limited scope for physical examination (252/338, 74.6%) and difficulty in building rapport with the patient (227/338, 67.2%). The main facilitators and barriers included a functioning (median rating 10, IQR 8-10) or lack of functioning (median rating 9, IQR 8-10) internet connection, respectively. Lack of training in DHTs was prominent regarding evaluation, diagnosing, and treatment (median rating 0, IQR 0-2), with minor, but significant, differences between nonusers and users (median rating 0, IQR 0-1 vs median rating 1, IQR 0-4); P<.001). Conclusions: Physiotherapists in Norwegian primary care treating patients with MSDs are positive about using DHTs, and almost 50% (156/338) have adopted them in clinical practice. Concerns are related to lack of a physical examination and technical aspects. Training in the use of DHTs should be addressed in implementation processes. %M 39283661 %R 10.2196/54116 %U https://rehab.jmir.org/2024/1/e54116 %U https://doi.org/10.2196/54116 %U http://www.ncbi.nlm.nih.gov/pubmed/39283661 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57033 %T User Experience of a Large-Scale Smartphone-Based Observational Study in Multiple Sclerosis: Global, Open-Access, Digital-Only Study %A Galati,Adriano %A Kriara,Lito %A Lindemann,Michael %A Lehner,Rea %A Jones,JB %+ F Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070, Switzerland, 41 61 682 25 79, adriano.galati@roche.com %K smartphone %K multiple sclerosis %K user experience %K retention %K digital health %K digital health technology %K mobile phone %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Floodlight Open app is a digital health technology tool (DHTT) that comprises remote, smartphone sensor–based tests (daily activities) for assessing symptoms of multiple sclerosis (MS). User acquisition, engagement, and retention remain a barrier to successfully deploying such tools. Objective: This study aims to quantitatively and qualitatively investigate key user experience (UX) factors associated with the Floodlight Open app. Methods: Floodlight Open is a global, open-access, digital-only study designed to understand the drivers and barriers in deploying a DHTT in a naturalistic setting without supervision and onboarding by a clinician. Daily activities included tests assessing cognition (Information Processing Speed and Information Processing Speed Digit–Digit), hand-motor function (Pinching Test and Draw a Shape Test), and postural stability and gait (Static Balance Test, U-Turn Test, and Two-Minute Walk Test [2MWT]). All daily activities except the 2MWT were taken in a fixed sequence. Qualitative UX was studied through semistructured interviews in a substudy of US participants with MS. The quantitative UX analysis investigated the impact of new UX design features on user engagement and retention in US participants for 3 separate test series: all daily activities included in the fixed sequence (DA), all daily activities included in the fixed sequence except the Static Balance Test and U-Turn Test (DAx), and the 2MWT. Results: The qualitative UX substudy (N=22) revealed the need for 2 new UX design features: a more seamless user journey during the activation process that eliminates the requirement of switching back and forth between the app and the email that the participants received upon registration, and configurable reminders and push notifications to help plan and remind the participants to complete their daily activities. Both UX design features were assessed in the quantitative UX analysis. Introducing the more seamless user journey (original user journey: n=608; more seamless user journey: n=481) improved the conversion rate of participants who enrolled in the study and proceeded to successfully activate the app from 53.9% (328/608) to 74.6% (359/481). Introducing reminders and push notifications (with reminders and notifications: n=350; without reminders and notifications: n=172) improved continuous usage time (proportion of participants with ≥3 consecutive days of usage: DA and DAx: ~30% vs ~12%; 2MWT: ~30% vs ~20%); test completion rates (maximum number of test series completed: DA: 279 vs 64; DAx: 283 vs 126; 2MWT: 302 vs 76); and user retention rates (at day 30: DA: 53/172, 30.8% vs 34/350, 9.7%; DAx: 53/172, 30.8% vs 60/350, 17.1%; 2MWT: 39/172, 22.6% vs 22/350, 6.2%). Inactivity times remained comparable. Conclusions: The remote assessment of MS with DHTTs is a relatively nascent but growing field of research. The continued assessment and improvement of UX design features can play a crucial role in the successful long-term adoption of new DHTTs. %M 39259964 %R 10.2196/57033 %U https://humanfactors.jmir.org/2024/1/e57033 %U https://doi.org/10.2196/57033 %U http://www.ncbi.nlm.nih.gov/pubmed/39259964 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48453 %T Evaluating the Impact of a Dutch Sexual Health Intervention for Adolescents: Think-Aloud and Semistructured Interview Study %A Metz,Gido %A Thielmann,Rosa R L C %A Roosjen,Hanneke %A Crutzen,Rik %+ Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882435, g.metz@maastrichtuniversity.nl %K web-based intervention %K eHealth %K engagement %K potential impact %K mixed methods %K evaluation %K acyclic behavior change diagram %K web analytics %K think-aloud method %K web-based %K user %K chlamydia %K behavior change %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engagement with and the potential impact of web-based interventions is often studied by tracking user behavior with web analytics. These metrics do provide insights into how users behave, but not why they behave as such. Objective: This paper demonstrates how a mixed methods approach consisting of (1) a theoretical analysis of intended use, (2) a subsequent analysis of actual use, and (3) an exploration of user perceptions can provide insights into engagement with and potential impact of web-based interventions. This paper focuses on the exploration of user perceptions, using the chlamydia page of the Dutch sexual health intervention, Sense.info, as a demonstration case. This prevention-focused platform serves as the main source of sexual and reproductive health information (and care if needed) for young people aged 12-25 years in the Netherlands. Methods: First, acyclic behavior change diagrams were used to theoretically analyze the intended use of the chlamydia page. Acyclic behavior change diagrams display how behavior change principles are applied in an intervention and which subbehaviors and target behaviors are (aimed to be) influenced. This analysis indicated that one of the main aims of the page is to motivate sexually transmitted infection (STI) testing. Second, the actual use of the chlamydia page was analyzed with the web analytics tool Matomo. Despite the page’s aim of promoting STI testing, a relatively small percentage (n=4948, 14%) of the 35,347 transfers from this page were to the STI testing page. Based on these two phases, preliminary assumptions about use and impact were formulated. Third, to further explore these assumptions, a study combining the think-aloud method and semistructured interviews was executed with 15 young individuals aged 16-25 (mean 20, SD 2.5) years. Template analysis was used to analyze interview transcripts. Results: Participants found the information on the Sense.info chlamydia page reliable and would visit it mostly for self-diagnosis purposes if they experienced potential STI symptoms. A perceived facilitator for STI testing was the possibility to learn about the symptoms and consequences of chlamydia through the page. Barriers included an easily overlooked link to the STI testing page and the use of language not meeting the needs of participants. Participants offered suggestions for lowering the threshold for STI testing. Conclusions: The mixed methods approach used provided detailed insights into the engagement with and potential impact of the Sense.info chlamydia page, as well as strategies to further engage end users and increase the potential impact of the page. We conclude that this approach, which triangulates findings from theoretical analysis with web analytics and a think-aloud study combined with semistructured interviews, may also have potential for the evaluation of web-based interventions in general. %M 39259573 %R 10.2196/48453 %U https://formative.jmir.org/2024/1/e48453 %U https://doi.org/10.2196/48453 %U http://www.ncbi.nlm.nih.gov/pubmed/39259573 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51061 %T A Smart Water Bottle and Companion App (HidrateSpark 3) to Improve Bladder-Filling Compliance in Patients With Prostate Cancer Receiving Radiotherapy: Nonrandomized Trial of Feasibility and Acceptability %A Jin,William %A Montoya,Christopher %A Rich,Benjamin James %A Taswell,Crystal Seldon %A Noy,Miguel %A Kwon,Deukwoo %A Spieler,Benjamin %A Mahal,Brandon %A Abramowitz,Matthew %A Yechieli,Raphael %A Pollack,Alan %A Dal Pra,Alan %+ Department of Radiation Oncology, Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL, 33136, United States, 1 3055851111, willhjin@gmail.com %K digital therapeutics %K behavioral intervention %K digital health %K prostate cancer %K radiation %K smart water bottle %K companion app %K oncology %K prostate %K privacy %K radiation therapy %K bladder %K compliance %K smartphone-based behavioral intervention %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with prostate cancer undergoing radiation therapy (RT) need comfortably full bladders to reduce toxicities during treatment. Poor compliance is common with standard of care written or verbal instructions, leading to wasted patient value (PV) and clinic resources via poor throughput efficiency (TE). Objective: Herein, we assessed the feasibility and acceptability of a smartphone-based behavioral intervention (SBI) to improve bladder-filling compliance and methods for quantifying PV and TE. Methods: In total, 36 patients with prostate cancer were enrolled in a single-institution, closed-access, nonrandomized feasibility trial. The SBI consists of a fully automated smart water bottle and smartphone app. Both pieces alert the patient to empty his bladder and drink a personalized volume goal, based on simulation bladder volume, 1.25 hours before his scheduled RT. Patients were trained to adjust their volume goal and notification times to achieve comfortably full bladders. The primary end point was met if qualitative (QLC) and quantitative compliance (QNC) were >80%. For QLC, patients were asked if they prepared their bladders before daily RT. QNC was met if bladder volumes on daily cone-beam tomography were >75% of the simulation’s volume. The Service User Technology Acceptability Questionnaire (SUTAQ) was given in person pre- and post-SBI. Additional acceptability and engagement end points were met if >3 out of 5 across 4 domains on the SUTAQ and >80% (15/18) of patients used the device >50% of the time, respectively. Finally, the impact of SBI on PV and TE was measured by time spent in a clinic and on the linear accelerator (linac), respectively, and contrasted with matched controls. Results: QLC was 100% in 375 out of 398 (94.2%) total treatments, while QNC was 88.9% in 341 out of 398 (85.7%) total treatments. Of a total score of 5, patients scored 4.33 on privacy concerns, 4 on belief in benefits, 4.56 on satisfaction, and 4.24 on usability via SUTAQ. Further, 83% (15/18) of patients used the SBI on >50% of treatments. Patients in the intervention arm spent less time in a clinic (53.24, SEM 1.71 minutes) compared to the control (75.01, SEM 2.26 minutes) group (P<.001). Similarly, the intervention arm spent less time on the linac (10.67, SEM 0.40 minutes) compared to the control (14.19, SEM 0.32 minutes) group (P<.001). Conclusions: This digital intervention trial showed high rates of bladder-filling compliance and engagement. High patient value and TE were feasibly quantified by shortened clinic times and linac usage, respectively. Future studies are needed to evaluate clinical outcomes, patient experience, and cost-benefit. Trial Registration: ClinicalTrials.gov NCT04946214; https://www.clinicaltrials.gov/study/NCT04946214 %M 39255484 %R 10.2196/51061 %U https://cancer.jmir.org/2024/1/e51061 %U https://doi.org/10.2196/51061 %U http://www.ncbi.nlm.nih.gov/pubmed/39255484 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e48810 %T Experiences of Using a Digital Guidance and Assessment Tool (the Technology-Optimized Practice Process in Nursing Application) During Clinical Practice in a Nursing Home: Focus Group Study Among Nursing Students %A Johnsen,Hege Mari %A Nes,Andréa Aparecida Gonçalves %A Haddeland,Kristine %+ Department of Health and Nursing Science, University of Agder, Jon Lilletuns vei 9, Grimstad, 4879, Norway, 47 97515773, hege.mari.johnsen@uia.no %K application %K assessment of clinical education %K AssCE %K clinical education assessment tool %K electronic reports %K feedback %K guidance model %K smartphone %K Technology-Optimized Practice Process in Nursing %K TOPP-N %K information system success model %K nurse %K nursing %K allied health %K education %K focus group %K focus groups %K technology enhanced learning %K digital health %K content analysis %K student %K students %K nursing home %K long-term care %K learning management %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Nursing %G English %X Background: Nursing students’ learning during clinical practice is largely influenced by the quality of the guidance they receive from their nurse preceptors. Students that have attended placement in nursing home settings have called for more time with nurse preceptors and an opportunity for more help from the nurses for reflection and developing critical thinking skills. To strengthen students’ guidance and assessment and enhance students’ learning in the practice setting, it has also been recommended to improve the collaboration between faculties and nurse preceptors. Objective: This study explores first-year nursing students’ experiences of using the Technology-Optimized Practice Process in Nursing (TOPP-N) application in 4 nursing homes in Norway. TOPP-N was developed to support guidance and assessment in clinical practice in nursing education. Methods: Four focus groups were conducted with 19 nursing students from 2 university campuses in Norway. The data collection and directed content analysis were based on DeLone and McLean’s information system success model. Results: Some participants had difficulties learning to use the TOPP-N tool, particularly those who had not attended the 1-hour digital course. Furthermore, participants remarked that the content of the TOPP-N guidance module could be better adjusted to the current clinical placement, level of education, and individual achievements to be more usable. Despite this, most participants liked the TOPP-N application’s concept. Using the TOPP-N mobile app for guidance and assessment was found to be very flexible. The frequency and ways of using the application varied among the participants. Most participants perceived that the use of TOPP-N facilitated awareness of learning objectives and enabled continuous reflection and feedback from nurse preceptors. However, the findings indicate that the TOPP-N application’s perceived usefulness was highly dependent on the preparedness and use of the app among nurse preceptors (or absence thereof). Conclusions: This study offers information about critical success factors perceived by nursing students related to the use of the TOPP-N application. To develop similar learning management systems that are usable and efficient, developers should focus on personalizing the content, clarifying procedures for use, and enhancing the training and motivation of users, that is, students, nurse preceptors, and educators. %M 39255477 %R 10.2196/48810 %U https://nursing.jmir.org/2024/1/e48810 %U https://doi.org/10.2196/48810 %U http://www.ncbi.nlm.nih.gov/pubmed/39255477 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55790 %T Evaluating the Usability and Quality of a Clinical Mobile App for Assisting Physicians in Head Computed Tomography Scan Ordering: Mixed Methods Study %A Meidani,Zahra %A Omidvar,Aydine %A Akbari,Hossein %A Asghari,Fatemeh %A Khajouei,Reza %A Nazemi,Zahra %A Nabovati,Ehsan %A Holl,Felix %+ Health Information Management Research Center, Kashan University of Medical Sciences, Qotbe Ravandi, Pezeshk Blvd, Kashan, 8715973449, Iran, 98 55589343, nabovati@kaums.ac.ir %K mobile apps %K user-centered design %K user-computer interface %K physicians %K tomography %K x-ray computed %K mobile phone %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Among the numerous factors contributing to health care providers’ engagement with mobile apps, including user characteristics (eg, dexterity, anatomy, and attitude) and mobile features (eg, screen and button size), usability and quality of apps have been introduced as the most influential factors. Objective: This study aims to investigate the usability and quality of the Head Computed Tomography Scan Appropriateness Criteria (HAC) mobile app for physicians’ computed tomography scan ordering. Methods: Our study design was primarily based on methodological triangulation by using mixed methods research involving quantitative and qualitative think-aloud usability testing, quantitative analysis of the Mobile Apps Rating Scale (MARS) for quality assessment, and debriefing across 3 phases. In total, 16 medical interns participated in quality assessment and testing usability characteristics, including efficiency, effectiveness, learnability, errors, and satisfaction with the HAC app. Results: The efficiency and effectiveness of the HAC app were deemed satisfactory, with ratings of 97.8% and 96.9%, respectively. MARS assessment scale indicated the overall favorable quality score of the HAC app (82 out of 100). Scoring 4 MARS subscales, Information (73.37 out of 100) and Engagement (73.48 out of 100) had the lowest scores, while Aesthetics had the highest score (87.86 out of 100). Analysis of the items in each MARS subscale revealed that in the Engagement subscale, the lowest score of the HAC app was “customization” (63.6 out of 100). In the Functionality subscale, the HAC app’s lowest value was “performance” (67.4 out of 100). Qualitative think-aloud usability testing of the HAC app found notable usability issues grouped into 8 main categories: lack of finger-friendly touch targets, poor search capabilities, input problems, inefficient data presentation and information control, unclear control and confirmation, lack of predictive capabilities, poor assistance and support, and unclear navigation logic. Conclusions: Evaluating the quality and usability of mobile apps using a mixed methods approach provides valuable information about their functionality and disadvantages. It is highly recommended to embrace a more holistic and mixed methods strategy when evaluating mobile apps, because results from a single method imperfectly reflect trustworthy and reliable information regarding the usability and quality of apps. %M 39250788 %R 10.2196/55790 %U https://humanfactors.jmir.org/2024/1/e55790 %U https://doi.org/10.2196/55790 %U http://www.ncbi.nlm.nih.gov/pubmed/39250788 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49714 %T The SoCAP (Social Communication, Affiliation, and Presence) Taxonomy of Social Features: Scoping Review of Commercially Available eHealth Apps %A Kwok,Ian %A Freedman,Melanie %A Kamsickas,Lisa %A Lattie,Emily G %A Yang,Dershung %A Moskowitz,Judith Tedlie %+ Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 323 364 1160, iankwok@u.northwestern.edu %K eHealth %K digital interventions %K social features %K taxonomy %K computer-human interaction %K social connection %K engagement %K eHealth apps %K intervention %K mental health %K behavioral health %K mobile app %D 2024 %7 3.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth interventions have proven to be valuable resources for users with diverse mental and behavioral health concerns. As these technologies continue to proliferate, both academic researchers and commercial app creators are leveraging the use of features that foster a sense of social connection on these digital platforms. Yet, the literature often insufficiently represents the functionality of these key social features, resulting in a lack of understanding of how they are being implemented. Objective: This study aimed to conduct a methodical review of commercially available eHealth apps to establish the SoCAP (social communication, affiliation, and presence) taxonomy of social features in eHealth apps. Our goal was to examine what types of social features are being used in eHealth apps and how they are implemented. Methods: A scoping review of commercially available eHealth apps was conducted to develop a taxonomy of social features. First, a shortlist of the 20 highest-rated eHealth apps was derived from One Mind PsyberGuide, a nonprofit organization with trained researchers who rate apps based on their (1) credibility, (2) user experience, and (3) transparency. Next, both mobile- and web-based versions of each app were double-coded by 2 trained raters to derive a list of social features. Subsequently, the social features were organized by category and tested on other apps to ensure their completeness. Results: Four main categories of social features emerged: (1) communication features (videoconferencing, discussion boards, etc), (2) social presence features (chatbots, reminders, etc), (3) affiliation and identity features (avatars, profiles, etc), and (4) other social integrations (social network and other app integrations). Our review shows that eHealth apps frequently use resource-intensive interactions (eg, videoconferencing with a clinician and phone calls from a facilitator), which may be helpful for participants with high support needs. Furthermore, among commercially available eHealth apps, there is a strong reliance on automated features (eg, avatars, personalized multimedia, and tailored content) that enhance a sense of social presence without requiring a high level of input from a clinician or staff member. Conclusions: The SoCAP taxonomy includes a comprehensive list of social features and brief descriptions of how these features work. This classification system will provide academic and commercial eHealth app creators with an understanding of the various social features that are commonly implemented, which will allow them to apply these features to enhance their own apps. Future research may include comparing the synergistic effects of various combinations of these social features. %M 39226544 %R 10.2196/49714 %U https://www.jmir.org/2024/1/e49714 %U https://doi.org/10.2196/49714 %U http://www.ncbi.nlm.nih.gov/pubmed/39226544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57827 %T Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies %A Goodday,Sarah M %A Karlin,Emma %A Brooks,Alexa %A Chapman,Carol %A Harry,Christiana %A Lugo,Nelly %A Peabody,Shannon %A Rangwala,Shazia %A Swanson,Ella %A Tempero,Jonell %A Yang,Robin %A Karlin,Daniel R %A Rabinowicz,Ron %A Malkin,David %A Travis,Simon %A Walsh,Alissa %A Hirten,Robert P %A Sands,Bruce E %A Bettegowda,Chetan %A Holdhoff,Matthias %A Wollett,Jessica %A Szajna,Kelly %A Dirmeyer,Kallan %A Dodd,Anna %A Hutchinson,Shawn %A Ramotar,Stephanie %A Grant,Robert C %A Boch,Adrien %A Wildman,Mackenzie %A Friend,Stephen H %+ 4YouandMe, 2901 3rd Ave, Seattle, WA, 98121, United States, 1 (206) 928 8243, sarah@4youandme.org %K wearables %K wearable %K mHealth %K mobile health %K app %K apps %K application %K applications %K engagement %K adherence %K retention %K participatory medicine %K participatory %K DHT %K digital health technology %K DHTs %K digital health technologies %K digital health %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. Objective: The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. Methods: Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. Results: The median proportion of participants retained in the study across the 6 studies was 77.2% (IQR 72.6%-88%). The probability of staying in the study stayed above 80% for all studies during the first month of study participation and stayed above 50% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80% and 90%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50%, IQR 20%-75%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. Conclusions: Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user. %M 39226552 %R 10.2196/57827 %U https://www.jmir.org/2024/1/e57827 %U https://doi.org/10.2196/57827 %U http://www.ncbi.nlm.nih.gov/pubmed/39226552 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60773 %T Establishing an Evaluation Indicator System for User Satisfaction With Hypertension Management Apps: Combining User-Generated Content and Analytic Hierarchy Process %A He,Yunfan %A Chen,Han %A Xiang,Peng %A Zhao,Min %A Li,Yingjun %A Liu,Yongcheng %A Wang,Tong %A Liang,Jun %A Lei,Jianbo %+ Department of AI and IT, Second Affiliated Hospital, School of Medicine, Zhejiang University, Number 88, Jiefang Road, Shangcheng District, Hangzhou, 310027, China, 86 571 87783942, junl@zju.edu.cn %K hypertension management %K mobile health %K user satisfaction %K evaluation indicator system %K analytic hierarchy process %D 2024 %7 3.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension management apps (HMAs) can be effective in controlling blood pressure, but their actual impact is often suboptimal. Establishing a user satisfaction evaluation indicator system for HMAs can assist app developers in enhancing app design and functionality, while also helping users identify apps that best meet their needs. This approach aims to improve the overall effectiveness of app usage. Objective: This study aims to systematically collect data on HMAs and their user reviews in the United States and China. It analyzes app usage patterns and functional characteristics, identifies factors influencing user satisfaction from existing research, and develops a satisfaction evaluation indicator system to provide more accurate recommendations for improving user satisfaction. Methods: We conducted a descriptive statistical analysis to assess the development status of HMAs in both countries and applied the task-technology fit model to evaluate whether the app functionalities align with business needs. We separately summarized the factors influencing user satisfaction in both countries from previous research, utilized the analytic hierarchy process to develop an evaluation indicator system for HMA user satisfaction, and calculated satisfaction levels. Based on these findings, we propose improvements to enhance app functionality and user satisfaction. Results: In terms of current development status, there were fewer HMAs and user reviews in China compared with the United States. Regarding app functional availability, fewer than 5% (4/91) of the apps achieved a demand fulfillment rate exceeding 80% (8/10). Overall, user satisfaction in both countries was low. Conclusions: In the United States, user satisfaction was lowest for advertising distribution, data synchronization, and reliability. By contrast, Chinese apps need improvements in cost efficiency and compatibility. %M 39226103 %R 10.2196/60773 %U https://www.jmir.org/2024/1/e60773 %U https://doi.org/10.2196/60773 %U http://www.ncbi.nlm.nih.gov/pubmed/39226103 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e57172 %T Exploring Acceptability, Barriers, and Facilitators for Digital Health in Dermatology: Qualitative Focus Groups With Dermatologists, Nurses, and Patients %A Reinders,Patrick %A Augustin,Matthias %A Fleyder,Anastasia %A Otten,Marina %+ Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20246, Germany, 49 40 7410 ext 24723, m.otten@uke.de %K digitalization %K digital health interventions %K UTAUT %K unified theory of acceptance and use of technology %K barriers and facilitators %K dermatology %K qualitative research %K focus groups %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Although several digital health interventions (DHIs) have shown promise in the care of skin diseases their uptake in Germany has been limited. To fully understand the reasons for the low uptake, an in-depth analysis of patients’ and health care providers’ barriers and facilitators in dermatology is needed. Objective: The objective of this study was to explore and compare attitudes, acceptability, barriers, and facilitators of patients, dermatologists, and nurses toward DHIs in dermatology. Methods: We conducted 6 web-based focus groups each with patients (n=34), dermatologists (n=30), and nurses (n=30) using a semistructured interview guide with short descriptions of DHIs described in the literature. A content analysis was performed using deductive constructs, following the unified theory of acceptance and use of technology framework, and inductive categories. Results: Patients identified many positive performance expectancies, such as reduced travel times and improvement in follow-up appointments. Dermatologists also stated positive effects (eg, promotion of standardized care), but also negative implications of health care digitalization (eg, increased workload). All stakeholders reported that a DHI should bring additional value to all stakeholders. A lack of digital competence among patients was identified as the major barrier to adoption by all 3 groups. Nurses and dermatologists want apps that are easy to use and easy to implement into their daily routines. Trust in selected institutions, colleagues, and physicians was identified as a facilitator. Patients reported their dependence on the dermatologists’ acceptance. All groups expressed concerns about data privacy risks and dermatologists stated insecurities toward data privacy laws. Conclusions: To ensure successful digitalization in dermatology, apps should be user-friendly, adapted to users’ skill levels, and beneficial for all stakeholders. The incorporation of dermatologists’ perspectives is especially important as their acceptance may impact use among patients and nurses. DHIs should ensure and be transparent about data privacy. The found barriers and facilitators can be used for implementation strategies. %M 39226097 %R 10.2196/57172 %U https://derma.jmir.org/2024/1/e57172 %U https://doi.org/10.2196/57172 %U http://www.ncbi.nlm.nih.gov/pubmed/39226097 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59168 %T Understanding Older Adults’ Experiences With a Digital Health Platform in General Practice: Qualitative Interview Study %A Knotnerus,Hanna R %A Ngo,Hà T N %A Maarsingh,Otto R %A van Vugt,Vincent A %K digital health care %K digital health platform %K general practice %K qualitative research %K older adults %K primary care %K mobile phone %D 2024 %7 30.8.2024 %9 %J JMIR Aging %G English %X Background: In our aging population, primary care is under pressure to remain accessible to all. Effective use of digital health care could potentially lower general practitioners’ (GPs) workload. Some general practices are already implementing a digital health platform as a primary method to contact their patients. However, it is unknown how older people experience this novel way to communicate with their GP. Objective: The aim of this study was to study the experiences of patients aged 65 years and older in general practices who use digital health as a primary communication tool. The secondary aims were to identify barriers and facilitators for the use of digital health care and whether a practice focus on digital health influences older patients’ choice to enlist. Methods: We invited all patients aged 65 years and older at 2 general practices in Amsterdam that work with a novel digital health platform. We used purposive sampling to select a heterogeneous group of patients in terms of age, sex, level of education, digital literacy, and experiences with the digital app of their general practice. We conducted 18 semistructured interviews from May through July 2023. All interviews were audio-recorded, transcribed, coded, and thematically analyzed. Results: We generated three themes: (1) experiences of older people with digital health care in general practice, (2) impact of individual factors on digital health experiences, and (3) reasons for choosing a digitally oriented general practice. Participants reported both positive and negative experiences. The main perceived advantages of the digital health platform were increased accessibility, direct GP contact without an intermediary, and saving time through asynchronous communication. The disadvantages mentioned were log-in difficulties and problems with the automated explanatory questionnaire. Individual factors such as age, digital literacy, and expectations of general practice care seemed to impact people’s experiences and could act as barriers or facilitators for using digital health. Reasons for older patients to enlist at a general practice were mainly practical. The digital orientation of the practice hardly played a role in this choice. Conclusions: Older patients in general practice see benefits to using a digital health platform that offers 2-way chat-based communication between the patient and GP. We found that individual factors such as skills, norms and values, attitudes toward digitalization, and expectations of general practice care impacted older patients’ experiences with digital health care. For many older participants, the digital profile of the general practice did not play a role in their choice to enlist. Further improvement of digital health platforms will be necessary to ensure digital health for all in general practice. %R 10.2196/59168 %U https://aging.jmir.org/2024/1/e59168 %U https://doi.org/10.2196/59168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54604 %T Multicomponent Support Program for Secondary Prevention of Stroke Using Digital Health Technology: Co-Design Study With People Living With Stroke or Transient Ischemic Attack %A Silvera-Tawil,David %A Cameron,Jan %A Li,Jane %A Varnfield,Marlien %A Allan,Liam P %A Harris,Mitch %A Lannin,Natasha A %A Redd,Christian %A Cadilhac,Dominique A %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, 158-164 Hawkesbury Road, Westmead, Sydney, 2145, Australia, 61 2 9372 4282, david.silvera@csiro.au %K mobile app %K stroke %K transient ischemic attack %K health service delivery %K mobile health %K mHealth %K mobile phone %D 2024 %7 22.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Few individuals (<2%) who experience a stroke or transient ischemic attack (TIA) participate in secondary prevention lifestyle programs. Novel approaches that leverage digital health technology may provide a viable alternative to traditional interventions that support secondary prevention in people living with stroke or TIA. To be successful, these strategies should focus on user needs and preferences and be acceptable to clinicians and people living with stroke or TIA. Objective: This study aims to co-design, with people with lived experience of stroke or TIA (referred to as consumers) and clinicians, a multicomponent digital technology support program for secondary prevention of stroke. Methods: A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. An invitation to a user needs survey (135 items) for clinicians was circulated via web-based professional forums and national organizations (eg, the Stroke Telehealth Community of Practice Microsoft Teams Channel) and the authors’ research networks using Twitter (subsequently rebranded X, X Corp) and LinkedIn (LinkedIn Corp). Following the surveys, 2 rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program. Results: Overall, 112 consumers (male individuals: n=63, 56.3%) and 54 clinicians (female individuals: n=43, 80%) responded to the survey; all items were completed by 75.8% (n=85) of consumers and 78% (n=42) of clinicians. Most clinicians (46/49, 94%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (87/96, 90%) and clinicians (41/49, 84%) agreed that providing alerts about potential deterioration in an individual’s condition were important functions for a digital program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 79/99, 80%; clinicians 36/42, 86%). In addition, 7 consumers (male individuals: n=5, 71%) and 9 clinicians (female individuals: n=6, 67%) took part in the user experience workshops. Participants endorsed using a digital health program to help consumers manage stroke or TIA and discussed preferred functions and health measures in a digital solution for secondary prevention of stroke. They also noted the need for a mobile app that is easy to use. Clinician feedback highlighted the need for a customizable clinician portal that captures individual consumer goals. Conclusions: Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing app that integrates wearable activity trackers and a clinician web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and use. %M 39172512 %R 10.2196/54604 %U https://www.jmir.org/2024/1/e54604 %U https://doi.org/10.2196/54604 %U http://www.ncbi.nlm.nih.gov/pubmed/39172512 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56319 %T Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach %A Franco,Pamela %A Olhaberry,Marcia %A Muzard,Antonia %A Harismendy,Ángeles %A Kelders,Saskia %+ Centre for eHealth & Well-being Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 0 534899180, s.m.kelders@utwente.nl %K internet-based intervention %K postpartum depression %K user-centered development %K perinatal mental health %K user-centered design %K mobile phone %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. Objective: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. Methods: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. Results: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders’ openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype’s final version. The resulting intervention, named Mamá, te entiendo (“Mom, I get you”), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. Conclusions: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions. %M 39159447 %R 10.2196/56319 %U https://formative.jmir.org/2024/1/e56319 %U https://doi.org/10.2196/56319 %U http://www.ncbi.nlm.nih.gov/pubmed/39159447 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56505 %T Co-Designing a Smoking Cessation Chatbot: Focus Group Study of End Users and Smoking Cessation Professionals %A Bendotti,Hollie %A Lawler,Sheleigh %A Ireland,David %A Gartner,Coral %A Marshall,Henry M %+ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, L5 Clinical Sciences Building, The Prince Charles Hospital, 627 Rode Road, Brisbane, 4032, Australia, 61 7 3139 4110, h.bendotti@uq.edu.au %K artificial intelligence %K chatbot %K smoking cessation %K behavior change %K smoking %K mobile health %K apps %K digital interventions %K smartphone %K mobile phone %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Our prototype smoking cessation chatbot, Quin, provides evidence-based, personalized support delivered via a smartphone app to help people quit smoking. We developed Quin using a multiphase program of co-design research, part of which included focus group evaluation of Quin among stakeholders prior to clinical testing. Objective: This study aimed to gather and compare feedback on the user experience of the Quin prototype from end users and smoking cessation professionals (SCPs) via a beta testing process to inform ongoing chatbot iterations and refinements. Methods: Following active and passive recruitment, we conducted web-based focus groups with SCPs and end users from Queensland, Australia. Participants tested the app for 1-2 weeks prior to focus group discussion and could also log conversation feedback within the app. Focus groups of SCPs were completed first to review the breadth and accuracy of information, and feedback was prioritized and implemented as major updates using Agile processes prior to end user focus groups. We categorized logged in-app feedback using content analysis and thematically analyzed focus group transcripts. Results: In total, 6 focus groups were completed between August 2022 and June 2023; 3 for SCPs (n=9 participants) and 3 for end users (n=7 participants). Four SCPs had previously smoked, and most end users currently smoked cigarettes (n=5), and 2 had quit smoking. The mean duration of focus groups was 58 (SD 10.9; range 46-74) minutes. We identified four major themes from focus group feedback: (1) conversation design, (2) functionality, (3) relationality and anthropomorphism, and (4) role as a smoking cessation support tool. In response to SCPs’ feedback, we made two major updates to Quin between cohorts: (1) improvements to conversation flow and (2) addition of the “Moments of Crisis” conversation tree. Participant feedback also informed 17 recommendations for future smoking cessation chatbot developments. Conclusions: Feedback from end users and SCPs highlighted the importance of chatbot functionality, as this underpinned Quin’s conversation design and relationality. The ready accessibility of accurate cessation information and impartial support that Quin provided was recognized as a key benefit for end users, the latter of which contributed to a feeling of accountability to the chatbot. Findings will inform the ongoing development of a mature prototype for clinical testing. %M 39159451 %R 10.2196/56505 %U https://humanfactors.jmir.org/2024/1/e56505 %U https://doi.org/10.2196/56505 %U http://www.ncbi.nlm.nih.gov/pubmed/39159451 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56605 %T A Handheld Tool for the Rapid Morphological Identification of Mosquito Species (VectorCam) for Community-Based Malaria Vector Surveillance: Summative Usability Study %A Dasari,Saisamhitha %A Gopinath,Bhavya %A Gaulke,Carter James %A Patel,Sunny Mahendra %A Merali,Khalil K %A Sunil Kumar,Aravind %A Acharya,Soumyadipta %+ Johns Hopkins University Center for Bioengineering Innovation and Design, 3400 Charles Street, Baltimore, MD, 21218, United States, 1 17707785272, dasari.sam21@gmail.com %K malaria %K vector surveillance %K usability study testing %K usability study %K usability studies %K usability %K usable %K usableness %K usefulness %K utility %K convolution neural networks %K artificial intelligence %K AI %K human factors design %K human factors %K mHealth %K mobile health %K app %K apps %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K mobile phone %D 2024 %7 16.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Malaria impacts nearly 250 million individuals annually. Specifically, Uganda has one of the highest burdens, with 13 million cases and nearly 20,000 deaths. Controlling the spread of malaria relies on vector surveillance, a system where collected mosquitos are analyzed for vector species’ density in rural areas to plan interventions accordingly. However, this relies on trained entomologists known as vector control officers (VCOs) who identify species via microscopy. The global shortage of entomologists and this time-intensive process cause significant reporting delays. VectorCam is a low-cost artificial intelligence–based tool that identifies a mosquito’s species, sex, and abdomen status with a picture and sends these results electronically from surveillance sites to decision makers, thereby deskilling the process to village health teams (VHTs). Objective: This study evaluates the usability of the VectorCam system among VHTs by assessing its efficiency, effectiveness, and satisfaction. Methods: The VectorCam system has imaging hardware and a phone app designed to identify mosquito species. Two users are needed: (1) an imager to capture images of mosquitos using the app and (2) a loader to load and unload mosquitos from the hardware. Critical success tasks for both roles were identified, which VCOs used to train and certify VHTs. In the first testing phase (phase 1), a VCO and a VHT were paired to assume the role of an imager or a loader. Afterward, they swapped. In phase 2, two VHTs were paired, mimicking real use. The time taken to image each mosquito, critical errors, and System Usability Scale (SUS) scores were recorded for each participant. Results: Overall, 14 male and 6 female VHT members aged 20 to 70 years were recruited, of which 12 (60%) participants had smartphone use experience. The average throughput values for phases 1 and 2 for the imager were 70 (SD 30.3) seconds and 56.1 (SD 22.9) seconds per mosquito, respectively, indicating a decrease in the length of time for imaging a tray of mosquitos. The loader’s average throughput values for phases 1 and 2 were 50.0 and 55.7 seconds per mosquito, respectively, indicating a slight increase in time. In terms of effectiveness, the imager had 8% (6/80) critical errors and the loader had 13% (10/80) critical errors in phase 1. In phase 2, the imager (for VHT pairs) had 14% (11/80) critical errors and the loader (for VHT pairs) had 12% (19/160) critical errors. The average SUS score of the system was 70.25, indicating positive usability. A Kruskal-Wallis analysis demonstrated no significant difference in SUS (H value) scores between genders or users with and without smartphone use experience. Conclusions: VectorCam is a usable system for deskilling the in-field identification of mosquito specimens in rural Uganda. Upcoming design updates will address the concerns of users and observers. %M 39150762 %R 10.2196/56605 %U https://humanfactors.jmir.org/2024/1/e56605 %U https://doi.org/10.2196/56605 %U http://www.ncbi.nlm.nih.gov/pubmed/39150762 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e50978 %T Acceptance of a French e–Mental Health Information Website (CléPsy) for Families: A Web-Based Survey %A Landman,Benjamin %A Khoury,Elie %A Cohen,Alicia %A Trebossen,Vincent %A Michel,Alexandre %A Lefebvre,Aline %A Delorme,Richard %K mental health education %K children %K family %K child %K pediatrics %K pediatric %K mental health %K parent %K parents %K parenting %K psychiatry %K website %K acceptance %K patient education %K online information %K health information %K ease of use %K usefulness %K survey %K surveys %K user %K experience %K questionnaire %K questionnaires %K families %D 2024 %7 15.8.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children’s difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, CléPsy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3%) or with their relatives (n=260, 82.1%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. %R 10.2196/50978 %U https://pediatrics.jmir.org/2024/1/e50978 %U https://doi.org/10.2196/50978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56043 %T Leveraging Feedback From Families of Children With Autism to Create Digital Support for Service Navigation: Descriptive Study %A Burke,Meghan %A Li,Chak %A Cheung,Waifong Catherine %A Terol,Adriana Kaori %A Johnston,Amanda %A Schueller,Stephen M %+ Department of Special Education, Vanderbilt University, 110 Magnolia Circle, Nashville, TN, 37203, United States, 1 6155851420, meghan.burke@vanderbilt.edu %K human-centered design %K autism %K service access %K families %K digital support %K autistic children %K autistic %K children %K child %K app %K apps %K application %K applications %K digital tool %K tool %K tools %D 2024 %7 14.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: It is difficult for families to navigate and access services for their children with autism. Barriers to service access are compounded among families from low-resourced backgrounds. Objective: The purpose of our study was to explore the development of an app to facilitate access to services among families of children with autism from low-resourced backgrounds. Our specific aims were to explore feedback from an advisory board about the app and to explore feedback from navigators about the app. Methods: Via a multistage codevelopment process, we elicited feedback from 5 key parties: the research team, a community organization, the app development team, the advisory board, and family navigators. Collectively, 36 individuals provided feedback about the development of the app via individual interviews, focus groups, observations, and surveys. The key features of the app included a dashboard showing the service needs of the family and related resources, a messaging feature between the family, the navigator, and the supervisor, and a fidelity checklist and evaluation feature. Results: The advisory board provided feedback about the app to increase its user-friendliness, include the ability to develop an action plan, improve the identification of needed services, and add information about service providers. Navigators suggested that the app should connect navigators to one another, have a clearer purpose for the notes section, and reflect an easier log-in process. Navigators also wanted training to role-play using the app. After participating in a role play using the app, navigators reported significantly more satisfaction with the app and greater usefulness (P<.001). Conclusions: Our work sheds light on the importance of eliciting feedback from end users, especially users who are often overlooked by the research community and app developers. Further, it is important to elicit feedback in multiple ways to improve the app. %M 39141412 %R 10.2196/56043 %U https://formative.jmir.org/2024/1/e56043 %U https://doi.org/10.2196/56043 %U http://www.ncbi.nlm.nih.gov/pubmed/39141412 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e39554 %T Exploring the Impact of a Sleep App on Sleep Quality in a General Population Sample: Pilot Randomized Controlled Trial %A Armitage,Bianca Tanya %A Potts,Henry W W %A Irwin,Michael R %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 020 7679 1722, abigail.fisher@ucl.ac.uk %K sleep %K mobile app %K app optimization %K intervention %K smartphone %K general population %K mindfulness %K cognitive behavioral therapy %K CBT %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A third of adults in Western countries have impaired sleep quality. A possible solution involves distributing sleep aids through smartphone apps, but most empirical studies are limited to small pilot trials in distinct populations (eg, soldiers) or individuals with clinical sleep disorders; therefore, general population data are required. Furthermore, recent research shows that sleep app users desire a personalized approach, offering an individually tailored choice of techniques. One such aid is Peak Sleep, a smartphone app based on scientifically validated principles for improving sleep quality, such as mindfulness meditation and cognitive behavioral therapy. Objective: We aimed to test the impact of the smartphone app Peak Sleep on sleep quality and collect user experience data to allow for future app development. Methods: This was a 2-arm pilot randomized controlled trial. Participants were general population adults in the United Kingdom (aged ≥18 years) who were interested in improving their sleep quality and were not undergoing clinical treatment for sleep disorder or using sleep medication ≥1 per week. Participants were individually randomized to receive the intervention (3 months of app use) versus a no-treatment control. The intervention involved free access to Peak Sleep, an app that offered a choice of behavioral techniques to support better sleep (mindfulness, cognitive behavioral therapy, and acceptance commitment therapy). The primary outcome was sleep quality assessed using the Insomnia Severity Index at baseline and 1-, 2-, and 3-month follow-ups. Assessments were remote using web-based questionnaires. Objective sleep data collection using the Oura Ring (Ōura Health Oy) was planned; however, because the COVID-19 pandemic lockdowns began just after recruitment started, this plan could not be realized. Participant engagement with the app was assessed using the Digital Behavior Change Intervention Engagement Scale and qualitative telephone interviews with a subsample. Results: A total of 101 participants were enrolled in the trial, and 21 (21%) were qualitatively interviewed. Sleep quality improved in both groups over time, with Insomnia Severity Index scores of the intervention group improving by a mean of 2.5 and the control group by a mean of 1.6 (between-group mean difference 0.9, 95% CI –2.0 to 3.8), with was no significant effect of group (P=.91). App users’ engagement was mixed, with qualitative interviews supporting the view of a polarized sample who either strongly liked or disliked the app. Conclusions: In this trial, self-reported sleep improved over time in both intervention and control arms, with no impact by group, suggesting no effect of the sleep app. Qualitative data suggested polarized views on liking or not liking the app, features that people engaged with, and areas for improvement. Future work could involve developing the app features and then testing the app using objective measures of sleep in a larger sample. Trial Registration: ClinicalTrials.gov NCT04487483; https://www.clinicaltrials.gov/study/NCT04487483 %M 39137016 %R 10.2196/39554 %U https://formative.jmir.org/2024/1/e39554 %U https://doi.org/10.2196/39554 %U http://www.ncbi.nlm.nih.gov/pubmed/39137016 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52363 %T Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys %A Pusnik,Adrijana %A Hartzler,Bryan %A Vjorn,Olivia %A Rutkowski,Beth A %A Chaple,Michael %A Becker,Sara %A Freese,Thomas %A Nichols,Maureen %A Molfenter,Todd %K telehealth %K COVID-19 %K substance use disorders %K telephone counseling %K video counseling %D 2024 %7 12.8.2024 %9 %J JMIR Ment Health %G English %X Background: The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was “Will telehealth ever take hold for SUD services?” Now that social distancing guidelines have been lifted, the question is “Will telehealth remain a commonly used care modality?” Objective: The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners’ perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. Methods: An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25‐35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. Results: A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] −0.23; P=.002), but not for video-based telehealth (MD −0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD−0.35; P<.001), but no difference was found for phone-based telehealth (MD −0.12; P=.11). From the staff’s perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Conclusions: Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations. %R 10.2196/52363 %U https://mental.jmir.org/2024/1/e52363 %U https://doi.org/10.2196/52363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56000 %T Identifying Barriers to the Adoption of Digital Contact Tracing Apps in England: Semistructured Interview Study With Professionals Involved in the Pandemic Response %A Palmer,Anna %A Sharma,Shaishab %A Nagpal,Jayesh %A Kimani,Victor %A Mai,Florence %A Ahmed,Zara %+ Imperial College School of Medicine, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, United Kingdom, 44 7887691537, anna.palmer16@imperial.ac.uk %K COVID-19 %K global health %K public health %K qualitative study %K tracing %K England %K apps %K effectiveness %K contact tracing %K barrier %K digital health %K thematic analysis %K privacy %K communication %K social support %K tracing app %K digital illiteracy %K technology %K support %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The NHS (National Health Service) COVID-19 app was a digital contact tracing app (DCTA) used in England in response to the COVID-19 pandemic. The aim of which was to limit the spread of COVID-19 by providing exposure alerts. At the time of the pandemic, questions were raised regarding the effectiveness and cost of the NHS COVID-19 app and whether DCTAs have a role in future pandemics. Objective: This study aims to explore key barriers to DCTAs in England during the COVID-19 pandemic. Methods: This is a qualitative study using semistructured video interviews conducted with professionals in public health, digital health, clinicians, health care law, and health executives who had an active role in the COVID-19 pandemic. These interviews aimed to explore the perspective of different experts involved in the pandemic response and gauge their opinions on the key barriers to DCTAs in England during the COVID-19 pandemic. The initial use of maximum variation sampling combined with a snowball sampling approach ensured diversity within the cohort of interviewees. Interview transcripts were then analyzed using Braun and Clarke's 6 steps for thematic analysis. Results: Key themes that acted as barriers to DCTAs were revealed by interviewees such as privacy concerns, poor communication, technological accessibility, digital literacy, and incorrect use of the NHS COVID-19 app. Interviewees believed that some of these issues stemmed from poor governmental communication and a lack of transparency regarding how the NHS COVID-19 app worked, resulting in decreased public trust. Moreover, interviewees highlighted that a lack of social support integration within the NHS COVID-19 app and delayed app notification period also contributed to the poor adoption rates. Conclusions: Qualitative findings from interviews highlighted barriers to the NHS COVID-19 app, which can be applied to DCTAs more widely and highlight some important implications for the future use of DCTAS. There was no consensus among interviewees as to whether the NHS COVID-19 app was a success; however, all interviewees provided recommendations for improvements in creating and implementing DCTAs in the future. %M 39133910 %R 10.2196/56000 %U https://formative.jmir.org/2024/1/e56000 %U https://doi.org/10.2196/56000 %U http://www.ncbi.nlm.nih.gov/pubmed/39133910 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e52676 %T Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists %A Reicherzer,Leah %A Scheermesser,Mandy %A Kläy,Adrian %A Duarte,Jaime E %A Graf,Eveline S %K assistive device %K barriers %K facilitators %K mobility %K older adults %K wearable robots %D 2024 %7 9.8.2024 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Light wearable robots have the potential to assist older adults with mobility impairments in daily life by compensating for age-related decline in lower extremity strength. Physiotherapists may be the first point of contact for older adults with these devices. Objective: The aims of this study were to explore views of older adults and physiotherapists on wearable robots as assistive devices for daily living and to identify the barriers and facilitators to their use. Methods: Six older adults (aged 72‐88 years) tested a wearable robot (Myosuit) and participated in semistructured interviews. A focus group with 6 physiotherapists who had a minimum of 5 years of professional experience and specialized in geriatrics was conducted. Data were analyzed using thematic qualitative text analysis. Results: Older adults perceived benefits and had positive use experiences, yet many saw no need to use the technology for themselves. Main barriers and facilitators to its use were the perception of usefulness, attitudes toward technology, ease of use, and environmental factors such as the support received. Physiotherapists named costs, reimbursement schemes, and complexity of the technology as limiting factors. Conclusions: A light wearable robot—the Myosuit—was found to be acceptable to study participants as an assistive device. Although characteristics of the technology are important, the use and acceptance by older adults heavily depend on perceived usefulness and need. %R 10.2196/52676 %U https://rehab.jmir.org/2024/1/e52676 %U https://doi.org/10.2196/52676 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e54762 %T Development, Feasibility, and Acceptability of the Electronic Patient Benefit Index for Psoriasis in Clinical Practice: Mixed Methods Study %A Otten,Marina %A Djamei,Vahid %A Augustin,Matthias %+ German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20246, Germany, 49 40741059369, m.otten@uke.de %K patient-reported outcomes %K Patient Benefit Index %K dermatology %K psoriasis %K feasibility %K acceptability %K eHealth %K digital health %K dermatologist %K dermatologists %K skin %K mobile health %K app %K apps %K application %K applications %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K mobile phone %D 2024 %7 9.8.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Patient-reported outcomes are relevant in clinical practice showing patient benefits, supporting clinicians’ decision-making, and contributing to the delivery of high standards of care. Digital monitoring of patient-reported outcomes is still rare. The Patient Benefit Index (PBI) measures benefits and goals from patients’ views and may be relevant for regular documentation and shared decision-making. Objective: This study aimed to develop electronic versions of the PBI to examine their feasibility and acceptability in clinical practice for patients with psoriasis. Methods: We developed an app and a web version of the existing, valid PBI using focus groups and cognitive debriefings with patients before conducting a quantitative survey on its feasibility and acceptability. Conduction took part in an outpatient dermatology care unit in Germany. Descriptive and subgroup analyses were conducted. Results: A total of 139 patients completed the electronic PBIs (ePBIs) and took part in the survey. The ePBI was understandable (n=129-137, 92.8%-98.6%) and feasible, for example, easy to read (n=135, 97.1%) and simple to handle (n=137, 98.5%). Acceptability was also high, for example, patients can imagine using and discussing the ePBI data in practice (n=91, 65.5%) and documenting it regularly (n=88, 63.3%). They believe it could support treatment decisions (n=118, 84.9%) and improve communication with their physician (n=112, 81.3%). They can imagine filling in electronic questionnaires regularly (n=118, 84.9%), even preferring electronic over paper versions (n=113, 81.2%). Older and less educated people show less feasibility, but the latter expected the relationship with their physician to improve and would be more willing to invest time or effort. Conclusions: The app and web version of the PBI are usable and acceptable for patients offering comprehensive documentation and patient participation in practice. An implementation strategy should consider patients’ needs, barriers, and facilitators but also physicians’ attitudes and requirements from the health care system. %M 39121470 %R 10.2196/54762 %U https://derma.jmir.org/2024/1/e54762 %U https://doi.org/10.2196/54762 %U http://www.ncbi.nlm.nih.gov/pubmed/39121470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53508 %T Exploring User Experiences of the Mom2B mHealth Research App During the Perinatal Period: Qualitative Study %A Bilal,Ayesha-Mae %A Pagoni,Konstantina %A Iliadis,Stavros I %A Papadopoulos,Fotios C %A Skalkidou,Alkistis %A Öster,Caisa %+ Department of Medical Sciences, Psychiatry, Uppsala University, Academic Hospital, Entrance 10, Floor 4, Uppsala, 751 85, Sweden, 46 737240915, ayesha.bilal@uu.se %K digital phenotyping %K smartphone app %K mHealth %K mobile health %K qualitative study %K user experience %K usability %K perinatal depression %K depression %K app %K user %K users %K qualitative %K perinatal %K mobile app %K clinical research %K acceptability %K behavioral data %K depressive symptoms %K interview %K pregnant %K postpartum %K women %K thematic analysis %K well-being %K monitor %K mobile phone %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area. %M 39115893 %R 10.2196/53508 %U https://formative.jmir.org/2024/1/e53508 %U https://doi.org/10.2196/53508 %U http://www.ncbi.nlm.nih.gov/pubmed/39115893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57258 %T Longitudinal Coadaptation of Older Adults With Wearables and Voice-Activated Virtual Assistants: Scoping Review %A Kokorelias,Kristina Marie %A Grigorovich,Alisa %A Harris,Maurita T %A Rehman,Umair %A Ritchie,Louise %A Levy,AnneMarie M %A Denecke,Kerstin %A McMurray,Josephine %+ Lazaridis School of Business and Economics/Community Health, Wilfrid Laurier University, 73 George St, Brantford, ON, N3T3Y3, Canada, 1 548 889 4492, jmcmurray@wlu.ca %K older adults %K coadaptation %K voice recognition %K virtual assistant %K wearable %K artificial intelligence %K smart-assistive technology %K scoping review %K review methods %K review methodology %K knowledge synthesis %K synthesis %K scoping %K older adult %K gerontechnology %K technology %K smart technology %K smart technologies %K smart %K geriatrics %K older people %K geriatric %K scoping literature review %K protocol %K Internet of Things %K IoT %K aging %K PRISMA-ScR %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews %K user-centered design %K design %K user centered %K mobile phone %D 2024 %7 7.8.2024 %9 Review %J J Med Internet Res %G English %X Background: The integration of smart technologies, including wearables and voice-activated devices, is increasingly recognized for enhancing the independence and well-being of older adults. However, the long-term dynamics of their use and the coadaptation process with older adults remain poorly understood. This scoping review explores how interactions between older adults and smart technologies evolve over time to improve both user experience and technology utility. Objective: This review synthesizes existing research on the coadaptation between older adults and smart technologies, focusing on longitudinal changes in use patterns, the effectiveness of technological adaptations, and the implications for future technology development and deployment to improve user experiences. Methods: Following the Joanna Briggs Institute Reviewer’s Manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, this scoping review examined peer-reviewed papers from databases including Ovid MEDLINE, Ovid Embase, PEDro, Ovid PsycINFO, and EBSCO CINAHL from the year 2000 to August 28, 2023, and included forward and backward searches. The search was updated on March 1, 2024. Empirical studies were included if they involved (1) individuals aged 55 years or older living independently and (2) focused on interactions and adaptations between older adults and wearables and voice-activated virtual assistants in interventions for a minimum period of 8 weeks. Data extraction was informed by the selection and optimization with compensation framework and the sex- and gender-based analysis plus theoretical framework and used a directed content analysis approach. Results: The search yielded 16,143 papers. Following title and abstract screening and a full-text review, 5 papers met the inclusion criteria. Study populations were mostly female participants and aged 73-83 years from the United States and engaged with voice-activated virtual assistants accessed through smart speakers and wearables. Users frequently used simple commands related to music and weather, integrating devices into daily routines. However, communication barriers often led to frustration due to devices’ inability to recognize cues or provide personalized responses. The findings suggest that while older adults can integrate smart technologies into their lives, a lack of customization and user-friendly interfaces hinder long-term adoption and satisfaction. The studies highlight the need for technology to be further developed so they can better meet this demographic’s evolving needs and call for research addressing small sample sizes and limited diversity. Conclusions: Our findings highlight a critical need for continued research into the dynamic and reciprocal relationship between smart technologies and older adults over time. Future studies should focus on more diverse populations and extend monitoring periods to provide deeper insights into the coadaptation process. Insights gained from this review are vital for informing the development of more intuitive, user-centric smart technology solutions to better support the aging population in maintaining independence and enhancing their quality of life. International Registered Report Identifier (IRRID): RR2-10.2196/51129 %M 39110963 %R 10.2196/57258 %U https://www.jmir.org/2024/1/e57258 %U https://doi.org/10.2196/57258 %U http://www.ncbi.nlm.nih.gov/pubmed/39110963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56528 %T Exploring How Patients Are Supported to Use Online Services in Primary Care in England Through “Digital Facilitation”: Survey Study %A Winder,Rachel %A Campbell,John L %A Akter,Nurunnahar %A Aminu,Abodunrin Q %A Lambert,Jeffrey %A Cockcroft,Emma %A Thomas,Chloe %A Clark,Christopher E %A Bryce,Carol %A Sussex,Jon %A Atherton,Helen %A Marriott,Christine %A Abel,Gary %+ University of Exeter Medical School, University of Exeter, Smeall Building, St Luke's Campus, Exeter, EX1 2LU, United Kingdom, 44 44 1392 722821, john.campbell@exeter.ac.uk %K primary care %K online services %K access to online health care services %K general practice %K survey %K digital support %K inequalities %K remote consultation %K health services research %K digital technology %D 2024 %7 7.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health service policy in many jurisdictions is driving greater investment into digital primary care services. While some patients and practices may benefit, there are concerns that not all are able or wish to access primary care services online. “Digital facilitation” is the “range of processes, procedures, and personnel seeking to support patients in their uptake and use of online services” and may address such concerns. Objective: As part of a multimethod research program, we undertook surveys of practice staff and patients to gain insight into the support being offered by practices and explore patients’ experiences of this support. Methods: General practices from 4 regions of England were sent a questionnaire exploring the modes of digital facilitation offered, the personnel involved in its delivery, and views on the motivations and drivers for providing support. Moreover, 12,822 patients registered with 62 general practices (predominantly those providing practice survey responses) were sent a questionnaire exploring their experiences of any support offered by their practice to use online services. Results: Almost one-third of practices (156/500, 31.2%) responded to the practice survey, with most reporting using passive modes of digital facilitation (eg, display, leaflets, and SMS text messages) and few using active modes (eg, offering tablets or computers or using practice champions). However, 90.9% (130/143) reported providing ad hoc support. Practices agreed that it was the responsibility of both the practice (105/144, 72.9%) and the wider National Health Service (118/143, 82.5%) to support patients in using online services and that providing such support benefited the practice (126/144, 87.5%) and their patients (132/144, 91.7%). Nearly a quarter of the patients (3051/12,822, 23.8%) responded to the patient survey, with few (522/3051, 17.11% or less) reporting awareness of any modes of digital facilitation apart from text messages and emails (1205/3051, 39.5%) and only 13.36% (392/2935) reporting receiving support to use online services. Adjusted logistic regression analyses showed that older patients had a lower likelihood of 4 outcomes: being aware of, or of using, digital facilitation efforts, or being told about or being helped to use online services (all P<.05), particularly with regard to being helped to use online services (adjusted odds ratio for patients aged 85 years versus those aged 55-64 years: 0.08, 95% CI 0.02-0.36). However, ethnic minority participants or those for whom their first language was not English had positive associations with these outcomes. Conclusions: General practices recognize that patients would benefit from support to access online services. However, the support provided is often passive or ad hoc, and patients were seldom aware of digital facilitation efforts that their practice provided. There is potential to increase engagement with online primary care services by providing more support for all patients, particularly to provide targeted support for older patients. %R 10.2196/56528 %U https://www.jmir.org/2024/1/e56528 %U https://doi.org/10.2196/56528 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e47072 %T Perceptions Toward Telemedicine of Health Care Staff in Nursing Homes in Northern Germany: Cross-Sectional Study %A Traulsen,Pia %A Kitschke,Lisa %A Steinhäuser,Jost %K eHealth %K telemedicine %K nursing home %K pandemic %K Germany %D 2024 %7 7.8.2024 %9 %J JMIR Aging %G English %X Background: Digitalization in the German health care system is progressing slowly, even though it offers opportunities for improvement of care. In nursing homes, most of the staff’s work is paper based. Following the pandemic, there has been a decrease in the use of telemedicine applications. To ensure long-term implementation, the views of users, in this case nurses, are of interest. Objective: This cross-sectional study was conducted to describe which digital applications are already being used at inpatient care facilities, the attitude of nurses toward telemedicine, and for which areas the use of telemedicine in the facilities is considered appropriate by the participants. Methods: All inpatient care facility staff in Schleswig-Holstein were invited to participate in the survey from August 1 to October 31, 2022. The questionnaire consists of 17 determinants that ask about the attitude, use, and possible applications of telemedicine. In addition to a descriptive analysis, the influence of the general attitude toward telemedicine on various determinants was examined using the Fisher exact test for nominal variables and Spearman correlation coefficient for metric variables. Results: A total of 425 caregivers participated in the survey. Of these respondents, 10.7% (n=41) currently used video consultations, and 76.1% (n=321) of the respondents were in favor of video consultations being practiced in training. Furthermore, 74.8% (n=312) of the respondents would attend a training on telephone medical consultation. Respondents indicated that video consultations have a small added value compared to asynchronous telemedicine (eg, sending photos). However, video consultations were perceived as somewhat less time-consuming than other communication channels. Video consultations are perceived as most useful for clarifying urgent problems. The respondents estimated that one in five paramedic calls at their facilities could be reduced through telemedicine approaches. It was important to the participants that telemedicine is as simple as possible and that there is a high level of data security. Conclusions: Although many caregivers have a positive attitude toward telemedicine and perceive its advantages, communication channels such as video consultation are still used infrequently in care facilities. To promote the use of telemedicine applications, it is important to emphasize their benefits. The presumed saving of paramedic calls thus represents a benefit, and it is crucial to train caregivers in the use of telemedicine to avoid uncertainties in dealing with the newer technologies. It is important to give them enough time and repetitions of the training. %R 10.2196/47072 %U https://aging.jmir.org/2024/1/e47072 %U https://doi.org/10.2196/47072 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56722 %T Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study %A Kapp,Julie M %A Dicke,Rachel %A Quinn,Kathleen %K adverse childhood experiences %K ACE %K training %K trauma-informed care %K provider %K rural %K adverse %K trauma %K traumatic %K provider %K providers %K teaching %K curriculum %K curricula %K education %K educational %K social work %K social worker %K social workers %K psychologist %K psychologists %K counselor %K counselors %K interprofessional %K pediatric %K pediatrics %K paediatric %K paediatrics %K child %K children %K experience %K experiences %K continuing education %D 2024 %7 7.8.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. Objective: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. Methods: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Results: Overall, 135 providers across Missouri requested enrollment, with 72.6% (n=98) enrolling and accessing the training. Of the latter, 49% (n=48) completed course requirements, with 100% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. Conclusions: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic’s importance and intention to translate knowledge into practice. %R 10.2196/56722 %U https://pediatrics.jmir.org/2024/1/e56722 %U https://doi.org/10.2196/56722 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53811 %T Perceived Benefit and Satisfaction With a Tablet Computer and an Emergency Smartwatch by Older Adults and Their Relatives: Prospective Real-World Pilot Study %A Wiegel,Patrick %A Fotteler,Marina Liselotte %A Kohn,Brigitte %A Mayer,Sarah %A Verri,Filippo Maria %A Dallmeier,Dhayana %A Denkinger,Michael %K assistive technology %K older adults %K caregiver %K benefits %K usability %K gerontechnology %D 2024 %7 2.8.2024 %9 %J JMIR Hum Factors %G English %X Background: Assistive technologies (ATs) have the potential to promote the quality of life and independent living of older adults and, further, to relieve the burden of formal and informal caregivers and relatives. Technological developments over the last decades have led to a boost of available ATs. However, evidence on the benefits and satisfaction with ATs in real-world applications remains scarce. Objective: This prospective, real-world, pilot study tested the perceived benefit and satisfaction with different ATs in the real-world environment. Methods: Community-dwelling adults aged ≥65 and their relatives tested a tablet computer with a simplified interface or a smartwatch with programmable emergency contacts for 8 weeks in their everyday life. Perceived benefits and satisfaction with ATs were assessed by all older adults and their relatives using different assessment tools before and after the intervention. Outcome measures included the Technology Usage Inventory, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0, and Canadian Occupational Performance Measure. Results: A total of 17 older adults (tablet computer: n=8, 47% and smartwatch: n=9, 53%) and 16 relatives (tablet computer: n=7, 44% and smartwatch: n=9, 56%) were included in the study. The number of participants that were frail (according to the Clinical Frailty Scale) and received care was higher in the smartwatch group than in the tablet computer group. Older adults of the smartwatch group reported higher technology acceptance (Technology Usage Inventory) and satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0) scores than those of the tablet computer group, although the differences were not significant (all P>.05). In the tablet computer group, relatives had significantly higher ratings on the item intention to use than older adults (t12.3=3.3, P=.006). Identified everyday issues with the Canadian Occupational Performance Measure included contact/communication and entertainment/information for the tablet computer, safety and getting help in emergency situations for the smartwatch, and the usability of the AT for both devices. While the performance (t8=3.5, P=.008) and satisfaction (t8=3.2, P=.01) in these domains significantly improved in the smartwatch group, changes in the tablet computer group were inconsistent (all P>.05). Conclusions: This study highlights the remaining obstacles for the widespread and effective application of ATs in the everyday life of older adults and their relatives. While the results do not provide evidence for a positive effect regarding communication deficits, perceived benefits could be shown for the area of safety. Future research and technical developments need to consider not only the preferences, problems, and goals of older adults but also their relatives and caregivers to improve the acceptability and effectiveness of ATs. %R 10.2196/53811 %U https://humanfactors.jmir.org/2024/1/e53811 %U https://doi.org/10.2196/53811 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56924 %T The Impact of Information Relevancy and Interactivity on Intensivists’ Trust in a Machine Learning–Based Bacteremia Prediction System: Simulation Study %A Katzburg,Omer %A Roimi,Michael %A Frenkel,Amit %A Ilan,Roy %A Bitan,Yuval %K user-interface design %K user-interface designs %K user interface %K human-automation interaction %K human-automation interactions %K trust in automation %K automation %K human-computer interaction %K human-computer interactions %K human-ML %K human-ML interaction %K human-ML interactions %K decision making %K decision support system %K clinical decision support %K decision support %K decision support systems %K machine learning %K ML %K artificial intelligence %K AI %K machine learning algorithm %K machine learning algorithms %K digitization %K digitization of information %D 2024 %7 1.8.2024 %9 %J JMIR Hum Factors %G English %X Background: The exponential growth in computing power and the increasing digitization of information have substantially advanced the machine learning (ML) research field. However, ML algorithms are often considered “black boxes,” and this fosters distrust. In medical domains, in which mistakes can result in fatal outcomes, practitioners may be especially reluctant to trust ML algorithms. Objective: The aim of this study is to explore the effect of user-interface design features on intensivists’ trust in an ML-based clinical decision support system. Methods: A total of 47 physicians from critical care specialties were presented with 3 patient cases of bacteremia in the setting of an ML-based simulation system. Three conditions of the simulation were tested according to combinations of information relevancy and interactivity. Participants’ trust in the system was assessed by their agreement with the system’s prediction and a postexperiment questionnaire. Linear regression models were applied to measure the effects. Results: Participants’ agreement with the system’s prediction did not differ according to the experimental conditions. However, in the postexperiment questionnaire, higher information relevancy ratings and interactivity ratings were associated with higher perceived trust in the system (P<.001 for both). The explicit visual presentation of the features of the ML algorithm on the user interface resulted in lower trust among the participants (P=.05). Conclusions: Information relevancy and interactivity features should be considered in the design of the user interface of ML-based clinical decision support systems to enhance intensivists’ trust. This study sheds light on the connection between information relevancy, interactivity, and trust in human-ML interaction, specifically in the intensive care unit environment. %R 10.2196/56924 %U https://humanfactors.jmir.org/2024/1/e56924 %U https://doi.org/10.2196/56924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57586 %T Training Service Users in the Use of Telehealth: Scoping Review %A Galvin,Emer %A Desselle,Shane %A Gavin,Blánaid %A McNicholas,Fiona %A Cullinan,Shane %A Hayden,John %+ School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 111 St Stephen's Green, Dublin, D02 YN77, Ireland, 353 1 402 2100, emergalvin20@rcsi.ie %K telehealth %K video consultations %K training %K education %K older adults %K digital divide %K digital literacy %K review %K scoping review %K modality of care %K training service %K user %K users %K older adult %K gerontology %K geriatric %K geriatrics %K caregiver %K caregivers %K consultation %K consultations %K health care professional %K health care professionals %K PRISMA-ScR %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews %K data extraction %K phone %K phones %K telemonitoring %D 2024 %7 31.7.2024 %9 Review %J J Med Internet Res %G English %X Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities have not been explored. Objective: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. Methods: Five databases (MEDLINE [via PubMed], Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on health care professional education were excluded. Papers were limited to those published in the English language. The review followed the Joanna Briggs Institute guidelines for scoping reviews and was reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Titles and abstracts were screened by 1 reviewer (EG). Full texts were screened by 2 reviewers (EG and JH or SC). Data extraction was guided by the research question. Results: The search identified 8087 unique publications. In total, 13 studies met the inclusion criteria. Telehealth training was commonly described as once-off preparatory phone calls to service users before a telehealth visit, facilitated primarily by student volunteers, and accompanied by written instructions. The training content included guidance on how to download and install software, troubleshoot technical issues, and adjust device settings. Older adults were the most common target population for the training. All but 1 of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited and mixed evidence that training improved participants’ competency with telehealth. Conclusions: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving the broader digital skills of service users. There is a need for further studies to evaluate the outcomes of telehealth training activities in geographically diverse areas. %M 39083789 %R 10.2196/57586 %U https://www.jmir.org/2024/1/e57586 %U https://doi.org/10.2196/57586 %U http://www.ncbi.nlm.nih.gov/pubmed/39083789 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50527 %T A Patient-Driven Mobile Health Innovation in Cystic Fibrosis Care: Comparative Cross-Case Study %A Mazzocato,Pamela %A Luckhaus,Jamie Linnea %A Malmqvist Castillo,Moa %A Burnett,Johan %A Hager,Andreas %A Oates,Gabriela %A Wannheden,Carolina %A Savage,Carl %+ Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, Sweden, 46 8 524 83 696, pamela.mazzocato@ki.se %K chronic illness %K implementation %K adoption %K spread %K patient-driven innovation %K mHealth %K mobile health %K innovation %K health care provider %K motivation %K interdependency %K adaptability %D 2024 %7 31.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-driven innovation in health care is an emerging phenomenon with benefits for patients with chronic conditions, such as cystic fibrosis (CF). However, previous research has not examined what may facilitate or hinder the implementation of such innovations from the provider perspective. Objective: The aim of this study was to explain variations in the adoption of a patient-driven innovation among CF clinics. Methods: A comparative multiple-case study was conducted on the adoption of a patient-controlled app to support self-management and collaboration with health care professionals (HCPs). Data collection and analysis were guided by the nonadoption, abandonment, spread, scale-up, and sustainability and complexity assessment tool (NASSS-CAT) framework. Data included user activity levels of patients and qualitative interviews with staff at 9 clinics (n=8, 88.9%, in Sweden; n=1, 11.1%, in the United States). We calculated the maximum and mean percentage of active users at each clinic and performed statistical process control (SPC) analysis to explore how the user activity level changed over time. Qualitative data were subjected to content analysis and complexity analysis and used to generate process maps. All data were then triangulated in a cross-case analysis. Results: We found no evidence of nonadoption or clear abandonment of the app. Distinct patterns of innovation adoption were discernable based on the maximum end-user activity for each clinic, which we labeled as low (16%-23%), middle (25%-47%), or high (58%-95%) adoption. SPC charts illustrated that the introduction of new app features and research-related activity had a positive influence on user activity levels. Variation in adoption was associated with providers’ perceptions of care process complexity. A higher perceived complexity of the value proposition, adopter system, and organization was associated with lower adoption. In clinics that adopted the innovation early or those that relied on champions, user activity tended to plateau or decline, suggesting a negative impact on sustainability. Conclusions: For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and providers’ perspectives on what generates value is essential. %M 39083342 %R 10.2196/50527 %U https://www.jmir.org/2024/1/e50527 %U https://doi.org/10.2196/50527 %U http://www.ncbi.nlm.nih.gov/pubmed/39083342 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48964 %T The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study %A Bear,Holly Alice %A Ayala Nunes,Lara %A Ramos,Giovanni %A Manchanda,Tanya %A Fernandes,Blossom %A Chabursky,Sophia %A Walper,Sabine %A Watkins,Edward %A Fazel,Mina %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom, 44 01865 6182, holly.bear@psych.ox.ac.uk %K adolescent mental health %K marginalized groups %K smartphone apps %K engagement %K implementation science %K mobile app %K smartphone %K mobile health %K mHealth %K mental health %K challenges %K acceptability %K young %K effectiveness %K mobile phone %D 2024 %7 30.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. Objective: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. Methods: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. Results: The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users’ objective engagement. Conclusions: Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in “real-world” settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. Trial Registration: PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241 %M 39078699 %R 10.2196/48964 %U https://www.jmir.org/2024/1/e48964 %U https://doi.org/10.2196/48964 %U http://www.ncbi.nlm.nih.gov/pubmed/39078699 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47578 %T Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study %A Galvin,Karyn %A Tomlin,Dani %A Timmer,Barbra H B %A McNeice,Zoe %A Mount,Nicole %A Gray,Kathleen %A Short,Camille E %+ Department of Audiology and Speech Pathology, University of Melbourne, 550 Swanston St, Carlton, 3053, Australia, 61 61390355323, kgalvin@unimelb.edu.au %K adults %K hearing loss %K listening difficulties %K digital health %K app %K self-management %K mobile health %K smartphone %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. Objective: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. Methods: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. Results: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. Conclusions: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician. %M 39042452 %R 10.2196/47578 %U https://formative.jmir.org/2024/1/e47578 %U https://doi.org/10.2196/47578 %U http://www.ncbi.nlm.nih.gov/pubmed/39042452 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e53193 %T The Utility of Wearable Cameras in Developing Examination Questions and Answers on Physical Examinations: Preliminary Study %A Fukui,Sho %A Shimizu,Taro %A Nishizaki,Yuji %A Shikino,Kiyoshi %A Yamamoto,Yu %A Kobayashi,Hiroyuki %A Tokuda,Yasuharu %K medical education %K medical technology %K wearable device %K wearable camera %K medical examination %K exam %K examination %K exams %K examinations %K physical %K resident physicians %K wearable %K wearables %K camera %K cameras %K video %K videos %K innovation %K innovations %K innovative %K recording %K recordings %K survey %K surveys %D 2024 %7 19.7.2024 %9 %J JMIR Med Educ %G English %X To assess the utility of wearable cameras in medical examinations, we created a physician-view video-based examination question and explanation, and the survey results indicated that these cameras can enhance the evaluation and educational capabilities of medical examinations. %R 10.2196/53193 %U https://mededu.jmir.org/2024/1/e53193 %U https://doi.org/10.2196/53193 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42319 %T Evaluating the Acceptability of the Drink Less App and the National Health Service Alcohol Advice Web Page: Qualitative Interview Process Evaluation %A Oldham,Melissa %A Dina,Larisa-Maria %A Loebenberg,Gemma %A Perski,Olga %A Brown,Jamie %A Angus,Colin %A Beard,Emma %A Burton,Robyn %A Field,Matt %A Greaves,Felix %A Hickman,Matthew %A Kaner,Eileen %A Michie,Susan %A Munafò,Marcus R %A Pizzo,Elena %A Garnett,Claire %+ Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 883, m.oldham@ucl.ac.uk %K alcohol reduction %K digital intervention %K acceptability %K mobile health %K mHealth %K mobile phone %D 2024 %7 18.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The extent to which interventions are perceived as acceptable to users impacts engagement and efficacy. Objective: In this study, we evaluated the acceptability of (1) the smartphone app Drink Less (intervention) and (2) the National Health Service (NHS) alcohol advice web page (usual digital care and comparator) among adult drinkers in the United Kingdom participating in a randomized controlled trial evaluating the effectiveness of the Drink Less app. Methods: A subsample of 26 increasing- and higher-risk drinkers (Alcohol Use Disorders Identification Test score≥8) assigned to the intervention group (Drink Less; n=14, 54%; female: n=10, 71%; age: 22-72 years; White: n=9, 64%) or usual digital care group (NHS alcohol advice web page; n=12, 46%; female: n=5, 42%; age: 23-68 years: White: n=9, 75%) took part in semistructured interviews. The interview questions were mapped on to the 7 facets of acceptability according to the Theoretical Framework of Acceptability: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Alongside these constructs, we also included a question on perceived personal relevance, which previous research has linked to acceptability and engagement. Framework and thematic analysis of data was undertaken. Results: The Drink Less app was perceived as being ethical, easy, user-friendly, and effective for the period the app was used. Participants reported particularly liking the tracking and feedback sections of the app, which they reported increased personal relevance and which resulted in positive affect when achieving their goals. They reported no opportunity cost. Factors such as negative affect when not meeting goals and boredom led to disengagement in the longer term for some participants. The NHS alcohol advice web page was rated as being easy and user-friendly with no opportunity costs. However, the information presented was not perceived as being personally relevant or effective in changing drinking behavior. Most participants reported neutral or negative affect, most participants thought the alcohol advice web page was accessible, and some participants reported ethical concerns around the availability of suggested resources. Some participants reported that it had acted as a starting point or a signpost to other resources. Participants in both groups discussed motivation to change and contextual factors such as COVID-19 lockdowns, which influenced their perceived self-efficacy regardless of their assigned intervention. Conclusions: Drink Less appears to be an acceptable digital intervention among the recruited sample. The NHS alcohol advice web page was generally considered unacceptable as a stand-alone intervention among the recruited sample, although it may signpost and help people access other resources and interventions. %M 39024575 %R 10.2196/42319 %U https://www.jmir.org/2024/1/e42319 %U https://doi.org/10.2196/42319 %U http://www.ncbi.nlm.nih.gov/pubmed/39024575 %0 Journal Article %@ 2369-2529 %I %V 11 %N %P e55718 %T Revolutionizing Care: Unleashing the Potential of Digital Health Technology in Physiotherapy Management for People With Cystic Fibrosis %A Morrison,Lisa %A Saynor,Zoe Louise %A Kirk,Alison %A McCann,Lisa %K cystic fibrosis %K physiotherapy %K digital technology %K telehealth %K cystic fibrosis transmembrane regulator modulators %K telemedicine %K digital health technology %K DHTs %K digital health %K physical therapy %K physical activity %K exercise %K monitoring %K physiotherapists %K user %K experience %K remote %K virtual care %K consultation %K consultations %K eConsultations %K preferences %K digital divide %K access %K accessible %K accessibility %K attitude %K perception %K attitudes %K opinion %K perceptions %K perspectives %K eHealth %K online health %K therapy %D 2024 %7 15.7.2024 %9 %J JMIR Rehabil Assist Technol %G English %X This viewpoint paper explores the dynamic intersection of physiotherapy and digital health technologies (DHTs) in enhancing the care of people with cystic fibrosis (CF), in the context of advancements such as highly effective modulator therapies that are enhancing life expectancy and altering physiotherapy needs. The role of DHTs, including telehealth, surveillance, home monitoring, and activity promotion, has expanded, becoming crucial in overcoming geographical barriers and accelerated by the recent pandemic. Physiotherapy, integral to CF care since 1946, has shifted toward patient-centered approaches, emphasizing exercise training and a physically active lifestyle. The reduction in inpatient admissions due to highly effective modulator therapies has led to increased home care and online or electronic consultations, and DHTs have revolutionized service delivery, offering flexibility, self-management, and personalized care options; however, there is a need to comprehensively understand user experiences from both people with CF and physiotherapists. This paper highlights the essential exploration of user experiences to facilitate clinician adaptation to the digital requirements of modern clinical management, ensuring equitable care in the “future hospitals” arena. Identifying research gaps, this paper emphasizes the need for a thorough evaluation of DHT use in CF physiotherapy education, training, and self-monitoring, as well as the experiences of people with CF with online or electronic consultations, self-monitoring, and remote interventions. Online group exercise platforms address historical challenges relating to infection control but necessitate comprehensive evaluations of user experiences and preferences. Future-proofing DHTs within the physiotherapy management of CF demands a shift toward full integration, considering stakeholder opinions and addressing barriers. While DHTs have the potential to extend physiotherapy beyond the hospital, this paper stresses the importance of understanding user experiences, addressing digital poverty, and working toward more equitable health care access. A flexible approach in the “future hospital” is advocated, emphasizing the need for a nuanced understanding of user preferences and experiences to optimize the integration of DHTs in CF care. %R 10.2196/55718 %U https://rehab.jmir.org/2024/1/e55718 %U https://doi.org/10.2196/55718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47785 %T Interactive Health Technology Tool for Kidney Living Donor Assessment to Standardize the Informed Consent Process: Usability and Qualitative Content Analysis %A Ortiz,Fernanda %A Grasberger,Juulia %A Ekstrand,Agneta %A Helanterä,Ilkka %A Giunti,Guido %+ Abdominal Center–Nephrology, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00130, Finland, 358 504270795, fernanda.ortiz@hus.fi %K eHealth %K kidney living donor %K informed consent %K telemedicine %K process standardization %K kidney %K donor %K tool %K usability %K psychological impact %K utility %K smartphone %K coping %K surgery %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Kidney living donation carries risks, yet standardized information provision regarding nephrectomy risks and psychological impacts for candidates remains lacking. Objective: This study assesses the benefit of interactive health technology in improving the informed consent process for kidney living donation. Methods: The Kidney Hub institutional open portal offers comprehensive information on kidney disease and donation. Individuals willing to start the kidney living donation process at Helsinki University Hospital (January 2019-January 2022) were invited to use the patient-tailored digital care path (Living Donor Digital Care Path) included in the Kidney Hub. This platform provides detailed donation process information and facilitates communication between health care professionals and patients. eHealth literacy was evaluated via the eHealth Literacy Scale (eHEALS), usability with the System Usability Scale (SUS), and system utility through Likert-scale surveys with scores of 1-5. Qualitative content analysis addressed an open-ended question. Results: The Kidney Hub portal received over 8000 monthly visits, including to its sections on donation benefits (n=1629 views) and impact on donors’ lives (n=4850 views). Of 127 living kidney donation candidates, 7 did not use Living Donor Digital Care Path. Users’ ages ranged from 20 to 79 years, and they exchanged over 3500 messages. A total of 74 living donor candidates participated in the survey. Female candidates more commonly searched the internet about kidney donation (n=79 female candidates vs n=48 male candidates; P=.04). The mean eHEALS score correlated with internet use for health decisions (r=0.45; P<.001) and its importance (r=0.40; P=.01). Participants found that the Living Donor Digital Care Path was technically satisfactory (mean SUS score 4.4, SD 0.54) and useful but not pivotal in donation decision-making. Concerns focused on postsurgery coping for donors and recipients. Conclusions: Telemedicine effectively educates living kidney donor candidates on the donation process. The Living Donor Digital Care Path serves as a valuable eHealth tool, aiding clinicians in standardizing steps toward informed consent. Trial Registration: ClinicalTrials.gov NCT04791670; https://clinicaltrials.gov/study/NCT04791670 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-051166 %M 38981119 %R 10.2196/47785 %U https://formative.jmir.org/2024/1/e47785 %U https://doi.org/10.2196/47785 %U http://www.ncbi.nlm.nih.gov/pubmed/38981119 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55716 %T An Artificial Intelligence–Based App for Self-Management of Low Back and Neck Pain in Specialist Care: Process Evaluation From a Randomized Clinical Trial %A Marcuzzi,Anna %A Klevanger,Nina Elisabeth %A Aasdahl,Lene %A Gismervik,Sigmund %A Bach,Kerstin %A Mork,Paul Jarle %A Nordstoga,Anne Lovise %+ Department of Public Health and Nursing, Norwegian University of Science and Technology, Håkon Jarls gate 11, Trondheim, 7030, Norway, 47 73412378, anna.marcuzzi@ntnu.no %K low back pain %K neck pain %K self-management %K smartphone app %K process evaluation %K focus group %K focus groups %K musculoskeletal %K mHealth %K mobile health %K app %K apps %K applications %K usage %K interview %K interviews %K qualitative %K engagement %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Self-management is endorsed in clinical practice guidelines for the care of musculoskeletal pain. In a randomized clinical trial, we tested the effectiveness of an artificial intelligence–based self-management app (selfBACK) as an adjunct to usual care for patients with low back and neck pain referred to specialist care. Objective: This study is a process evaluation aiming to explore patients’ engagement and experiences with the selfBACK app and specialist health care practitioners’ views on adopting digital self-management tools in their clinical practice. Methods: App usage analytics in the first 12 weeks were used to explore patients’ engagement with the SELFBACK app. Among the 99 patients allocated to the SELFBACK interventions, a purposive sample of 11 patients (aged 27-75 years, 8 female) was selected for semistructured individual interviews based on app usage. Two focus group interviews were conducted with specialist health care practitioners (n=9). Interviews were analyzed using thematic analysis. Results: Nearly one-third of patients never accessed the app, and one-third were low users. Three themes were identified from interviews with patients and health care practitioners: (1) overall impression of the app, where patients discussed the interface and content of the app, reported on usability issues, and described their app usage; (2) perceived value of the app, where patients and health care practitioners described the primary value of the app and its potential to supplement usual care; and (3) suggestions for future use, where patients and health care practitioners addressed aspects they believed would determine acceptance. Conclusions: Although the app’s uptake was relatively low, both patients and health care practitioners had a positive opinion about adopting an app-based self-management intervention for low back and neck pain as an add-on to usual care. Both described that the app could reassure patients by providing trustworthy information, thus empowering them to take actions on their own. Factors influencing app acceptance and engagement, such as content relevance, tailoring, trust, and usability properties, were identified. Trial Registration: ClinicalTrials.gov NCT04463043; https://clinicaltrials.gov/study/NCT04463043 %M 38980710 %R 10.2196/55716 %U https://humanfactors.jmir.org/2024/1/e55716 %U https://doi.org/10.2196/55716 %U http://www.ncbi.nlm.nih.gov/pubmed/38980710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56716 %T Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study %A Belanger,Christopher %A Peixoto,Cayden %A Francoeur,Sara %A Bjerre,Lise M %+ Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada, 1 613 746 4621, lbjerre@uottawa.ca %K primary care %K language-concordant care %K web-based maps %K maps %K physicians %K experience %K language %K access %K accessibility %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Language-concordant health care, or health care in a patient’s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were “very satisfied” or “somewhat satisfied” with the map, 16 (17%) were “neither satisfied nor dissatisfied,” and 20 (22%) were “very dissatisfied” or “somewhat dissatisfied.” We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. %M 38980717 %R 10.2196/56716 %U https://formative.jmir.org/2024/1/e56716 %U https://doi.org/10.2196/56716 %U http://www.ncbi.nlm.nih.gov/pubmed/38980717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51931 %T Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study %A Atherton,Helen %A Eccles,Abi %A Poltawski,Leon %A Dale,Jeremy %A Campbell,John %A Abel,Gary %+ Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, United Kingdom, 44 023 8059 5000, h.atherton@soton.ac.uk %K appointment %K patient appointments %K online systems %K primary health care %K general practice %K qualitative research %K secondary data analysis %K mobile phone %D 2024 %7 8.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. Objective: This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients’ views regarding online appointment booking arrangements. Methods: This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. Results: The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. Conclusions: Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice. %M 38976870 %R 10.2196/51931 %U https://www.jmir.org/2024/1/e51931 %U https://doi.org/10.2196/51931 %U http://www.ncbi.nlm.nih.gov/pubmed/38976870 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e47565 %T Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study %A Ansaldo,Ana Inés %A Masson-Trottier,Michèle %A Delacourt,Barbara %A Dubuc,Jade %A Dubé,Catherine %+ Laboratoire de Plasticité cérébrale, Communication et Vieillissement, Centre de recherche de l'Institut Universitaire de gériatrie de Montréal, Université de Montréal, 4565 Queen Mary Road, Montréal, QC, H3W1W5, Canada, 1 5143403540 ext 3933, ana.ines.ansaldo@umontreal.ca %K dementia %K communication %K caregivers %K technology %K burden %K mixed methods design %K quality of life %K mobile phone %K tablet %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout. Objective: This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden. Methods: In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs. Results: Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65%; t15=2.430; P=.03; d=0.61 [medium effect size]). Conclusions: COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions. %M 38963691 %R 10.2196/47565 %U https://aging.jmir.org/2024/1/e47565 %U https://doi.org/10.2196/47565 %U http://www.ncbi.nlm.nih.gov/pubmed/38963691 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e51987 %T Technology Usability for People Living With Dementia: Concept Analysis %A Chien,Shao-Yun %A Zaslavsky,Oleg %A Berridge,Clara %+ School of Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K usability %K dementia %K older adults %K technology %K concept analysis %K mobile phone %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology’s role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. Objective: This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. Methods: The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords “technology usability” and “dementia.” We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. Results: The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. Conclusions: Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions. %M 38959053 %R 10.2196/51987 %U https://aging.jmir.org/2024/1/e51987 %U https://doi.org/10.2196/51987 %U http://www.ncbi.nlm.nih.gov/pubmed/38959053 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e54774 %T Hospital Staff Perspectives on the Drivers and Challenges in Implementing a Virtual Rehabilitation Ward: Qualitative Study %A Greene,Leanne %A Rahja,Miia %A Laver,Kate %A Wong,Vun Vun %A Leung,Chris %A Crotty,Maria %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %K telerehabilitation %K rehabilitation %K rehab %K workflow %K hospitalization %K health services accessibility %K accessibility %K clinical decision-making %K equipment failure %K telemedicine %K telehealth %K tele-medicine %K tele-health %K virtual care %K virtual health %K virtual medicine %K remote consultation %K telephone consultation %K video consultation %K remote consultations %K telephone consultations %K video consultations %K personnel %K hospital %D 2024 %7 27.6.2024 %9 %J JMIR Aging %G English %X Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood. Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff’s perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery. Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework. Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families. Conclusions: In this qualitative study exploring health care staff’s experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW. %R 10.2196/54774 %U https://aging.jmir.org/2024/1/e54774 %U https://doi.org/10.2196/54774 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58551 %T Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design %A Hall,Evelyn %A Keyser,Laura %A McKinney,Jessica %A Pulliam,Samantha %A Weinstein,Milena %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Ste 400, San Francisco, CA, 94158, United States, 1 866 657 5382, laura.keyser@ucsf.edu %K urinary incontinence %K digital health %K pelvic floor muscle training %K real-world %K evidence %K user-centered design %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women’s access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. Objective: The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. Methods: This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. Results: Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ≥10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. Conclusions: This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ≥10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes. %R 10.2196/58551 %U https://formative.jmir.org/2024/1/e58551 %U https://doi.org/10.2196/58551 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48777 %T Detection of Mild Cognitive Impairment Through Hand Motor Function Under Digital Cognitive Test: Mixed Methods Study %A Li,Aoyu %A Li,Jingwen %A Chai,Jiali %A Wu,Wei %A Chaudhary,Suamn %A Zhao,Juanjuan %A Qiang,Yan %+ College of Computer Science and Technology (College of Data Science), Taiyuan University of Technology, No. 209, University Street, Yuji District, Shanxi Province, Jinzhong, 030024, China, 86 18635168680, qiangyan@tyut.edu.cn %K mild cognitive impairment %K movement kinetics %K digital cognitive test %K dual task %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early detection of cognitive impairment or dementia is essential to reduce the incidence of severe neurodegenerative diseases. However, currently available diagnostic tools for detecting mild cognitive impairment (MCI) or dementia are time-consuming, expensive, or not widely accessible. Hence, exploring more effective methods to assist clinicians in detecting MCI is necessary. Objective: In this study, we aimed to explore the feasibility and efficiency of assessing MCI through movement kinetics under tablet-based “drawing and dragging” tasks. Methods: We iteratively designed “drawing and dragging” tasks by conducting symposiums, programming, and interviews with stakeholders (neurologists, nurses, engineers, patients with MCI, healthy older adults, and caregivers). Subsequently, stroke patterns and movement kinetics were evaluated in healthy control and MCI groups by comparing 5 categories of features related to hand motor function (ie, time, stroke, frequency, score, and sequence). Finally, user experience with the overall cognitive screening system was investigated using structured questionnaires and unstructured interviews, and their suggestions were recorded. Results: The “drawing and dragging” tasks can detect MCI effectively, with an average accuracy of 85% (SD 2%). Using statistical comparison of movement kinetics, we discovered that the time- and score-based features are the most effective among all the features. Specifically, compared with the healthy control group, the MCI group showed a significant increase in the time they took for the hand to switch from one stroke to the next, with longer drawing times, slow dragging, and lower scores. In addition, patients with MCI had poorer decision-making strategies and visual perception of drawing sequence features, as evidenced by adding auxiliary information and losing more local details in the drawing. Feedback from user experience indicates that our system is user-friendly and facilitates screening for deficits in self-perception. Conclusions: The tablet-based MCI detection system quantitatively assesses hand motor function in older adults and further elucidates the cognitive and behavioral decline phenomenon in patients with MCI. This innovative approach serves to identify and measure digital biomarkers associated with MCI or Alzheimer dementia, enabling the monitoring of changes in patients’ executive function and visual perceptual abilities as the disease advances. %M 38924786 %R 10.2196/48777 %U https://mhealth.jmir.org/2024/1/e48777 %U https://doi.org/10.2196/48777 %U http://www.ncbi.nlm.nih.gov/pubmed/38924786 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e50980 %T An Ontology-Based Decision Support System for Tailored Clinical Nutrition Recommendations for Patients With Chronic Obstructive Pulmonary Disease: Development and Acceptability Study %A Spoladore,Daniele %A Colombo,Vera %A Fumagalli,Alessia %A Tosi,Martina %A Lorenzini,Erna Cecilia %A Sacco,Marco %+ Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing, National Research Council of Italy, Via G. Previati 1E, Lecco, 23900, Italy, 39 03412350202, daniele.spoladore@stiima.cnr.it %K ontology-based decision support system %K nutritional recommendation %K chronic obstructive pulmonary disease %K clinical decision support system %K pulmonary rehabilitation %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a chronic condition among the main causes of morbidity and mortality worldwide, representing a burden on health care systems. Scientific literature highlights that nutrition is pivotal in respiratory inflammatory processes connected to COPD, including exacerbations. Patients with COPD have an increased risk of developing nutrition-related comorbidities, such as diabetes, cardiovascular diseases, and malnutrition. Moreover, these patients often manifest sarcopenia and cachexia. Therefore, an adequate nutritional assessment and therapy are essential to help individuals with COPD in managing the progress of the disease. However, the role of nutrition in pulmonary rehabilitation (PR) programs is often underestimated due to a lack of resources and dedicated services, mostly because pneumologists may lack the specialized training for such a discipline. Objective: This work proposes a novel knowledge-based decision support system to support pneumologists in considering nutritional aspects in PR. The system provides clinicians with patient-tailored dietary recommendations leveraging expert knowledge. Methods: The expert knowledge—acquired from experts and clinical literature—was formalized in domain ontologies and rules, which were developed leveraging the support of Italian clinicians with expertise in the rehabilitation of patients with COPD. Thus, by following an agile ontology engineering methodology, the relevant formal ontologies were developed to act as a backbone for an application targeted at pneumologists. The recommendations provided by the decision support system were validated by a group of nutrition experts, whereas the acceptability of such an application in the context of PR was evaluated by pneumologists. Results: A total of 7 dieticians (mean age 46.60, SD 13.35 years) were interviewed to assess their level of agreement with the decision support system’s recommendations by evaluating 5 patients’ health conditions. The preliminary results indicate that the system performed more than adequately (with an overall average score of 4.23, SD 0.52 out of 5 points), providing meaningful and safe recommendations in compliance with clinical practice. With regard to the acceptability of the system by lung specialists (mean age 44.71, SD 11.94 years), the usefulness and relevance of the proposed solution were extremely positive—the scores on each of the perceived usefulness subscales of the technology acceptance model 3 were 4.86 (SD 0.38) out of 5 points, whereas the score on the intention to use subscale was 4.14 (SD 0.38) out of 5 points. Conclusions: Although designed for the Italian clinical context, the proposed system can be adapted for any other national clinical context by modifying the domain ontologies, thus providing a multidisciplinary approach to the management of patients with COPD. %M 38922666 %R 10.2196/50980 %U https://medinform.jmir.org/2024/1/e50980 %U https://doi.org/10.2196/50980 %U http://www.ncbi.nlm.nih.gov/pubmed/38922666 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e51662 %T Acceptability of a Digital Adherence Tool Among Patients With Tuberculosis and Tuberculosis Care Providers in Kilimanjaro Region, Tanzania: Mixed Methods Study %A Mtenga,Alan Elias %A Maro,Rehema Anenmose %A Dillip,Angel %A Msoka,Perry %A Emmanuel,Naomi %A Ngowi,Kennedy %A Sumari-de Boer,Marion %+ mHealth Department, Kilimanjaro Clinical Research Institute, KCMC/Kitandu, Longuo st, 2236, Moshi, Moshi, 25116, United Republic of Tanzania, 255 763285424, a.mtenga@kcri.ac.tz %K acceptability %K digital adherence tool %K medication reminder monitors %K patients with tuberculosis %K TB %K adherence %K TB care provider %D 2024 %7 26.6.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: The World Health Organization has recommended digital adherence tools (DATs) as a promising intervention to improve antituberculosis drug adherence. However, the acceptability of DATs in resource-limited settings is not adequately studied. Objective: We investigated the acceptability of a DAT among patients with tuberculosis (TB) and TB care providers in Kilimanjaro, Tanzania. Methods: We conducted a convergent parallel mixed methods study among patients with TB and TB care providers participating in our 2-arm cluster randomized trial (REMIND-TB). The trial aimed to investigate whether the evriMED pillbox with reminder cues and adherence feedback effectively improves adherence to anti-TB treatment among patients with TB in Kilimanjaro, Tanzania. We conducted exit and in-depth interviews among patients as well as in-depth interviews among TB care providers in the intervention arm. We conducted a descriptive analysis of the quantitative data from exit interviews. Translated transcripts and memos were organized using NVivo software. We employed inductive and deductive thematic framework analysis, guided by Sekhon’s theoretical framework of acceptability. Results: Out of the 245 patients who completed treatment, 100 (40.8%) were interviewed during exit interviews, and 18 patients and 15 TB care providers were interviewed in-depth. Our findings showed that the DAT was highly accepted: 83% (83/100) expressed satisfaction, 98% (98/100) reported positive experiences with DAT use, 78% (78/100) understood how the intervention works, and 92% (92/100) successfully used the pillbox. Good perceived effectiveness was reported by 84% (84/100) of the participants who noticed improved adherence, and many preferred continuing receiving reminders through SMS text messages, indicating high levels of self-efficacy. Ethical concerns were minimal, as 85 (85%) participants did not worry about remote monitoring. However, some participants felt burdened using DATs; 9 (9%) faced difficulties keeping the device at home, 12 (12%) were not pleased with receiving daily reminder SMS text messages, and 30 (30%) reported challenges related to mobile network connectivity issues. TB care providers accepted the intervention due to its perceived impact on treatment outcomes and behavior change in adherence counseling, and they demonstrated high level of intervention coherence. Conclusions: DATs are highly acceptable in Tanzania. However, some barriers such as TB-related stigma and mobile network connectivity issues may limit acceptance. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3483-4 %M 38922643 %R 10.2196/51662 %U https://ojphi.jmir.org/2024/1/e51662 %U https://doi.org/10.2196/51662 %U http://www.ncbi.nlm.nih.gov/pubmed/38922643 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55443 %T Provider Adoption of mHealth in Rural Patient Care: Web-Based Survey Study %A Weichelt,Bryan P %A Burke,Rick %A Kieke,Burney %A Pilz,Matt %A Shimpi,Neel %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 715 221 7276, weichelt.bryan@marshfieldresearch.org %K mHealth %K clinician %K physician %K rural %K patient %K mobile %K health care %K adoption %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K mobile health %K app %K apps %K provider %K providers %K physicians %K survey %K surveys %K barrier %K barriers %K digital health %D 2024 %7 24.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas. Objective: This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system. We investigated (1) mHealth apps that providers use for their own benefit and (2) mHealth apps that a provider uses in conjunction with a patient. Methods: We surveyed all patient-seeing providers within the Marshfield Clinic Health System with a brief, 16-item, web-based survey assessing attitudes toward mHealth, adoption of these technologies, and perceived barriers faced by providers, their peers, and the institution. Survey results were summarized via descriptive statistics, with log-binomial regression and accompanying pairwise analyses, using Kruskal-Wallis and Jonckheere-Terpstra tests for significance, respectively. Respondents were grouped by reported clinical role and specialty. Results: We received a 38% (n/N=916/2410) response rate, with 60.7% (n=556) of those sufficiently complete for analyses. Roughly 54.1% (n=301) of respondents reported mHealth use, primarily around decision-making and supplemental information, with use differing based on provider role and years of experience. Self-reported barriers to using mHealth included a lack of knowledge and time to study mHealth technologies. Providers also reported concerns about patients’ internet access and the complexity of mHealth apps to adequately use mHealth technologies. Providers believed the health system’s barriers were largely privacy, confidentiality, and legal review concerns. Conclusions: These findings echo similar studies in other health systems, surrounding providers’ lack of time and concerns over privacy and confidentiality of patient data. Providers emphasized concerns over the complexity of these technologies for their patients and concerns over patients’ internet access to fully use mHealth in their delivery of care. %M 38913992 %R 10.2196/55443 %U https://humanfactors.jmir.org/2024/1/e55443 %U https://doi.org/10.2196/55443 %U http://www.ncbi.nlm.nih.gov/pubmed/38913992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49309 %T Patients’ and Clinicians’ Perceptions of the Clinical Utility of Predictive Risk Models for Chemotherapy-Related Symptom Management: Qualitative Exploration Using Focus Groups and Interviews %A Miller,Morven %A McCann,Lisa %A Lewis,Liane %A Miaskowski,Christine %A Ream,Emma %A Darley,Andrew %A Harris,Jenny %A Kotronoulas,Grigorios %A V Berg,Geir %A Lubowitzki,Simone %A Armes,Jo %A Patiraki,Elizabeth %A Furlong,Eileen %A Fox,Patricia %A Gaiger,Alexander %A Cardone,Antonella %A Orr,Dawn %A Flowerday,Adrian %A Katsaragakis,Stylianos %A Skene,Simon %A Moore,Margaret %A McCrone,Paul %A De Souza,Nicosha %A Donnan,Peter T %A Maguire,Roma %+ Computer & Information Sciences, University of Strathclyde, 13.15 Livingston Tower, 26 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 141 548 4101, roma.maguire@strath.ac.uk %K chemotherapy %K digital health %K education %K predictive risk models %K qualitative research methods %K symptoms %K symptom cluster %K tailored information %D 2024 %7 20.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Interest in the application of predictive risk models (PRMs) in health care to identify people most likely to experience disease and treatment-related complications is increasing. In cancer care, these techniques are focused primarily on the prediction of survival or life-threatening toxicities (eg, febrile neutropenia). Fewer studies focus on the use of PRMs for symptoms or supportive care needs. The application of PRMs to chemotherapy-related symptoms (CRS) would enable earlier identification and initiation of prompt, personalized, and tailored interventions. While some PRMs exist for CRS, few were translated into clinical practice, and human factors associated with their use were not reported. Objective: We aim to explore patients’ and clinicians’ perspectives of the utility and real-world application of PRMs to improve the management of CRS. Methods: Focus groups (N=10) and interviews (N=5) were conducted with patients (N=28) and clinicians (N=26) across 5 European countries. Interactions were audio-recorded, transcribed verbatim, and analyzed thematically. Results: Both clinicians and patients recognized the value of having individualized risk predictions for CRS and appreciated how this type of information would facilitate the provision of tailored preventative treatments or supportive care interactions. However, cautious and skeptical attitudes toward the use of PRMs in clinical care were noted by both groups, particularly in relationship to the uncertainty regarding how the information would be generated. Visualization and presentation of PRM information in a usable and useful format for both patients and clinicians was identified as a challenge to their successful implementation in clinical care. Conclusions: Findings from this study provide information on clinicians’ and patients’ perspectives on the clinical use of PRMs for the management of CRS. These international perspectives are important because they provide insight into the risks and benefits of using PRMs to evaluate CRS. In addition, they highlight the need to find ways to more effectively present and use this information in clinical practice. Further research that explores the best ways to incorporate this type of information while maintaining the human side of care is warranted. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 %M 38901021 %R 10.2196/49309 %U https://www.jmir.org/2024/1/e49309 %U https://doi.org/10.2196/49309 %U http://www.ncbi.nlm.nih.gov/pubmed/38901021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56074 %T Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study %A Podda,Jessica %A Tacchino,Andrea %A Ponzio,Michela %A Di Antonio,Federica %A Susini,Alessia %A Pedullà,Ludovico %A Battaglia,Mario Alberto %A Brichetto,Giampaolo %+ Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, 16149, Italy, 39 0102713306, jessica.podda@aism.it %K cognitive assessment %K cognitive impairment %K digital health %K mHealth app %K multiple sclerosis %K self-management %K usability %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) apps have proven useful for people with multiple sclerosis (MS). Thus, easy-to-use digital solutions are now strongly required to assess and monitor cognitive impairment, one of the most disturbing symptoms in MS that is experienced by almost 43% to 70% of people with MS. Therefore, we developed DIGICOG-MS (Digital assessment of Cognitive Impairment in Multiple Sclerosis), a smartphone- and tablet-based mHealth app to self-assess cognitive impairment in MS. Objective: This study aimed to test the validity and usability of the novel mHealth app with a sample of people with MS. Methods: DIGICOG-MS includes 4 digital tests assumed to evaluate the most affected cognitive domains in MS (visuospatial memory [VSM], verbal memory [VM], semantic fluency [SF], and information processing speed [IPS]) and inspired by traditional paper-based tests that assess the same cognitive functions (10/36 Spatial Recall Test, Rey Auditory Verbal Learning Test, Word List Generation, Symbol Digit Modalities Test). Participants were asked to complete both digital and traditional assessments in 2 separate sessions. Convergent validity was analyzed using the Pearson correlation coefficient to determine the strength of the associations between digital and traditional tests. To test the app’s reliability, the agreement between 2 repeated measurements was assessed using intraclass correlation coefficients (ICCs). Usability of DIGICOG-MS was evaluated using the System Usability Scale (SUS) and mHealth App Usability Questionnaire (MAUQ) administered at the conclusion of the digital session. Results: The final sample consisted of 92 people with MS (60 women) followed as outpatients at the Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Genoa (Italy). They had a mean age of 51.38 (SD 11.36) years, education duration of 13.07 (SD 2.74) years, disease duration of 12.91 (SD 9.51) years, and a disability level (Expanded Disability Status Scale) of 3.58 (SD 1.75). Relapsing-remitting MS was most common (68/92, 74%), followed by secondary progressive (15/92, 16%) and primary progressive (9/92, 10%) courses. Pearson correlation analyses indicated significantly strong correlations for VSM, VM, SF, and IPS (all P<.001), with r values ranging from 0.58 to 0.78 for all cognitive domains. Test-retest reliability of the mHealth app was excellent (ICCs>0.90) for VM and IPS and good for VSM and SF (ICCs>0.80). Moreover, the SUS score averaged 84.5 (SD 13.34), and the mean total MAUQ score was 104.02 (SD 17.69), suggesting that DIGICOG-MS was highly usable and well appreciated. Conclusions: The DIGICOG-MS tests were strongly correlated with traditional paper-based evaluations. Furthermore, people with MS positively evaluated DIGICOG-MS, finding it highly usable. Since cognitive impairment poses major limitations for people with MS, these findings open new paths to deploy digital cognitive tests for MS and further support the use of a novel mHealth app for cognitive self-assessment by people with MS in clinical practice. %M 38900535 %R 10.2196/56074 %U https://formative.jmir.org/2024/1/e56074 %U https://doi.org/10.2196/56074 %U http://www.ncbi.nlm.nih.gov/pubmed/38900535 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49992 %T Assessing the Relationship Between Digital Trail Making Test Performance and IT Task Performance: Empirical Study %A Depauw,Tanguy %A Boasen,Jared %A Léger,Pierre-Majorique %A Sénécal,Sylvain %+ Tech3lab, HEC Montréal, 5540 Av Louis-Colin, Montréal, QC, H3T 1T7, Canada, 1 514 340 6000, jared.boasen@hec.ca %K Trail Making Test %K user experience %K cognitive profile %K information technology %K task performance %K cognitive assessment %K human factors %K cognitive function %K CAPTCHA %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cognitive functional ability affects the accessibility of IT and is thus something that should be controlled for in user experience (UX) research. However, many cognitive function assessment batteries are long and complex, making them impractical for use in conventional experimental time frames. Therefore, there is a need for a short and reliable cognitive assessment that has discriminant validity for cognitive functions needed for general IT tasks. One potential candidate is the Trail Making Test (TMT). Objective: This study investigated the usefulness of a digital TMT as a cognitive profiling tool in IT-related UX research by assessing its predictive validity on general IT task performance and exploring its discriminant validity according to discrete cognitive functions required to perform the IT task. Methods: A digital TMT (parts A and B) named Axon was administered to 27 healthy participants, followed by administration of 5 IT tasks in the form of CAPTCHAs (Completely Automated Public Turing tests to Tell Computers and Humans Apart). The discrete cognitive functions required to perform each CAPTCHA were rated by trained evaluators. To further explain and cross-validate our results, the original TMT and 2 psychological assessments of visuomotor and short-term memory function were administered. Results: Axon A and B were administrable in less than 5 minutes, and overall performance was significantly predictive of general IT task performance (F5,19=6.352; P=.001; Λ=0.374). This result was driven by performance on Axon B (F5,19=3.382; P=.02; Λ=0.529), particularly for IT tasks involving the combination of executive processing with visual object and pattern recognition. Furthermore, Axon was cross-validated with the original TMT (Pcorr=.001 and Pcorr=.017 for A and B, respectively) and visuomotor and short-term memory tasks. Conclusions: The results demonstrate that variance in IT task performance among an age-homogenous neurotypical population can be related to intersubject variance in cognitive function as assessed by Axon. Although Axon’s predictive validity seemed stronger for tasks involving the combination of executive function with visual object and pattern recognition, these cognitive functions are arguably relevant to the majority of IT interfaces. Considering its short administration time and remote implementability, the Axon digital TMT demonstrates the potential to be a useful cognitive profiling tool for IT-based UX research. %M 38875007 %R 10.2196/49992 %U https://humanfactors.jmir.org/2024/1/e49992 %U https://doi.org/10.2196/49992 %U http://www.ncbi.nlm.nih.gov/pubmed/38875007 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49040 %T Doctors’ Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study %A Chen,Dongjin %A Han,Wenchao %A Yang,Yili %A Pan,Jay %+ West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China, 86 28 85501096, panjie.jay@scu.edu.cn %K medical platforms %K doctor-patient communication %K social networking apps %K thematic content analysis %K China %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients’ mobile app adoption behavior; however, they offer limited insights into doctors’ personal preferences among a variety of choices of mobile apps. Objective: This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? Methods: We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. Results: In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees’ perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors’ affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. Conclusions: Our findings contribute to a nuanced understanding of doctors’ adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns. %M 38857491 %R 10.2196/49040 %U https://mhealth.jmir.org/2024/1/e49040 %U https://doi.org/10.2196/49040 %U http://www.ncbi.nlm.nih.gov/pubmed/38857491 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47810 %T Predictive Factors of Physicians’ Satisfaction and Quality of Work Under Teleconsultation Conditions: Structural Equation Analysis %A Hawrysz,Liliana %A Kludacz-Alessandri,Magdalena %A Walczak,Renata %+ Faculty of Civil Engineering, Mechanics and Petrochemistry, Warsaw University of Technology, 17 Lukasiewicza St, Plock, 09-400, Poland, 48 887780100, renata.walczak@pw.edu.pl %K perceived ease of use %K perceived usefulness %K physicians’ satisfaction %K behavioral intention to use telemedicine %K health care quality %K technology acceptance model %K TAM %K COVID-19: telemedicine %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic contributed to an increase in teleconsultation adoption in the Polish primary health care system. It is expected that in the long run, teleconsultations will successfully replace a significant part of face-to-face visits. Therefore, a significant challenge facing primary health care facilities (PHCs) is the acceptance of teleconsultations by their users, especially physicians. Objective: This study aimed to explore physicians’ acceptance of teleconsultations during the COVID-19 pandemic in Poland. Methods: A representative survey was conducted among 361 physicians of PHCs across Poland in 2021. For the purposes of the study, we developed a modified Technology Acceptance Model (TAM) model. Based on the modified TAM, we analyzed the impact of perceived usefulness (PU), perceived ease of use (PEU), and intention to use teleconsultation (INT) on physicians’ satisfaction (SAT) and quality of work (Q). The psychometric properties of the research instrument were examined using exploratory factor analysis. Finally, structural equation modeling was used for data analysis. Results: The results indicated a generally high level of PU (mean 3.85-4.36, SD 0.87-1.18), PEU (mean 3.81-4.60, SD 0.60-1.42), INT (mean 3.87-4.22, SD 0.89-1.12), and SAT (mean 3.55-4.13, SD 0.88-1.16); the lowest rated dimension in TAM was Q (mean 3.28-3.73, SD 1.06-1.26). The most important independent variable was PU. The influence of PU on INT (estimate=0.63, critical ratio [CR]=15.84, P<.001) and of PU on SAT (estimate=0.44, CR= 9.53, P<.001) was strong. INT was also a key factor influencing SAT (estimate=0.4, CR=8.57, P<.001). A weaker relationship was noted in the effect of PEU on INT (estimate=0.17, CR=4.31, P<.001). In turn, Q was positively influenced by INT (estimate=0.179, CR=3.64, P<.001), PU (estimate=0.246, CR=4.79, P<.001), PEU (estimate=0.18, CR=4.93, P<.001), and SAT (estimate=0.357, CR=6.97, P<.001). All paths between the constructs (PU, PEU, INT, SAT, and Q) were statistically significant, which highlights the multifaceted nature of the adoption of teleconsultations among physicians. Conclusions: Our findings provide strong empirical support for the hypothesized relationships in TAM. The findings suggest that the PU and PEU of teleconsultation have a significant impact on the intention of physicians to adopt teleconsultation. This results in an improvement in the satisfaction of Polish physicians with the use of teleconsultation and an increase in Q. The study contributes to both theory and practice by identifying important prognostic factors affecting physicians’ acceptance of teleconsultation systems. %M 38857081 %R 10.2196/47810 %U https://humanfactors.jmir.org/2024/1/e47810 %U https://doi.org/10.2196/47810 %U http://www.ncbi.nlm.nih.gov/pubmed/38857081 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53784 %T Feasibility of Web-Based Single-Session Empowered Relief in Patients With Chronic Pain Taking Methadone or Buprenorphine: Protocol for a Single-Arm Trial %A Klein,Morgan R %A Darnall,Beth D %A You,Dokyoung S %+ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Rd, Suite 200, Palo Alto, CA, 94304, United States, 1 650 724 9320, dsyou@stanford.edu %K chronic pain %K opioid use disorder %K methadone %K buprenorphine %K behavioral medicine %K telehealth %K psychology %D 2024 %7 6.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain affects tens of millions of US adults and continues to rise in prevalence. Nonpharmacologic behavioral pain treatments are greatly needed and yet are often inaccessible, particularly in settings where medication prescribing is prioritized. Objective: This study aims to test the feasibility of a live-instructor, web-based 1-session pain relief skills class in an underserved and potentially at-risk population: people with chronic pain prescribed methadone or buprenorphine either solely for pain or for comorbid opioid use disorder (OUD). Methods: This is a national, prospective, single-arm, uncontrolled feasibility trial. The trial is untethered from medical care; to enhance participants’ willingness to join the study, no medical records or drug-monitoring records are accessed. At least 45 participants will be recruited from outpatient pain clinics and from an existing research database of individuals who have chronic pain and are taking methadone or buprenorphine. Patient-reported measures will be collected at 6 time points (baseline, immediately post treatment, 2 weeks, and months 1-3) via a web-based platform, paper, or phone formats to include individuals with limited internet or computer access and low literacy skills. At baseline, participants complete demographic questions and 13 study measures (Treatment Expectations, Body Pain Map, Medication Use, Pain Catastrophizing Scale [PCS], Patient-Reported Outcomes Measurement Information System [PROMIS] Measures, and Opioid Craving Scale). Immediately post treatment, a treatment satisfaction and acceptability measure is administered on a 0 (very dissatisfied) to 10 (completely satisfied) scale, with 3 of these items being the primary outcome (perceived usefulness, participant satisfaction, and likelihood of using the skills). At each remaining time point, the participants complete all study measures minus treatment expectations and satisfaction. Participants who do not have current OUD will be assessed for historical OUD, with presence of OUD (yes or no), and history of OUD (yes or no) reported separately. Feasibility threshold is set as an overall group treatment satisfaction rating of 8 of 10. In-depth qualitative interviews will be conducted with about 10 participants to obtain additional data on patient perceptions, satisfactions, needs, and wants. To assess preliminary efficacy, we will examine changes in pain catastrophizing, pain intensity, pain bothersomeness, sleep disturbance, pain interference, depression, anxiety, physical function, global impression of change, and opioid craving at 1 month post treatment. Results: This project opened to enrollment in September 2021 and completed the recruitment in October 2023. The data collection was completed in February 2024. Results are expected to be published in late 2024. Conclusions: Results from this trial will inform the feasibility and preliminary efficacy of Empowered Relief in this population and will inform the design of a future randomized controlled trial testing web-based Empowered Relief in chronic pain and comorbid OUD. Trial Registration: ClinicalTrials.gov NCT05057988; https://clinicaltrials.gov/study/NCT05057988 International Registered Report Identifier (IRRID): DERR1-10.2196/53784 %M 38843513 %R 10.2196/53784 %U https://www.researchprotocols.org/2024/1/e53784 %U https://doi.org/10.2196/53784 %U http://www.ncbi.nlm.nih.gov/pubmed/38843513 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53918 %T Chinese Oncologists’ Perspectives on Integrating AI into Clinical Practice: Cross-Sectional Survey Study %A Li,Ming %A Xiong,XiaoMin %A Xu,Bo %A Dickson,Conan %+ Department of Health Policy Management, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3543, cdickso1@jh.edu %K artificial intelligence %K AI %K machine learning %K oncologist %K concern %K clinical practice %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid development of artificial intelligence (AI) has brought significant interest to its potential applications in oncology. Although AI-powered tools are already being implemented in some Chinese hospitals, their integration into clinical practice raises several concerns for Chinese oncologists. Objective: This study aims to explore the concerns of Chinese oncologists regarding the integration of AI into clinical practice and to identify the factors influencing these concerns. Methods: A total of 228 Chinese oncologists participated in a cross-sectional web-based survey from April to June in 2023 in mainland China. The survey gauged their worries about AI with multiple-choice questions. The survey evaluated their views on the statements of “The impact of AI on the doctor-patient relationship” and “AI will replace doctors.” The data were analyzed using descriptive statistics, and variate analyses were used to find correlations between the oncologists’ backgrounds and their concerns. Results: The study revealed that the most prominent concerns were the potential for AI to mislead diagnosis and treatment (163/228, 71.5%); an overreliance on AI (162/228, 71%); data and algorithm bias (123/228, 54%); issues with data security and patient privacy (123/228, 54%); and a lag in the adaptation of laws, regulations, and policies in keeping up with AI’s development (115/228, 50.4%). Oncologists with a bachelor’s degree expressed heightened concerns related to data and algorithm bias (34/49, 69%; P=.03) and the lagging nature of legal, regulatory, and policy issues (32/49, 65%; P=.046). Regarding AI’s impact on doctor-patient relationships, 53.1% (121/228) saw a positive impact, whereas 35.5% (81/228) found it difficult to judge, 9.2% (21/228) feared increased disputes, and 2.2% (5/228) believed that there is no impact. Although sex differences were not significant (P=.08), perceptions varied—male oncologists tended to be more positive than female oncologists (74/135, 54.8% vs 47/93, 50%). Oncologists with a bachelor’s degree (26/49, 53%; P=.03) and experienced clinicians (≥21 years; 28/56, 50%; P=.054). found it the hardest to judge. Those with IT experience were significantly more positive (25/35, 71%) than those without (96/193, 49.7%; P=.02). Opinions regarding the possibility of AI replacing doctors were diverse, with 23.2% (53/228) strongly disagreeing, 14% (32/228) disagreeing, 29.8% (68/228) being neutral, 16.2% (37/228) agreeing, and 16.7% (38/228) strongly agreeing. There were no significant correlations with demographic and professional factors (all P>.05). Conclusions: Addressing oncologists’ concerns about AI requires collaborative efforts from policy makers, developers, health care professionals, and legal experts. Emphasizing transparency, human-centered design, bias mitigation, and education about AI’s potential and limitations is crucial. Through close collaboration and a multidisciplinary strategy, AI can be effectively integrated into oncology, balancing benefits with ethical considerations and enhancing patient care. %M 38838307 %R 10.2196/53918 %U https://formative.jmir.org/2024/1/e53918 %U https://doi.org/10.2196/53918 %U http://www.ncbi.nlm.nih.gov/pubmed/38838307 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50957 %T The Influence of Incentive-Based Mobile Fitness Apps on Users’ Continuance Intention With Gender Moderation Effects: Quantitative and Qualitative Study %A Faizah,Aaya %A Hardian,Alifah Fatimah Azzahra %A Nandini,Rania Devina %A Handayani,Putu Wuri %A Harahap,Nabila Cyldea %+ Faculty of Computer Science, University of Indonesia, Kampus UI, Depok, 16424, Indonesia, 62 217863419, Putu.wuri@cs.ui.ac.id %K incentive %K fitness %K mobile fitness apps %K gender %K continuance usage intention %K Indonesia %K mobile phone %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A survey conducted by McKinsey & Company reported that, as of May 2022, as many as 26% of Indonesians had recently started to engage actively in physical activity, 32% undertook regular physical activity, and 9% exercised intensely. The Fourth Industrial Revolution has spurred the rapid development of mobile fitness apps (MFAs) used to track people’s sports activities. However, public interest in using these apps for any length of time is still relatively low. Objective: In this study, we aimed to determine the effect of incentives (eg, self-monitoring, social support, platform rewards, and external influence) on the use of MFAs and the moderating effect of gender on users’ continuance usage intention. Methods: The study used a mixed methods approach. Quantitative data were collected through a web-based questionnaire and qualitative data from interviews with 30 respondents. The quantitative data, collected from 379 valid responses, were processed using covariance-based structural equation modeling. The qualitative data were processed using thematic analysis. The MFAs included in this research were those used as sports or physical activity trackers, such as Apple Fitness, Strava, Nike Run Club, and Fita. Results: The results of the data analysis show that 3 groups of incentives, namely, self-monitoring, platform rewards, and external influence (with the exception of social support), affect the perceived usefulness of these apps. Gender was also shown to moderate user behavior in relation to physical activity. The study showed that women were more likely to be motivated to exercise by social and external factors, while men paid greater attention to the tracking features of the app and to challenges and rewards. Conclusions: This research contributes to the field of health promotion by providing guidance for MFA developers. %M 38837199 %R 10.2196/50957 %U https://humanfactors.jmir.org/2024/1/e50957 %U https://doi.org/10.2196/50957 %U http://www.ncbi.nlm.nih.gov/pubmed/38837199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50376 %T eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey %A Turnbull,Joanne %A Prichard,Jane %A MacLellan,Jennifer %A Pope,Catherine %+ School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, United Kingdom, 44 2380597940, j.c.turnbull@soton.ac.uk %K urgent care %K digital health %K access to health care %K eHealth %K health care system %K COVID-19 %K urgent %K emergency %K health literacy %K eHealth literacy %K digital literacy %K access %K cross-sectional %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. “Digital first” may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. Objective: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. Methods: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Results: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). Conclusions: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand. %M 38833297 %R 10.2196/50376 %U https://www.jmir.org/2024/1/e50376 %U https://doi.org/10.2196/50376 %U http://www.ncbi.nlm.nih.gov/pubmed/38833297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55714 %T Methods, Indicators, and End-User Involvement in the Evaluation of Digital Health Interventions for the Public: Scoping Review %A Weirauch,Vera %A Soehnchen,Clarissa %A Burmann,Anja %A Meister,Sven %+ Fraunhofer Institute for Software and Systems Engineering, Speicherstraße 6, Dortmund, 44147, Germany, 49 023197677329, vera.weirauch@isst.fraunhofer.de %K digital health %K digital health intervention %K public end user %K evaluation methods %K evaluation criteria %K end-user involvement %K scoping review %D 2024 %7 31.5.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) have the potential to enable public end users, such as citizens and patients, to manage and improve their health. Although the number of available DHIs is increasing, examples of successfully established DHIs in public health systems are limited. To counteract the nonuse of DHIs, they should be comprehensively evaluated while integrating end users. Unfortunately, there is a wide variability and heterogeneity according to the approaches of evaluation, which creates a methodological challenge. Objective: This scoping review aims to provide an overview of the current established processes for evaluating DHIs, including methods, indicators, and end-user involvement. The review is not limited to a specific medical field or type of DHI but offers a holistic overview. Methods: This scoping review was conducted following the JBI methodology for scoping reviews based on the framework by Arksey & O’Malley and complies with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Three scientific databases (PubMed, Scopus, and Science Direct) were searched in April 2023. English and German studies between 2008 and 2023 were considered when evaluating DHIs that explicitly address public end users. The process of study selection was carried out by several researchers to avoid reviewer bias. Results: The search strategy identified 9618 publications, of which 160 were included. Among these included articles, 200 evaluations were derived and analyzed. The results showed that there is neither a consensus on the methods to evaluate DHIs nor a commonly agreed definition or usage of the evaluated indicators, which results in a broad variety of evaluation practices. This aligns with observations of the existing literature. It was found that there is a lack of references to existing frameworks for the evaluation of DHIs. The majority of the included studies referred to user-centered approaches and involved end users in the evaluation process. As assistance for people developing and evaluating DHIs and as a basis for thinking about appropriate ways to evaluate DHIs, a results matrix was created where the findings were combined per DHI cluster. Additionally, general recommendations for the evaluators of DHIs were formulated. Conclusions: The findings of this scoping review offer a holistic overview of the variety and heterogeneity according to the approaches of evaluation of DHIs for public end users. Evaluators of these DHIs should be encouraged to reference established frameworks or measurements for justification. This would ease the transferability of the results among similar evaluation studies within the digital health sector, thereby enhancing the coherence and comparability of research in this area. %M 38819891 %R 10.2196/55714 %U https://www.jmir.org/2024/1/e55714 %U https://doi.org/10.2196/55714 %U http://www.ncbi.nlm.nih.gov/pubmed/38819891 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51695 %T How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography %A Seuren,Lucas Martinus %A Shaw,Sara %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 1 4372607372, lucas.seuren@phc.ox.ac.uk %K delivery of health care %K remote consultation %K carer %K telemedicine %K videoconferencing %K language %K linguistics %K gestures %K physiotherapy %K heart failure %K care %K patient care %K feasibility %K safety %K communication %K mobile phone %D 2024 %7 31.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient’s behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible. Objective: This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations. Methods: We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context. Results: Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties. Conclusions: Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services. %M 38819900 %R 10.2196/51695 %U https://www.jmir.org/2024/1/e51695 %U https://doi.org/10.2196/51695 %U http://www.ncbi.nlm.nih.gov/pubmed/38819900 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47996 %T Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study %A Musiimenta,Angella %A Tumuhimbise,Wilson %A Atukunda,Esther %A Mugaba,Aaron %A Linnemayr,Sebastian %A Haberer,Jessica %+ Faculty of Computing and Informatics, Mbarara University of Science and Technology, Plot 8-19 Mbarara Kabale Road, Mbarara, P.O. Box 653, Uganda, 256 776820598, amusiimenta@must.ac.ug %K digital adherence technologies %K real-time monitoring %K SMS text message reminders %K mobile money %K financial incentives %K tuberculosis %K medication adherence %K user-centered approach %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. Objective: This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. Methods: We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients’ experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. Results: All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox–based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as “being watched” while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily. Conclusions: The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care. %M 38819905 %R 10.2196/47996 %U https://humanfactors.jmir.org/2024/1/e47996 %U https://doi.org/10.2196/47996 %U http://www.ncbi.nlm.nih.gov/pubmed/38819905 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56653 %T Smartphone App Designed to Collect Health Information in Older Adults: Usability Study %A Murabito,Joanne M %A Faro,Jamie M %A Zhang,Yuankai %A DeMalia,Angelo %A Hamel,Alexander %A Agyapong,Nakesha %A Liu,Hongshan %A Schramm,Eric %A McManus,David D %A Borrelli,Belinda %+ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St Suite L-516, Boston, MA, 02118, United States, 1 508 935 3500, murabito@bu.edu %K mobile application surveys %K mixed methods %K electronic data collection %K mHealth %K mobile health %K mobile application %K mobile applications %K app %K apps %K application %K applications %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K usability %K usable %K usableness %K usefulness %K utility %K health information %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. %M 38815261 %R 10.2196/56653 %U https://humanfactors.jmir.org/2024/1/e56653 %U https://doi.org/10.2196/56653 %U http://www.ncbi.nlm.nih.gov/pubmed/38815261 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e57849 %T Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops %A So,Jeffrey Tsz Hei %A Nambiar,Smita %A Byrne,Rebecca %A Gallegos,Danielle %A Baxter,Kimberley A %+ Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, 62 Graham Street, South Brisbane, Brisbane, 4101, Australia, 61 73069 7308, jeffrey.so@hdr.qut.edu.au %K co-design %K fathers %K child nutrition %K child feeding %K intervention design %K digital delivery %K parenting %K participatory %K videoconference %K communication technology %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers’ experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. Objective: This study aims to explore fathers’ experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. Methods: Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. Results: A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation–Behavior model. The interview data illuminated factors influencing fathers’ initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers’ diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men’s caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child’s age and targeted at fathers using comprehensive promotion strategies. Conclusions: Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice. %M 38815260 %R 10.2196/57849 %U https://pediatrics.jmir.org/2024/1/e57849 %U https://doi.org/10.2196/57849 %U http://www.ncbi.nlm.nih.gov/pubmed/38815260 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e57668 %T Nurses’ Use of mHealth Apps for Chronic Conditions: Cross-Sectional Survey %A Shiyab,Wa'ed %A Rolls,Kaye %A Ferguson,Caleb %A Halcomb,Elizabeth %+ School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 42213784, weys741@uowmail.edu.au %K mHealth apps %K adoption %K smartphone %K chronic conditions %K nursing %K technology %K chronic %K nurse %K nurses %K mHealth %K mobile health %K app %K apps %K use %K cross-sectional %K survey %K surveys %K questionnaire %K questionnaires %K mobile phone %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Nursing %G English %X Background: Mobile health (mHealth) is increasingly used to support public health practice, as it has positive benefits such as enhancing self-efficacy and facilitating chronic disease management. Yet, relatively few studies have explored the use of mHealth apps among nurses, despite their important role in caring for patients with and at risk of chronic conditions. Objective: The aim of the study is to explore nurses’ use of mHealth apps to support adults with or at risk of chronic conditions and understand the factors that influence technology adoption. Methods: A web-based cross-sectional survey was conducted between September 2022 and January 2023. The survey was shared via social media and professional nursing organizations to Australian nurses caring for adults with or at risk of chronic conditions. Results: A total of 158 responses were included in the analysis. More than two-thirds (n=108, 68.4%) of respondents reported that they personally used at least 1 mHealth app. Over half (n=83, 52.5% to n=108, 68.4%) reported they use mHealth apps at least a few times a month for clinical purposes. Logistic regression demonstrated that performance expectancy (P=.04), facilitating condition (P=.05), and personal use of mHealth apps (P=.05) were significantly associated with mHealth app recommendation. In contrast, effort expectancy (P=.09) and social influence (P=.46) did not have a significant influence on whether respondents recommended mHealth apps to patients. The inability to identify the quality of mHealth apps and the lack of access to mobile devices or internet were the most common barriers to mHealth app recommendation. Conclusions: While nurses use mHealth apps personally, there is potential to increase their clinical application. Given the challenges reported in appraising and assessing mHealth apps, app regulation and upskilling nurses will help to integrate mHealth apps into usual patient care. %M 38809593 %R 10.2196/57668 %U https://nursing.jmir.org/2024/1/e57668 %U https://doi.org/10.2196/57668 %U http://www.ncbi.nlm.nih.gov/pubmed/38809593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51408 %T Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study %A Willemsen,Romy Fleur %A Chavannes,Niels Henrik %A Aardoom,Jiska Joëlle %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 615174812, r.f.willemsen@lumc.nl %K acceptability %K accessible %K adoption %K application %K design %K ehealth %K engagement %K evaluation study %K feasibility %K health app platform %K health apps %K health empowerment %K prevention %K public health %K uptake %K user-friendly %K users %K wellbeing %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform “FitKnip” was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR €1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society. Objective: The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored. Methods: This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire–8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one’s perceived level of stress by the 10-item Perceived Stress Scale (PSS-10). Results: A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform. Conclusions: A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users’ needs and preferences. This can help to increase uptake, engagement, and ultimately the platform’s adoption and effectiveness. %M 38809585 %R 10.2196/51408 %U https://formative.jmir.org/2024/1/e51408 %U https://doi.org/10.2196/51408 %U http://www.ncbi.nlm.nih.gov/pubmed/38809585 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55399 %T The Impact of Performance Expectancy, Workload, Risk, and Satisfaction on Trust in ChatGPT: Cross-Sectional Survey Analysis %A Choudhury,Avishek %A Shamszare,Hamid %+ Industrial and Management Systems Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, 321 Engineering Sciences Building, 1306 Evansdale Drive, Morgantown, WV, 26506, United States, 1 3042939431, avishek.choudhury@mail.wvu.edu %K ChatGPT %K chatbots %K health care %K health care decision-making %K health-related decision-making %K health care management %K decision-making %K user perception %K usability %K usable %K usableness %K usefulness %K artificial intelligence %K algorithms %K predictive models %K predictive analytics %K predictive system %K practical models %K deep learning %K cross-sectional survey %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: ChatGPT (OpenAI) is a powerful tool for a wide range of tasks, from entertainment and creativity to health care queries. There are potential risks and benefits associated with this technology. In the discourse concerning the deployment of ChatGPT and similar large language models, it is sensible to recommend their use primarily for tasks a human user can execute accurately. As we transition into the subsequent phase of ChatGPT deployment, establishing realistic performance expectations and understanding users’ perceptions of risk associated with its use are crucial in determining the successful integration of this artificial intelligence (AI) technology. Objective: The aim of the study is to explore how perceived workload, satisfaction, performance expectancy, and risk-benefit perception influence users’ trust in ChatGPT. Methods: A semistructured, web-based survey was conducted with 607 adults in the United States who actively use ChatGPT. The survey questions were adapted from constructs used in various models and theories such as the technology acceptance model, the theory of planned behavior, the unified theory of acceptance and use of technology, and research on trust and security in digital environments. To test our hypotheses and structural model, we used the partial least squares structural equation modeling method, a widely used approach for multivariate analysis. Results: A total of 607 people responded to our survey. A significant portion of the participants held at least a high school diploma (n=204, 33.6%), and the majority had a bachelor’s degree (n=262, 43.1%). The primary motivations for participants to use ChatGPT were for acquiring information (n=219, 36.1%), amusement (n=203, 33.4%), and addressing problems (n=135, 22.2%). Some participants used it for health-related inquiries (n=44, 7.2%), while a few others (n=6, 1%) used it for miscellaneous activities such as brainstorming, grammar verification, and blog content creation. Our model explained 64.6% of the variance in trust. Our analysis indicated a significant relationship between (1) workload and satisfaction, (2) trust and satisfaction, (3) performance expectations and trust, and (4) risk-benefit perception and trust. Conclusions: The findings underscore the importance of ensuring user-friendly design and functionality in AI-based applications to reduce workload and enhance user satisfaction, thereby increasing user trust. Future research should further explore the relationship between risk-benefit perception and trust in the context of AI chatbots. %M 38801658 %R 10.2196/55399 %U https://humanfactors.jmir.org/2024/1/e55399 %U https://doi.org/10.2196/55399 %U http://www.ncbi.nlm.nih.gov/pubmed/38801658 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e41202 %T Usability, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology-Supported Mental Health Intervention for Family Caregivers of People With Dementia: Field Usability Study %A Collins-Pisano,Caroline %A Leggett,Amanda N %A Gambee,David %A Fortuna,Karen L %+ Department of Psychology, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO, 80918, United States, 1 (719) 255 8227, ccolli20@uccs.edu %K family caregivers %K dementia %K peer support %K technology %K mobile phone %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of health care systems but face an increased risk of emotional distress and negative physical and mental health outcomes. Objective: The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, the Caregiver Remote Education and Support (CARES) smartphone or tablet app. Methods: A total of 9 adult family caregivers of people with dementia received the CARES intervention, and 3 former family caregivers of people with dementia were trained to deliver it. Quantitative data were collected at baseline and at the end of the 2-week field usability study. Qualitative data were also collected at the end of the 2-week field usability study. Results: The field usability study demonstrated that a 2-week peer-delivered and technology-supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers of people with dementia as acceptable. Current family caregivers rated CARES as above average in usability, whereas the caregiver peer supporters rated CARES as marginally usable. CARES was associated with non–statistically significant improvements in burden, stress, and strain levels. Conclusions: This field usability study demonstrated that it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current family caregivers of people with dementia. Future studies would benefit from a longer trial; a larger sample size; a randomized controlled design; and a control of covariables such as stages of dementia, years providing care, and severity of dementia symptoms. %M 38801660 %R 10.2196/41202 %U https://humanfactors.jmir.org/2024/1/e41202 %U https://doi.org/10.2196/41202 %U http://www.ncbi.nlm.nih.gov/pubmed/38801660 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51789 %T Accessibility, Relevance, and Impact of a Symptom Monitoring Tool for Home Hospice Care: Theory Elaboration and Qualitative Assessment %A Washington,Karla T %A Oliver,Debra Parker %A Donehower,Allison K %A White,Patrick %A Benson,Jacquelyn J %A Lyons,Patrick G %A Demiris,George %+ Department of Medicine, School of Medicine, Washington University in St. Louis, Mid Campus Center, 4590 Children's Place, Mailstop 90-29-931, St. Louis, MO, 63110, United States, 1 (314) 285 0905, kwashington@wustl.edu %K caregivers %K home care services %K hospice care %K signs and symptoms %K technology %K mobile phone %D 2024 %7 23.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Early users found Engagement and Visualization to Improve Symptoms in Oncology Care (ENVISION), a web-based application designed to improve home management of hospice patients’ symptoms and support patients’ and family caregivers’ well-being, to be generally useful and easy to use. However, they also raised concerns about potential challenges users with limited technological proficiency might experience. Objective: We sought to concurrently accomplish two interrelated study aims: (1) to develop a conceptual framework of digital inclusivity for health information systems and (2) to apply the framework in evaluating the digital inclusivity of the ENVISION application. Methods: We engaged ENVISION users (N=34) in a qualitative study in which data were collected via direct observation, think-aloud techniques, and responses to open-ended queries. Data were analyzed via theory elaboration and basic qualitative description. Results: Accessibility, relevance, and impact were identified as 3 essential considerations in evaluating a health system’s digital inclusivity. Study findings generally supported ENVISION’s digital inclusivity, particularly concerning its perceived relevance to the work of family caregivers and hospice clinicians and its potentially positive impact on symptom management and quality of life. Limitations to ENVISION’s digital inclusivity centered around issues of accessibility, particularly operability among individuals with limited technological knowledge and skills. Conclusions: The Accessibility, Relevance, and Impact conceptual framework of digital inclusivity for health information systems can help identify opportunities to strengthen the digital inclusivity of tools, such as ENVISION, intended for use by a broad and diverse range of users. %M 38781581 %R 10.2196/51789 %U https://humanfactors.jmir.org/2024/1/e51789 %U https://doi.org/10.2196/51789 %U http://www.ncbi.nlm.nih.gov/pubmed/38781581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50205 %T Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey %A Odebunmi,Olufeyisayo O %A Hughes,Tamera D %A Waters,Austin R %A Urick,Benjamin Y %A Herron,Caroline %A Wangen,Mary %A Rohweder,Catherine %A Ferrari,Renée M %A Marciniak,Macary W %A Wheeler,Stephanie B %A Brenner,Alison T %A Shah,Parth D %+ Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue, PO Box 19024, Seattle, WA, 98109, United States, 1 2066676120, pshah@fredhutch.org %K community pharmacy %K telehealth %K telemedicine %K telepharmacy %K pharmacy service quality %K patient willingness %K willingness %K cross-sectional %K national survey %K telehealth cost %D 2024 %7 23.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients’ willingness to use telehealth services, and we sought to investigate this. Objective: This study aims to examine respondents’ (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services. Methods: We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services. Results: Overall willingness to use telemedicine was high (674/1045, 64.5%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95% CI 1-1.02) and long travel times (OR 1.75, 95% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5% (674/1045) to 83% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95% CI 1.03-1.09) than those who did not. Conclusions: Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable. %M 38780994 %R 10.2196/50205 %U https://www.jmir.org/2024/1/e50205 %U https://doi.org/10.2196/50205 %U http://www.ncbi.nlm.nih.gov/pubmed/38780994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46151 %T Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study %A Lemos,Marta %A Henriques,Ana Rita %A Lopes,David Gil %A Mendonça,Nuno %A Victorino,André %A Costa,Andreia %A Arriaga,Miguel %A Gregório,Maria João %A de Sousa,Rute %A Canhão,Helena %A Rodrigues,Ana M %+ CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5 Edifício Amarelo, Lisboa, 1150-190, Portugal, 351 214956435 ext 27016, anarita.henriques@nms.unl.pt %K DigiAdherence %K mHealth %K mobile app %K technology %K utility %K usability %K ICT %K application %K patient-centered %K tool %K prevention %K falls %K treatment %K nutrition %K physical activity %K pilot study %K older adults %K adherence %K engagement %K compliance %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. Objective: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. Methods: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. Results: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%). Conclusions: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. International Registered Report Identifier (IRRID): RR2-10.2196/29675 %M 38758585 %R 10.2196/46151 %U https://formative.jmir.org/2024/1/e46151 %U https://doi.org/10.2196/46151 %U http://www.ncbi.nlm.nih.gov/pubmed/38758585 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50851 %T Understanding Patient Perspectives on the Use of Gamification and Incentives in mHealth Apps to Improve Medication Adherence: Qualitative Study %A Tran,Steven %A Smith,Lorraine %A Carter,Stephen %+ School of Pharmacy, Faculty of Medicine and Health, University of Sydney, A15, Science Rd, Camperdown, 2050, Australia, 61 93512222, steventran@hotmail.com.au %K qualitative %K patient %K perspectives %K gamification %K incentives %K mobile app %K mobile health %K mHealth %K medication adherence %K mobile phone %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medication nonadherence remains a significant health and economic burden in many high-income countries. Emerging smartphone interventions have started to use features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention. Objective: This qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mobile health (mHealth) apps for medication adherence in Australian patients taking medication for chronic conditions. Methods: A total of 19 participants were included in iterative semistructured web-based focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes. Results: Three themes were identified: purpose-driven design, trust-based standards, and personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Major concerns relating to gamification and financial incentives were perceived trivialization and potential for medication abuse, respectively. Conclusions: The study’s findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework. %M 38743461 %R 10.2196/50851 %U https://mhealth.jmir.org/2024/1/e50851 %U https://doi.org/10.2196/50851 %U http://www.ncbi.nlm.nih.gov/pubmed/38743461 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53691 %T Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions %A Aspelund,Anna %A Valkonen,Paula %A Viitanen,Johanna %A Rauta,Virpi %+ Department of Computer Science, Aalto University, PO Box 15400, Espoo, FI-00076, Finland, 358 504763381, anna.aspelund@aalto.fi %K usability %K UX %K user experience %K PX %K patient experience %K user-based evaluation %K patients %K eHealth %K digital health solution %K kidney disease %K home dialysis %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic kidney disease affects 10% of the population worldwide, and the number of patients receiving treatment for end-stage kidney disease is forecasted to increase. Therefore, there is a pressing need for innovative digital solutions that increase the efficiency of care and improve patients’ quality of life. The aim of the eHealth in Home Dialysis project is to create a novel eHealth solution, called eC4Me, to facilitate predialysis and home dialysis care for patients with chronic kidney disease. Objective: Our study aimed to evaluate the usability, user experience (UX), and patient experience (PX) of the first version of the eC4Me solution. Methods: We used a user-based evaluation approach involving usability testing, questionnaire, and interview methods. The test sessions were conducted remotely with 10 patients with chronic kidney disease, 5 of whom had used the solution in their home environment before the tests, while the rest were using it for the first time. Thematic analysis was used to analyze user test and questionnaire data, and descriptive statistics were calculated for the UMUX (Usability Metric for User Experience) scores. Results: Most usability problems were related to navigation, the use of terminology, and the presentation of health-related data. Despite usability challenges, UMUX ratings of the solution were positive overall. The results showed noteworthy variation in the expected benefits and perceived effort of using the solution. From a PX perspective, it is important that the solution supports patients’ own health-related goals and fits with the needs of their everyday lives with the disease. Conclusions: A user-based evaluation is a useful and necessary part of the eHealth solution development process. Our study findings can be used to improve the usability and UX of the evaluated eC4Me solution. Patients should be actively involved in the solution development process when specifying what information is relevant for them. Traditional usability tests complemented with questionnaire and interview methods can serve as a meaningful methodological approach for gaining insight not only into usability but also into UX- and PX-related aspects of digital health solutions. %M 38743476 %R 10.2196/53691 %U https://humanfactors.jmir.org/2024/1/e53691 %U https://doi.org/10.2196/53691 %U http://www.ncbi.nlm.nih.gov/pubmed/38743476 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e45115 %T Facilitators of and Barriers to the Use of a Digital Self-Management Service for Diagnostic Testing: Focus Group Study With Potential Users %A Schnoor,Kyma %A Talboom-Kamp,Esther P W A %A Hajtić,Muamer %A Chavannes,Niels H %A Versluis,Anke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, Netherlands, 31 71526 8433, k.schnoor@lumc.nl %K eHealth %K usability %K self-management %K diagnostic test service %K diagnostic %K testing %K test service %K perspective %K focus group %K user need %K user testing %K implementation %K qualitative %K test result %K laboratory test %K laboratory result %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health care lags in digital transformation, despite the potential of technology to improve the well-being of individuals. The COVID-19 pandemic has accelerated the uptake of technology in health care and increased individuals’ willingness to perform self-management using technology. A web-based service, Directlab Online, provides consumers with direct digital access to diagnostic test packages, which can digitally support the self-management of health. Objective: This study aims to identify the facilitators, barriers, and needs of Directlab Online, a self-management service for web-based access to diagnostic testing. Methods: A qualitative method was used from a potential user’s perspective. The needs and future needs for, facilitators of, and barriers to the use of Directlab Online were evaluated. Semistructured focus group meetings were conducted in 2022. Two focus groups were focused on sexually transmitted infection test packages and 2 were focused on prevention test packages. Data analysis was performed according to the principles of the Framework Method. The Consolidated Framework for Implementation Research was used to categorize the facilitators and barriers. Results: In total, 19 participants, with a mean age of 34.32 (SD 14.70) years, participated in the focus groups. Important barriers were a lack of privacy information, too much and difficult information, and a commercial appearance. Important facilitators were the right amount of information, the right kind of tests, and the involvement of a health care professional. The need for a service such as Directlab Online was to ensure its availability for users’ health and to maintain their health. Conclusions: According to the participants, facilitators and barriers were comprehension of the information, the goal of the website, and the overall appearance of the service. Although the service was developed in cocreation with health care professionals and users, the needs did not align. The users preferred understandable and adequate, but not excessive, information. In addition, they preferred other types of tests to be available on the service. For future research, it would be beneficial to focus on cocreation between the involved medical professionals and users to develop, improve, and implement a service such as Directlab Online. %M 38728071 %R 10.2196/45115 %U https://humanfactors.jmir.org/2024/1/e45115 %U https://doi.org/10.2196/45115 %U http://www.ncbi.nlm.nih.gov/pubmed/38728071 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e51601 %T Intention to Use Mobile-Based Partograph and Its Predictors Among Obstetric Health Care Providers Working at Public Referral Hospitals in the Oromia Region of Ethiopia in 2022: Cross-Sectional Questionnaire Study %A Tilahun,Kefyalew Naniye %A Adem,Jibril Bashir %A Atinafu,Wabi Temesgen %A Walle,Agmasie Damtew %A Mengestie,Nebyu Demeke %A Birhanu,Abraham Yeneneh %+ College of Medicine and Health Sciences, Ambo University, Addis Ababa, Ambo, Ethiopia, 251 922298660, kefyalewnaniye64@gmail.com %K mobile-based partograph %K mHealth %K mobile health %K cross-sectional %K questionnaire %K questionnaires %K survey %K surveys %K modified TAM %K technology acceptance model %K intention to use %K obstetric health care providers %K Ethiopia %K intent %K intention %K TAM %K experience %K experiences %K attitude %K attitudes %K opinion %K opinions %K perception %K perceptions %K perspective %K perspectives %K acceptance %K adoption %K partograph %K digital health %K health technology %K birth %K women's health %K obstetrics %K obstetric %K obstetric health care %K labor monitoring %D 2024 %7 10.5.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: A partograph is a pictorial representation of the relationship between cervical dilatation and the time used to diagnose prolonged and obstructed labor. However, the utilization of paper-based partograph is low and it is prone to documentation errors, which can be avoided with the use of electronic partographs. There is only limited information on the proportion of intention to use mobile-based partographs and its predictors. Objective: The objective of this study was to determine the proportion of obstetric health care providers at public referral hospitals in Oromia, Ethiopia, in 2022 who had the intention to use mobile-based partographs and to determine the predictors of their intention to use mobile-based partographs. Methods: We performed an institution-based cross-sectional study from June 1 to July 1, 2022. Census was conducted on 649 participants. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for descriptive analysis and AMOS (analysis of moment structure; version 23) for structural and measurement model assessment. Descriptive and structural equation modeling analyses were performed. The hypotheses developed based on a modified Technology Acceptance Model were tested using path coefficients and P values <.05. Results: About 65.7% (414/630; 95% CI 61.9%-69.4%) of the participants intended to use mobile-based electronic partographs, with a 97% (630/649) response rate. Perceived usefulness had a positive influence on intention to use (β=.184; P=.02) and attitude (β=.521; P=.002). Perceived ease of use had a positive influence on attitude (β=.382; P=.003), perceived usefulness (β=.503; P=.002), and intention to use (β=.369; P=.001). Job relevance had a positive influence on perceived usefulness (β=.408; P=.001) and intention to use (β=.185; P=.008). Attitude positively influenced intention to use (β=.309; P=.002). Subjective norms did not have a significant influence on perceived usefulness (β=.020; P=.61) and intention to use (β=–.066; P=.07). Conclusions: Two-thirds of the obstetric health care providers in our study intended to use mobile-based partographs. Perceived usefulness, perceived ease of use, job relevance, and attitude positively and significantly influenced their intention to use mobile-based electronic partographs. The development of a user-friendly mobile-based partograph that meets job and user expectations can enhance the intention to use. %M 38728079 %R 10.2196/51601 %U https://ojphi.jmir.org/2024/1/e51601 %U https://doi.org/10.2196/51601 %U http://www.ncbi.nlm.nih.gov/pubmed/38728079 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53890 %T A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study %A Rizzi,Silvia %A Poggianella,Stefania %A Pavesi,Maria Chiara %A Gios,Lorenzo %A Bincoletto,Giorgia %A Scolari,Isabella %A Paoli,Claudia %A Marroni,Debora %A Tassinari,Irene %A Baietti,Barbara %A Gianatti,Anna %A Albertini,Veronica %A Burlon,Barbara %A Chiodega,Vanda %A Endrizzi,Barbara %A Benini,Elena %A Guella,Chiara %A Gadotti,Erik %A Forti,Stefano %A Taddei,Fabrizio %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mobile health %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mindfulness based %K intervention %K pregnant women %K pregnant %K feasibility study %K well-being %K women %K quality of life %K psychological symptoms %K digital solution %K virtual coach %K smartphone %K mobile phone %D 2024 %7 10.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pregnancy is a complex time characterized by major transformations in a woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. The literature indicates that pregnant women commonly experience psychological symptoms, with anxiety, stress, and depression being among the most frequent. Hence, promoting a healthy lifestyle focused on women’s psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the need becomes evident for the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological and psychiatric disorders. Objective: This study aims to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. The primary objective is to explore the feasibility of using a virtual coach, Maia, developed within the TreC Mamma app to promote women’s psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective. Methods: This is a proof-of-concept study in which a small sample (N=50) is sufficient to achieve the intended purposes. Recruitment will occur within the group of pregnant women belonging to the pregnancy care services of the Trento Azienda Provinciale per i Servizi Sanitari di Trento. The convenience sampling method will be used. Maia will interact with the participating women for 8 weeks, starting from weeks 24 and 26 of pregnancy. Specifically, there will be 2 sessions per week, which the woman can choose, to allow more flexibility toward her needs. Results: The psychoeducational pathway is expected to lead to significant results in terms of usability and engagement in women’s interactions with Maia. Furthermore, it is anticipated that there will be improvements in psychological well-being and overall quality of life. The analysis of the data collected in this study will be mainly descriptive, orientated toward assessing the achievement of the study objectives. Conclusions: Literature has shown that women preferred web-based support during the perinatal period, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psychoeducational support for women during pregnancy. International Registered Report Identifier (IRRID): RR1-10.2196/53890 %M 38567964 %R 10.2196/53890 %U https://www.researchprotocols.org/2024/1/e53890 %U https://doi.org/10.2196/53890 %U http://www.ncbi.nlm.nih.gov/pubmed/38567964 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50826 %T Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study %A Cruz,Stefany %A Lu,Claire %A Ulloa,Mara %A Redding,Alexander %A Hester,Josiah %A Jacobs,Maia %+ Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, 633 Clark Street, Evanston, IL, 60208, United States, 1 8474913741, stefanycruz2024@u.northwestern.edu %K mHealth %K mobile health %K wearable %K wearables %K Health wearables %K COVID-19 %K digital divide %K low-socioeconomic status %K socioeconomic %K adoption %K underserved %K poverty %K low income %K low resource %K marginalized %K equity %K attitude %K attitudes %K opinion %K opinions %K perception %K perceptions %K perspective %K perspectives %K acceptance %K Spanish %K Hispanic %K Latinx %K Hispanics %K interview %K interviews %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low–socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. Objective: This study’s aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. Methods: We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Results: Through qualitative analysis, we identified 4 main themes. Participants’ perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants’ interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. Conclusions: The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices. %M 38717816 %R 10.2196/50826 %U https://mhealth.jmir.org/2024/1/e50826 %U https://doi.org/10.2196/50826 %U http://www.ncbi.nlm.nih.gov/pubmed/38717816 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52575 %T Knowledge, Skills, and Experience With Technology in Relation to Nutritional Intake and Physical Activity Among Older Adults at Risk of Falls: Semistructured Interview Study %A Kikkenborg,Julie %A Magelund,Emma %A Riise,Maria Silke %A Kayser,Lars %A Terp,Rikke %+ Section of Health Service Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark, 45 28757291, lk@sund.ku.dk %K eHealth %K self-management %K fall prevention %K older adults %K physical activity %K nutritional intake %K Readiness and Enablement Index for Health Technology %K READHY %K social support %K support %K management %K fall %K nutrition %K diet %K qualitative study %K malnutrition %K physical inactivity %K injury %K injuries %K food %K food intake %K nutritional needs %K outpatient clinic %K social network %K mobile phone %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: More than one-third of older adults (aged ≥65 y) experience falls every year. The prevalent modifiable risk factors for falling are malnutrition and physical inactivity, among others. The involvement of older adults in the prevention of falls can decrease injuries, hospitalizations, and dependency on health care professionals. In this regard, eHealth can support older adults’ self-management through more physical activity and adequate food intake. eHealth must be tailored to older adults’ needs and preferences so that they can reap its full benefits. Therefore, it is necessary to gain insight into the knowledge, skills, and mindset of older adults living at home who are at risk of falls regarding eHealth. Objective: This qualitative study aims to explore older adults’ use of everyday digital services and technology and how they acquire knowledge about and manage their nutritional intake and physical activity in relation to their health. Methods: Semistructured interviews were conducted with 15 older adults (n=9, 60% women; n=6, 40% men; age range 71-87 y) who had all experienced falls or were at risk of falling. These individuals were recruited from a geriatric outpatient clinic. The interviews were analyzed using deductive content analysis based on a modification of the Readiness and Enablement Index for Health Technology framework. Results: The qualitative data showed that the informants’ social networks had a positive impact on their self-management, use of technology, and mindset toward nutritional intake and physical activity. Although the informants generally lived active lives, they all lacked knowledge about how their food intake influenced their physical health, including their risk of falling. Another finding was the large diversity in the use of technology among the informants, which was related to their mindset toward technology. Conclusions: Older adults can use technology for everyday purposes, but some need additional introduction and support to be able to use it for managing their health. They also need to learn about the importance of proper nutritional intake and physical activity in preventing falls. Older adults need a more personalized introduction to technology, nutrition, and physical activity in their contact with health professionals. %M 38717810 %R 10.2196/52575 %U https://humanfactors.jmir.org/2024/1/e52575 %U https://doi.org/10.2196/52575 %U http://www.ncbi.nlm.nih.gov/pubmed/38717810 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55559 %T Development and Pilot-Testing of an Optimized Conversational Agent or “Chatbot” for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study %A Galea,Jerome T %A Vasquez,Diego H %A Rupani,Neil %A Gordon,Moya B %A Tapia,Milagros %A Greene,Karah Y %A Kolevic,Lenka %A Franke,Molly F %A Contreras,Carmen %+ School of Social Work, College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 1400, Tampa, FL, 33612-3807, United States, 1 813 974 2310, jeromegalea@usf.edu %K chatbot %K digital assistant %K depression %K HIV %K adolescents %D 2024 %7 7.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents living with HIV are disproportionally affected by depression, which worsens antiretroviral therapy adherence, increases viral load, and doubles the risk of mortality. Because most adolescents living with HIV live in low- and middle-income countries, few receive depression treatment due to a lack of mental health services and specialists in low-resource settings. Chatbot technology, used increasingly in health service delivery, is a promising approach for delivering low-intensity depression care to adolescents living with HIV in resource-constrained settings. Objective: The goal of this study is to develop and pilot-test for the feasibility and acceptability of a prototype, optimized conversational agent (chatbot) to provide mental health education, self-help skills, and care linkage for adolescents living with HIV. Methods: Chatbot development comprises 3 phases conducted over 2 years. In the first phase (year 1), formative research will be conducted to understand the views, opinions, and preferences of up to 48 youths aged 10-19 years (6 focus groups of up to 8 adolescents living with HIV per group), their caregivers (5 in-depth interviews), and HIV program personnel (5 in-depth interviews) regarding depression among adolescents living with HIV. We will also investigate the perceived acceptability of a mental health chatbot, including barriers and facilitators to accessing and using a chatbot for depression care by adolescents living with HIV. In the second phase (year 1), we will iteratively program a chatbot using the SmartBot360 software with successive versions (0.1, 0.2, and 0.3), meeting regularly with a Youth Advisory Board comprised of adolescents living with HIV who will guide and inform the chatbot development and content to arrive at a prototype version (version 1.0) for pilot-testing. In the third phase (year 2), we will pilot-test the prototype chatbot among 50 adolescents living with HIV naïve to its development. Participants will interact with the chatbot for up to 2 weeks, and data will be collected on the acceptability of the chatbot-delivered depression education and self-help strategies, depression knowledge changes, and intention to seek care linkage. Results: The study was awarded in April 2022, received institutional review board approval in November 2022, received funding in December 2022, and commenced recruitment in March 2023. By the completion of study phases 1 and 2, we expect our chatbot to incorporate key needs and preferences gathered from focus groups and interviews to develop the chatbot. By the completion of study phase 3, we will have assessed the feasibility and acceptability of the prototype chatbot. Study phase 3 began in April 2024. Final results are expected by January 2025 and published thereafter. Conclusions: The study will produce a prototype mental health chatbot developed with and for adolescents living with HIV that will be ready for efficacy testing in a subsequent, larger study. International Registered Report Identifier (IRRID): DERR1-10.2196/55559 %M 38713501 %R 10.2196/55559 %U https://www.researchprotocols.org/2024/1/e55559 %U https://doi.org/10.2196/55559 %U http://www.ncbi.nlm.nih.gov/pubmed/38713501 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e53596 %T User Experience of Persons Using Ingestible Sensor–Enabled Pre-Exposure Prophylaxis to Prevent HIV Infection: Cross-Sectional Survey Study %A Browne,Sara %A Umlauf,Anya %A Moore,David J %A Benson,Constance A %A Vaida,Florin %K ingestible sensor %K sensor %K sensors %K oral %K UX %K user experience %K HIV prevention %K medication adherence %K HIV %K prevention %K prophylaxis %K STI %K STD %K sexually transmitted %K sexual transmission %K drug %K drugs %K pharmacy %K pharmacies %K pharmacology %K pharmacotherapy %K pharmaceutic %K pharmaceutics %K pharmaceuticals %K pharmaceutical %K medication %K medications %K adherence %K compliance %K sexually transmitted infection %K sexually transmitted disease %D 2024 %7 3.5.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: A digital health technology’s success or failure depends on how it is received by users. Objectives: We conducted a user experience (UX) evaluation among persons who used the Food and Drug Administration–approved Digital Health Feedback System incorporating ingestible sensors (ISs) to capture medication adherence, after they were prescribed oral pre-exposure prophylaxis (PrEP) to prevent HIV infection. We performed an association analysis with baseline participant characteristics, to see if “personas” associated with positive or negative UX emerged. Methods: UX data were collected upon exit from a prospective intervention study of adults who were HIV negative, prescribed oral PrEP, and used the Digital Health Feedback System with IS-enabled tenofovir disoproxil fumarate plus emtricitabine (IS-Truvada). Baseline demographics; urine toxicology; and self-report questionnaires evaluating sleep (Pittsburgh Sleep Quality Index), self-efficacy, habitual self-control, HIV risk perception (Perceived Risk of HIV Scale 8-item), and depressive symptoms (Patient Health Questionnaire–8) were collected. Participants with ≥28 days in the study completed a Likert-scale UX questionnaire of 27 questions grouped into 4 domain categories: overall experience, ease of use, intention of future use, and perceived utility. Means and IQRs were computed for participant total and domain subscores, and linear regressions modeled baseline participant characteristics associated with UX responses. Demographic characteristics of responders versus nonresponders were compared using the Fisher exact and Wilcoxon rank-sum tests. Results: Overall, 71 participants were enrolled (age: mean 37.6, range 18-69 years; n=64, 90% male; n=55, 77% White; n=24, 34% Hispanic; n=68, 96% housed; and n=53, 75% employed). No demographic differences were observed in the 63 participants who used the intervention for ≥28 days. Participants who completed the questionnaire were more likely to be housed (52/53, 98% vs 8/10, 80%; P=.06) and less likely to have a positive urine toxicology (18/51, 35% vs 7/10, 70%; P=.08), particularly methamphetamine (4/51, 8% vs 4/10, 40%; P=.02), than noncompleters. Based on IQR values, ≥75% of participants had a favorable UX based on the total score (median 3.78, IQR 3.17-4.20), overall experience (median 4.00, IQR 3.50-4.50), ease of use (median 3.72, IQR 3.33-4.22), and perceived utility (median 3.72, IQR 3.22-4.25), and ≥50% had favorable intention of future use (median 3.80, IQR 2.80-4.40). Following multipredictor modeling, self-efficacy was significantly associated with the total score (0.822, 95% CI 0.405-1.240; P<.001) and all subscores (all P<.05). Persons with more depressive symptoms reported better perceived utility (P=.01). Poor sleep was associated with a worse overall experience (−0.07, 95% CI −0.133 to −0.006; P=.03). Conclusions: The UX among persons using IS-enabled PrEP (IS-Truvada) to prevent HIV infection was positive. Association analysis of baseline participant characteristics linked higher self-efficacy with positive UX, more depressive symptoms with higher perceived utility, and poor sleep with negative UX. Trial Registration: ClinicalTrials.gov NCT03693040; https://clinicaltrials.gov/study/NCT03693040 %R 10.2196/53596 %U https://mhealth.jmir.org/2024/1/e53596 %U https://doi.org/10.2196/53596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50385 %T An Exploration of the Goodness of Fit of Web-Based Tools for Māori: Qualitative Study Using Interviews and Focus Groups %A Donkin,Liesje %A Bidois-Putt,Marie-Claire %A Wilson,Holly %A Hayward,Penelope %A Chan,Amy Hai Yan %+ Department of Psychology and Neuroscience, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K Indigenous people %K Māori %K eHealth %K mental health %K web-based intervention %K digital intervention %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for Māori people who are tāngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of Māori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 Māori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the Māori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for Māori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao Māori (the Māori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for Māori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with Māori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of Māori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations’ world views. %M 38696236 %R 10.2196/50385 %U https://formative.jmir.org/2024/1/e50385 %U https://doi.org/10.2196/50385 %U http://www.ncbi.nlm.nih.gov/pubmed/38696236 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e50620 %T Monitoring Adolescent and Young Adult Patients With Cancer via a Smart T-Shirt: Prospective, Single-Cohort, Mixed Methods Feasibility Study (OncoSmartShirt Study) %A Steen-Olsen,Emma Balch %A Pappot,Helle %A Hjerming,Maiken %A Hanghoej,Signe %A Holländer-Mieritz,Cecilie %K smart T-shirt %K AYA %K oncology %K home monitoring %K patients' perspective %K perspective %K perspectives %K experiences %K experience %K youth %K adolescent %K adolescents %K smart %K monitoring %K biometric %K sensor %K sensors %K young adult %K young adults %K feasibility %K cancer %K cancers %K electrode %K electrodes %K adherence %K mobile phone %D 2024 %7 1.5.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Wearables that measure vital parameters can be potential tools for monitoring patients at home during cancer treatment. One type of wearable is a smart T-shirt with embedded sensors. Initially, smart T-shirts were designed to aid athletes in their performance analyses. Recently however, researchers have been investigating the use of smart T-shirts as supportive tools in health care. In general, the knowledge on the use of wearables for symptom monitoring during cancer treatment is limited, and consensus and awareness about compliance or adherence are lacking. Objectives: The aim of this study was to evaluate adherence to and experiences with using a smart T-shirt for the home monitoring of biometric sensor data among adolescent and young adult patients undergoing cancer treatment during a 2-week period. Methods: This study was a prospective, single-cohort, mixed methods feasibility study. The inclusion criteria were patients aged 18 to 39 years and those who were receiving treatment at Copenhagen University Hospital - Rigshospitalet, Denmark. Consenting patients were asked to wear the Chronolife smart T-shirt for a period of 2 weeks. The smart T-shirt had multiple sensors and electrodes, which engendered the following six measurements: electrocardiogram (ECG) measurements, thoracic respiration, abdominal respiration, thoracic impedance, physical activity (steps), and skin temperature. The primary end point was adherence, which was defined as a wear time of >8 hours per day. The patient experience was investigated via individual, semistructured telephone interviews and a paper questionnaire. Results: A total of 10 patients were included. The number of days with wear times of >8 hours during the study period (14 d) varied from 0 to 6 (mean 2 d). Further, 3 patients had a mean wear time of >8 hours during each of their days with data registration. The number of days with any data registration ranged from 0 to 10 (mean 6.4 d). The thematic analysis of interviews pointed to the following three main themes: (1) the smart T-shirt is cool but does not fit patients with cancer, (2) the technology limits the use of the smart T-shirt, and (3) the monitoring of data increases the feeling of safety. Results from the questionnaire showed that the patients generally had confidence in the device. Conclusions: Although the primary end point was not reached, the patients’ experiences with using the smart T-shirt resulted in the knowledge that patients acknowledged the need for new technologies that improve supportive cancer care. The patients were positive when asked to wear the smart T-shirt. However, technical and practical challenges in using the device resulted in low adherence. Although wearables might have potential for home monitoring, the present technology is immature for clinical use. Trial Registration: ClinicalTrials.gov NCT05235594; https://clinicaltrials.gov/study/NCT05235594 International Registered Report Identifier (IRRID): RR2-10.2196/37626 %R 10.2196/50620 %U https://mhealth.jmir.org/2024/1/e50620 %U https://doi.org/10.2196/50620 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54120 %T Community-Dwelling Older Adults’ Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study %A Ausserhofer,Dietmar %A Piccoliori,Giuliano %A Engl,Adolf %A Mahlknecht,Angelika %A Plagg,Barbara %A Barbieri,Verena %A Colletti,Nicoletta %A Lombardo,Stefano %A Gärtner,Timon %A Tappeiner,Waltraud %A Wieser,Heike %A Wiedermann,Christian Josef %+ Institute of General Medicine and Public Health, Lorenz-Böhler-Str. 13, Bolzano, 39100, Italy, 39 0471 067290, dietmar.ausserhofer@claudiana.bz.it %K frail older adults %K Italy %K Italian %K Europe %K European %K digital health %K health technologies %K health technology %K telemedicine %K telehealth %K eHealth %K e-health %K adoption %K readiness %K usage %K survey %K surveys %K questionnaire %K questionnaires %K robotics %K readiness %K adoption %K cross-sectional study %K population-based survey %K stratified probabilistic sampling %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults’ readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults’ readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7% (n=571), telemedicine by 30.1% (n=510), smartphones and texting apps by 24.5% (n=416), and assistant robots by 13.7% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ≥85 years (odds ratio [OR] 0.74, 95% CI 0.56-0.96), financial constraints (OR 0.68, 95% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95% CI 1.16-2.60), smartphones (OR 1.69, 95% CI 1.22-2.35), and the internet (OR 2.26, 95% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. %M 38687989 %R 10.2196/54120 %U https://formative.jmir.org/2024/1/e54120 %U https://doi.org/10.2196/54120 %U http://www.ncbi.nlm.nih.gov/pubmed/38687989 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50922 %T Digital Intervention (Keep-On-Keep-Up Nutrition) to Improve Nutrition in Older Adults: Protocol for a Feasibility Randomized Controlled Trial %A French,Chloe %A Burden,Sorrel %A Stanmore,Emma %+ School of Health Sciences, University of Manchester, 176 Oxford Road, Manchester, M13 9PL, United Kingdom, 44 01613067856, emma.stanmore@manchester.ac.uk %K feasibility %K usability %K digital health %K diet %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K dietary %K nutrition %K hydration %K community dwelling %K RCT %K randomized %K controlled trial %K controlled trials %D 2024 %7 30.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health tools can support behavior change and allow interventions to be scalable at a minimal cost. Keep-on-Keep-up Nutrition (KOKU-Nut) is a free, tablet-based app that focuses on increasing physical activity and improving the dietary intake of older adults based on UK guidelines. The intervention targets an important research area identified as a research priority reported by the James Lind Alliance priority setting partnership for malnutrition. Objective: This study aims to assess the feasibility of using the digital health tool KOKU-Nut among community-dwelling older adults to inform a future randomized controlled trial. The secondary aims are to determine the acceptability, usability, preliminary effect sizes, and safety of the study and the intervention (KOKU-Nut). Methods: This is a feasibility randomized controlled trial. We plan to recruit a total of 36 community-dwelling older adults using purposive sampling. Participants will be randomized 1:1 to either the intervention or the control group. The intervention group will be asked to engage with KOKU-Nut 3 times a week for 12 weeks. Participants in the control group will receive a leaflet promoting a healthy lifestyle. All study participants will complete questionnaires at baseline and the end of the 12 weeks. A sample of participants will be asked to participate in an optional interview. The study will collect a range of data including anthropometry (height and weight), dietary intake (3-day food diary), physical function (grip strength and 5-times sit-to-stand), perceived quality of life (EQ-5D), usability (System Usability Scale), and safety (adverse events). Results: Data collection commenced in March 2024, and the results will be ready for publication by January 2025. Feasibility will be determined on the basis of participants’ self-reported engagement with the intervention, and recruitment and retention rates and will be summarized descriptively. We will also consider the amount of missing data and assess how outcomes are related to group assignment. Acceptability will be measured using the modified treatment evaluation inventory and one-to-one semistructured interviews. Transcripts from the interviews will be analyzed using NVivo (version 12; QSR International) software using framework analysis to understand any barriers to the recruitment process, the suitability of the assessment measures, and the acceptability of the intervention and study design. Conclusions: The study aligns with guidelines developed by the Medical Research Council for developing a complex intervention by using qualitative and quantitative research to examine the barriers of the intervention and identify potential challenges around recruitment and retention. We anticipate that these results will inform the development of a future powered randomized controlled design trial to test the true effectiveness of KOKU-Nut. Trial Registration: ClinicalTrials.gov NCT05943366; https://classic.clinicaltrials.gov/ct2/show/NCT05943366 International Registered Report Identifier (IRRID): PRR1-10.2196/50922 %M 38687981 %R 10.2196/50922 %U https://www.researchprotocols.org/2024/1/e50922 %U https://doi.org/10.2196/50922 %U http://www.ncbi.nlm.nih.gov/pubmed/38687981 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52957 %T Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study %A Innominato,Pasquale F %A Macdonald,Jamie H %A Saxton,Wendy %A Longshaw,Laura %A Granger,Rachel %A Naja,Iman %A Allocca,Carlo %A Edwards,Ruth %A Rasheed,Solah %A Folkvord,Frans %A de Batlle,Jordi %A Ail,Rohit %A Motta,Enrico %A Bale,Catherine %A Fuller,Claire %A Mullard,Anna P %A Subbe,Christian P %A Griffiths,Dawn %A Wreglesworth,Nicholas I %A Pecchia,Leandro %A Fico,Giuseppe %A Antonini,Alessio %+ Knowledge Media Institute, The Open University, Level 4, Room 4, Berrill Building, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908 654356, alessio.antonini@open.ac.uk %K cancer %K survivorship %K artificial intelligence %K remote monitoring %K mobile health %K mHealth %K digital health %K circadian %K actigraphy %K mobile phone %D 2024 %7 30.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. Objective: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. Methods: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). Results: This study is part of an array of pilots within a European Union funded project, entitled “GATEKEEPER,” conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. Conclusions: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/52957 %M 38687985 %R 10.2196/52957 %U https://www.researchprotocols.org/2024/1/e52957 %U https://doi.org/10.2196/52957 %U http://www.ncbi.nlm.nih.gov/pubmed/38687985 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48185 %T Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study %A Olsen,Christine %A Lungu,Daniel Adrian %+ Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 51 83 10 00, daniel.a.lungu@uis.no %K app %K BMI %K diet %K exercise %K health %K Heia Meg %K lifestyle change %K longitudinal %K mHealth %K mobile health %K motivation %K nutrition %K obese %K obesity %K overweight %K physical activity %K smartphone apps %K weight %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. Objective: This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. Methods: A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. Results: The majority (159/199, 79.9%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. Conclusions: Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings. %M 38687565 %R 10.2196/48185 %U https://formative.jmir.org/2024/1/e48185 %U https://doi.org/10.2196/48185 %U http://www.ncbi.nlm.nih.gov/pubmed/38687565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51076 %T Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study %A Chen,Tzu Han %A Lee,Shin-Da %A Ma,Wei-Fen %+ PhD Program in Healthcare Science, School of Nursing, China Medical University, No 100, Sec 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, 886 4 22053366 ext 7107, lhdaisy@mail.cmu.edu.tw %K app quality %K caregiver %K dementia %K geriatrics %K aging %K technology %K digital health %K mHealth %K mobile health %K seniors %K mobile app %K patient %K adoption %K development %K management %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three– and bottom three–rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app’s perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. %M 38684083 %R 10.2196/51076 %U https://formative.jmir.org/2024/1/e51076 %U https://doi.org/10.2196/51076 %U http://www.ncbi.nlm.nih.gov/pubmed/38684083 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54581 %T Usability Comparison Among Healthy Participants of an Anthropomorphic Digital Human and a Text-Based Chatbot as a Responder to Questions on Mental Health: Randomized Controlled Trial %A Thunström,Almira Osmanovic %A Carlsen,Hanne Krage %A Ali,Lilas %A Larson,Tomas %A Hellström,Andreas %A Steingrimsson,Steinn %+ Region Västra Götaland, Psychiatric Department, Sahlgrenska University Hospital, Journalvägen 5, Gothenburg, 41650, Sweden, 46 313421000, steinn.steingrimsson@gu.se %K chatbot %K chatbots %K chat-bot %K chat-bots %K text-only chatbot, voice-only chatbot %K mental health %K mental illness %K mental disease %K mental diseases %K mental illnesses %K mental health service %K mental health services %K interface %K system usability %K usability %K digital health %K machine learning %K ML %K artificial intelligence %K AI %K algorithm %K algorithms %K NLP %K natural language processing %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of chatbots in mental health support has increased exponentially in recent years, with studies showing that they may be effective in treating mental health problems. More recently, the use of visual avatars called digital humans has been introduced. Digital humans have the capability to use facial expressions as another dimension in human-computer interactions. It is important to study the difference in emotional response and usability preferences between text-based chatbots and digital humans for interacting with mental health services. Objective: This study aims to explore to what extent a digital human interface and a text-only chatbot interface differed in usability when tested by healthy participants, using BETSY (Behavior, Emotion, Therapy System, and You) which uses 2 distinct interfaces: a digital human with anthropomorphic features and a text-only user interface. We also set out to explore how chatbot-generated conversations on mental health (specific to each interface) affected self-reported feelings and biometrics. Methods: We explored to what extent a digital human with anthropomorphic features differed from a traditional text-only chatbot regarding perception of usability through the System Usability Scale, emotional reactions through electroencephalography, and feelings of closeness. Healthy participants (n=45) were randomized to 2 groups that used a digital human with anthropomorphic features (n=25) or a text-only chatbot with no such features (n=20). The groups were compared by linear regression analysis and t tests. Results: No differences were observed between the text-only and digital human groups regarding demographic features. The mean System Usability Scale score was 75.34 (SD 10.01; range 57-90) for the text-only chatbot versus 64.80 (SD 14.14; range 40-90) for the digital human interface. Both groups scored their respective chatbot interfaces as average or above average in usability. Women were more likely to report feeling annoyed by BETSY. Conclusions: The text-only chatbot was perceived as significantly more user-friendly than the digital human, although there were no significant differences in electroencephalography measurements. Male participants exhibited lower levels of annoyance with both interfaces, contrary to previously reported findings. %M 38683664 %R 10.2196/54581 %U https://humanfactors.jmir.org/2024/1/e54581 %U https://doi.org/10.2196/54581 %U http://www.ncbi.nlm.nih.gov/pubmed/38683664 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50234 %T Developing Social Enhancements for a Web-Based, Positive Emotion Intervention for Alzheimer Disease Caregivers: Qualitative Focus Group and Interview Study %A Kwok,Ian %A Lattie,Emily Gardiner %A Yang,Dershung %A Summers,Amanda %A Cotten,Paul %A Leong,Caroline Alina %A Moskowitz,Judith Tedlie %+ Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 323 364 1160, iankwok@u.northwestern.edu %K Alzheimer disease %K dementia %K caregiving %K eHealth %K web-based interventions %K positive emotion %K stress %K coping %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of these responsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychological outcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being among dementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the format required significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed to develop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for social connection. Objective: The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention. In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features (eg, discussion board, automated support, and profiles) to maximize engagement among participants. Methods: Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previous version of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had not previously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted a qualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented in a way that would be best received by caregivers. Results: Interview and focus group feedback indicated that participants generally liked the potential features suggested, including the discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation. For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the duration of the study. However, they expressed concern about differing expectations among caregivers and the possibility of matched caregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, which would allow them to review additional content when they wished. Conclusions: Taken together, the discussions with caregivers and providers offered unique insights into the types of social features that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve the acceptability of the features among caregivers. These insights will allow us to design social features for the intervention that are optimally engaging and helpful for caregivers. %M 38662432 %R 10.2196/50234 %U https://formative.jmir.org/2024/1/e50234 %U https://doi.org/10.2196/50234 %U http://www.ncbi.nlm.nih.gov/pubmed/38662432 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49982 %T Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study %A Giebel,Godwin Denk %A Abels,Carina %A Plescher,Felix %A Speckemeier,Christian %A Schrader,Nils Frederik %A Börchers,Kirstin %A Wasem,Jürgen %A Neusser,Silke %A Blase,Nikola %+ Institute for Health Care Management and Research, Universität Duisburg-Essen, Weststadt-Carree, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 20118 ext 33180, godwin.giebel@medman.uni-due.de %K mobile health %K mHealth %K mHealth app %K patient %K problems %K barriers %K digital health applications %K DiGA %K app %K barrier %K mobile app %K health care system %K economic outcome %K context %K mobile phone %D 2024 %7 23.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. Objective: The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. Methods: Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories (“validity,” “usability,” “technology,” “use and adherence,” “data privacy and security,” “patient-physician relationship,” “knowledge and skills,” “individuality,” “implementation,” and “costs”) identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. Results: A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. Conclusions: There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients. %M 38652508 %R 10.2196/49982 %U https://www.jmir.org/2024/1/e49982 %U https://doi.org/10.2196/49982 %U http://www.ncbi.nlm.nih.gov/pubmed/38652508 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50219 %T Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study %A Bults,Marloes %A van Leersum,Catharina Margaretha %A Olthuis,Theodorus Johannes Josef %A Siebrand,Egbert %A Malik,Zohrah %A Liu,Lili %A Miguel-Cruz,Antonio %A Jukema,Jan Seerp %A den Ouden,Marjolein Elisabeth Maria %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, M H Tromplaan 28 Enschede, Enschede, 7513 AB, Netherlands, 31 620946213, m.bults@saxion.nl %K assistive technology %K technology acceptance %K immigrant %K dementia %K marginalized older adults %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. Objective: This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. Methods: This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. Results: All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Conclusions: Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one’s home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance. %M 38639994 %R 10.2196/50219 %U https://aging.jmir.org/2024/1/e50219 %U https://doi.org/10.2196/50219 %U http://www.ncbi.nlm.nih.gov/pubmed/38639994 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e47992 %T Health Care Workers’ Expectations of the Mercury Advance SMARTcare Solution to Prevent Pressure Injuries: Individual and Focus Group Interview Study %A Slob,Joeri %A van Houwelingen,Thijs %A Kort,Helianthe S M %+ Research Group Technology for Healthcare Innovations, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 641097762, thijs.vanhouwelingen@hu.nl %K digital technology %K pressure injury %K health care professionals %K mobile phone %K health care workers %D 2024 %7 18.4.2024 %9 Original Paper %J JMIR Nursing %G English %X Background: The transformation in global demography and the shortage of health care workers require innovation and efficiency in the field of health care. Digital technology can help improve the efficiency of health care. The Mercury Advance SMARTcare solution is an example of digital technology. The system is connected to a hybrid mattress and is able to detect patient movement, based on which the air pump either starts automatically or sends a notification to the app. Barriers to the adoption of the system are unknown, and it is unclear if the solution will be able to support health care workers in their work. Objective: This study aims to gain insight into health care workers’ expectations of factors that could either hamper or support the adoption of the Mercury Advance SMARTcare unit connected to a Mercury Advance mattress to help prevent patients from developing pressure injuries in hospitals and long-term care facilities. Methods: We conducted a generic qualitative study from February to December 2022. Interviews were conducted, and a focus group was established using an interview guide of health care workers from both the United Kingdom and the Netherlands. Thematic analysis was performed by 2 independent researchers. Results: A total of 14 participants took part in the study: 6 (43%) participants joined the focus group, and 8 (57%) participants took part in the individual interviews. We identified 13 factors based on four themes: (1) factors specifically related to SMARTresponse, (2) vision on innovation, (3) match with health care activities, and (4) materials and resources involved. Signaling function, SMARTresponse as prevention, patient category, representatives, and implementation strategy were identified as facilitators. Perception of patient repositioning, accessibility to pressure injury aids, and connectivity were identified as barriers. Conclusions: Several conditions must be met to enhance the adoption of the Mercury Advance SMARTcare solution, including the engagement of representatives during training and a reliable wireless network. The identified factors can be used to facilitate the implementation process. %M 38635323 %R 10.2196/47992 %U https://nursing.jmir.org/2024/1/e47992 %U https://doi.org/10.2196/47992 %U http://www.ncbi.nlm.nih.gov/pubmed/38635323 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54172 %T A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops %A McCallum,Claire %A Campbell,Miglena %A Vines,John %A Rapley,Tim %A Ellis,Jason %A Deary,Vincent %A Hackett,Katie %+ Department of Social Work, Education and Community Wellbeing, Northumbria University, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA, United Kingdom, 44 191 215 6098, kate.hackett@northumbria.ac.uk %K self-management %K mobile health %K mHealth %K eHealth %K Sjögren's syndrome %K patient participation %K patient involvement %K fatigue %K chronic disease %K focus groups %K complex intervention development %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sjögren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. Objective: We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. Methods: We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. Results: Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. Conclusions: An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users’ limitations may support users in their interactions with others and improve engagement in symptom management strategies. For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities. %M 38630530 %R 10.2196/54172 %U https://humanfactors.jmir.org/2024/1/e54172 %U https://doi.org/10.2196/54172 %U http://www.ncbi.nlm.nih.gov/pubmed/38630530 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48793 %T User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study %A Wahl,Kate J %A Brooks,Melissa %A Trenaman,Logan %A Desjardins-Lorimer,Kirsten %A Bell,Carolyn M %A Chokmorova,Nazgul %A Segall,Romy %A Syring,Janelle %A Williams,Aleyah %A Li,Linda C %A Norman,Wendy V %A Munro,Sarah %+ Department of Obstetrics and Gynecology, University of British Columbia, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada, 1 4165231923, kate.wahl@cw.bc.ca %K family planning %K abortion %K shared decision-making %K patient decision aid %K qualitative %K evaluation %K Canada %K health equity %D 2024 %7 16.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive—there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers’ decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (“patient” participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. %M 38625731 %R 10.2196/48793 %U https://www.jmir.org/2024/1/e48793 %U https://doi.org/10.2196/48793 %U http://www.ncbi.nlm.nih.gov/pubmed/38625731 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51518 %T Assessing Differences in mHealth Usability and App Experiences Among Young African American Women: Secondary Analysis of a Randomized Controlled Trial %A Opper,Claudia A %A Browne,Felicia A %A Howard,Brittni N %A Zule,William A %A Wechsberg,Wendee M %+ RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, United States, 1 919 541 6596, fbrowne@rti.org %K HIV %K Black women %K mobile apps %K social determinants of health %K prevention %K substance use %K usability %D 2024 %7 16.4.2024 %9 Short Paper %J JMIR Hum Factors %G English %X Background: In North Carolina, HIV continues to disproportionately affect young African American women. Although mobile health (mHealth) technology appears to be a tool capable of making public health information more accessible for key populations, previous technology use and social determinants may impact users’ mHealth experiences. Objective: The objective of this study was to evaluate mHealth usability, assessing differences based on previous technology use and social determinants among a sample of African American women in emerging adulthood. Methods: As part of a National Institute on Drug Abuse–funded randomized controlled trial with African American women (aged 18-25 years), counties were assigned to receive an evidence-based HIV risk reduction intervention through mHealth and participants were asked to complete usability surveys at 6- and 12-month follow-ups. Participants’ first survey responses were analyzed through 2-tailed t tests and linear regression models to examine associations with previous technology use and social determinants (P<.05). Results: The mean System Usability Scale (SUS) score was 69.2 (SD 17.9; n=159), which was higher than the threshold of acceptability (68.0). Participants who had previously used a tablet indicated higher usability compared to participants without previous use (mean 72.9, SD 18.1 vs mean 57.6, SD 11.4; P<.001), and participants with previous smartphone use also reported higher usability compared to participants without previous use (mean 71.9, SD 18.3 vs mean 58.0, SD 10.7; P<.001). Differences in SUS scores were observed among those reporting homelessness (mean 58.3, SD 19.0 vs mean 70.8, SD 17.2; P=.01), unemployment (mean 65.9, SD 17.2 vs mean 71.6, SD 18.1; P=.04), or current school enrollment (mean 73.2, SD 18.5 vs mean 65.4, SD 16.5; P=.006). Statistically significant associations were not observed for food insecurity (mean 67.3, SD 18.6 vs mean 69.9, SD 17.7; P=.45). Conclusions: Although above-average usability was observed overall, these findings demonstrate differences in mHealth usability based on past and current life experiences. As mHealth interventions become more prevalent, these findings may have important implications for ensuring that mHealth apps improve the reach of evidence-based interventions. Trial Registration: ClinicalTrials.gov NCT02965014; https://clinicaltrials.gov/study/NCT02965014 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5796-8 %M 38625721 %R 10.2196/51518 %U https://humanfactors.jmir.org/2024/1/e51518 %U https://doi.org/10.2196/51518 %U http://www.ncbi.nlm.nih.gov/pubmed/38625721 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54214 %T Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach %A Sobrinho,Andressa Crystine da Silva %A Gomes,Grace Angelica de Oliveira %A Bueno Júnior,Carlos Roberto %+ Faculty of Medicine of the University of São Paulo, Bandeirantes Avenue 9000, Ribeirão Preto, 14055-230, Brazil, 55 16988155152, andressa.sobrinho@usp.br %K information and communications technologies %K ICTs %K health care %K digital inclusion %K focus groups %K health promotion %K user %K usability %K health literacy %K digital competencies %K digital skills %K mobile phone %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirão Prêto, São Paulo, Brazil, and involved 20 older adults of both genders who were aged ≥60 years and enrolled in the Physical Education Program for the Elderly at the University of São Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. %M 38619865 %R 10.2196/54214 %U https://formative.jmir.org/2024/1/e54214 %U https://doi.org/10.2196/54214 %U http://www.ncbi.nlm.nih.gov/pubmed/38619865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49993 %T Lessons From the Field From a Volunteer Telehealth Ambassador Program to Enhance Video Visits Among Low-Income Patients: Qualitative Improvement Study %A Tuot,Delphine S %A Mukherjee,Aarya %A Churape,Amanda %A DeFries,Triveni %A Su,George %A Khoong,Elaine C %A Lyles,Courtney %+ Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 6282068242, Delphine.tuot@ucsf.edu %K digital barriers %K digital support %K digital technologies %K equity %K health care delivery %K safety-net %K telehealth %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of telehealth video use across the United States is uneven, with low uptake in safety-net health care delivery systems, which care for patient populations who face barriers to using digital technologies. Objective: This study aimed to increase video visit use in an urban safety-net delivery system. We piloted a telehealth ambassador program, in which volunteers offered technical support to patients with access to digital technologies to convert primary care visits already scheduled as telehealth audio-only visits to telehealth video visits. Methods: We used a descriptive approach to assess the feasibility, efficacy, and acceptability of the pilot telehealth ambassador program. Feasibility was quantified by the percentage of eligible patients who answered calls from telehealth ambassadors. Program efficacy was measured in two ways: (1) the percentage of patients with access to digital technology who interacted with the navigators and were successfully prepared for a telehealth video visit, and (2) the percentage of prepared patients who completed their scheduled video visits. Program acceptability was ascertained by a structured telephone survey. Results: Telehealth ambassadors attempted to contact 776 eligible patients; 43.6% (338/776) were reached by phone, among whom 44.4% (150/338) were provided digital support between March and May 2021. The mean call duration was 8.8 (range 0-35) minutes. Overall, 67.3% (101/150) of patients who received support successfully completed a telehealth video visit with their provider. Among the 188 patients who were contacted but declined video visit digital support, 61% (114/188) provided a reason for their decline; 42% (48/114) did not see added value beyond a telehealth audio-only visit, 20% (23/114) had insufficient internet access, and 27% (31/114) declined learning about a new technology. The acceptability of the telehealth ambassador program was generally favorable, although some patients preferred having in-real-time technology support on the day of their telehealth video visit. Conclusions: This high-touch program reached approximately one-half of eligible patients and helped two-thirds of interested patients with basic video visit capability successfully complete a video visit. Increasing the program’s reach will require outreach solutions that do not rely solely on phone calls. Routinely highlighting the benefits of video visits, partnering with community-based organizations to overcome structural barriers to telehealth use, and offering in-real-time technology support will help increase the program’s efficacy. %M 38619874 %R 10.2196/49993 %U https://formative.jmir.org/2024/1/e49993 %U https://doi.org/10.2196/49993 %U http://www.ncbi.nlm.nih.gov/pubmed/38619874 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49751 %T Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review %A Lyzwinski,Lynnette Nathalie %A Elgendi,Mohamed %A Menon,Carlo %+ Menrva Research Group, School of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, 250-13450 102 Avenue, Metro Vancouver, Vancouver, BC, V3T 0A3, Canada, 1 778 302 1151, lnl2@sfu.ca %K acceptability %K addict %K addiction %K addictions %K app %K app-based %K application %K applications %K apps %K barrier %K barriers %K challenge %K challenges %K messaging %K mHealth %K mobile health %K monitoring %K opioid %K opioids %K overdose %K overdosing %K pharmacology %K review methodology %K review methods %K scoping %K sensor %K sensors %K SMS %K substance abuse %K substance use %K text message %K wearable technology %K wearable %K wearables %D 2024 %7 11.4.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions. Objective: This study aims to synthesize qualitative insights into opioid users’ acceptability and perceived efficacy of mHealth and wearable technologies for opioid use disorder. Methods: A scoping review of PubMed (MEDLINE) and Google Scholar databases was conducted to identify research on opioid user perspectives concerning mHealth-assisted interventions, including wearable sensors, SMS text messaging, and app-based technology. Results: Overall, users demonstrate a high willingness to engage with mHealth interventions to prevent overdose-related deaths and manage opioid use. Users perceive mHealth as an opportunity to access care and desire the involvement of trusted health care professionals in these technologies. User comfort with wearing opioid sensors emerged as a significant factor. Personally tailored content, social support, and encouragement are preferred by users. Privacy concerns and limited access to technology pose barriers to care. Conclusions: To maximize benefits and minimize risks for users, it is crucial to implement robust privacy measures, provide comprehensive user training, integrate behavior change techniques, offer professional and peer support, deliver tailored messages, incorporate behavior change theories, assess readiness for change, design stigma-reducing apps, use visual elements, and conduct user-focused research for effective opioid management in mHealth interventions. mHealth demonstrates considerable potential as a tool for addressing opioid use disorder and preventing overdose-related deaths, given the high acceptability and perceived benefits reported by users. %M 38602751 %R 10.2196/49751 %U https://mhealth.jmir.org/2024/1/e49751 %U https://doi.org/10.2196/49751 %U http://www.ncbi.nlm.nih.gov/pubmed/38602751 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48783 %T Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey %A Choi,Soyoung %+ Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 272 Freer Hall, 906 S. Goodwin Ave, Urbana, IL, 61801, United States, 1 2173332573, soyoung@illinois.edu %K college students %K personal health data %K self-tracking %K eHealth literacy %K well-being %K tracking %K students %K disability %K cross-sectional survey %K pediatric care %K adult care %K smartphone health app %K application %K literacy %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: College students with disabilities need to transition from pediatric-centered care to adult care. However, they may become overwhelmed by multiple responsibilities, such as academic activities, peer relationships, career preparation, job seeking, independent living, as well as managing their health and promoting healthy behaviors. Objective: As the use of smartphones and wearable devices for collecting personal health data becomes popular, this study aimed to compare the characteristics of self-tracking health practices between college students with disabilities and their counterparts. In addition, this study examined the relationships between disability status, self-tracking health practices, eHealth literacy, and subjective well-being among college students. Methods: The web-based questionnaire was designed using Qualtrics for the cross-sectional online survey. The survey data were collected from February 2023 to April 2023 and included responses from 702 participants. Results: More than 80% (563/702, 80.2%) of the respondents participated voluntarily in self-tracking health practices. College students with disabilities (n=83) showed significantly lower levels of eHealth literacy and subjective well-being compared with college students without disabilities (n=619). The group with disabilities reported significantly lower satisfaction (t411=–5.97, P<.001) and perceived efficacy (t411=–4.85, P<.001) when using smartphone health apps and wearable devices. Finally, the study identified a significant correlation between subjective well-being in college students and disability status (β=3.81, P<.001), self-tracking health practices (β=2.22, P=.03), and eHealth literacy (β=24.29, P<.001). Conclusions: Given the significant relationships among disability status, self-tracking health practices, eHealth literacy, and subjective well-being in college students, it is recommended to examine their ability to leverage digital technology for self-care. Offering learning opportunities to enhance eHealth literacy and self-tracking health strategies within campus environments could be a strategic approach to improve the quality of life and well-being of college students. %M 38598285 %R 10.2196/48783 %U https://formative.jmir.org/2024/1/e48783 %U https://doi.org/10.2196/48783 %U http://www.ncbi.nlm.nih.gov/pubmed/38598285 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56143 %T Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study %A Detsomboonrat,Palinee %A Pisarnturakit,Pagaporn Pantuwadee %+ Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Road, Patumwan, Bangkok, 10330, Thailand, 66 22188545, pagaporn.p@chula.ac.th %K capability %K health survey %K oral health %K mobile apps %K personal health information %K PHI %K satisfaction %K tooth %K teeth %K oral %K dental %K dentist %K dentistry %K data entry %K data collection %K mHealth %K mobile health %K app %K apps %K applications %K periodontal %K survey %K questionnaire %K questionnaires %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information. Objective: This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app. Methods: There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients’ information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction. Results: Of the 103 dental records on DMFT and CPI, 5.2% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28). Conclusions: The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app. %M 38598287 %R 10.2196/56143 %U https://formative.jmir.org/2024/1/e56143 %U https://doi.org/10.2196/56143 %U http://www.ncbi.nlm.nih.gov/pubmed/38598287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48144 %T Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study %A Mabetha,Khuthala %A Soepnel,Larske M %A Mabena,Gugulethu %A Motlhatlhedi,Molebogeng %A Nyati,Lukhanyo %A Norris,Shane A %A Draper,Catherine E %+ South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa, 27 011 717 2382, khuthala.mabetha@wits.ac.za %K mobile technologies %K health promotion %K mixed methods %K clinical practice %K mobile phone %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice. %M 38588527 %R 10.2196/48144 %U https://formative.jmir.org/2024/1/e48144 %U https://doi.org/10.2196/48144 %U http://www.ncbi.nlm.nih.gov/pubmed/38588527 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54658 %T Understanding Adolescents’ Experiences With Menstrual Pain to Inform the User-Centered Design of a Mindfulness-Based App: Mixed Methods Investigation Study %A Gagnon,Michelle M %A Brilz,Alexandra R %A Alberts,Nicole M %A Gordon,Jennifer L %A Risling,Tracie L %A Stinson,Jennifer N %+ Department of Psychology and Health Studies, University of Saskatchewan, 9 Campus Drive, Arts 154, Saskatoon, SK, S7N5A2, Canada, 1 306 966 2052, michelle.gagnon@usask.ca %K adolescent health %K endometriosis %K pain management, biopsychosocial %K women’s health %K dysmenorrhea %K thematic analysis %K mHealth %K mobile health %K app %K apps %K applications %K applications %K attitude %K attitudes %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K interest %K intent %K intention %K survey %K surveys %K focus group %K focus groups %K content analysis %K mindfulness %K meditation %K menstrual %K menstruation %K experience %K experiences %K pain %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Digital interventions are increasingly popular for the provision of nonpharmacological pain interventions, but few exist for adolescents with menstrual pain. User-centered design involves incorporating users across phases of digital health intervention design, development, and implementation and leads to improved user engagement and outcomes. A needs assessment is the first step of this approach. Objective: The goal of this study was to conduct a needs assessment to understand menstrual pain management needs and preferences and mindfulness experiences, preferences, and knowledge of adolescents with menstrual pain to inform the future development of an app for managing menstrual pain. Methods: We used an explanatory sequential mixed method design that included a survey followed by focus groups. Adolescents aged 13-17 years completed a survey (n=111) and participated in focus groups (n=16). Data were analyzed using descriptive statistics and thematic content analysis and synthesized to provide specific recommendations based on adolescent responses. Results: Adolescents (n=111) who completed the survey reported a moderate understanding of mindfulness and menstrual pain. Over three-quarters (n=87, 78%) of participants practiced some form of mindfulness and 87% (n=97) of survey participants used nonpharmacological pain management strategies. Teens had a moderate perception that mindfulness could help their menstrual pain (mean 4.51/10, SD 2.45, with higher scores suggesting more interest). Themes were generated related to mindfulness experiences, menstrual pain knowledge and experiences, and app functionality. These themes underscored adolescents’ need for continued support and flexible access to mindfulness activities; their awareness of multiple influences to pain, with potential for further education in this area; and the need for menstrual pain–specific content, along with content relevant to typical day-to-day experiences of adolescents. Conclusions: Adolescents with menstrual pain have an interest in using a mindfulness app for pain but have unique needs that need to be addressed to ensure app engagement and relevance for this population. Concrete recommendations for future app development are provided. %M 38587886 %R 10.2196/54658 %U https://pediatrics.jmir.org/2024/1/e54658 %U https://doi.org/10.2196/54658 %U http://www.ncbi.nlm.nih.gov/pubmed/38587886 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52179 %T Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review %A Moorthy,Preetha %A Weinert,Lina %A Schüttler,Christina %A Svensson,Laura %A Sedlmayr,Brita %A Müller,Julia %A Nagel,Till %+ Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 8078, preetha.moorthy@medma.uni-heidelberg.de %K wearables %K mobile health %K mHealth %K mobile phone %K usability methods %K usability attributes %K evaluation frameworks %K health care %D 2024 %7 5.4.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users’ acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential. Objective: This study aims to identify studies that have incorporated wearable devices and determine their frequency of use in conjunction with mHealth apps or their combination. Specifically, this study aims to understand the attributes and evaluation techniques used to evaluate usability in the health care domain for these technologies and their combinations. Methods: We conducted an extensive search across 4 electronic databases, spanning the last 30 years up to December 2021. Studies including the keywords “wearable devices,” “mobile apps,” “mHealth apps,” “physiological data,” “usability,” “user experience,” and “user evaluation” were considered for inclusion. A team of 5 reviewers screened the collected publications and charted the features based on the research questions. Subsequently, we categorized these characteristics following existing usability and wearable taxonomies. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Results: A total of 382 reports were identified from the search strategy, and 68 articles were included. Most of the studies (57/68, 84%) involved the simultaneous use of wearables and connected mobile apps. Wrist-worn commercial consumer devices such as wristbands were the most prevalent, accounting for 66% (45/68) of the wearables identified in our review. Approximately half of the data from the medical domain (32/68, 47%) focused on studies involving participants with chronic illnesses or disorders. Overall, 29 usability attributes were identified, and 5 attributes were frequently used for evaluation: satisfaction (34/68, 50%), ease of use (27/68, 40%), user experience (16/68, 24%), perceived usefulness (18/68, 26%), and effectiveness (15/68, 22%). Only 10% (7/68) of the studies used a user- or human-centered design paradigm for usability evaluation. Conclusions: Our scoping review identified the types and categories of wearable devices and mHealth apps, their frequency of use in studies, and their implementation in the medical context. In addition, we examined the usability evaluation of these technologies: methods, attributes, and frameworks. Within the array of available wearables and mHealth apps, health care providers encounter the challenge of selecting devices and companion apps that are effective, user-friendly, and compatible with user interactions. The current gap in usability and user experience in health care research limits our understanding of the strengths and limitations of wearable technologies and their companion apps. Additional research is necessary to overcome these limitations. %M 38578671 %R 10.2196/52179 %U https://mhealth.jmir.org/2024/1/e52179 %U https://doi.org/10.2196/52179 %U http://www.ncbi.nlm.nih.gov/pubmed/38578671 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54386 %T The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study %A van den Berg,Liselot N %A Hallensleben,Cynthia %A Vlug,Lisa AE %A Chavannes,Niels H %A Versluis,Anke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 71 526 57 61, L.N.van_den_Berg@lumc.nl %K asthma %K short-acting beta2-agonist %K SABA overuse %K app %K eHealth %K feasibility %K usability %K mobile phone %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication—specifically, short-acting beta2-agonist (SABA) overuse—is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. Objective: This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. Methods: A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. Results: The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; β=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. Conclusions: The initial findings regarding the app’s feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices. %M 38574348 %R 10.2196/54386 %U https://humanfactors.jmir.org/2024/1/e54386 %U https://doi.org/10.2196/54386 %U http://www.ncbi.nlm.nih.gov/pubmed/38574348 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51522 %T Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing %A Adler,Rachel F %A Baez,Kevin %A Morales,Paulina %A Sotelo,Jocelyn %A Victorson,David %A Magasi,Susan %+ School of Information Sciences, University of Illinois Urbana-Champaign, 501 E. Daniel St., Champaign, IL, 61820, United States, 1 217 244 4192, radler@illinois.edu %K mobile health %K mHealth %K apps %K usability %K cancer survivors %K accessibility %K disabilities %K cancer %K oncology %K heuristics %K empowerment %K advocacy %K mindfulness %K problem-solving %D 2024 %7 2.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. Objective: Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. Methods: We evaluated the prototype using Nielsen’s 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). Results: The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app’s design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. Conclusions: Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone. %M 38564261 %R 10.2196/51522 %U https://humanfactors.jmir.org/2024/1/e51522 %U https://doi.org/10.2196/51522 %U http://www.ncbi.nlm.nih.gov/pubmed/38564261 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55742 %T User Friendliness and Perioperative Guidance Benefits of a Cataract Surgery Education App: Randomized Controlled Trial %A Gerbutavicius,Rokas %A Merle,David A %A Wolf,Armin %A Dimopoulos,Spyridon %A Kortuem,Karsten Ulrich %A Kortuem,Friederike Charlotte %+ Department for Ophthalmology, University of Tuebingen, Elfriede-Aulhorn-Str.7, Tuebingen, 72076, Germany, 49 70712988088, rokas.gerbutavicius@med.uni-tuebingen.de %K mHealth %K mobile health %K workflow optimization %K patient satisfaction %K health education %K educational background %K phacoemulsification %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients. Objective: This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment. Methods: All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the “Patient Journey” app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed. Results: Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily. Conclusions: The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally. %M 38551619 %R 10.2196/55742 %U https://formative.jmir.org/2024/1/e55742 %U https://doi.org/10.2196/55742 %U http://www.ncbi.nlm.nih.gov/pubmed/38551619 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55199 %T Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study %A He,Yunfan %A Zhu,Wei %A Wang,Tong %A Chen,Han %A Xin,Junyi %A Liu,Yongcheng %A Lei,Jianbo %A Liang,Jun %+ Department of AI and IT, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Shangcheng District, Hangzhou, 310000, China, 86 571 87783942, junl@zju.edu.cn %K hypertension management %K mobile health %K topic modeling %K satisfaction %K 2-factor model %K comparative study %D 2024 %7 28.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. Objective: This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. Methods: The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. Results: We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73%) compared with that for American HMAs (73,907/100,125, 73.81%). Chinese users primarily focus on reliability (2165/16,561, 13.07%) and measurement accuracy (2091/16,561, 12.63%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26%) and data synchronization (12,837/100,125, 12.82%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD (β=.354, P<.001), while cost had the most significant impact on ND (β=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD (β=0.312, P<.001), while data synchronization had the most significant impact on ND (β=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. Conclusions: User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements. %M 38547475 %R 10.2196/55199 %U https://mhealth.jmir.org/2024/1/e55199 %U https://doi.org/10.2196/55199 %U http://www.ncbi.nlm.nih.gov/pubmed/38547475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54073 %T Adapting mHealth Interventions (PrEPmate and DOT Diary) to Support PrEP Retention in Care and Adherence Among English and Spanish-Speaking Men Who Have Sex With Men and Transgender Women in the United States: Formative Work and Pilot Randomized Trial %A Liu,Albert Y %A Alleyne,Cat-Dancing %A Doblecki-Lewis,Susanne %A Koester,Kimberly A %A Gonzalez,Rafael %A Vinson,Janie %A Scott,Hyman %A Buchbinder,Susan %A Torres,Thiago S %+ Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, United States, 1 628 217 7408, albert.liu@sfdph.org %K preexposure prophylaxis %K PrEP %K Spanish-speaking %K Latino %K transgender %K men who have sex with men %K mobile health %K mHealth %K HIV prevention %K HIV %K technology %K formative %K development %K mobile technology, mobile app %K text-messaging %K SMS %K app %K application %K USA %K United States %K health equity %K mHealth tool %K tool %K acceptability %K self-management %K pilot %K support %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing number of mobile health (mHealth) technologies are being developed to support HIV preexposure prophylaxis (PrEP) adherence and persistence; however, most tools have focused on men who have sex with men (MSM), and few are available in Spanish. To maximize the potential impact of these tools in reducing gender and racial/ethnic disparities and promoting health equity, mHealth tools tailored to Spanish-speaking people and transgender women are critically needed. Objective: The aim of this study is to adapt and tailor 2 mHealth technologies, PrEPmate and DOT Diary, to support daily PrEP adherence and persistence among Spanish-speaking MSM and English- and Spanish-speaking transgender women and to evaluate the feasibility and acceptability of these tools. Methods: PrEPmate, an interactive, bidirectional, text messaging intervention that promotes personalized communication between PrEP users and providers, and DOT Diary, a mobile app that promotes self-management of PrEP use and sexual health through an integrated electronic pill-taking and sexual activity diary, were previously developed for English-speaking MSM. We conducted 3 focus groups with 15 English- and Spanish-speaking transgender women and MSM in San Francisco and Miami to culturally tailor these tools for these priority populations. We then conducted a 1-month technical pilot among 21 participants to assess the usability and acceptability of the adapted interventions and optimize the functionality of these tools. Results: Participants in focus groups liked the “human touch” of text messages in PrEPmate and thought it would be helpful for scheduling appointments and asking questions. They liked the daily reminder messages, especially the fun facts, gender affirmations, and transgender history topics. Participants recommended changes to tailor the language and messages for Spanish-speaking and transgender populations. For DOT Diary, participants liked the adherence tracking and protection level feedback and thought the calendar functions were easy to use. Based on participant recommendations, we tailored language within the app for Spanish-speaking MSM and transgender women, simplified the sexual diary, and added motivational badges. In the technical pilot of the refined tools, mean System Usability Scale scores were 81.2/100 for PrEPmate and 76.4/100 for DOT Diary (P=.48), falling in the “good” to “excellent” range, and mean Client Satisfaction Questionnaire scores were 28.6 and 28.3 for PrEPmate and DOT Diary, respectively (maximum possible score=32). Use of both tools was high over the 1-month pilot (average of 10.5 messages received from each participant for PrEPmate; average of 17.6 times accessing the DOT Diary app), indicating good feasibility for both tools. Conclusions: Using a user-centered design approach, we culturally tailored PrEPmate and DOT Diary to support daily PrEP use among Spanish-speaking MSM and English- and Spanish-speaking transgender women. Our positive findings in a technical pilot support further testing of these mHealth interventions in an upcoming comparative effectiveness trial. %M 38536232 %R 10.2196/54073 %U https://formative.jmir.org/2024/1/e54073 %U https://doi.org/10.2196/54073 %U http://www.ncbi.nlm.nih.gov/pubmed/38536232 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50337 %T Assessment of the Barriers and Enablers of the Use of mHealth Systems in Sub-Saharan Africa According to the Perceptions of Patients, Physicians, and Health Care Executives in Ethiopia: Qualitative Study %A Aboye,Genet Tadese %A Simegn,Gizeaddis Lamesgin %A Aerts,Jean-Marie %+ M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, kasteelpark Arenberg 30, Leuven, 3001, Belgium, 32 489304866, genettadese.aboye@kuleuven.be %K barriers %K chronic disease %K digital health %K eHealth %K enablers %K health care %K mHealth %K mobile health %K perspectives %K Sub-Saharan Africa %D 2024 %7 27.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies are increasingly being used to deliver health care services and promote public health. Mobile wireless technologies or mobile health (mHealth) technologies are particularly relevant owing to their ease of use, broad reach, and wide acceptance. Unlike developed countries, Sub-Saharan Africa experiences more challenges and obstacles when it comes to deploying, using, and expanding mHealth systems. In addition to barriers, there are enabling factors that could be exploited for the design, implementation, and scaling up of mHealth systems. Sub-Saharan Africa may require tailored solutions that address the specific challenges facing the region. Objective: The overall aim of this study was to identify the barriers and enablers for using mHealth systems in Sub-Saharan Africa from the perspectives of patients, physicians, and health care executives. Methods: Multi-level and multi-actor in-depth semistructured interviews were employed to qualitatively explore the barriers and enablers of the use of mHealth systems. Data were collected from patients, physicians, and health care executives. The interviews were audio recorded, transcribed verbatim, translated, and coded. Thematic analysis methodology was adopted, and NVivo software was used for the data analysis. Results: Through this rigorous study, a total of 137 determinants were identified. Of these determinants, 68 were identified as barriers and 69 were identified as enablers. Perceived barriers in patients included lack of awareness about mHealth systems and language barriers. Perceived enablers in patients included need for automated tools for health monitoring and an increasing literacy level of the society. According to physicians, barriers included lack of available digital health systems in the local context and concern about patients’ mHealth capabilities, while enablers included the perceived usefulness in reducing workload and improving health care service quality, as well as the availability of mobile devices and the internet. As perceived by health care executives, barriers included competing priorities alongside digitalization in the health sector and lack of interoperability and complete digitalization of implemented digital health systems, while enablers included the perceived usefulness of digitalization for the survival of the highly overloaded health care system and the abundance of educated manpower specializing in technology. Conclusions: mHealth systems in Sub-Saharan Africa are hindered and facilitated by various factors. Common barriers and enablers were identified by patients, physicians, and health care executives. To promote uptake, all relevant stakeholders must actively mitigate the barriers. This study identified a promising outlook for mHealth in Sub-Saharan Africa, despite the present barriers. Opportunities exist for successful integration into health care systems, and a user-centered design is crucial for maximum uptake. %M 38536231 %R 10.2196/50337 %U https://www.jmir.org/2024/1/e50337 %U https://doi.org/10.2196/50337 %U http://www.ncbi.nlm.nih.gov/pubmed/38536231 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49501 %T Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study %A Paul,Lorna %A Thomson,Katie %A Asibey,Shadrack Osei %A Brady,Marian %A van Wijck,Frederike %A Antwi,Derrick %A Opoku,Eric Nkansah %A Sarfo,Fred Stephen %+ School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 01413318108, Lorna.Paul@gcu.ac.uk %K telerehabilitation %K low- to middle-income country %K LMIC %K service user %K health care professional %K qualitative study %K caregiver %K neurorehabilitation %K barriers %K facilitators %K eHealth %K focus group %K thematic analysis %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. Objective: This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. Methods: Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. Results: Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. Conclusions: Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required. %M 38536218 %R 10.2196/49501 %U https://mhealth.jmir.org/2024/1/e49501 %U https://doi.org/10.2196/49501 %U http://www.ncbi.nlm.nih.gov/pubmed/38536218 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51236 %T Patient Engagement With and Perspectives on a Mobile Health Home Spirometry Intervention: Mixed Methods Study %A Liu,Andrew W %A Brown, III,William %A Madu,Ndubuisi E %A Maiorano,Ali R %A Bigazzi,Olivia %A Medina,Eli %A Sorric,Christopher %A Hays,Steven R %A Odisho,Anobel Y %+ Center for Digital Health Innovation, University of California, 1700 Owens St 541, San Francisco, CA, 94158, United States, 1 415 353 7171, anobel.odisho@ucsf.edu %K mobile health %K mHealth %K remote patient monitoring %K interview %K interviews %K dropout %K attrition %K eHealth %K methods %K telemedicine %K statistics %K numerical data %K patient-centered care %K spirometry %K lung transplant %K lung %K transplant %K transplants %K transplantation %K organ %K organs %K engagement %K monitor %K monitoring %K pulmonary %K respiratory %K lungs %K experience %K experiences %K device %K devices %K complication %K complications %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patient engagement attrition in mobile health (mHealth) remote patient monitoring (RPM) programs decreases program benefits. Systemic disparities lead to inequities in RPM adoption and use. There is an urgent need to understand patients’ experiences with RPM in the real world, especially for patients who have stopped using the programs, as addressing issues faced by patients can increase the value of mHealth for patients and subsequently decrease attrition. Objective: This study sought to understand patient engagement and experiences in an RPM mHealth intervention in lung transplant recipients. Methods: Between May 4, 2020, and November 1, 2022, a total of 601 lung transplant recipients were enrolled in an mHealth RPM intervention to monitor lung function. The predictors of patient engagement were evaluated using multivariable logistic and linear regression. Semistructured interviews were conducted with 6 of 39 patients who had engaged in the first month but stopped using the program, and common themes were identified. Results: Patients who underwent transplant more than 1 year before enrollment in the program had 84% lower odds of engaging (odds ratio [OR] 0.16, 95% CI 0.07-0.35), 82% lower odds of submitting pulmonary function measurements (OR 0.18, 95% CI 0.09-0.33), and 78% lower odds of completing symptom checklists (OR 0.22, 95% CI 0.10-0.43). Patients whose primary language was not English had 78% lower odds of engaging compared to English speakers (OR 0.22, 95% CI 0.07-0.67). Interviews revealed 4 prominent themes: challenges with devices, communication breakdowns, a desire for more personal interactions and specific feedback with the care team about their results, understanding the purpose of the chat, and understanding how their data are used. Conclusions: Care delivery and patient experiences with RPM in lung transplant mHealth can be improved and made more equitable by tailoring outreach and enhancements toward non-English speakers and patients with a longer time between transplant and enrollment. Attention to designing programs to provide personalization through supplementary provider contact, education, and information transparency may decrease attrition rates. %M 38506896 %R 10.2196/51236 %U https://mhealth.jmir.org/2024/1/e51236 %U https://doi.org/10.2196/51236 %U http://www.ncbi.nlm.nih.gov/pubmed/38506896 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49808 %T A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study %A Veneman,Tim %A Koopman,Fieke Sophia %A Oorschot,Sander %A Koomen,Pien G %A Nollet,Frans %A Voorn,Eric L %+ Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 56 64421, e.l.voorn@amsterdamumc.nl %K neuromuscular disorders %K endurance training %K home-based exercise %K eHealth %K tele-rehabilitation %K app %K exercise %K aerobic exercise %K mhealth %K mobile app %K neuromuscular disease %K usability %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). Objective: We aimed to determine the usability of the ReVi app. Methods: Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. Results: Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70%) and physiotherapists (n=6, 60%) were satisfied with the use of the app. The median attendance rate was 88% (IQR 63%-98%), with 76% (IQR 69%-82%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. Conclusions: The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice. %M 38488838 %R 10.2196/49808 %U https://humanfactors.jmir.org/2024/1/e49808 %U https://doi.org/10.2196/49808 %U http://www.ncbi.nlm.nih.gov/pubmed/38488838 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52048 %T Usability and Acceptability of a Conversational Agent Health Education App (Nthabi) for Young Women in Lesotho: Quantitative Study %A Nkabane-Nkholongo,Elizabeth %A Mpata-Mokgatle,Mathildah %A Jack,Brian W %A Julce,Clevanne %A Bickmore,Timothy %+ School of Public Health, Sefako Makgatho Health Sciences University, Motlalegi Street, Garankuwa, Pretoria, 0208, South Africa, 27 (012) 521 5759 ext 012, elizabeth.nkholongo@gmail.com %K preconception care %K conversational agent technology %K women’s health education %K mHealth adaptation %K health information technology %K health education in Africa %K education %K women's health %K women %K woman %K health information %K young women %K survey %K usability %K acceptability %K application %K applications %K app %K health promotion %D 2024 %7 12.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Young women in Lesotho face myriad sexual and reproductive health problems. There is little time to provide health education to women in low-resource settings with critical shortages of human resources for health. Objective: This study aims to determine the acceptability and usability of a conversational agent system, the Nthabi health promotion app, which was culturally adapted for use in Lesotho. Methods: We conducted a descriptive quantitative study, using a 22-item Likert scale survey to assess the perceptions of the usability and acceptability of 172 young women aged 18-28 years in rural districts of Lesotho, who used the system on either smartphones or tablets for up to 6 weeks. Descriptive statistics were used to calculate the averages and frequencies of the variables. χ2 tests were used to determine any associations among variables. Results: A total of 138 participants were enrolled and completed the survey. The mean age was 22 years, most were unmarried, 56 (40.6%) participants had completed high school, 39 (28.3%) participants were unemployed, and 88 (63.8%) participants were students. Respondents believed the app was helpful, with 134 (97.1%) participants strongly agreeing or agreeing that the app was “effective in helping them make decisions” and “could quickly improve health education and counselling.” In addition, 136 (98.5%) participants strongly agreed or agreed that the app was “simple to use,” 130 (94.2 %) participants reported that Nthabi could “easily repeat words that were not well understood,” and 128 (92.7%) participants reported that the app “could quickly load the information on the screen.” Respondents were generally satisfied with the app, with 132 (95.6%) participants strongly agreeing or agreeing that the health education content delivered by the app was “well organised and delivered in a timely way,” while 133 (96.4%) participants “enjoyed using the interface.” They were satisfied with the cultural adaptation, with 133 (96.4%) participants strongly agreeing or agreeing that the app was “culturally appropriate and that it could be easily shared with a family or community members.” They also reported that Nthabi was worthwhile, with 127 (92%) participants reporting that they strongly agreed or agreed that they were “satisfied with the application and intended to continue using it,” while 135 (97.8%) participants would “encourage others to use it.” Participants aged 18-24 years (vs those aged 25-28 years) agreed that the “Nthabi app was simple to use” (106/106, 100% vs 30/32, 98.8%; P=.01), and agreed that “the educational content was well organised and delivered in a timely way” (104/106, 98.1% vs 28/32, 87.5%; P=.01). Conclusions: These results support further study of conversational agent systems as alternatives to traditional face-to-face provision of health education services in Lesotho, where there are critical shortages of human resources for health. Trial Registration: ClinicalTrials.gov NCT04354168; https://www.clinicaltrials.gov/study/NCT04354168 %M 38470460 %R 10.2196/52048 %U https://humanfactors.jmir.org/2024/1/e52048 %U https://doi.org/10.2196/52048 %U http://www.ncbi.nlm.nih.gov/pubmed/38470460 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48986 %T The Roles of Trust in Government and Sense of Community in the COVID-19 Contact Tracing Privacy Calculus: Mixed Method Study Using a 2-Wave Survey and In-Depth Interviews %A Kang,Hyunjin %A Lee,Jeong Kyu %A Lee,Edmund WJ %A Toh,Cindy %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, 65 69083431, hjkang@ntu.edu.sg %K COVID-19 %K contact tracing technology %K privacy calculus %K trust in government %K sense of community %K mixed method %K mobile phone %D 2024 %7 7.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Contact tracing technology has been adopted in many countries to aid in identifying, evaluating, and handling individuals who have had contact with those infected with COVID-19. Singapore was among the countries that actively implemented the government-led contact tracing program known as TraceTogether. Despite the benefits the contact tracing program could provide to individuals and the community, privacy issues were a significant barrier to individuals’ acceptance of the program. Objective: Building on the privacy calculus model, this study investigates how the perceptions of the 2 key groups (ie, government and community members) involved in the digital contact tracing factor into individuals’ privacy calculus of digital contact tracing. Methods: Using a mixed method approach, we conducted (1) a 2-wave survey (n=674) and (2) in-depth interviews (n=12) with TraceTogether users in Singapore. Using structural equation modeling, this study investigated how trust in the government and the sense of community exhibited by individuals during the early stage of implementation (time 1) predicted privacy concerns, perceived benefits, and future use intentions, measured after the program was fully implemented (time 2). Expanding on the survey results, this study conducted one-on-one interviews to gain in-depth insights into the privacy considerations involved in digital contact tracing. Results: The results from the survey showed that trust in the government increased perceived benefits while decreasing privacy concerns regarding the use of TraceTogether. Furthermore, individuals who felt a connection to community members by participating in the program (ie, the sense of community) were more inclined to believe in its benefits. The sense of community also played a moderating role in the influence of government trust on perceived benefits. Follow-up in-depth interviews highlighted that having a sense of control over information and transparency in the government’s data management were crucial factors in privacy considerations. The interviews also highlighted surveillance as the most prevalent aspect of privacy concerns regarding TraceTogether use. In addition, our findings revealed that trust in the government, particularly the perceived transparency of government actions, was most strongly associated with concerns regarding the secondary use of data. Conclusions: Using a mixed method approach involving a 2-wave survey and in-depth interview data, we expanded our understanding of privacy decisions and the privacy calculus in the context of digital contact tracing. The opposite influences of privacy concerns and perceived benefit on use intention suggest that the privacy calculus in TraceTogether might be viewed as a rational process of weighing between privacy risks and use benefits to make an uptake decision. However, our study demonstrated that existing perceptions toward the provider and the government in the contact tracing context, as well as the perception of the community triggered by TraceTogether use, may bias user appraisals of privacy risks and the benefits of contact tracing. %M 38451602 %R 10.2196/48986 %U https://mhealth.jmir.org/2024/1/e48986 %U https://doi.org/10.2196/48986 %U http://www.ncbi.nlm.nih.gov/pubmed/38451602 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50926 %T Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking %A Anders,Carolin %A Moorthy,Preetha %A Svensson,Laura %A Müller,Julia %A Heinze,Oliver %A Knaup,Petra %A Wallwiener,Markus %A Deutsch,Thomas M %A Le,Thao-Vy %A Weinert,Lina %+ Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156 ext 34651, Carolin.Anders@med.uni-heidelberg.de %K mobile health %K mHealth %K usability %K breast cancer %K eye tracking %K user interface %K mixed methods %K mobile phone %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app’s content regularly, and self-administration. In contrast to the app’s current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients’ feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. %M 38441959 %R 10.2196/50926 %U https://humanfactors.jmir.org/2024/1/e50926 %U https://doi.org/10.2196/50926 %U http://www.ncbi.nlm.nih.gov/pubmed/38441959 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49492 %T Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility %A Zheng,Amy %A Bergh,Marissa %A Patel Murali,Komal %A Sadarangani,Tina %+ New York University Rory Meyers College of Nursing, 433 First Avenue, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, msb7677@nyu.edu %K adult day services %K primary health care %K health communication %K dementia %K mobile health %K mHealth %K community-based %K health care %K older adults %K older adult %K chronic condition %K health information %K feasibility %K acceptability %K CareMOBI %K mixed methods design %K caregivers %K caregiver %K care workers %K nurses %K social workers %D 2024 %7 1.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users’ health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting. %M 38427418 %R 10.2196/49492 %U https://formative.jmir.org/2024/1/e49492 %U https://doi.org/10.2196/49492 %U http://www.ncbi.nlm.nih.gov/pubmed/38427418 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38803 %T Use Intention and User Expectations of Human-Supported and Self-Help eHealth Interventions: Internet-Based Randomized Controlled Trial %A Cohen Rodrigues,Talia R %A Reijnders,Thomas %A Breeman,Linda D %A Janssen,Veronica R %A Kraaijenhagen,Roderik A %A Atsma,Douwe E %A Evers,Andrea WM %+ Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 71 527 3627, t.r.cohen.rodrigues@fsw.leidenuniv.nl %K eHealth %K human support %K Unified Theory of Acceptance and Use of Technology %K use intention %K UTAUT %K working alliance %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-help eHealth interventions provide automated support to change health behaviors without any further human assistance. The main advantage of self-help eHealth interventions is that they have the potential to lower the workload of health care professionals. However, one disadvantage is that they generally have a lower uptake. Possibly, the absence of a relationship with a health care professional (referred to as the working alliance) could lead to negative expectations that hinder the uptake of self-help interventions. The Unified Theory of Acceptance and Use of Technology (UTAUT) identifies which expectations predict use intention. As there has been no previous research exploring how expectations affect the adoption of both self-help and human-supported eHealth interventions, this study is the first to investigate the impact of expectations on the uptake of both kinds of eHealth interventions. Objective: This study investigated the intention to use a self-help eHealth intervention compared to a human-supported eHealth intervention and the expectations that moderate this relationship. Methods: A total of 146 participants were randomly assigned to 1 of 2 conditions (human-supported or self-help eHealth interventions). Participants evaluated screenshots of a human-supported or self-help app–based stress intervention. We measured intention to use the intervention-expected working alliance and the UTAUT constructs: performance expectancy, effort expectancy, and social influence. Results: Use intention did not differ significantly between the 2 conditions (t142=–1.133; P=.26). Performance expectancy (F1,140=69.269; P<.001), effort expectancy (F1,140=3.961; P=.049), social influence (F1,140=90.025; P<.001), and expected working alliance (F1,140=26.435; P<.001) were positively related to use intention regardless of condition. The interaction analysis showed that performance expectancy (F1,140=4.363; P=.04) and effort expectancy (F1,140=4.102; P=.045) more strongly influenced use intention in the self-help condition compared to the human-supported condition. Conclusions: As we found no difference in use intention, our results suggest that we could expect an equal uptake of self-help eHealth interventions and human-supported ones. However, attention should be paid to people who have doubts about the intervention’s helpfulness or ease of use. For those people, providing additional human support would be beneficial to ensure uptake. Screening user expectations could help health care professionals optimize self-help eHealth intervention uptake in practice. Trial Registration: OSF Registries osf.io/n47cz; https://osf.io/n47cz %M 38358784 %R 10.2196/38803 %U https://formative.jmir.org/2024/1/e38803 %U https://doi.org/10.2196/38803 %U http://www.ncbi.nlm.nih.gov/pubmed/38358784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50839 %T mHealth App Usability Questionnaire for Stand-Alone mHealth Apps Used by Health Care Providers: Canadian French Translation, Cross-Cultural Adaptation, and Validation (Part 1) %A Gagnon,Julie %A Probst,Sebastian %A Chartrand,Julie %A Lalonde,Michelle %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8L1, Canada, 1 613 562 5700, jgagn156@uottawa.ca %K cross-cultural adaptation %K French language %K mHealth App Usability Questionnaire %K MAUQ %K mobile health %K mHealth %K mobile app %K questionnaire translation %K usability %K validation %K health care providers %K French translation %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An increasing number of health care professionals are using mobile apps. The mHealth App Usability Questionnaire (MAUQ) was designed to evaluate the usability of mobile health apps by patients and providers. However, this questionnaire is not available in French. Objective: This study aims to translate (from English to Canadian French), cross-culturally adapt, and initiate the validation of the original version of MAUQ for stand-alone mobile health apps used by French-speaking health care providers. Methods: A cross-cultural research study using a well-established method was conducted to translate MAUQ to Canadian French by certified translators and subsequently review it with a translation committee. It was then back translated to English. The back translations were compared with the original by the members of the committee to reach consensus regarding the prefinal version. A pilot test of the prefinal version was conducted with a sample of 49 potential users and 10 experts for content validation. Results: The statements are considered clear, with interrater agreement of 99.14% among potential users and 90% among experts. Of 21 statements, 5 (24%) did not exceed the 80% interrater agreement of the experts regarding clarity. Following the revisions, interrater agreement exceeded 80%. The content validity index of the items varied from 0.90 to 1, and the overall content validity index was 0.981. Individual Fleiss multirater κ of each item was between 0.89 and 1, showing excellent agreement and increasing confidence in the questionnaire’s content validity. Conclusions: This process of translation and cultural adaptation produced a new version of MAUQ that was validated for later use among the Canadian French–speaking population. An upcoming separate study will investigate the psychometric properties of the adapted questionnaire. %M 38349710 %R 10.2196/50839 %U https://formative.jmir.org/2024/1/e50839 %U https://doi.org/10.2196/50839 %U http://www.ncbi.nlm.nih.gov/pubmed/38349710 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47472 %T Investigating the Integration and the Long-Term Use of Smart Speakers in Older Adults’ Daily Practices: Qualitative Study %A Chang,Fangyuan %A Sheng,Lin %A Gu,Zhenyu %+ Interaction Design Lab, School of Design, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China, 86 13167232872, zygu@sjtu.edu.cn %K smart speaker %K private home %K older adults %K long-term use %K daily practices %K smart speakers %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As smart speakers become more popular, there have been an increasing number of studies on how they may benefit older adults or how older adults perceive them. Despite the increasing ownership rates of smart speakers among older adults, studies that examine their integration and the long-term use in older adults’ daily practices are scarce. Objective: This study aims to uncover the integration of smart speakers into the daily practices of older adults over the long term, contributing to an in-depth understanding of maintained technology use among this demographic. Methods: To achieve these objectives, the study interviewed 20 older adults who had been using smart speakers for over 6 months. These semistructured interviews enabled participants to share their insights and experiences regarding the maintained use of smart speakers in the long term. Results: We identified 4 dimensions of the long-term use of smart speakers among older adults, including functional integration, spatial integration, cognitive integration, and semantic integration. For the functional integration of smart speakers, the study reported different types of use, including entertainment, information collection, medication reminders, companionship, environment modification, and emergency calls. For the spatial integration of smart speakers, the study showed older adults’ agency in defining, changing, and reshaping daily practices through the spatial organization of smart speakers. For the cognitive integration of smart speakers, the findings showed the cognitive processes involved in adapting to and incorporating smart speakers into daily habits and routines. For the semantic integration of smart speakers, the findings revealed that older adults’ enjoyable user experience and strong bonds with the device contributed to their acceptance of occasional functional errors. Finally, the study proposed several suggestions for designers and developers to better design smart speakers that promote maintainable use behaviors among older adults. Conclusions: On the basis of the findings, this study highlighted the importance of understanding how older adults use smart speakers and the practices through which they integrate them into their daily routines. The findings suggest that smart speakers can provide significant benefits for older adults, including increased convenience and improved quality of life. However, to promote maintainable use behaviors, designers and developers should consider more about the technology use contexts and the specific needs and preferences of older adults when designing these devices. %M 38345844 %R 10.2196/47472 %U https://mhealth.jmir.org/2024/1/e47472 %U https://doi.org/10.2196/47472 %U http://www.ncbi.nlm.nih.gov/pubmed/38345844 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51057 %T Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study %A Robertson,Michael C %A Cox-Martin,Emily %A Basen-Engquist,Karen %A Lyons,Elizabeth J %+ Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Pkwy #400, Oklahoma City, OK, 73104, United States, 1 405 271 6872, michael-robertson@ouhsc.edu %K survivors of cancer %K exercise %K acceptance and commitment therapy %K fatigue %K mindfulness %K motivation %K behavioral sciences %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. Objective: The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. Methods: Of the intervention’s 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants’ written responses. They assessed each comment’s depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants’ (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. Results: Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=−1.04, SE 0.50, 95% CI −0.06 to −2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04). Conclusions: We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy. %M 38335025 %R 10.2196/51057 %U https://mhealth.jmir.org/2024/1/e51057 %U https://doi.org/10.2196/51057 %U http://www.ncbi.nlm.nih.gov/pubmed/38335025 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50196 %T A Smartphone Food Record App Developed for the Dutch National Food Consumption Survey: Relative Validity Study %A Ocké,Marga %A Dinnissen,Ceciel Simone %A van den Bogaard,Coline %A Beukers,Marja %A Drijvers,José %A Sanderman-Nawijn,Eline %A van Rossum,Caroline %A Toxopeus,Ido %+ National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, Netherlands, 31 088 689 8989, ceciel.dinnissen@rivm.nl %K relative validity %K smartphone food record %K 24-hour dietary recall %K mobile app %K national food consumption surveys %K smartphone %K food %K food consumption %K app %K diet %K dietary intake %K nutrients %K survey %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the Dutch National Food Consumption Survey, dietary intake has been assessed since 2003 through 24-hour dietary recalls using the GloboDiet software. A new self-administered smartphone food record app called DitEetIk! was developed for potential use in future surveys. Objective: This study aims to evaluate the data collected using the DitEetIk! app and its relative validity for food group, energy, and nutrient intake compared with the previous dietary assessment method (GloboDiet 24-hour dietary recalls). Methods: A total of 300 participants aged 18 to 79 years were recruited from a consumer panel. Participants were asked to keep a record of their consumption using the DitEetIk! app on 3 nonconsecutive days. Trained dietitians conducted a 24-hour dietary recall interview by telephone using the GloboDiet software (International Agency for Research on Cancer) regarding 1 of 3 DitEetIk! recording days. Nutrient intake was calculated using the NEVO database (version 2021/7.0). Relative validity was studied by comparing data from GloboDiet 24-hour dietary recalls and the DitEetIk app for the same day. Participants with implausible records, defined as days with energy intake of <0.6 or >3.0 basal metabolic rate, were excluded from the analyses. For 19 food groups and 29 nutrients, differences in median intake were assessed using the Wilcoxon signed rank test, and Spearman correlation coefficients were calculated. Bland-Altman plots with mean differences and 95% limits of agreement were created for energy intake and the contribution to energy intake from fat, carbohydrates, and protein. Results: A total of 227 participants completed a combination of a DitEetIk! app recording day and a 24-hour dietary recall interview for the same day. Of this group, 211 participants (n=104, 49.3% men and n=107, 50.7% women) had plausible recording days. Of all recorded food items, 12.8% (114/894) were entered via food barcode scanning, and 18.9% (169/894) were searched at the brand level. For 31% (5/16) of the food groups, the median intake assessed using the DitEetIk! app was >10% lower than that assessed using 24-hour dietary recalls; this was the case for fruit (P=.005), added fats (P=.001), milk and milk products (P=.02), cereal products (P=.01), and sauces (P<.001). This was also the case for 14% (4/29) of the nutrients (all P<.001). Regarding mean intake, differences were generally smaller. Regarding energy intake, the mean difference and 95% limits of agreement were 14 kcal (−1096 to 1124). Spearman correlation coefficients between intake assessed using the DitEetIk! app and 24-hour dietary recalls ranged from 0.48 to 0.88 (median 0.78) for food groups and from 0.58 to 0.90 (median 0.72) for nutrients. Conclusions: Compared with GloboDiet 24-hour dietary recalls, the DitEetIk! app assessed similar mean energy intake levels but somewhat lower median intake levels for several food groups and nutrients. %M 38335009 %R 10.2196/50196 %U https://mhealth.jmir.org/2024/1/e50196 %U https://doi.org/10.2196/50196 %U http://www.ncbi.nlm.nih.gov/pubmed/38335009 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48526 %T User Perception of Smart Home Surveillance Among Adults Aged 50 Years and Older: Scoping Review %A Percy Campbell,Jessica %A Buchan,Jacob %A Chu,Charlene H %A Bianchi,Andria %A Hoey,Jesse %A Khan,Shehroz S %+ Institute of Biomedical Engineering, University of Toronto, Rosebrugh Bldg, 164 College St, Toronto, ON, M5S 3G9, Canada, 1 4169787459, shehroz.khan@uhn.ca %K smart homes %K privacy %K surveillance %K ambient assisted living %K smart speakers %K Internet of Things %K sensors %K sensor %K smart home %K perception %K perceptions %K elderly %K older adult %K older adults %K review methods %K review methodology %K home monitoring %K security %K safety %K ageing %K ageing-in-place %K integrative review %K integrative reviews %D 2024 %7 9.2.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Smart home technology (SHT) can be useful for aging in place or health-related purposes. However, surveillance studies have highlighted ethical issues with SHTs, including user privacy, security, and autonomy. Objective: As digital technology is most often designed for younger adults, this review summarizes perceptions of SHTs among users aged 50 years and older to explore their understanding of privacy, the purpose of data collection, risks and benefits, and safety. Methods: Through an integrative review, we explored community-dwelling adults’ (aged 50 years and older) perceptions of SHTs based on research questions under 4 nonmutually exclusive themes: privacy, the purpose of data collection, risk and benefits, and safety. We searched 1860 titles and abstracts from Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, and IEEE Xplore or IET Electronic Library, resulting in 15 included studies. Results: The 15 studies explored user perception of smart speakers, motion sensors, or home monitoring systems. A total of 13 (87%) studies discussed user privacy concerns regarding data collection and access. A total of 4 (27%) studies explored user knowledge of data collection purposes, 7 (47%) studies featured risk-related concerns such as data breaches and third-party misuse alongside benefits such as convenience, and 9 (60%) studies reported user enthusiasm about the potential for home safety. Conclusions: Due to the growing size of aging populations and advances in technological capabilities, regulators and designers should focus on user concerns by supporting higher levels of agency regarding data collection, use, and disclosure and by bolstering organizational accountability. This way, relevant privacy regulation and SHT design can better support user safety while diminishing potential risks to privacy, security, autonomy, or discriminatory outcomes. %M 38335026 %R 10.2196/48526 %U https://mhealth.jmir.org/2024/1/e48526 %U https://doi.org/10.2196/48526 %U http://www.ncbi.nlm.nih.gov/pubmed/38335026 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55700 %T Physical Activity Intervention for Urban Black Women With Asthma: Protocol for a Randomized Controlled Efficacy Study %A Davis,Ellen %A Townsend,Elizabeth %A Cavalier,Aero %A Chen,Yi-Fan %A Edwards-Hart,Dameka %A Kitsiou,Spyros %A Kowalczyk,Wiktoria %A Mansur,Iliana %A Okpara,Ebere %A Powell,Karen %A Press,Valerie G %A Ramirez,Toni %A Salvo,Deborah %A Sharp,Lisa K %A Wright,Brittani %A Nyenhuis,Sharmilee Maria %+ Section of Allergy and Immunology, Department of Pediatrics, University of Chicago, 5837 S Maryland Ave, Chicago, IL, 60637, United States, 1 7738347121, snyenhuis@bsd.uchicago.edu %K asthma %K physical activity %K lifestyle %K Black women %D 2024 %7 7.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black women experience a higher prevalence of poor asthma outcomes and physical inactivity than their White counterparts. Black women comprise a particularly vulnerable group of patients with asthma, with some of the highest rates of asthma in adults, high health care use (emergency department visits and hospitalizations), and the highest crude asthma mortality rate of all race or ethnicity groups. Despite recommendations to engage in regular physical activity, fewer than 15% of Black women meet the 2008 National Physical Activity Guidelines, the lowest of all racial subgroups of adults. Given the connection between physical inactivity and poor asthma outcomes, addressing physical activity among Black women with asthma is imperative. Objective: This 2-arm randomized controlled trial aims to (1) determine the efficacy of a lifestyle walking intervention on asthma control compared to an education (control) group over 24 weeks, (2) examine the maintenance effects of the lifestyle walking intervention on asthma control at 48 weeks, (3) explore the behavioral mediators (eg, self-efficacy, social support, self-regulation, and daily physical activity levels) and contextual moderators (eg, baseline asthma severity, neighborhood environment, comorbid conditions, and social determinants of health) that contribute to treatment responsiveness, and (4) assess the reach and implementation potential of the intervention. Methods: The proposed study (ACTION [A Lifestyle Physical Activity Intervention for Minority Women with Asthma]) delivers a 24-week lifestyle walking intervention designed for and by urban Black women with asthma. Participants (n=224) will be recruited through 2 urban health care systems that care for a diverse Black population. Patients will be randomized to one of two groups: (1) ACTION intervention (group sessions, physical activity self-monitoring—Fitbit, and text-based support for step goal setting) or (2) education control (an individual asthma education session and SMS text messages related to asthma education). Outcome assessments will take place at baseline, 12, 24, and 48 weeks. The primary outcome is a change in asthma control from baseline to week 24 as assessed by the asthma control questionnaire-6 (ACQ-6). Secondary outcomes include asthma-related quality of life, health care use, and asthma exacerbations and behavioral outcomes such as self-efficacy, self-regulation, social support, and physical activity. Results: This study was funded by the National Institute of Minority Health Disparities in August 2022. We pilot-tested our recruitment and intervention procedures and began recruitment in April 2023, with the enrollment of our first participant in May 2023. The anticipated completion of the study is April 2027. Conclusions: This study will deliver a new approach to physical activity interventions in Black women with asthma and help to provide guidance for addressing physical activity within this subgroup. This study will also provide a potential framework for future studies in minoritized populations with other disease conditions associated with low levels of physical activity. Trial Registration: ClinicalTrials.gov NCT05726487; https://clinicaltrials.gov/study/NCT05726487 International Registered Report Identifier (IRRID): DERR1-10.2196/55700 %M 38324365 %R 10.2196/55700 %U https://www.researchprotocols.org/2024/1/e55700 %U https://doi.org/10.2196/55700 %U http://www.ncbi.nlm.nih.gov/pubmed/38324365 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e49493 %T Toward Sustaining Web-Based Senior Center Programming Accessibility With and for Older Adult Immigrants: Community-Based Participatory Research Cross-Sectional Study %A Nguyen-Truong,Connie Kim Yen %A Wuestney,Katherine %A Leung,Holden %A Chiu,Chenya %A Park,Maria %A Chac,Christina %A Fritz,Roschelle Lynette %+ Nursing and Systems Science Department, College of Nursing in Vancouver, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686-9600, United States, 1 3605469395, c.nguyen-truong@wsu.edu %K Asian American %K Chinese %K Korean %K Vietnamese %K community-based participatory research %K CBPR %K COVID-19 %K health equity %K immigrants %K older adults %K psychosocial %K technology access %K telehealth use %K web-based senior center %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: During the COVID-19 pandemic, many community-based organizations serving Asian Americans pivoted to provide web-based care and social services. Asian American community leaders in the United States Pacific Northwest, including Asian Health & Service Center expressed that there are older immigrant adults who experienced backlash from discrimination, fear, and anxiety owing in part to anti-Asian hate and isolation, including from infection precautions. Pivoting supported staying safe from COVID-19 transmission and anti-Asian hate crimes. Objective: This study aims to examine the readiness of diverse groups of older Asian American immigrant adults (Chinese, Koreans, and Vietnamese) to use a web-based senior center, including technology access and telehealth use, and to identify the psychosocial health impacts that a web-based senior center could be positioned to meet. Methods: A community-based participatory research approach was used to conduct a cross-sectional survey study in an Asian-based health and service center in 2022. We selected surveys from the National Institutes of Health–supported PhenX Toolkit. Analyses were performed using R software. Results: There was an 88.2% (216/245) response rate. Overall, 39.8% (86/216) of participants were Chinese, 25% (54/216) were Korean, and 24.5% (53/216) were Vietnamese. There were significant group differences in mobile data plans (P=.0005). Most had an unlimited mobile data plan (38/86, 44% Chinese; 39/54, 72% Koreans; 25/53, 47% Vietnamese). Significant group differences existed regarding whether they started using a new electronic device to communicate with friends or family after the COVID-19 outbreak (P=.0005); most were Korean participants (31/54, 57%). For written text and audio or video apps, most Chinese participants used WeChat (65/85, 76%; 57/84, 68%, respectively), most Koreans used KakaoTalk (49/54, 91%; 49/54, 91%, respectively), and most Vietnamese used Facebook Messenger for written text (32/50, 64%) and Apple Face Time (33/50, 66%) or Facebook Messenger (31/50, 62%) for audio or video. Significant group differences existed regarding whether to try telehealth (P=.0005); most Vietnamese expressed that they would never consider it (41/53, 77%). Significant group differences existed regarding how well they were able to concentrate (χ22=44.7; P<.0001); Chinese participants reported a greater inability (median 5, IQR 4-6). With regard to difficulties in life experiences (χ22=51; P<.0001), the median was 6 (IQR 5-7) for the Vietnamese group. Significant group differences existed in having had a family/household member’s salary, hours, and contracts reduced (P=.0005) and having had a family/household member or friend fallen physically ill (P=.0005)—most Vietnamese (15/53, 28%) and Korean participants (10/53, 19%). Conclusions: To build an efficacious, web-based senior center with web-based care and social service options, more older adults need access to the internet and education about using technology-enabled communication devices. Addressing the unique psychosocial impacts of the COVID-19 pandemic on each group could improve health equity. The strength of the participating older adults was observed and honored. %M 38277216 %R 10.2196/49493 %U https://apinj.jmir.org/2024/1/e49493 %U https://doi.org/10.2196/49493 %U http://www.ncbi.nlm.nih.gov/pubmed/38277216 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47572 %T Improving Medical Photography in a Level 1 Trauma Center by Implementing a Specialized Smartphone-Based App in Comparison to the Usage of Digital Cameras: Prospective Panel Study %A El Barbari,Jan Siad %A Fikuart,Maxim %A Beisemann,Nils %A Müller,Michael %A Syrek,Hannah %A Grützner,Paul Alfred %A Franke,Jochen %A Vetter,Sven Yves %+ Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str 13, Ludwigshafen am Rhein, 67071, Germany, 49 621 6810 2480, sven.vetter@bgu-ludwigshafen.de %K app %K device usability %K digital camera %K medical photo %K medical photography %K mRay app %K PACS %K patient care %K patient education %K picture archiving and communication system %K questionnaire %K smartphone %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently. Objective: This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography. Methods: We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed. Results: A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer’s intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection. Conclusions: Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size. %M 38271087 %R 10.2196/47572 %U https://formative.jmir.org/2024/1/e47572 %U https://doi.org/10.2196/47572 %U http://www.ncbi.nlm.nih.gov/pubmed/38271087 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48700 %T Investigating Citizens’ Acceptance of Contact Tracing Apps: Quantitative Study of the Role of Trust and Privacy %A Fox,Grace %A van der Werff,Lisa %A Rosati,Pierangelo %A Lynn,Theo %+ Irish Institute of Digital Business, Dublin City University, Collins Ave, Dublin9, Dublin, Ireland, 353 1 700 6873, theo.lynn@dcu.ie %K privacy %K trust %K public health surveillance %K contact tracing %K mobile apps %K adoption %K information disclosure %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic accelerated the need to understand citizen acceptance of health surveillance technologies such as contact tracing (CT) apps. Indeed, the success of these apps required widespread public acceptance and the alleviation of concerns about privacy, surveillance, and trust. Objective: This study aims to examine the factors that foster a sense of trust and a perception of privacy in CT apps. Our study also investigates how trust and perceived privacy influence citizens’ willingness to adopt, disclose personal data, and continue to use these apps. Methods: Drawing on privacy calculus and procedural fairness theories, we developed a model of the antecedents and behavioral intentions related to trust and privacy perceptions. We used structural equation modeling to test our hypotheses on a data set collected at 2 time points (before and after the launch of a national CT app). The sample consisted of 405 Irish residents. Results: Trust in CT apps was positively influenced by propensity to trust technology (β=.074; P=.006), perceived need for surveillance (β=.119; P<.001), and perceptions of government motives (β=.671; P<.001) and negatively influenced by perceived invasion (β=−.224; P<.001). Perceived privacy was positively influenced by trust (β=.466; P<.001) and perceived control (β=.451; P<.001) and negatively influenced by perceived invasion (β=−.165; P<.001). Prelaunch intentions toward adoption were influenced by trust (β=.590; P<.001) and perceived privacy (β=.247; P<.001). Prelaunch intentions to disclose personal data to the app were also influenced by trust (β=.215; P<.001) and perceived privacy (β=.208; P<.001) as well as adoption intentions before the launch (β=.550; P<.001). However, postlaunch intentions to use the app were directly influenced by prelaunch intentions (β=.530; P<.001), but trust and perceived privacy only had an indirect influence. Finally, with regard to intentions to disclose after the launch, use intentions after the launch (β=.665; P<.001) and trust (β=.215; P<.001) had a direct influence, but perceived privacy only had an indirect influence. The proposed model explained 74.4% of variance in trust, 91% of variance in perceived privacy, 66.6% of variance in prelaunch adoption intentions, 45.9% of variance in postlaunch use intentions, and 83.9% and 79.4% of variance in willingness to disclose before the launch and after the launch, respectively. Conclusions: Positive perceptions of trust and privacy can be fostered through clear communication regarding the need and motives for CT apps, the level of control citizens maintain, and measures to limit invasive data practice. By engendering these positive beliefs before launch and reinforcing them after launch, citizens may be more likely to accept and use CT apps. These insights are important for the launch of future apps and technologies that require mass acceptance and information disclosure. %M 38085914 %R 10.2196/48700 %U https://mhealth.jmir.org/2024/1/e48700 %U https://doi.org/10.2196/48700 %U http://www.ncbi.nlm.nih.gov/pubmed/38085914 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48345 %T Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study %A Schroeder,Tanja %A Haug,Maximilian %A Georgiou,Andrew %A Seaman,Karla %A Gewald,Heiko %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, 2109, Australia, 61 2 9850 ext 6281, tanja.schroeder@mq.edu.au %K mobile health apps %K DiGA %K adoption %K prescription %K mHealth %K aging and individual differences %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The enactment of the “Act to Improve Healthcare Provision through Digitalisation and Innovation ” (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany’s medical landscape. Objective: This study aims to investigate physicians’ responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps. Methods: Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021. Results: The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians’ self-perceived digital competence and their evaluation of patients’ digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps. Conclusions: Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians’ and patients’ sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice. %M 38231550 %R 10.2196/48345 %U https://mhealth.jmir.org/2024/1/e48345 %U https://doi.org/10.2196/48345 %U http://www.ncbi.nlm.nih.gov/pubmed/38231550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51361 %T Rosie, a Health Education Question-and-Answer Chatbot for New Mothers: Randomized Pilot Study %A Nguyen,Quynh C %A Aparicio,Elizabeth M %A Jasczynski,Michelle %A Channell Doig,Amara %A Yue,Xiaohe %A Mane,Heran %A Srikanth,Neha %A Gutierrez,Francia Ximena Marin %A Delcid,Nataly %A He,Xin %A Boyd-Graber,Jordan %+ Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 4254 Stadium Dr., College Park, MD, 20742, United States, 1 301 405 6425, qtnguyen@umd.edu %K chatbot %K health information %K maternal and child health %K health disparities %K health equity %K health informatics %K preventive health care %K postpartum care %K patient education %K newborn care %K prenatal care %K mobile phone %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stark disparities exist in maternal and child outcomes and there is a need to provide timely and accurate health information. Objective: In this pilot study, we assessed the feasibility and acceptability of a health chatbot for new mothers of color. Methods: Rosie, a question-and-answer chatbot, was developed as a mobile app and is available to answer questions about pregnancy, parenting, and child development. From January 9, 2023, to February 9, 2023, participants were recruited using social media posts and through engagement with community organizations. Inclusion criteria included being aged ≥14 years, being a woman of color, and either being currently pregnant or having given birth within the past 6 months. Participants were randomly assigned to the Rosie treatment group (15/29, 52% received the Rosie app) or control group (14/29, 48% received a children’s book each month) for 3 months. Those assigned to the treatment group could ask Rosie questions and receive an immediate response generated from Rosie’s knowledgebase. Upon detection of a possible health emergency, Rosie sends emergency resources and relevant hotline information. In addition, a study staff member, who is a clinical social worker, reaches out to the participant within 24 hours to follow up. Preintervention and postintervention tests were completed to qualitatively and quantitatively evaluate Rosie and describe changes across key health outcomes, including postpartum depression and the frequency of emergency room visits. These measurements were used to inform the clinical trial’s sample size calculations. Results: Of 41 individuals who were screened and eligible, 31 (76%) enrolled and 29 (71%) were retained in the study. More than 87% (13/15) of Rosie treatment group members reported using Rosie daily (5/15, 33%) or weekly (8/15, 53%) across the 3-month study period. Most users reported that Rosie was easy to use (14/15, 93%) and provided responses quickly (13/15, 87%). The remaining issues identified included crashing of the app (8/15, 53%), and users were not satisfied with some of Rosie’s answers (12/15, 80%). Mothers in both the Rosie treatment group and control group experienced a decline in depression scores from pretest to posttest periods, but the decline was statistically significant only among treatment group mothers (P=.008). In addition, a low proportion of treatment group infants had emergency room visits (1/11, 9%) compared with control group members (3/13, 23%). Nonetheless, no between-group differences reached statistical significance at P<.05. Conclusions: Rosie was found to be an acceptable, feasible, and appropriate intervention for ethnic and racial minority pregnant women and mothers of infants owing to the chatbot’s ability to provide a personalized, flexible tool to increase the timeliness and accessibility of high-quality health information to individuals during a period of elevated health risks for the mother and child. Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515 %M 38214963 %R 10.2196/51361 %U https://formative.jmir.org/2024/1/e51361 %U https://doi.org/10.2196/51361 %U http://www.ncbi.nlm.nih.gov/pubmed/38214963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47308 %T Office Workers’ Views About the Uses, Concerns, and Acceptance of Hand Hygiene Data Collected From Smart Sanitizers: Exploratory Qualitative Interview Study %A Rutter,Sophie %A Sanger,Sally %A Madden,Andrew D %A Ehdeed,Sukaina %A Stones,Catherine %+ Information School, University of Sheffield, The Wave 2, Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 0114 222 2659, s.rutter@sheffield.ac.uk %K hand hygiene %K smart sanitizers %K Internet of Things %K IoT %K offices %K workplaces %K smart systems %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 and the prospect of future pandemics have emphasized the need to reduce disease transmission in workplaces. Despite the well-established link between good hand hygiene (HH) and employee health, HH in nonclinical workplaces has received little attention. Smart sanitizers have been deployed in clinical settings to motivate and enforce HH. This study is part of a large project that explores the potential of smart sanitizers in office settings. Objective: Our previous study found that for office workers to accept the deployment of smart sanitizers, they would need to find the data generated as useful and actionable. The objectives of this study were to identify (1) the potential uses and actions that could be taken from HH data collected by smart sanitizers (2) the concerns of office workers for the identified uses and actions and (3) the circumstances in which office workers accept HH monitoring. Methods: An interview study was conducted with 18 office workers from various professions. Interview questions were developed using a framework from personal informatics. Transcripts were analyzed thematically. Results: A wide range of uses of smart sanitizer data was identified including managing hygiene resources and workflows, finding operating sanitizers, communicating the (high) standard of organizational hygiene, promoting and enforcing organizational hygiene policies, improving workers’ own hygiene practices, executing more effective interventions, and identifying the causes of outbreaks. However, hygiene is mostly considered as a private matter, and it is also possible that no action would be taken. Office workers were also concerned about bullying, coercion, and use of hygiene data for unintended purposes. They were also worried that the data could be inaccurate or incomplete, leading to misrepresentation of hygiene practices. Office workers suggested that they would be more likely to accept monitoring in situations where hygiene is considered important, when there are clear benefits to data collection, if their privacy is respected, if they have some control over how their data are collected, and if the ways in which the data will be used are clearly communicated. Conclusions: Smart sanitizers could have a valuable role in improving hygiene practices in offices and reducing disease transmission. Many actionable uses for data collected from smart systems were identified. However, office workers consider HH as a personal matter, and acceptance of smart systems is likely to be dynamic and will depend on the broad situation. Except when there are disease outbreaks, smart systems may need to be restricted to uses that do not require the sharing of personal data. Should organizations wish to implement smart sanitizers in offices, it would be advisable to consult widely with staff and develop systems that are customizable and personalizable. %M 38206674 %R 10.2196/47308 %U https://formative.jmir.org/2024/1/e47308 %U https://doi.org/10.2196/47308 %U http://www.ncbi.nlm.nih.gov/pubmed/38206674 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e46744 %T Documentation Completeness and Nurses’ Perceptions of a Novel Electronic App for Medical Resuscitation in the Emergency Room: Mixed Methods Approach %A Cheung,Kin %A Yip,Chak Sum %+ School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong, China (Hong Kong), 852 2766 6773, kin.cheung@polyu.edu.hk %K tablet computer %K nursing documentation %K paper resuscitation record %K electronic resuscitation record %K medical resuscitation %K electronic medical record %K documentation %K resuscitation %K electronic health record %K nurses’ perception %K traditional paper record %K nurse %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Complete documentation of critical care events in the accident and emergency department (AED) is essential. Due to the fast-paced and complex nature of resuscitation cases, missing data is a common issue during emergency situations. Objective: This study aimed to evaluate the impact of a tablet-based resuscitation record on documentation completeness during medical resuscitations and nurses’ perceptions of the use of the tablet app. Methods: A mixed methods approach was adopted. To collect quantitative data, randomized retrospective reviews of paper-based resuscitation records before implementation of the tablet (Pre-App Paper; n=176), paper-based resuscitation records after implementation of the tablet (Post-App Paper; n=176), and electronic tablet-based resuscitation records (Post-App Electronic; n=176) using a documentation completeness checklist were conducted. The checklist was validated by 4 experts in the emergency medicine field. The content validity index (CVI) was calculated using the scale CVI (S-CVI). The universal agreement S-CVI was 0.822, and the average S-CVI was 0.939. The checklist consisted of the following 5 domains: basic information, vital signs, procedures, investigations, and medications. To collect qualitative data, nurses’ perceptions of the app for electronic resuscitation documentation were obtained using individual interviews. Reporting of the qualitative data was guided by Consolidated Criteria for Reporting Qualitative Studies (COREQ) to enhance rigor. Results: A significantly higher documentation rate in all 5 domains (ie, basic information, vital signs, procedures, investigations, and medications) was present with Post-App Electronic than with Post-App Paper, but there were no significant differences in the 5 domains between Pre-App Paper and Post-App Paper. The qualitative analysis resulted in main categories of “advantages of tablet-based documentation of resuscitation records,” “challenges with tablet-based documentation of resuscitation records,” and “areas for improvement of tablet-based resuscitation records.” Conclusions: This study demonstrated that higher documentation completion rates are achieved with electronic tablet-based resuscitation records than with traditional paper records. During the transition period, the nurse documenters faced general problems with resuscitation documentation such as multitasking and unique challenges such as software updates and a need to familiarize themselves with the app’s layout. Automation should be considered during future app development to improve documentation and redistribute more time for patient care. Nurses should continue to provide feedback on the app’s usability and functionality during app refinement to ensure a successful transition and future development of electronic documentation records. %M 38180801 %R 10.2196/46744 %U https://mhealth.jmir.org/2024/1/e46744 %U https://doi.org/10.2196/46744 %U http://www.ncbi.nlm.nih.gov/pubmed/38180801 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47755 %T Usability of an App for Medical History Taking in General Practice From the Patients’ Perspective: Cross-Sectional Study %A Albrink,Klara %A Schröder,Dominik %A Joos,Carla %A Müller,Frank %A Noack,Eva Maria %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 551 39 65745, evamaria.noack@med.uni-goettingen.de %K digitization %K application software %K usability %K mHealth %K history of present illness %K medical history taking %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A future shortage of physicians, especially in general practice, will result in an increasing workload for health care providers as a whole. Therefore, it is important to optimize patient-encounter processes to increase time efficiency related to visits. Utilizing digital tools to record patients’ medical histories prior to a consultation offers great potential to achieve this goal. The collected information can be stored into the practice’s electronic medical record, allowing for the general practitioner to review structured information of the patients’ complaints and related medical history beforehand, thereby saving time during the encounter. However, the low usability of new digital developments in this setting often hinders implementation. Objective: The aim of this study was to evaluate the usability of an app designed for medical history taking in general practice to capture the patients’ perspective. Methods: Between November 2021 and January 2022, we recruited 406 patients with acute complaints in one out-of-hour urgent care and seven general practice clinics. These study participants used the app during their waiting time and subsequently assessed its usability by completing the System Usability Scale (SUS), a robust and well-established 10-question survey measuring the perceived usability of products and technologies. Additionally, we collected general participant information, including age, sex, media usage, health literacy, and native language. Descriptive and inferential statistics were applied to identify patient characteristics associated with low or high SUS scores. Results: We analyzed data from 397 patients (56.7% female, 43.3% male). The mean total SUS score was 77.8 points; 54.4% (216/397) of participants had SUS scores of 80 points or higher, indicating high usability of the app. In a multiple linear regression predicting SUS score, male sex and higher age (65 years or older) were significantly negatively associated with the SUS score. Conversely, a higher health literacy score and German as the native language were significantly positively associated with the SUS score. Conclusions: Usability testing based on the SUS anticipates successful implementation of the app. However, not all patients will easily adapt to utilizing the app, as exemplified by the participants of older age in this study who reported lower perceived usability. Further research should examine these groups of people, identify the exact problems in operating such an app, and provide targeted solutions. Trial Registration: German Clinical Trials Register World Health Organization Trial Registration Data Set DRKS00026659; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659 %M 38180798 %R 10.2196/47755 %U https://humanfactors.jmir.org/2024/1/e47755 %U https://doi.org/10.2196/47755 %U http://www.ncbi.nlm.nih.gov/pubmed/38180798 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49353 %T User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study %A Young,Karen %A Xiong,Ting %A Lee,Rachel %A Banerjee,Ananya Tina %A Leslie,Myles %A Ko,Wellam Yu %A Pham,Quynh %+ Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto General Hospital, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 (416) 340 4800 ext 4765, q.pham@uhn.ca %K digital health %K virtual care %K digital therapeutics %K prostate cancer %K cancer survivorship %K user-centred design %K usability %K supportive care %K cultural adaptation %K Chinese Canadians %D 2024 %7 1.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. Objective: This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. Methods: The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Results: Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants’ desires for relationality, accountability, and care. Conclusions: We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing. %M 38163295 %R 10.2196/49353 %U https://humanfactors.jmir.org/2024/1/e49353 %U https://doi.org/10.2196/49353 %U http://www.ncbi.nlm.nih.gov/pubmed/38163295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49239 %T Patient Acceptability of Symptom Screening and Patient Education Using a Chatbot for Autoimmune Inflammatory Diseases: Survey Study %A Tan,Tze Chin %A Roslan,Nur Emillia Binte %A Li,James Weiquan %A Zou,Xinying %A Chen,Xiangmei %A Ratnasari, %A Santosa,Anindita %+ Division of Rheumatology and Immunology, Department of Medicine, Changi General Hospital, 2 Simei Street 3, Level 6, Medical Centre, Singapore, 529889, Singapore, 65 90128379, anindita.santosa@singhealth.com.sg %K conversational agents %K digital technology in medicine %K rheumatology %K early diagnosis %K education %K patient‒physician interactions %K autoimmune rheumatic diseases %K chatbot %K implementation %K patient survey %K digital health intervention %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chatbots have the potential to enhance health care interaction, satisfaction, and service delivery. However, data regarding their acceptance across diverse patient populations are limited. In-depth studies on the reception of chatbots by patients with chronic autoimmune inflammatory diseases are lacking, although such studies are vital for facilitating the effective integration of chatbots in rheumatology care. Objective: We aim to assess patient perceptions and acceptance of a chatbot designed for autoimmune inflammatory rheumatic diseases (AIIRDs). Methods: We administered a comprehensive survey in an outpatient setting at a top-tier rheumatology referral center. The target cohort included patients who interacted with a chatbot explicitly tailored to facilitate diagnosis and obtain information on AIIRDs. Following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the survey was designed to gauge the effectiveness, user acceptability, and implementation of the chatbot. Results: Between June and October 2022, we received survey responses from 200 patients, with an equal number of 100 initial consultations and 100 follow-up (FU) visits. The mean scores on a 5-point acceptability scale ranged from 4.01 (SD 0.63) to 4.41 (SD 0.54), indicating consistently high ratings across the different aspects of chatbot performance. Multivariate regression analysis indicated that having a FU visit was significantly associated with a greater willingness to reuse the chatbot for symptom determination (P=.01). Further, patients’ comfort with chatbot diagnosis increased significantly after meeting physicians (P<.001). We observed no significant differences in chatbot acceptance according to sex, education level, or diagnosis category. Conclusions: This study underscores that chatbots tailored to AIIRDs have a favorable reception. The inclination of FU patients to engage with the chatbot signifies the possible influence of past clinical encounters and physician affirmation on its use. Although further exploration is required to refine their integration, the prevalent positive perceptions suggest that chatbots have the potential to strengthen the bridge between patients and health care providers, thus enhancing the delivery of rheumatology care to various cohorts. %M 37219234 %R 10.2196/49239 %U https://formative.jmir.org/2023/1/e49239 %U https://doi.org/10.2196/49239 %U http://www.ncbi.nlm.nih.gov/pubmed/37219234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52410 %T mHealth Technology Experiences of Middle-Aged and Older Individuals With Visual Impairments: Cross-Sectional Interview Study %A Choi,Soyoung %A Sajib,Md Refat Uz Zaman %A Manzano,Jenna %A Chlebek,Christian Joseph %+ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 272 Freer Hall, 906 South Goodwin Avenue, Urbana, IL, 61801-3028, United States, 1 2174024128, soyoung@illinois.edu %K aging %K mobile health %K older adults %K technology %K visual impairment %K wearables %K wearable %K vision %K visual %K qualitative analysis %K health behavior %K mHealth %K mHealth technology %K digital technology %K medical application %K application %K app %K applications %K usage %K well-being %K cross-section interview %K interview %K interviews %K tracking %K health data %K symptom monitoring %K monitor %K monitoring %K symptom %K symptoms %K physical activity %K walking %K routine %K mobile phone %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Current mobile health (mHealth) technology is predominantly designed with a visual orientation, often resulting in user interfaces that are inaccessible to visually impaired users. While mHealth technology offers potential for facilitating chronic illness management and enhancing health behaviors among visually impaired older populations, understanding its usage remains limited. Objective: This qualitative research aimed to explore the mHealth technology experiences of middle-aged and older individuals with visual impairments including the accessibility and usability issues they faced. Methods: The qualitative exploration was structured using the mHealth for Older Users framework. Cross-sectional interviews were conducted via Zoom between June 1 and July 31, 2023, using an interview protocol for data collection. A thematic analysis approach was employed to analyze the transcribed interview scripts. Results: Of the 7 participants who took part in the Zoom interviews, 3 were men and 4 were women, with ages ranging from 53 to 70 years. Most participants adopted mHealth apps and wearable devices for promoting health. They exhibited 3 distinct adoption patterns. Seven themes were emerged from the perceived challenges in using mHealth technologies: (1) a scarcity of accessible user manuals, (2) user interfaces that are not visually impaired-friendly, (3) health data visualizations that are not accessible, (4) unintuitive arrangement of app content, (5) health information that is challenging to comprehend, (6) cognitive overload caused by an excess of audible information, and (7) skepticism regarding the accuracy of health records. mHealth technologies seem to positively affect the health and health management of participants. Conclusions: Design considerations for mHealth technologies should consider individuals’ disabilities and chronic conditions and should emphasize the importance of providing accessible manuals and training opportunities when introducing new mHealth solutions. %M 38145472 %R 10.2196/52410 %U https://formative.jmir.org/2023/1/e52410 %U https://doi.org/10.2196/52410 %U http://www.ncbi.nlm.nih.gov/pubmed/38145472 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48335 %T Preferences in the Willingness to Download an mHealth App: Discrete Choice Experimental Study in Spain, Germany, and the Netherlands %A Folkvord,Frans %A Bol,Nadine %A Stazi,Giacomo %A Peschke,Lutz %A Lupiáñez-Villanueva,Francisco %+ Tilburg School of Humanities and Digital Sciences, Tilburg University, Warrandelaan, Tilburg, 5037 AB, Netherlands, 31 682240480, fransfolkvord@gmail.com %K mHealth adoption %K discrete choice task %K mobile apps %K self-monitoring %K willingness %K mobile health app %K mobile app %K mobile health %K mHealth %K adoption %K mHealth tools %K health care cost %K effectiveness %K mobile phone %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the adoption of mHealth is low, and only a limited number of studies have examined the intention to download mHealth apps. Objective: In this study, we investigated individuals’ preferences in the adoption of a health app. Methods: We conducted a discrete choice experimental study in 3 countries (Spain: n=800, Germany: n=800, and the Netherlands: n=416) with 4 different attributes and levels (ie, price: €1.99 vs €4.99 [a currency exchange rate of €1=US $1.09 is applicable] vs for free, data protection: data protection vs no information, recommendation: patients’ association vs doctors, and manufacturer: medical association vs pharmaceutical company). Participants were randomly assigned. For the analyses, we used the conditional logistic model separately for each country. Results: The results showed that price and data protection were considered important factors that significantly increased the probability to download an mHealth app. In general, the source of the recommendation and the manufacturer affected the probability to download the mHealth app less. However, in Germany and the Netherlands, we found that if the app was manufactured by a pharmaceutical company, the probability to download the mHealth app decreased. Conclusions: mHealth tools are highly promising to reduce health care costs and increase the effectiveness of traditional health interventions and therapies. Improving data protection, reducing costs, and creating sound business models are the major driving forces to increase the adoption of mHealth apps in the future. It is thereby essential to create trustworthy standards for mobile apps, whereby prices, legislation concerning data protection, and health professionals can have a leading role to inform the potential consumers. %M 38145470 %R 10.2196/48335 %U https://formative.jmir.org/2023/1/e48335 %U https://doi.org/10.2196/48335 %U http://www.ncbi.nlm.nih.gov/pubmed/38145470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49277 %T Patient and Provider Experiences With a Digital App to Improve Compliance With Enhanced Recovery After Surgery (ERAS) Protocols: Mixed Methods Evaluation of a Canadian Experience %A Beesoon,Sanjay %A Drobot,Ashley %A Smokeyday,Melissa %A Ali,Al-Bakir %A Collins,Zoe %A Reynolds,Colin %A Berzins,Sandra %A Gibson,Alison %A Nelson,Gregg %+ Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, 3260 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada, 1 5877170011, gregg.nelson@ahs.ca %K app %K digital health %K patient experience %K provider satisfaction %K application %K recovery %K cost-effective %K evaluation %K implementation %K gynecologic oncology %K colorectal surgery %K surgery %K care %D 2023 %7 15.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS. Objective: The objective of this work was to conduct a thorough assessment of patient and provider experiences using the ERAS app. Methods: Patients undergoing colorectal or gynecological oncology surgery at 2 different hospitals in the province of Alberta, Canada, were invited to use the ERAS app and report on their experiences using it. Likewise, care providers were recruited to participate in this study to provide feedback on the performance of this app. Data were collected by an online survey and using qualitative interviews with participants. NVivo was used to analyze qualitative interview data, while quantitative data were analyzed using Excel and SPSS. Results: Overall, patients found the app to be helpful in preparation for and recovery after surgery. Patients reported having access to reliable unbiased information regarding their surgery, and the app provided them with clarity of actions needed along their surgical journey and enhanced the self-management of their care. Clinicians found that the ERAS app was easy to navigate, was simple for older adults, and has the potential to decrease unnecessary visits and phone calls to care providers. Overall, this proof-of-concept study on the use of a digital health app to accompany patients during their health care journey has shown positive results. Conclusions: This is an important finding considering the massive investment and interest in promoting digital health in health care systems around the world. %R 10.2196/49277 %U https://formative.jmir.org/2023/1/e49277/ %U https://doi.org/10.2196/49277 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50729 %T Implementation of Remote Activity Sensing to Support a Rehabilitation Aftercare Program: Observational Mixed Methods Study With Patients and Health Care Professionals %A Lu,Ziyuan %A Signer,Tabea %A Sylvester,Ramona %A Gonzenbach,Roman %A von Wyl,Viktor %A Haag,Christina %+ Institute for Implementation Science in Health Care, University of Zurich, Universitätstrasse 84, Zurich, 8006, Switzerland, 41 446346380, viktor.vonwyl@uzh.ch %K physical activity %K activity sensor %K normalization process theory %K rehabilitation %K chronic disease %K chronic %K aftercare %K sensor %K sensors %K exercise %K neurology %K neuroscience %K neurorehabilitation %K adherence %K need %K needs %K experience %K experiences %K questionnaire %K questionnaires %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity is central to maintaining the quality of life for patients with complex chronic conditions and is thus at the core of neurorehabilitation. However, maintaining activity improvements in daily life is challenging. The novel Stay With It program aims to promote physical activity after neurorehabilitation by cultivating self-monitoring skills and habits. Objective: We examined the implementation of the Stay With It program at the Valens Rehabilitation Centre in Switzerland using the normalization process theory framework, focusing on 3 research aims. We aimed to examine the challenges and facilitators of program implementation from the perspectives of patients and health care professionals. We aimed to evaluate the potential of activity sensors to support program implementation and patient acceptance. Finally, we aimed to evaluate patients’ engagement in physical activity after rehabilitation, patients’ self-reported achievement of home activity goals, and factors influencing physical activity. Methods: Patients were enrolled if they had a disease that was either chronic or at risk for chronicity and participated in the Stay With It program. Patients were assessed at baseline, the end of rehabilitation, and a 3-month follow-up. The health care professionals designated to deliver the program were surveyed before and after program implementation. We used a mixed methods approach combining standardized questionnaires, activity-sensing data (patients only), and free-text questions. Results: This study included 23 patients and 13 health care professionals. The diverse needs of patients and organizational hurdles were major challenges to program implementation. Patients’ intrinsic motivation and health care professionals’ commitment to refining the program emerged as key facilitators. Both groups recognized the value of activity sensors in supporting program implementation and sustainability. Although patients appreciated the sensor’s ability to monitor, motivate, and quantify activity, health care professionals saw the sensor as a motivational tool but expressed concerns about technical difficulties and potential inaccuracies. Physical activity levels after patients returned home varied considerably, both within and between individuals. The self-reported achievement of activity goals at home also varied, in part because of vague definitions. Common barriers to maintaining activity at home were declining health and fatigue often resulting from heat and pain. At the 3-month follow-up, 35% (8/23) of the patients withdrew from the study, with most citing deteriorating physical health as the reason and that monitoring and discussing their low activity would negatively affect their mental health. Conclusions: Integrating aftercare programs like Stay With It into routine care is vital for maintaining physical activity postrehabilitation. Although activity trackers show promise in promoting motivation through monitoring, they may lead to frustration during health declines. Their acceptability may also be influenced by an individual’s health status, habits, and technical skills. Our study highlights the importance of considering health care professionals’ perspectives when integrating new interventions into routine care. %M 38064263 %R 10.2196/50729 %U https://mhealth.jmir.org/2023/1/e50729 %U https://doi.org/10.2196/50729 %U http://www.ncbi.nlm.nih.gov/pubmed/38064263 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48845 %T A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study %A Seinsche,Julia %A de Bruin,Eling D %A Saibene,Enrico %A Rizzo,Francesco %A Carpinella,Ilaria %A Ferrarin,Maurizio %A Moza,Sotiria %A Ritter,Tanja %A Giannouli,Eleftheria %+ Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Leopold-Ruzicka-Weg 4, HCP H 24.3, Zurich, 8093, Switzerland, 41 44 633 08 52, julia.seinsche@hest.ethz.ch %K older adults %K motor-cognitive intervention %K exergame %K telerehabilitation %K information and communications technologies %K user-centered design %K usability %K technology acceptance %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). Objective: This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. Methods: At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants’ perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire–3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. Results: A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system’s usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ρ=0.35, P=.02 to ρ=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ρ=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ρ=−0.35; P=.02) and the UTAUT total score (ρ=−0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. Conclusions: The study’s findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system’s feasibility and effectiveness. %M 38060283 %R 10.2196/48845 %U https://humanfactors.jmir.org/2023/1/e48845 %U https://doi.org/10.2196/48845 %U http://www.ncbi.nlm.nih.gov/pubmed/38060283 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46336 %T The Effectiveness of Publicly Available Web-Based Interventions in Promoting Health App Use, Digital Health Literacy, and Media Literacy: Pre-Post Evaluation Study %A König,Lars %A Suhr,Ralf %+ Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30419549262, lars.koenig@charite.de %K digital health literacy %K e-learning %K health apps %K health education %K health literacy %K media literacy %K mHealth %K mobile health %K serious games %K user experience %K web-based intervention %D 2023 %7 4.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: According to the World Health Organization, implementing mobile health (mHealth) technologies can increase access to quality health services worldwide. mHealth apps for smartphones, also known as health apps, are a central component of mHealth, and they are already used in diverse medical contexts. To benefit from health apps, potential users need specific skills that enable them to use such apps in a responsible and constructive manner. Objective: This study aimed to evaluate the effectiveness of the free and widely used web-based intervention, The APPocalypse?. Besides providing knowledge about health apps, the web-based intervention was designed to promote digital health and media literacy by teaching skills that enable users to distinguish between trustworthy and less trustworthy health apps. It was hypothesized that after completing the web-based intervention, participants’ knowledge in the domain of health apps, their digital health literacy, and their media literacy would be higher than it was before completing the web-based intervention. Methods: The study was divided into 3 parts. During part 1, participants (n=365; 181 female, 181 male, and 3 diverse; mean age 17.74, SD 1.391 years) provided demographic information and answered the pre- and postmeasurements. The measurements included questionnaires about participants’ knowledge in the domain of health apps, digital health literacy, and media literacy. During part 2, participants had 1 week to complete the web-based intervention. During part 3, participants answered the pre- and postmeasurements again. Furthermore, they answered educational quality and user experience questionnaires. Bayesian paired samples 2-tailed t tests were conducted to test the hypotheses. Results: Overall, the results support the hypotheses. After completing the web-based intervention, participants demonstrated more elaborate knowledge in the domain of health apps. Specifically, they displayed higher competencies in the domains of subjective (Bayes factor10 [BF10]=1.475×1079; effect size δ=–1.327) and objective health app knowledge (BF10=8.162×1080; effect size δ=–1.350). Furthermore, participants demonstrated higher digital health literacy. Specifically, they displayed higher competencies in the domains of information appraisal (BF10=3.413×1043; effect size δ=–0.870), information searching (BF10=3.324×1023; effect size δ=–0.604), evaluating reliability (BF10=3.081×1035; effect size δ=–0.766), and determining relevance (BF10=3.451×1024; effect size δ=–0.618). Regarding media literacy, the results were mixed. Participants displayed higher competencies in the domain of technology literacy beliefs (BF10=1.533×1021; effect size δ=–0.570). In the domain of technology control beliefs, their competencies did not seem to improve (BF10=0.109; effect size δ=–0.058). In comparison to relevant benchmarks, the web-based intervention offers exceptional educational quality and a superior user experience. Conclusions: The free web-based intervention The APPocalypse? might promote the constructive use of health apps, digital health literacy, and media literacy. Therefore, it may contribute to achieving the health-related United Nations Sustainable Development Goals. %M 38048146 %R 10.2196/46336 %U https://www.jmir.org/2023/1/e46336 %U https://doi.org/10.2196/46336 %U http://www.ncbi.nlm.nih.gov/pubmed/38048146 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46430 %T Older Adults’ Perceptions About Using Intelligent Toilet Seats Beyond Traditional Care: Web-Based Interview Survey %A Esmaeilzadeh,Pouyan %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A. Maidique Campus, 11200 S.W. 8th St, RB 261B, Miami, FL, 33199, United States, 1 (305) 348 3302, pesmaeil@fiu.edu %K older adults %K age tech %K intelligent toilet seat %K survey interview %K qualitative study %K mobile phone %D 2023 %7 1.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In contemporary society, age tech (age technology) represents a significant advancement in health care aimed at enhancing patient engagement, ensuring sustained independence, and promoting quality of life for older people. One innovative form of age tech is the intelligent toilet seat, which is designed to collect, analyze, and provide insights based on toileting logs and excreta data. Understanding how older people perceive and interact with such technology can offer invaluable insights to researchers, technology developers, and vendors. Objective: This study examined older adults’ perspectives regarding the use of intelligent toilet seats. Through a qualitative methodology, this research aims to unearth the nuances of older people’s opinions, shedding light on their preferences, concerns, and potential barriers to adoption. Methods: Data were collected using a web-based interview survey distributed on Amazon Mechanical Turk. The analyzed data set comprised 174 US-based individuals aged ≥65 years who voluntarily participated in this study. The qualitative data were carefully analyzed using NVivo (Lumivero) based on detailed content analysis, ensuring that emerging themes were coded and classified based on the conceptual similarities in the respondents’ narratives. Results: The analysis revealed 5 dominant themes encompassing the opinions of aging adults. The perceived benefits and advantages of using the intelligent toilet seat were grouped into 3 primary themes: health-related benefits including the potential for early disease detection, continuous health monitoring, and seamless connection to health care insights. Technology-related advantages include the noninvasive nature of smart toilet seats and leveraging unique and innovative data collection and analysis technology. Use-related benefits include ease of use, potential for multiple users, and cost reduction owing to the reduced need for frequent clinical visits. Conversely, the concerns and perceived risks were classified into 2 significant themes: psychological concerns, which included concerns about embarrassment and aging-related stereotypes, and the potential emotional impact of constant health monitoring. Technical performance risks include concerns centered on privacy and security, device reliability, data accuracy, potential malfunctions, and the implications of false positives or negatives. Conclusions: The decision of older adults to incorporate intelligent toilet seats into their daily lives depends on myriad factors. Although the potential health and technological benefits are evident, valid concerns that need to be addressed remain. To foster widespread adoption, it is imperative to enhance the advantages while simultaneously addressing and mitigating the identified risks. This balanced approach will pave the way for a more holistic integration of smart health care devices into the routines of the older population, ensuring that they reap the full benefits of age tech advancements. %M 38039065 %R 10.2196/46430 %U https://mhealth.jmir.org/2023/1/e46430 %U https://doi.org/10.2196/46430 %U http://www.ncbi.nlm.nih.gov/pubmed/38039065 %0 Journal Article %@ 2291-5222 %I %V 11 %N %P e49148 %T Use Patterns of Smartphone Apps and Wearable Devices Supporting Physical Activity and Exercise: Large-Scale Cross-Sectional Survey %A Oba,Takeyuki %A Takano,Keisuke %A Katahira,Kentaro %A Kimura,Kenta %K mobile health %K smartphone app %K physical activity %K wearable devices %K telemedicine %K wearable %K wearables %K mHealth %K app %K apps %K use %K usage %K survey %K cross sectional %K cross-sectional %K technology use %K exercise %D 2023 %7 22.11.2023 %9 %J JMIR Mhealth Uhealth %G English %X 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. %R 10.2196/49148 %U https://mhealth.jmir.org/2023/1/e49148 %U https://doi.org/10.2196/49148 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46937 %T Association Between the Characteristics of mHealth Apps and User Input During Development and Testing: Secondary Analysis of App Assessment Data %A Frey,Anna-Lena %A Baines,Rebecca %A Hunt,Sophie %A Kent,Rachael %A Andrews,Tim %A Leigh,Simon %+ Organisation for the Review of Care and Health Apps, V2, Sci-Tech Daresbury, Keckwick Lane, Daresbury, WA4 4FS, United Kingdom, 44 01925 606542, anna.frey@orchahealth.com %K patient and public involvement %K user involvement %K mobile apps %K digital health %K mobile health %K quality assessment %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: User involvement is increasingly acknowledged as a central part of health care innovation. However, meaningful user involvement during the development and testing of mobile health apps is often not fully realized. Objective: This study aims to examine in which areas user input is most prevalent and whether there is an association between user inclusion and compliance with best practices for mobile health apps. Methods: A secondary analysis was conducted on an assessment data set of 1595 health apps. The data set contained information on whether the apps had been developed or tested with user input and whether they followed best practices across several domains. Background information was also available regarding the apps’ country of origin, targeted condition areas, subjective user ratings, download numbers, and risk (as per the National Institute for Health and Care Excellence Evidence Standards Framework [ESF]). Descriptive statistics, Mann-Whitney U tests, and Pearson chi-square analyses were applied to the data. Results: User involvement was reported by 8.71% (139/1595) of apps for only the development phase, by 33.67% (537/1595) of apps for only the testing phase, by 21.88% (349/1595) of apps for both phases, and by 35.74% (570/1595) of apps for neither phase. The highest percentage of health apps with reported user input during development was observed in Denmark (19/24, 79%); in the condition areas of diabetes (38/79, 48%), cardiology (15/32, 47%), pain management (20/43, 47%), and oncology (25/54, 46%); and for high app risk (ESF tier 3a; 105/263, 39.9%). The highest percentage of health apps with reported user input during testing was observed in Belgium (10/11, 91%), Sweden (29/34, 85%), and France (13/16, 81%); in the condition areas of neurodiversity (42/52, 81%), respiratory health (58/76, 76%), cardiology (23/32, 72%), and diabetes (56/79, 71%); and for high app risk (ESF tier 3a; 176/263, 66.9%). Notably, apps that reported seeking user input during testing demonstrated significantly more downloads than those that did not (P=.008), and user inclusion was associated with better compliance with best practices in clinical assurance, data privacy, risk management, and user experience. Conclusions: The countries and condition areas in which the highest percentage of health apps with user involvement were observed tended to be those with higher digital maturity in health care and more funding availability, respectively. This suggests that there may be a trade-off between developers’ willingness or ability to involve users and the need to meet challenges arising from infrastructure limitations and financial constraints. Moreover, the finding of a positive association between user inclusion and compliance with best practices indicates that, where no other guidance is available, users may benefit from prioritizing health apps developed with user input as the latter may be a proxy for broader app quality. %M 37991822 %R 10.2196/46937 %U https://mhealth.jmir.org/2023/1/e46937 %U https://doi.org/10.2196/46937 %U http://www.ncbi.nlm.nih.gov/pubmed/37991822 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47103 %T Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users %A Alluhaidan,Ala Saleh %A Chatterjee,Samir %A Drew,David E %A Ractham,Peter %A Kaewkitipong,Laddawan %+ Center of Excellence in Operations and Information Management, Thammasat Business School, Thammasat University, 2 Prachan Rd., Pranakorn, Bangkok, 10200, Thailand, 66 26132200, laddawan@tbs.tu.ac.th %K empowerment %K behavior change %K information and communications technology %K ICT %K sustaining health behavior %K long-term health behavior %K mobile phone %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Most people with chronic conditions fail to adhere to self-management behavioral guidelines. In the last 2 decades, several mobile health apps and IT-based systems have been designed and developed to help patients change and sustain their healthy behaviors. However, these systems often lead to short-term behavior change or adherence while the goal is to engage the population toward long-term behavior change. Objective: This study aims to contribute to the development of long-term health behavior changes or to help people sustain their healthy behavior. For this purpose, we built and tested a theoretical model that includes enablers of empowerment and an intention to sustain a healthy behavior when patients are assisted by information and communications technology. Methods: Structural equation modeling was used to analyze 427 survey returns collected from a diverse population of participants and patients. Notably, the model testing was performed for physical activity as a generally desirable healthy goal. Results: Message aligned with personal goals, familiarity with technology tools, high self-efficacy, social connection, and community support played a significant role (P<.001) in empowering individuals to maintain a healthy behavior. The feeling of being empowered exhibited a strong influence, with a path coefficient of 0.681 on an intention to sustain healthy behavior. Conclusions: The uniqueness of this model is its recognition of needs (ie, social connection, community support, and self-efficacy) to sustain a healthy behavior. Individuals are empowered when they are assisted by family and community, specifically when they possess the knowledge, skills, and self-awareness to ascertain and achieve their goals. This nascent theory explains what might lead to more sustainable behavior change and is meant to help designers build better apps that enable people to conduct self-care routines and sustain their behavior. %M 37991814 %R 10.2196/47103 %U https://humanfactors.jmir.org/2023/1/e47103 %U https://doi.org/10.2196/47103 %U http://www.ncbi.nlm.nih.gov/pubmed/37991814 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48209 %T A Novel System for the Device-Based Measurement of Physical Activity, Sedentary Behavior, and Sleep (Motus): Usability Evaluation %A Crowley,Patrick %A Kildedal,Rasmus %A Vindelev,Simon Overvad %A Jacobsen,Sandra Schade %A Larsen,Jon Roslyng %A Johansson,Peter J %A Aadahl,Mette %A Straker,Leon %A Stamatakis,Emmanuel %A Holtermann,Andreas %A Mork,Paul Jarle %A Gupta,Nidhi %+ The National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, 2100, Denmark, 45 40357831, rak@nfa.dk %K usability %K accelerometry %K development %K accelerometer %K design %K mhealth %K mobile health %K app %K application %K diary %K thematic analysis %K monitor %K monitoring %K physical activity %K exercise %K sedentary %K sleep %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Device-based measurements of physical behavior, using the current methods, place a large burden on participants. The Motus system could reduce this burden by removing the necessity for in-person meetings, replacing diaries written on paper with digital diaries, and increasing the automation of feedback generation. Objective: This study aims to describe the development of the Motus system and evaluate its potential to reduce participant burden in a two-phase usability evaluation. Methods: Motus was developed around (1) a thigh-worn accelerometer with Bluetooth data transfer; (2) a smartphone app containing an attachment guide, a digital diary, and facilitating automated data transfer; (3) a cloud infrastructure for data storage; (4) an analysis software to generate feedback for participants; and (5) a web-based app for administrators. We recruited 19 adults with a mean age of 45 (SD 11; range 27-63) years, of which 11 were female, to assist in the two-phase evaluation of Motus. A total of 7 participants evaluated the usability of mockups for a smartphone app in phase 1. Participants interacted with the app while thinking aloud, and any issues raised were classified as critical, serious, or minor by observers. This information was used to create an improved and functional smartphone app for evaluation in phase 2. A total of 12 participants completed a 7-day free-living measurement with Motus in phase 2. On day 1, participants attempted 20 system-related tasks under observation, including registration on the study web page, reading the information letter, downloading and navigating the smartphone app, attaching an accelerometer on the thigh, and completing a diary entry for both work and sleep hours. Task completion success and any issues encountered were noted by the observer. On completion of the 7-day measurement, participants provided a rating from 0 to 100 on the System Usability Scale and participated in a semistructured interview aimed at understanding their experience in more detail. Results: The task completion rate for the 20 tasks was 100% for 13 tasks, >80% for 4 tasks, and <50% for 3 tasks. The average rating of system usability was 86 on a 0-100 scale. Thematic analysis indicated that participants perceived the system as easy to use and remember, and subjectively pleasing overall. Participants with shift work reported difficulty with entering sleep hours, and 66% (8/12) of the participants experienced slow data transfer between the app and the cloud infrastructure. Finally, a few participants desired a greater degree of detail in the generated feedback. Conclusions: Our two-phase usability evaluation indicated that the overall usability of the Motus system is high in free-living. Issues around the system’s slow data transfer, participants with atypical work shifts, and the degree of automation and detail of generated feedback should be addressed in future iterations of the Motus system. International Registered Report Identifier (IRRID): RR2-10.2196/35697 %M 37976096 %R 10.2196/48209 %U https://formative.jmir.org/2023/1/e48209 %U https://doi.org/10.2196/48209 %U http://www.ncbi.nlm.nih.gov/pubmed/37976096 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49251 %T Fostering Patient-Clinician Communication to Promote Rapid HIV, Hepatitis B Virus, and Hepatitis C Virus Diagnostic Testing: Conceptual Development of a Multilingual App %A Brown,Carter %A Roucoux,Guillaume %A Rousset-Torrente,Olivia %A Ali,Saleh %A Yombo-Kokule,Lisa %A Chaplin,John %A Chassany,Olivier %A Duracinsky,Martin %+ Épidémiologie Clinique et Évaluation Économique appliquées aux Populations Vulnérables (UMR-S 1123), Université Paris Cité, 1 Parvis Notre Dame - Place Jean-Paul II, Paris, 75004, France, 33 0140274664, duracinsky.m@gmail.com %K app development %K agile development %K mobile health %K mHealth %K user-centered design %K communication barriers %K migrants %K HIV %K AIDS %K hepatitis %K rapid diagnostic testing %K public health %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Migrants are disproportionately affected by HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV). Clinicians, at times, fail to offer rapid diagnostic testing (RDT) for these viruses when a language barrier exists in the patient-clinician relationship, therefore creating missed testing opportunities. Although their effectiveness has been demonstrated elsewhere, conventional, in-person interpreters are costly and underused in practice. Furthermore, clinicians often call upon ad hoc interpreters, which introduces complexities in the clinical relationship. Digital solutions exist to diminish the burden of language barriers; however, the challenges of developing a multilingual and multicultural app have yet to be documented with respect to RDT in the nonfrancophone migrant population in France. Objective: Our goal was to design a multilingual app to overcome language barriers, health literacy barriers, and fears related to being tested to promote RDT of HIV, HBV, and HCV in the nonfrancophone migrant population in France. Methods: A combination of qualitative methods, agile development, and user-centered design was used. We conducted 2 focus groups (FGs) with 12 participants, including physicians, nurses, and social workers conducting RDT, as well as 1 modified Delphi survey with 68 participants including physicians and nurses. FGs explored the content (risk factors and medical history), functions (cultural adaptation and instant translation), and interface ergonomics (graphics and font) needed in the app. The Delphi presented 95 content items that the researchers sought to include in the app. Results: Using FGs to inform the Delphi survey, we scientifically determined the app’s content consisting of 95 items using expert consensus, developed a mock-up, and conducted initial user testing. We created an app that contains both migrant and clinician interfaces and includes a sociodemographic, risk assessment, health literacy, and testing barrier questionnaires available in 11 languages. Educational content is related to HIV, HBV, and HCV, along with the ability to understand whether the migrant agrees to be tested. Conclusions: This study allowed us to conceptualize a multilingual app that aims to increase the acceptance of RDT for HIV, HBV, and HCV. The specific features of the Assistant intelligent au dépistage des allophones app were designed to overcome the testing barriers in the nonfrancophone migrant population. The next phase will be an implementation study, as we intend to validate our app. %M 37971810 %R 10.2196/49251 %U https://formative.jmir.org/2023/1/e49251 %U https://doi.org/10.2196/49251 %U http://www.ncbi.nlm.nih.gov/pubmed/37971810 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48950 %T Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study %A Lunde,Pernille %A Skoglund,Gyri %A Olsen,Cecilie Fromholt %A Hilde,Gunvor %A Bong,Way Kiat %A Nilsson,Birgitta Blakstad %+ Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, P44, PB 4, Street Olavs Plass, Oslo, 0130, Norway, 47 48063537, plunde@oslomet.no %K mHealth %K mobile phone app %K smartphone %K lifestyle %K usability %K diabetes %K diabetic %K mobile health %K smartphone %K app %K apps %K application %K applications %K think-aloud %K think aloud %K user experience %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. Objective: The aim of this study was to assess the usability of an app among people at risk of DM2. Methods: A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. Results: In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. Conclusions: Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial. %M 37966894 %R 10.2196/48950 %U https://humanfactors.jmir.org/2023/1/e48950 %U https://doi.org/10.2196/48950 %U http://www.ncbi.nlm.nih.gov/pubmed/37966894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47404 %T Testing a Digital Health App for Patients With Alcohol-Associated Liver Disease: Mixed Methods Usability Study %A Park,Linda S %A Kornfield,Rachel %A Yezihalem,Mihret %A Quanbeck,Andrew %A Mellinger,Jessica %A German,Margarita %+ Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N. Whitney Way #200, Madison, WI, 53705, United States, 1 608 345 6859, linda.park@fammed.wisc.edu %K alcohol-associated liver disease %K ALD %K alcohol use disorder %K AUD %K mobile health %K mHealth %K digital tools %K alcohol cessation %K usability test %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol-associated liver disease (ALD) is increasingly common and associated with serious and costly health consequences. Cessation of drinking can improve ALD morbidity and mortality; however, support for cessation is not routinely offered to those diagnosed with ALD, and continued drinking or resumption of drinking after diagnosis is common. Mobile health (mHealth) has the potential to offer convenient and scalable support for alcohol cessation to those diagnosed with ALD, but mHealth interventions for alcohol cessation have not been designed for or evaluated in a population with ALD. Objective: This study aims to understand how individuals with ALD would perceive and use an mHealth tool for alcohol cessation and to gather their perspectives on potential refinements to the tool that would allow it to better meet their needs. Methods: We interviewed 11 individuals who attended clinic visits related to their ALD to elicit their needs related to support for alcohol cessation and views on how mHealth could be applied. After completing initial interviews (pre), participants were provided with access to an mHealth app designed for alcohol cessation, which they used for 1 month. Afterward, they were interviewed again (post) to give feedback on their experiences, including aspects of the app that met their needs and potential refinements. We applied a mixed methods approach, including a qualitative analysis to identify major themes from the interview transcripts and descriptive analyses of use of the app over 1 month. Results: First, we found that a diagnosis of ALD is perceived as a motivator to quit drinking but that patients had difficulty processing the overwhelming amount of information about ALD they received and finding resources for cessation of alcohol use. Second, we found that the app was perceived as usable and useful for supporting drinking recovery, with patients responding favorably to the self-tracking and motivational components of the app. Finally, patients identified areas in which the app could be adapted to meet the needs of patients with ALD, such as providing information on the medical implications of an ALD diagnosis and how to care for their liver as well as connecting individuals with ALD to one another via a peer-to-peer support forum. Rates of app use were high and sustained across the entire study, with participants using the app a little more than half the days during the study on average and with 100% (11/11) of participants logging in each week. Conclusions: Our results highlight the need for convenient access to resources for alcohol cessation after ALD diagnosis and support the potential of an mHealth approach to integrate recovery support into care for ALD. Our findings also highlight the ways the alcohol cessation app should be modified to address ALD-specific concerns. %M 37966869 %R 10.2196/47404 %U https://formative.jmir.org/2023/1/e47404 %U https://doi.org/10.2196/47404 %U http://www.ncbi.nlm.nih.gov/pubmed/37966869 %0 Journal Article %@ 2291-5222 %I %V 11 %N %P e46846 %T Assessing the Usefulness of Mobile Apps for Noise Management in Occupational Health and Safety: Quantitative Measurement and Expert Elicitation Study %A Huyan,Jingchen %A Ramkissoon,Chandnee %A Laka,Mah %A Gaskin,Sharyn %K occupational health %K noise management %K mobile applications %K mobile apps %K mHealth %K Mobile App Rating Scale %K MARS %K management %K hearing %K hearing loss %K mobile phone %K noise detection %K usefulness %K tool %D 2023 %7 14.11.2023 %9 %J JMIR Mhealth Uhealth %G English %X Background: Overexposure to occupational noise can lead to hearing loss. Occupational noise mapping is conventionally performed with a calibrated sound level meter (SLM). With the rise of mobile apps, there is a growing number of SLM apps available on mobile phones. However, few studies have evaluated such apps for accuracy and usefulness to guide those with occupational noise detection needs in selecting a quality app. Objective: The purpose of this study was to evaluate the accuracy and usefulness of SLM mobile apps to guide workplace health and safety professionals in determining these apps’ suitability for assessing occupational noise exposure. Methods: The following three iOS apps were assessed: the NIOSH (National Institute for Occupational Safety and Health) Sound Level Meter, Decibel X, and SoundMeter X apps. The selected apps were evaluated for their accuracy in measuring sound levels in low-, moderate-, and high-noise settings within both simulated environments and real-world environments by comparing them to a conventional SLM. The usefulness of the apps was then assessed by occupational health specialists using the Mobile App Rating Scale (MARS). Results: The NIOSH Sound Level Meter app accurately measured noise across a range of sound levels in both simulated settings and real-world settings. However, considerable variation was observed between readings. In comparison, the Decibel X and SoundMeter X apps showed more consistent readings but consistently underestimated noise levels, suggesting that they may pose a risk for workers. Nevertheless, none of the differences in sound measurements between the three apps and the conventional SLM were statistically significant (NIOSH Sound Level Meter: P=.78; Decibel X: P=.38; SoundMeter X: P=.40). The MARS scores for the three apps were all above 3.0, indicating the usefulness of these apps. Conclusions: Under the conditions of this study, the NIOSH Sound Level Meter app had equivalent accuracy to the calibrated SLM and a degree of usefulness according to the MARS. This suggests that the NIOSH Sound Level Meter app may be suitable for mapping noise levels as part of a monitoring strategy in workplaces. However, it is important to understand its limitations. Mobile apps should complement but not replace conventional SLMs when trying to assess occupational noise exposure risk. Our outcomes also suggest that the MARS tool may have limited applicability to measurement-based apps and may be more suited to information-based apps that collect, record, and store information. %R 10.2196/46846 %U https://mhealth.jmir.org/2023/1/e46846 %U https://doi.org/10.2196/46846 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48637 %T Feasibility and Usability of the Job Adjustment Mobile App for Pregnant Women: Longitudinal Observational Study %A Wada,Aya %A Nakamura,Yasuka %A Kawajiri,Maiko %A Takeishi,Yoko %A Yoshida,Mikako %A Yoshizawa,Toyoko %+ Department of Women’s Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1, Sendai, Miyagi, 9800872, Japan, 81 227177957, ynaka@tohoku.ac.jp %K work %K pregnancy %K occupation %K occupational health %K mHealth %K mobile application %K feasibility %K usability %K longitudinal %K observational study %K pregnancy %K Japan %K mobile health %K occupational health and safety %K ergonomics %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial. Objective: This study aims to verify the feasibility and usability of the Job Adjustment mobile app. Methods: A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale. Results: The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01). Conclusions: The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women. Trial Registration: UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas %M 37962945 %R 10.2196/48637 %U https://formative.jmir.org/2023/1/e48637 %U https://doi.org/10.2196/48637 %U http://www.ncbi.nlm.nih.gov/pubmed/37962945 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50419 %T Factors Influencing the Acceptance and Adoption of Mobile Health Apps by Physicians During the COVID-19 Pandemic: Systematic Review %A Alsahli,Sultan %A Hor,Su-yin %A Lam,Mary %+ School of Public Health, Faculty of Health, University of Technology Sydney, 235 Jones St., Sydney, 2007, Australia, 61 (02) 9514 2000, Sultan.alsahli@student.uts.edu.au %K mobile health %K mHealth %K mobile app %K adoption %K acceptance %K barrier %K attitude %K physician %K doctor %K practitioner %K mobile phone %D 2023 %7 8.11.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, the provision of and access to health care have been uniquely challenging, particularly during lockdowns or when dealing with COVID-19 cases. Health care professionals have had to provide patients with the necessary health care. However, delivering health care services while reducing face-to-face interaction puts an immense strain on health systems that are already overburdened. Against this backdrop, it is now more critical than ever to ensure the accessibility of health care services. Such access has been made increasingly available through mobile health (mHealth) apps. These apps have the potential to significantly improve health care outcomes and expectations and address some of the challenges confronting health care systems worldwide. Despite the advantages of mHealth, its acceptance and adoption remain low. Hence, health care organizations must consider the perceptions and opinions of physicians if the technology is to be successfully implemented. Objective: The objective of this systematic review was to explore and synthesize the scientific literature on the factors influencing the acceptance and adoption of mHealth among physicians during the COVID-19 pandemic. Methods: A systematic review of the studies published between March 2020 and December 2022 was conducted using the MEDLINE, Scopus, Embase, and ProQuest databases. The database search yielded an initial sample of 455 potential publications for analysis, of which 9 (2%) met the inclusion criteria. The methodology of this review was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Results: The factors influencing mHealth acceptance and adoption by physicians were divided into perceived barriers and perceived facilitators, which were further grouped into the following 3 major thematic categories: technological, individual, and organizational barriers and facilitators, respectively. The technological barriers were accessibility, technical issues, usefulness, and data management; individual barriers were perceived patient barriers, time and workload pressure, technical literacy, knowledge of mHealth, and peer support; and organizational barriers were financial factors, management support and engagement, data security, telemonitoring policy, and collaboration. The technological facilitators of uptake were technical factors, clinical usefulness, and data management; individual facilitators were patient-related care, intrinsic motivation, collaboration, and data sharing (individual); and organizational facilitators were workflow-related determinants, organizational financial support, recommendation of mHealth services, and evidence-based guidelines. Conclusions: This review summarized the evidence on the factors influencing mHealth acceptance and adoption by physicians during the COVID-19 pandemic. The main findings highlighted the importance of addressing organizational readiness to support physicians with adequate resources, shifting the focus from technological to patient-centered factors, and the seamless integration of mHealth into routine practice during and beyond the pandemic. Trial Registration: PROSPERO CRD42022356125; https://tinyurl.com/2mmhn5yu %M 37938873 %R 10.2196/50419 %U https://mhealth.jmir.org/2023/1/e50419 %U https://doi.org/10.2196/50419 %U http://www.ncbi.nlm.nih.gov/pubmed/37938873 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47913 %T Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study %A Beyeler,Marina %A Légeret,Corinne %A Kiwitz,Fabian %A van der Horst,Klazine %+ Nutrition and Dietetics, School of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, Bern, 3008, Switzerland, 41 799576535, klazine.vanderhorst@bfh.ch %K bariatric surgery %K nutrition information %K usability %K satisfaction %K artificial intelligence %K health bot %K mobile phone %D 2023 %7 8.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Currently, over 4000 bariatric procedures are performed annually in Switzerland. To improve outcomes, patients need to have good knowledge regarding postoperative nutrition. To potentially provide them with knowledge between dietetic consultations, a health bot (HB) was created. The HB can answer bariatric nutrition questions in writing based on artificial intelligence. Objective: This study aims to evaluate the usability and perception of the HB among patients receiving bariatric care. Methods: Patients before or after bariatric surgery tested the HB. A mixed methods approach was used, which consisted of a questionnaire and qualitative interviews before and after testing the HB. The dimensions usability of, usefulness of, satisfaction with, and ease of use of the HB, among others, were measured. Data were analyzed using R Studio (R Studio Inc) and Excel (Microsoft Corp). The interviews were transcribed and a summary inductive content analysis was performed. Results: A total of 12 patients (female: n=8, 67%; male: n=4, 33%) were included. The results showed excellent usability with a mean usability score of 87 (SD 12.5; range 57.5-100) out of 100. Other dimensions of acceptability included usefulness (mean 5.28, SD 2.02 out of 7), satisfaction (mean 5.75, SD 1.68 out of 7), and learnability (mean 6.26, SD 1.5 out of 7). The concept of the HB and availability of reliable nutrition information were perceived as desirable (mean 5.5, SD 1.64 out of 7). Weaknesses were identified in the response accuracy, limited knowledge, and design of the HB. Conclusions: The HB’s ease of use and usability were evaluated to be positive; response accuracy, topic selection, and design should be optimized in a next step. The perceptions of nutrition professionals and the impact on patient care and the nutrition knowledge of participants need to be examined in further studies. %M 37938894 %R 10.2196/47913 %U https://humanfactors.jmir.org/2023/1/e47913 %U https://doi.org/10.2196/47913 %U http://www.ncbi.nlm.nih.gov/pubmed/37938894 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e51090 %T German Version of the mHealth App Usability Questionnaire in a Cohort of Patients With Cancer: Translation and Validation Study %A Moorthy,Preetha %A Weinert,Lina %A Harms,Bendix Christian %A Anders,Carolin %A Siegel,Fabian %+ Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 8078, preetha.moorthy@medma.uni-heidelberg.de %K usability %K mobile health %K mHealth app %K questionnaire validation %K questionnaire translation %K mHealth App Usability Questionnaire %K MAUQ %K mobile phone %D 2023 %7 1.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Good usability is important for the adoption and continued use of mobile health (mHealth) apps. In particular, high usability can support intuitive use by patients, which improves compliance and increases the app’s effectiveness. However, many usability studies do not use adequate tools to measure perceived usability. The mHealth App Usability Questionnaire (MAUQ) was developed specifically for end users in a medical context. MAUQ is a relatively new but increasingly used questionnaire to evaluate mHealth apps, but it is not yet available in German. Objective: This study aims to translate MAUQ into German and determine its internal consistency, reliability, and construct validity. Methods: This validation study was conducted as part of a usability evaluation project for an mHealth app used as a therapy support tool during breast cancer chemotherapy. MAUQ was translated into German through a rigorous forward-backward translation process, ensuring semantic and conceptual equivalence. Patient responses to MAUQ and System Usability Scale (SUS) were analyzed for validation. Descriptive analysis was performed for the MAUQ subscales and SUS standard scores. Significance tests and correlation coefficients assessed the relationship between the SUS and MAUQ results, confirming construct validity. Internal consistency was assessed for item reliability and consistency in measuring the target construct. Free-text questions assessed translation comprehensibility, with responses analyzed descriptively and qualitatively using content analysis. Results: In this study, 133 participants responded to the questionnaire, and the validation analysis showed substantially positive correlations between the overall MAUQ score and its subscales: ease of use (r=0.56), interface and satisfaction (r=0.75), and usefulness (r=0.83). These findings support the construct validity of MAUQ and emphasize the importance of these subscales in assessing the usability of the Enable app. The correlation coefficients ranging from 0.39 to 0.68 for the items further validate the questionnaire by aligning with the overall score and capturing the intended concept. The high internal consistency reliability of MAUQ (Cronbach α=.81) and its subscales further enhances the instrument’s robustness in accurately evaluating the usability of mHealth apps. Conclusions: We successfully validated the German translation of the MAUQ for stand-alone apps using a standardized approach in a cohort of patients with breast cancer. In our validation study, MAUQ exhibited strong internal consistency reliability (Cronbach α=.81) across its subscales, indicating reliable and consistent measurement. Furthermore, a significant positive correlation (P<.001) was found between the subscales and the overall score, supporting their consistent measurement of the intended construct. Therefore, MAUQ can be considered a reliable instrument for assessing the usability of mHealth apps among German-speaking adults. The availability of the German version of MAUQ will help other researchers in conducting usability studies of mHealth apps in German-speaking cohorts and allow for international comparability of their results. %M 37910144 %R 10.2196/51090 %U https://humanfactors.jmir.org/2023/1/e51090 %U https://doi.org/10.2196/51090 %U http://www.ncbi.nlm.nih.gov/pubmed/37910144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e30443 %T Reducing Dental Anxiety in Children Using a Mobile Health App: Usability and User Experience Study %A del Carmen,María del Carmen %A Cagigas-Muñiz,Daniel %A García-Robles,Rocío %A Oprescu,Andreea Madalina %+ Universidad de Sevilla, Avda. Reina Mercedes s/n, Sevilla, 41012, Spain, 34 954554324, mcromerot@us.es %K dentistry %K dental anxiety %K children %K mobile %K app %K usability %K user experience %K human-centered design %K mobile health %K mHealth %K digital health %K mobile application %K application development %D 2023 %7 27.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Dentistry interventions cause common anxiety and fear problems in children (6-11 years), and according to scientific evidence, this causes a decrease in their quality of life. Therapies mediated by IT-based tools have been shown to positively influence children’s mood based on distraction as well as relaxing activities, but there is no evidence of their use to reduce dental anxiety in children. Objective: The aim of this study was to answer the following research question: Does our new children-centered codesign methodology contribute to achieving a usable mobile-based product with a highly scored user experience? Methods: A mobile health app was developed to reduce dental anxiety in children using rapid application development following the usage-centered design methodology. Structured interviews were conducted to test the usability and user experience of the app prototype among 40 children (n=20, 50%, boys and n=20, 50%, girls; age 6-11 years) using a children-adapted questionnaire and the 7-point Single Ease Question rating scale. The Smiley Faces Program—Revised questionnaire was used to assess the level of dental anxiety in participants. Results: There were no significant differences between girls and boys. The task completion rate was 95% (n=19) for children aged 6-8 years (group 1) and 100% (n=20) for children aged 9-11 years (group 2). Group 1 found watching the relaxing video (task C) to be the easiest, followed by playing a video minigame (task B) and watching the narrative (task A). Group 2 found task C to be the easiest, followed by task A and then task B. The average time spent on the different types of tasks was similar in both age groups. Most of the children in both age groups were happy with the app and found it funny. All children thought that having the app in the waiting room during a dental visit would be useful. Conclusions: The findings confirmed that the app is usable and provides an excellent user experience. Our children-adapted methodology contributes to achieving usable mobile-based products for children with a highly scored user experience. %M 37889521 %R 10.2196/30443 %U https://formative.jmir.org/2023/1/e30443 %U https://doi.org/10.2196/30443 %U http://www.ncbi.nlm.nih.gov/pubmed/37889521 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48515 %T A Mobile App to Assist the Mentors of African American Young Men Who Have Sex With Men: Usability Study %A Kaufman,Michelle R %A Wright,Kate %A Eschliman,Evan L %A Levine,Deborah %A Simon,Jeannette %+ Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, United States, 1 410 955 2313, michellekaufman@jhu.edu %K mentoring %K youth %K mobile app %K men who have sex with men %K MSM %K HIV prevention %K healthy relationships %K African American %D 2023 %7 27.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in general and even less on the role that mentors may play in promoting healthy outcomes in sexual and gender minority youth. African American young men who have sex with men (YMSM) are more likely to reside in communities with limited access to formalized mentorship programs and may benefit from naturally occurring mentoring relationships that address health outcomes, specifically related to HIV. Objective: This study is a usability test of a mobile app designed for the mentors of African American YMSM to increase mentors’ knowledge of and confidence in talking about HIV prevention and related topics with mentees. Methods: Following consent, eligible and naturally occurring mentoring pairs involving African American YMSM in Baltimore; Philadelphia; and Washington, District of Columbia, tested the app, UrbanMentorHub, for usability. Participants downloaded the app and used it for 1 month, completed pre- and postintervention surveys, and participated in a follow-up focus group discussion. Participants’ sociodemographic characteristics and HIV- and mentorship-related measures were characterized using descriptive statistics. Wilcoxon signed rank tests were used to test for pre- and postintervention differences in knowledge, confidence, and outcome expectancy measures. Focus group discussions were audio recorded and transcribed. Transcripts were thematically coded and analyzed to identify ways that UrbanMentorHub could be improved in the mentoring context. Results: Nine mentorship pairs participated in this usability study (N=18). Mentors obtained high scores on knowledge, confidence, outcome expectancies, skills, and intentions related to HIV and mentoring. No pre- or postintervention changes were observed in these measures. Mentors reported usually initiating conversations around HIV testing and pre-exposure prophylaxis; mentees and mentors equally initiated conversations on sexual practices and same-sex relationships. Mentors reported sexual practices as the most frequently discussed topic in the past month and pre-exposure prophylaxis being the least discussed. Mentees reported high comfort with HIV-related conversations. No pre- or postintervention change was observed regarding HIV knowledge. Most mentees reported having discussed most HIV-related topics with their mentor in the past month. Mentor feedback on the app was mostly neutral, although they reported positive perceptions of the idea of the app, indicating the potential for addressing a need in their communities. Mentors suggested ways to improve the app content and design elements. Conclusions: Although there was no observed statistical change in measured outcomes, and qualitative feedback was overall neutral, the results of this usability study can inform future work to design and promote interventions and resources that support mentoring relationships for African American YMSM. %M 37889552 %R 10.2196/48515 %U https://formative.jmir.org/2023/1/e48515 %U https://doi.org/10.2196/48515 %U http://www.ncbi.nlm.nih.gov/pubmed/37889552 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47813 %T Identifying Design Opportunities for Adaptive mHealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners %A Yan,Xinghui %A Newman,Mark W %A Park,Sun Young %A Sander,Angelle %A Choi,Sung Won %A Miner,Jennifer %A Wu,Zhenke %A Carlozzi,Noelle %+ Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex 2800 Plymouth Rd., Building NCRC B14, Ann Arbor, MI, 48108, United States, 1 734 764 0644, carlozzi@umich.edu %K mHealth intervention %K mobile health %K behavior change %K qualitative study %K user adherence %K behavioral messages %K general well-being %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages. Objective: The goal of this study was to understand the factors that impact care partners’ decision-making and actions in response to different behavioral messages. Insights from this study will help optimize future tailored and personalized behavioral interventions. Methods: We conducted semistructured interviews with participants who had recently completed a 3-month randomized controlled feasibility trial of the CareQOL mHealth intervention app. Of the 36 participants from the treatment group of the randomized controlled trial, 23 (64%) participated in these interviews. To prepare for each interview, the team first selected representative behavioral messages (eg, targeting different health dimensions) and presented them to participants during the interview to probe their influence on participants’ thoughts and actions. The time of delivery, self-reported perceptions of the day, and user ratings of a message were presented to the participants during the interviews to assist with recall. Results: The interview data showed that after receiving a message, participants took various actions in response to different messages. Participants performed suggested behaviors or adjusted them either immediately or in a delayed manner (eg, sometimes up to a month later). We identified 4 factors that shape the variations in user actions in response to different behavioral messages: uncertainties about the workload required to perform suggested behaviors, concerns about one’s ability to routinize suggested behaviors, in-the-moment willingness and ability to plan for suggested behaviors, and overall capability to engage with the intervention. Conclusions: Our study showed that care partners use mHealth behavioral messages differently regarding the immediacy of actions and the adaptation to suggested behaviors. Multiple factors influence people’s perceptions and decisions regarding when and how to take actions. Future systems should consider these factors to tailor behavioral support for individuals and design system features to support the delay or adaptation of the suggested behaviors. The findings also suggest extending the assessment of user adherence by considering the variations in user actions on behavioral support (ie, performing suggested or adjusted behaviors immediately or in a delayed manner). International Registered Report Identifier (IRRID): RR2-10.2196/32842 %M 37874621 %R 10.2196/47813 %U https://formative.jmir.org/2023/1/e47813 %U https://doi.org/10.2196/47813 %U http://www.ncbi.nlm.nih.gov/pubmed/37874621 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47374 %T Design, Development, and Evaluation of an mHealth App for Reporting of Side Effects During Cytostatic Treatment: Usability Test and Interview Study %A Hægermark,Emil Aale %A Kongshaug,Nina %A Raj,Sunil Xavier %A Hofsli,Eva %A Faxvaag,Arild %+ Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Olav Kyrres gate 9, Trondheim, 7491, Norway, 47 98069390, echaeger@stud.ntnu.no %K mobile health %K mHealth %K user-centered design %K usability testing %K cancer %K side effects %K cytostatic treatment %K intervention %K mobile app %K usability %K user interface %K user %K smartphone %K mobile phone %D 2023 %7 19.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Using mobile health (mHealth) interventions such as smartphone apps to deliver health services is an opportunity to engage patients more actively in their own treatment. Usability tests allow for the evaluation of a service by testing it out on the relevant users before implementation in clinical practice. Objective: The objective of this study was to design, develop, and evaluate the user interface of an app that would aid patients with cancer in reporting a more comprehensive summary of their side effects. Methods: The usability test was conducted by exposing patients with cancer to a prototype of an mHealth app that allowed for reporting of side effects from a chemotherapy regimen. After solving a set of 13 tasks, the test participants completed a system usability scale questionnaire and were interviewed using a semistructured interview guide. The interviews were later transcribed and analyzed. Results: The 10 test participants had a mean age of 56.5 (SD 7.11) years. The mean total task completion time for the task-solving session was 240.15 (SD 166.78) seconds. The calculated system usability scale score was 92.5. Most participants solved most of the tasks without any major issues. A minority reported having difficulties using apps on smartphones in general. One patient never achieved a meaningful interaction with our app prototype. Most of those who engaged with the app approved of features that calmed them down, made them more empowered, and put them in control. They preferred to report on side effects in a detailed and concise manner. App features that provided specific advice could provoke both fear and rational action. Conclusions: The user tests uncovered design flaws that allowed for subsequent refining of an app that has the potential to enhance the safety of patients undergoing home-based chemotherapy. However, a refined version of the app is unlikely to be of value to all patients. Some might not be able to use apps on smartphones in general, or their ability to use apps is impaired because of their disease. This finding should have implications for health care providers’ overall design of their follow-up service as the service must allow for all the patients to receive safe treatment whether they can use an mHealth app or not. %M 37856183 %R 10.2196/47374 %U https://formative.jmir.org/2023/1/e47374 %U https://doi.org/10.2196/47374 %U http://www.ncbi.nlm.nih.gov/pubmed/37856183 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e50116 %T A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study %A Morgan,Jessica Kelley %A Rawlins,Caitlin R %A Walther,Steven K %A Harvey,Andrew %A O'Donnell,Annmarie %A Greene,Marla %A Schmidt,Troy G %+ Continuous Precision Medicine, 800 Park Offices Drive, Suite 3718, Research Triangle Park, NC, 27709-3547, United States, 1 9196185405, jmorgan@cpmed.io %K mobile app %K pain management %K opioids %K older adults %K veterans %K mobile phone %D 2023 %7 18.10.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Prescription opioid misuse risk is disproportionate among veterans; military veterans wounded in combat misuse prescription opioids at an even higher rate (46.2%). Opioid misuse is costly in terms of morbidity, mortality, and humanitarian and economic burden and costs the Civilian Health and Medical Program of the Department of Veterans Affairs more than US $1.13 billion annually. Preventing opioid misuse at the time of prescription is a critical component in the response to the opioid crisis. The CPMRx mobile app has been shown to decrease the odds of opioid misuse during the postoperative period. Objective: The overarching purpose of this feasibility pilot study was to explore whether deploying a mobile app (CPMRx) to track postoperative pain and medication use is feasible in a Department of Veterans Affairs medical center. In support of this goal, we had four complementary specific aims: (1) determine the technological and logistical feasibility of the mobile app, (2) assess the acceptability of the mobile app to participants, (3) measure demand for and engagement with the mobile app, and (4) explore the potential use of the mobile app to patients and providers. Methods: Participants (N=10) were veterans undergoing total knee arthroplasty within the Veterans Health Administration provided with the CPMRx app to self-manage their pain during their 7-day at-home recovery following surgery. CPMRx uses scientifically validated tools to help clinicians understand how a patient can use the least amount of medication while getting the most benefit. The suite of software includes a mobile app for patients that includes a behavioral health intervention and a clinical decision support tool for health care providers that provides feedback about pain and medication use trends. Patients filled out paper questionnaires regarding acceptability at their postoperative follow-up appointment. Results: Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the app was 4.9 of 5 (5=“very little”), and the average rating for ease of use was 4.4 of 5 (5=“very easy”). Open-ended questions also revealed that most participants found ease of use to be high. Demand and engagement were high as well with a mean number of mobile app entries of 34.1 (SD 20.1) during the postoperative period. There were no reported technological or logistical issues with the mobile app. Participants took an average of 25.13 (SD 14.37) opioid tablets to manage their postoperative pain. Conclusions: Results of this study revealed that the use of a mobile app for pain and medication management during postoperative recovery was both feasible and acceptable in older veterans undergoing total knee arthroplasty within the Veterans Health Administration. The wide variation in opioid consumption across participants revealed the potential use of the mobile app to provide actionable insights to clinicians if adopted more widely. %M 37851497 %R 10.2196/50116 %U https://periop.jmir.org/2023/1/e50116 %U https://doi.org/10.2196/50116 %U http://www.ncbi.nlm.nih.gov/pubmed/37851497 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e46058 %T Nurses’ Roles in mHealth App Development: Scoping Review %A Bakker,Caitlin J %A Wyatt,Tami H %A Breth,Melissa CS %A Gao,Grace %A Janeway,Lisa M %A Lee,Mikyoung A %A Martin,Christie L %A Tiase,Victoria L %+ Dr John Archer Library, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 3065854015, caitlin.bakker@uregina.ca %K mobile health %K mHealth %K mobile app %K product development %K software design %K scoping %K search strategy %K nursing %K health app %K mobile app %K nurse %K nursing %K allied health %K development %K design %K software %K scoping literature review %K scoping review %K app %K sensor %K wearable %K software development %K mobile phone %D 2023 %7 17.10.2023 %9 Review %J JMIR Nursing %G English %X Background: Although mobile health (mHealth) apps for both health consumers and health care providers are increasingly common, their implementation is frequently unsuccessful when there is a misalignment between the needs of the user and the app’s functionality. Nurses are well positioned to help address this challenge. However, nurses’ engagement in mHealth app development remains unclear. Objective: This scoping review aims to determine the extent of the evidence of the role of nurses in app development, delineate developmental phases in which nurses are involved, and to characterize the type of mHealth apps nurses are involved in developing. Methods: We conducted a scoping review following the 6-stage methodology. We searched 14 databases to identify publications on the role of nurses in mHealth app development and hand searched the reference lists of relevant publications. Two independent researchers performed all screening and data extraction, and a third reviewer resolved any discrepancies. Data were synthesized and grouped by the Software Development Life Cycle phase, and the app functionality was described using the IMS Institute for Healthcare Informatics functionality scoring system. Results: The screening process resulted in 157 publications being included in our analysis. Nurses were involved in mHealth app development across all stages of the Software Development Life Cycle but most frequently participated in design and prototyping, requirements gathering, and testing. Nurses most often played the role of evaluators, followed by subject matter experts. Nurses infrequently participated in software development or planning, and participation as patient advocates, research experts, or nurse informaticists was rare. Conclusions: Although nurses were represented throughout the preimplementation development process, nurses’ involvement was concentrated in specific phases and roles. %M 37847533 %R 10.2196/46058 %U https://nursing.jmir.org/2023/1/e46058 %U https://doi.org/10.2196/46058 %U http://www.ncbi.nlm.nih.gov/pubmed/37847533 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48372 %T Feasibility and Usability of a Mobile App–Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study %A Young,Nathan P %A Ridgeway,Jennifer L %A Haddad,Tufia C %A Harper,Sarah B %A Philpot,Lindsey M %A Christopherson,Laura A %A McColley,Samantha M %A Phillips,Sarah A %A Brown,Julie K %A Zimmerman,Kelly S %A Ebbert,Jon O %+ Integrated Community Specialty Practice, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 284 2844, young.nathan@mayo.edu %K migraine %K mobile app %K smartphone %K care model %K feasibility %K usability %K digital health %K remote monitoring %K care plan %K pilot %K mobile health %K mHealth %K mobile phone %K patient-reported outcomes %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app–based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. Objective: This study aims to describe a novel electronic health record–integrated mobile app–based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. Methods: Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. Results: A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). Conclusions: We describe the successful implementation of an electronic health record–integrated mobile app–based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care. %M 37796560 %R 10.2196/48372 %U https://formative.jmir.org/2023/1/e48372 %U https://doi.org/10.2196/48372 %U http://www.ncbi.nlm.nih.gov/pubmed/37796560 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e44985 %T User-Centered Development of a Mobile App to Assess the Quality of Life of Patients With Cancer: Iterative Investigation and Usability Testing %A Beutter,Chantal N L %A Zeller,Katharina %A Martens,Uwe M %A Pfleiderer,Bettina %A Fegeler,Christian %+ MOLIT Institute gGmbH, Im Zukunftspark 10, Heilbronn, 74076, Germany, 49 7131 1334500, chantal.beutter@molit.eu %K quality of life %K cancer %K mHealth %K mobile health %K patient empowerment %K user-centered design %K user %K user centered %K design %K physical well-being %K well-being %K mental health %K monitoring %K development %K usability %D 2023 %7 26.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: The treatment for cancer can have a negative impact not only on physical well-being but also on mental health and the quality of life (QoL). Health apps enable the monitoring of different parameters, but to date, there are only few that support patients with cancer and none that focuses on the assessment of QoL. Furthermore, patients as stakeholders are often only integrated at the late stage of the development process, if at all. Objective: The aim of this research was to develop and evaluate a smartphone app (Lion-App) to enable patients with cancer to autonomously measure the QoL with an iterative, user-centered approach. Methods: Patients with cancer were involved in a 3-stage process from conceptualization to the point when the app was available on the tester’s private device. First, focus groups with members (N=21) of cancer support groups were conducted to understand their expectations and needs. Thereafter, individual tests were performed. After developing a prototype that incorporated findings from the focus groups, a second test cycle was conducted, followed by a beta test lasting 2 months. In our app, the QoL can be assessed via a patient diary and an integrated questionnaire. Through all stages, usability was evaluated using the modular extended version of the User Experience Questionnaire (UEQ+), including the calculation of a key performance indicator (KPI). If possible, the impact of sex on the results was evaluated. As part of the beta test, usage rates as well as age-dependent differences were also assessed. Results: A total of 21 participants took part in the initial 3 focus groups. In the subsequent usability testing (N=18), 17 (94%) participants rated their impression through the UEQ+, with a mean KPI of 2.12 (SD 0.64, range: –3 to 3). In the second usability test (N=14), the mean KPI increased to 2.28 (SD=0.49). In the beta test, the usage rate of 19 participants was evaluated, of whom 14 (74%) also answered the UEQ+ (mean KPI 1.78, SD 0.84). An influence of age on the number of questionnaire responses in Lion-App was observed, with a decrease in responses with increasing age (P=.02). Sex-dependent analyses were only possible for the first usability test and the beta test. The main adjustments based on user feedback were a restructuring of the diary as well as integration of a shorter questionnaire to assess the QoL. Conclusions: The iterative, user-centered approach for development and usability testing resulted in positive evaluations of Lion-App. Our app was rated as suitable for everyday use to monitor the QoL of patients with cancer. Initial results indicated that the sex and age of participants seem to play only a minor role. %M 37751285 %R 10.2196/44985 %U https://cancer.jmir.org/2023/1/e44985 %U https://doi.org/10.2196/44985 %U http://www.ncbi.nlm.nih.gov/pubmed/37751285 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43186 %T Design Guidelines of Mobile Apps for Older Adults: Systematic Review and Thematic Analysis %A Gomez-Hernandez,Miguel %A Ferre,Xavier %A Moral,Cristian %A Villalba-Mora,Elena %+ Center for Biomedical Technology, Universidad Politécnica de Madrid, Campus Montegancedo, Pozuelo de Alarcón, 28223, Spain, 34 91067925, xavier.ferre@upm.es %K tablet %K smartphone %K older user %K design recommendations %K usability testing %K user experience design %K UX design %K design %K mobile app %K tool %K quality of life %K software %K training %K visual design %K older adults %K mobile phone %D 2023 %7 21.9.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are fundamental tools in today’s society for practical and social endeavors. However, these technologies are often not usable for older users. Given the increased use of mobile apps by this group of users and the impact that certain services may have on their quality of life, such as mobile health, personal finance, or online administrative procedures, a clear set of guidelines for mobile app designers is needed. Existing recommendations for older adults focus on investigations with certain groups of older adults or have not been extracted from experimental results. Objective: In this research work, we systematically reviewed the scientific literature that provided recommendations for the design of mobile apps based on usability testing with older adults and organized such recommendations into a meaningful set of design guidelines. Methods: We conducted a systematic literature review of journal and conference articles from 2010 to 2021. We included articles that carried out usability tests with populations aged >60 years and presented transferable guidelines on mobile software design, resulting in a final set of 40 articles. We then carried out a thematic analysis with 3 rounds of analysis to provide meaning to an otherwise diverse set of recommendations. At this stage, we discarded recommendations that were made by just 1 article, were based on a specific mobile app and were therefore nontransferrable, were based on other authors’ literature (as opposed to recommendations based on the results of usability tests), or were not sufficiently argued. With the remaining recommendations, we identified commonalities, wrote a faithful statement for each guideline, used a common language for the entire set, and organized the guidelines into categories, thereby giving shape to an otherwise diverse set of recommendations. Results: Among the 27 resulting guidelines, the rules Simplify and Increase the size and distance between interactive controls were transversal and of the greatest significance. The rest of the guidelines were divided into 5 categories (Help & Training, Navigation, Visual Design, Cognitive Load, and Interaction) and consequent subcategories in Visual Design (Layout, Icons, and Appearance) and Interaction (Input and Output). The recommendations were structured, explained in detail, and illustrated with applied examples extracted from the selected studies, where appropriate. We discussed the design implications of applying these guidelines, contextualized with relevant studies. We also discussed the limitations of the approach followed, stressing the need for further experimentation to gain a better understanding of how older adults use mobile apps and how to better design such apps with these users in mind. Conclusions: The compiled guidelines support the design of mobile apps that cater to the needs of older adults because they are based on the results of actual usability tests with users aged >60 years. %M 37733401 %R 10.2196/43186 %U https://mhealth.jmir.org/2023/1/e43186 %U https://doi.org/10.2196/43186 %U http://www.ncbi.nlm.nih.gov/pubmed/37733401 %0 Journal Article %@ 2291-5222 %I %V 11 %N %P e25908 %T Consumers’ Preferences for Purchasing mHealth Apps: Discrete Choice Experiment %A Xie,Zhenzhen %A Or,Calvin Kalun %K consumer preferences %K discrete choice experiment %K DCE %K mobile health %K mHealth %K digital health %D 2023 %7 13.9.2023 %9 %J JMIR Mhealth Uhealth %G English %X 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. %R 10.2196/25908 %U https://mhealth.jmir.org/2023/1/e25908 %U https://doi.org/10.2196/25908 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47566 %T Racial Disparities in Shared Decision-Making and the Use of mHealth Technology Among Adults With Hypertension in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study in the United States %A Chen,Yuling %A Kruahong,Suratsawadee %A Elias,Sabrina %A Turkson-Ocran,Ruth-Alma %A Commodore-Mensah,Yvonne %A Koirala,Binu %A Himmelfarb,Cheryl R Dennison %+ Johns Hopkins School of Nursing, 525 N Wolfe St, Baltimore, MD, 21215, United States, ychen408@jh.edu %K mobile health %K disparities %K shared decision-making %K hypertension %K association %K decision-making %K mHealth %K technology %K health disparity %K adult %K smartphone %K racial %K ethnic %K health literacy %K digital literacy %D 2023 %7 13.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) technology has the potential to support shared decision-making (SDM) and improve hypertension control. However, our understanding of the variations in individuals’ involvement in SDM and mHealth usage across different racial and ethnic groups in the United States is still limited. Objective: This study aimed to investigate the extent of involvement in SDM and the usage of mHealth technology in health-related activities among US adults with hypertension from diverse racial and ethnic backgrounds and to examine whether the mHealth usage differed by individuals’ level of engagement in SDM. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey, which was conducted on US adults with self-reported hypertension, and race and ethnicity data were included. The exposure of interest was race and ethnicity. The outcomes were SDM and mHealth usage. SDM was assessed using an item: “In the past 12 months, how often did your health professional: involve you in decisions about your healthcare as much as you wanted?” mHealth usage was defined as using a smartphone or tablet to engage in (1) making health decisions, (2) discussing health decisions with health providers, (3) tracking health progress, and (4) sharing health information. Weighted multivariable logistic regression models were used to examine the association between race and ethnicity and SDM or mHealth usage adjusted for covariates and stratified by the level of engagement in SDM. Results: This study included 4893 adults with hypertension, and the mean age was 61 (SD 13) years. The sample was 53% female, 61% (n=3006) non-Hispanic White, 19% (n=907) non-Hispanic Black or African American, 12% (n=605) Hispanic, 4% (n=193) non-Hispanic Asian, and 4% (n=182) non-Hispanic other. Compared to the non-Hispanic White adults, non-Hispanic Black adults were more likely to use mHealth to make health decisions (adjusted odds ratio [aOR] 1.70, 95% CI 1.23-2.34), share health information (aOR 1.46, 95% CI 1.02-2.08), and discuss health decisions with health providers (aOR 1.38, 95% CI 1.02-1.87). Significant associations were observed specifically among those who were always involved in SDM. Asian adults were less likely to be involved in SDM (aOR 0.51, 95% CI 0.26-0.99) and were more likely to use mHealth to track progress on a health-related goal (aOR 2.07, 95% CI 1.28-3.34) than non-Hispanic White adults. Hispanic adults were less likely to use mHealth to share health information (aOR 0.47, 95% CI 0.33-0.67) and discuss health decisions with health providers (aOR 0.65, 95% CI 0.46-0.94) compared to non-Hispanic White adults. Conclusions: This study observed racial and ethnic disparities in SDM and mHealth usage among US adults with hypertension. These findings emphasize the significance of comprehending the involvement of SDM and the usage of mHealth technology within racially and ethnically diverse populations. %M 37703088 %R 10.2196/47566 %U https://www.jmir.org/2023/1/e47566 %U https://doi.org/10.2196/47566 %U http://www.ncbi.nlm.nih.gov/pubmed/37703088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45437 %T Health Providers’ Perceptions and Experiences of Using mHealth for Chronic Noncommunicable Diseases: Qualitative Systematic Review and Meta-Synthesis %A Gu,Yu %A Guan,Yushan %A Meng,Zhaolin %+ School of Nursing, Capital Medical University, NO 10 Xi Toutiao Road, Beijing, 100069, China, 86 010 83916503, mengzhaolin@ccmu.edu.cn %K mHealth %K mobile health %K health providers %K adoption %K chronic noncommunicable diseases %K systematic review %K meta-synthesis %K mobile phone %D 2023 %7 12.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) technology has great potential for addressing the epidemic of chronic noncommunicable diseases (CNCDs) by assisting health providers (HPs) with managing these diseases. However, there is currently limited evidence regarding the acceptance of mHealth among HPs, which is a key prerequisite for harnessing this potential. Objective: This review aimed to investigate the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Methods: A systematic search was conducted in MEDLINE (via Ovid), Embase, Web of Science, Google Scholar, and Cochrane Library (via Ovid) for studies that assessed the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Qualitative studies and mixed methods studies involving qualitative methods published in English were included. Data synthesis and interpretation were performed using a thematic synthesis approach. Results: A total of 18,242 studies were identified, of which 24 (0.13%) met the inclusion criteria. Overall, 6 themes related to facilitators were identified, namely empowering patient self-management, increasing efficiency, improving access to care, increasing the quality of care, improving satisfaction, and improving the usability of the internet and mobile software. Furthermore, 8 themes related to barriers were identified, namely limitation due to digital literacy, personal habits, or health problems; concern about additional burden; uncertainty around the value of mHealth technology; fear of medicolegal risks; lack of comfortable design and experience; lack of resources and incentives; lack of policy guidance and regulation; and worrisome side effects resulting from the use of mHealth. Conclusions: This study contributes to the understanding of the beneficial factors of and obstacles to mHealth adoption by HPs for CNCDs. The findings of this study may provide significant insights for health care workers and policy makers who seek ways to improve the adoption of mHealth by HPs for CNCDs. %M 37698902 %R 10.2196/45437 %U https://www.jmir.org/2023/1/e45437 %U https://doi.org/10.2196/45437 %U http://www.ncbi.nlm.nih.gov/pubmed/37698902 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45957 %T Development of an App for Tracking Family Engagement With Early Intervention Services: Focus Groups and Pilot Evaluation Study %A Wagner,Liliana %A Corona,Laura %A Khan,Nibraas %A Hooper,Madison %A Dixon,Alexa %A Munoz Lavanderos,Ambar %A Zheng,Zhaobo %A Sarkar,Nandan %A Sarkar,Nilanjan %A Warren,Zachary %+ Department of Pediatrics, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, United States, 1 615 936 5777, liliana.wagner@vumc.org %K mobile health %K early intervention %K families %K mobile phone %K autism %K focus groups %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Expedient access to early intervention (EI) systems has been identified as a priority for children with developmental delays, identified disabilities, and other special health care needs. Despite the mandated availability of EI, it remains challenging for families to navigate referral processes and establish appropriate services. Such challenges disproportionately affect families from traditionally underserved communities. Mobile health apps can improve clinical outcomes, increase accessibility to health services, and promote adherence to health-related interventions. Though promising, the implementation of apps within routine care is in its infancy, with limited research examining the components of what makes an effective app or how to reach families most impacted by inequities in health care delivery. Objective: In study 1, we conducted focus groups to access a broad range of perspectives on the process of navigating the EI system, with the dual goals of identifying ways in which a patient-facing app might facilitate this process and identifying barriers to use with traditionally underrepresented and underserved groups. In study 2, focus group findings informed the development of a patient-facing app, which was subsequently tested with a pilot sample of 5 families. Methods: In study 1, the focus groups included 29 participants from 4 shareholder groups. Targeted sampling was used to recruit participants from traditionally underrepresented groups. Focus group questions sought information about barriers families experience as they navigate the EI system, ideal features of a patient-facing app designed to track family engagement with the EI system, and potential barriers. Focus group procedures were informed by the Consolidated Framework for Implementation Research framework. In study 2, a pilot app was developed. The app was tested with a sample of 5 families of young children involved in the EI system. Families provided information on app functionality and usability. Results: Qualitative analysis revealed a desire for increased communication and information about the process of accessing EI services, potential utility of an app for communication purposes, and clear recommendations for app features. Insights from focus groups were used to inform the development of the Family on Track app and related implementation supports. App features included survey customization, timing and delivery of prompts, and questions related to barriers and service satisfaction. Implementation supports include a visual guide for app installation, resources related to common family questions, and availability of study personnel to guide families through installation and provide ongoing support. Field testing provided preliminary information about app usability, including identifying future directions. Conclusions: The results of this study could support the development of a new way for the EI system to communicate and connect with families, provide families with a means to communicate satisfaction and frustration, and access the supports they need to be active participants in their child’s care. %M 37698912 %R 10.2196/45957 %U https://humanfactors.jmir.org/2023/1/e45957 %U https://doi.org/10.2196/45957 %U http://www.ncbi.nlm.nih.gov/pubmed/37698912 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e49775 %T Predictors of the Use of a Mental Health–Focused eHealth System in Patients With Breast and Prostate Cancer: Bayesian Structural Equation Modeling Analysis of a Prospective Study %A Petros,Nuhamin Gebrewold %A Alvarsson-Hjort,Jesper %A Hadlaczky,Gergö %A Wasserman,Danuta %A Ottaviano,Manuel %A Gonzalez-Martinez,Sergio %A Carletto,Sara %A Scilingo,Enzo Pasquale %A Valenza,Gaetano %A Carli,Vladimir %+ National Centre for Suicide Research and Prevention of Mental Ill-Health, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Grantis Väg 4, Stockholm, 171 65, Sweden, 46 707313324, nuhamin.petros@ki.se %K mental health %K eHealth system %K perceived usefulness %K structural equation modeling %K cancer %K NEVERMIND system %K usability %K digital health %K Technology Acceptance Model %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: eHealth systems have been increasingly used to manage depressive symptoms in patients with somatic illnesses. However, understanding the factors that drive their use, particularly among patients with breast and prostate cancer, remains a critical area of research. Objective: This study aimed to determine the factors influencing use of the NEVERMIND eHealth system among patients with breast and prostate cancer over 12 weeks, with a focus on the Technology Acceptance Model. Methods: Data from the NEVERMIND trial, which included 129 patients with breast and prostate cancer, were retrieved. At baseline, participants completed questionnaires detailing demographic data and measuring depressive and stress symptoms using the Beck Depression Inventory–II and the Depression, Anxiety, and Stress Scale–21, respectively. Over a 12-week period, patients engaged with the NEVERMIND system, with follow-up questionnaires administered at 4 weeks and after 12 weeks assessing the system’s perceived ease of use and usefulness. Use log data were collected at the 2- and 12-week marks. The relationships among sex, education, baseline depressive and stress symptoms, perceived ease of use, perceived usefulness (PU), and system use at various stages were examined using Bayesian structural equation modeling in a path analysis, a technique that differs from traditional frequentist methods. Results: The path analysis was conducted among 100 patients with breast and prostate cancer, with 66% (n=66) being female and 81% (n=81) having a college education. Patients reported good mental health scores, with low levels of depression and stress at baseline. System use was approximately 6 days in the initial 2 weeks and 45 days over the 12-week study period. The results revealed that PU was the strongest predictor of system use at 12 weeks (βuse at 12 weeks is predicted by PU at 12 weeks=.384), whereas system use at 2 weeks moderately predicted system use at 12 weeks (βuse at 12 weeks is predicted by use at 2 weeks=.239). Notably, there were uncertain associations between baseline variables (education, sex, and mental health symptoms) and system use at 2 weeks, indicating a need for better predictors for early system use. Conclusions: This study underscores the importance of PU and early engagement in patient engagement with eHealth systems such as NEVERMIND. This suggests that, in general eHealth implementations, caregivers should educate patients about the benefits and functionalities of such systems, thus enhancing their understanding of potential health impacts. Concentrating resources on promoting early engagement is also essential given its influence on sustained use. Further research is necessary to clarify the remaining uncertainties, enabling us to refine our strategies and maximize the benefits of eHealth systems in health care settings. %M 37698900 %R 10.2196/49775 %U https://cancer.jmir.org/2023/1/e49775 %U https://doi.org/10.2196/49775 %U http://www.ncbi.nlm.nih.gov/pubmed/37698900 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e37604 %T An Artificial Intelligence Exercise Coaching Mobile App: Development and Randomized Controlled Trial to Verify Its Effectiveness in Posture Correction %A Chae,Han Joo %A Kim,Ji-Been %A Park,Gwanmo %A O'Sullivan,David Michael %A Seo,Jinwook %A Park,Jung-Jun %+ Division of Sports Science, Pusan National University, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan, 46241, Republic of Korea, 82 10 3285 1626, jjparkpnu@pusan.ac.kr %K home workout %K mobile assistant %K deep-learning %K posture correction %K physical activity %K exercise %K social distance %K COVID-19 %K mobile device %K workout %D 2023 %7 12.9.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Insufficient physical activity due to social distancing and suppressed outdoor activities increases vulnerability to diseases like cardiovascular diseases, sarcopenia, and severe COVID-19. While bodyweight exercises, such as squats, effectively boost physical activity, incorrect postures risk abnormal muscle activation joint strain, leading to ineffective sessions or even injuries. Avoiding incorrect postures is challenging for novices without expert guidance. Existing solutions for remote coaching and computer-assisted posture correction often prove costly or inefficient. Objective: This study aimed to use deep neural networks to develop a personal workout assistant that offers feedback on squat postures using only mobile devices—smartphones and tablets. Deep learning mimicked experts’ visual assessments of proper exercise postures. The effectiveness of the mobile app was evaluated by comparing it with exercise videos, a popular at-home workout choice. Methods: Twenty participants were recruited without squat exercise experience and divided into an experimental group (EXP) with n=10, age=21.90 (2.18), and BMI=20.75 (2.11); and a control group (CTL) with n=10, age=22.60 (1.95), and BMI=18.72 (1.23) using randomized controlled trials. A data set with over 20,000 squat videos annotated by experts was created and a deep-learning model was trained using pose estimation and video classification to analyze the workout postures. Subsequently, a mobile workout assistant app, Home Alone Exercise, was developed, and a 2-week interventional study, in which the EXP used the app while the CTL only followed workout videos, showed how the app helps people improve squat exercise. Results: The EXP significantly improved their squat postures evaluated by the app after 2 weeks (Pre: 0.20 vs Mid: 4.20 vs Post: 8.00, P=.001), whereas the CTL (without the app) showed no significant change in squat posture (Pre: 0.70 vs Mid: 1.30 vs Post: 3.80, P=.13). Significant differences were observed in the left (Pre: 75.06 vs Mid: 76.24 vs Post: 63.13, P=.02) and right (Pre: 71.99 vs Mid: 76.68 vs Post: 62.82, P=.03) knee joint angles in the EXP before and after exercise, with no significant effect found for the CTL in the left (Pre: 73.27 vs Mid: 74.05 vs Post: 70.70, P=.68) and right (Pre: 70.82 vs Mid: 74.02 vs Post: 70.23, P=.61) knee joint angles. Conclusions: EXP participants trained with the app experienced faster improvement and learned more nuanced details of the squat exercise. The proposed mobile app, offering cost-effective self-discovery feedback, effectively taught users about squat exercises without expensive in-person trainer sessions. Trial Registration: Clinical Research Information Service KCT0008178 (retrospectively registered); https://cris.nih.go.kr/cris/search/detailSearch.do/24006 %R 10.2196/37604 %U https://www.i-jmr.org/2023/1/e37604/ %U https://doi.org/10.2196/37604 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45258 %T Mobile Apps Aimed at Preventing and Handling Unintentional Injuries in Children Aged <7 Years: Systematic Review %A Schulze,Annett %A Lindemann,Ann-Kathrin %A Brand,Fabian %A Geppert,Johanna %A Menning,Axel %A Stehr,Paula %A Reifegerste,Doreen %A Rossmann,Constanze %+ Department of Risk Communication, German Federal Institute for Risk Assessment, Max-Dohrn-Str 8-10, Berlin, 10589, Germany, 49 18412 52002, annett.schulze@bfr.bund.de %K mobile health %K mHealth %K caregiver %K parental %K prevention %K first aid %K pediatric %K review method %K injuries %K health app %K needs %K mobile phone %D 2023 %7 6.9.2023 %9 Review %J Interact J Med Res %G English %X Background: Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development. Objective: This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles. Methods: In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app’s architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps. Conclusions: The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies. %M 37672312 %R 10.2196/45258 %U https://www.i-jmr.org/2023/1/e45258 %U https://doi.org/10.2196/45258 %U http://www.ncbi.nlm.nih.gov/pubmed/37672312 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42541 %T Evaluating the Effectiveness of Apps Designed to Reduce Mobile Phone Use and Prevent Maladaptive Mobile Phone Use: Multimethod Study %A Rahmillah,Fety Ilma %A Tariq,Amina %A King,Mark %A Oviedo-Trespalacios,Oscar %+ Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, Delft, 2628 BX, Netherlands, 31 15 2783887, O.OviedoTrespalacios@tudelft.nl %K mobile phone %K maladaptive mobile phone use %K apps %K features %K problematic phone use %D 2023 %7 29.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps are a popular strategy for reducing mobile phone use and preventing maladaptive mobile phone use (MMPU). Previous research efforts have been made to understand the features of apps that have the potential to reduce mobile phone use and MMPU. However, there has been a lack of a comprehensive examination of the effectiveness of such apps and their features. Objective: This paper investigated existing apps designed to reduce mobile phone use and prevent MMPU and examined the evidence of their effectiveness. The research aimed to provide a comprehensive analysis of app features that can reduce mobile phone use and MMPU, while also assessing their effectiveness. In addition, we explored users’ perceptions of these apps and the various features the apps offer to understand potential adoption issues and identify opportunities. Methods: This study used 3 methods: a review of scientific evidence, content analysis, and sentiment analysis. Results: Our study comprehensively examine the common features of 13 apps designed to reduce mobile phone use. We extracted and classified the features into 7 types: self-tracking, social tracking, goal setting, blocking, gamification, simplification, and assessment. The effectiveness of these apps in reducing mobile phone use and MMPU varied from weak to strong. On the basis of content analysis, self-tracking and goal setting were the most frequently used features, whereas gamification and assessment were used the least frequently. The intervention strategies that effectively reduce mobile phone use and MMPU included using grayscale mode, app limit features, and mixed interventions. Overall, users tended to accept these apps, as indicated by sentiment scores ranging from 61 to 86 out of 100. Conclusions: This study demonstrates that app-based management has the potential to reduce mobile phone use and MMPU. However, further research is required to evaluate the effectiveness of app-based interventions. Collaborations among researchers, app developers, mobile phone manufacturers, and policy makers could enhance the process of delivering, evaluating, and optimizing apps aimed at reducing mobile phone use and MMPU. %M 37643002 %R 10.2196/42541 %U https://www.jmir.org/2023/1/e42541 %U https://doi.org/10.2196/42541 %U http://www.ncbi.nlm.nih.gov/pubmed/37643002 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47183 %T Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study %A Prochaska,Judith J %A Wang,Yixin %A Bowdring,Molly A %A Chieng,Amy %A Chaudhary,Neha P %A Ramo,Danielle E %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 3180 Porter Drive Room A105, Palo Alto, CA, 94304-1212, United States, 1 650 724 3608, jpro@stanford.edu %K adolescents %K mobile app %K depression %K anxiety %K resilience %K digital intervention %K digital mental health %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people’s mental health. Objective: This study aimed to describe the BeMe app-based platform to support adolescents’ mental health and well-being and to examine app engagement, usability, and satisfaction. Methods: Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live). Results: The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization–Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe’s content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001). Conclusions: Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe’s content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes. %M 37639293 %R 10.2196/47183 %U https://mhealth.jmir.org/2023/1/e47183 %U https://doi.org/10.2196/47183 %U http://www.ncbi.nlm.nih.gov/pubmed/37639293 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41833 %T Acceptability of Personal Sensing Among People With Alcohol Use Disorder: Observational Study %A Wyant,Kendra %A Moshontz,Hannah %A Ward,Stephanie B %A Fronk,Gaylen E %A Curtin,John J %+ Department of Psychology, University of Wisconsin-Madison, 1202 W Johnson St, Madison, WI, 53706, United States, 1 (608) 262 1040, jjcurtin@wisc.edu %K personal sensing %K digital therapeutics %K mobile health %K smartphone %K alcohol use disorder %K self-report %K alcohol use %K symptom monitoring %K mental health %K acceptability %K alcohol intake %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personal sensing may improve digital therapeutics for mental health care by facilitating early screening, symptom monitoring, risk prediction, and personalized adaptive interventions. However, further development and the use of personal sensing requires a better understanding of its acceptability to people targeted for these applications. Objective: We aimed to assess the acceptability of active and passive personal sensing methods in a sample of people with moderate to severe alcohol use disorder using both behavioral and self-report measures. This sample was recruited as part of a larger grant-funded project to develop a machine learning algorithm to predict lapses. Methods: Participants (N=154; n=77, 50% female; mean age 41, SD 11.9 years; n=134, 87% White and n=150, 97% non-Hispanic) in early recovery (1-8 weeks of abstinence) were recruited to participate in a 3-month longitudinal study. Participants were modestly compensated for engaging with active (eg, ecological momentary assessment [EMA], audio check-in, and sleep quality) and passive (eg, geolocation, cellular communication logs, and SMS text message content) sensing methods that were selected to tap into constructs from the Relapse Prevention model by Marlatt. We assessed 3 behavioral indicators of acceptability: participants’ choices about their participation in the study at various stages in the procedure, their choice to opt in to provide data for each sensing method, and their adherence to a subset of the active methods (EMA and audio check-in). We also assessed 3 self-report measures of acceptability (interference, dislike, and willingness to use for 1 year) for each method. Results: Of the 192 eligible individuals screened, 191 consented to personal sensing. Most of these individuals (169/191, 88.5%) also returned 1 week later to formally enroll, and 154 participated through the first month follow-up visit. All participants in our analysis sample opted in to provide data for EMA, sleep quality, geolocation, and cellular communication logs. Out of 154 participants, 1 (0.6%) did not provide SMS text message content and 3 (1.9%) did not provide any audio check-ins. The average adherence rate for the 4 times daily EMA was .80. The adherence rate for the daily audio check-in was .54. Aggregate participant ratings indicated that all personal sensing methods were significantly more acceptable (all P<.001) compared with neutral across subjective measures of interference, dislike, and willingness to use for 1 year. Participants did not significantly differ in their dislike of active methods compared with passive methods (P=.23). However, participants reported a higher willingness to use passive (vs active) methods for 1 year (P=.04). Conclusions: These results suggest that active and passive sensing methods are acceptable for people with alcohol use disorder over a longer period than has previously been assessed. Important individual differences were observed across people and methods, indicating opportunities for future improvement. %M 37639300 %R 10.2196/41833 %U https://mhealth.jmir.org/2023/1/e41833 %U https://doi.org/10.2196/41833 %U http://www.ncbi.nlm.nih.gov/pubmed/37639300 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46043 %T Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study %A Frisby,Caitlin %A Eikelboom,Robert H %A Mahomed-Asmail,Faheema %A Kuper,Hannah %A Moore,David R %A de Kock,Tersia %A Manchaiah,Vinaya %A Swanepoel,De Wet %+ Department of Speech-Language Pathology and Audiology, University of Pretoria, cnr Lynnwood Road and Roper Street, Pretoria, 0028, South Africa, 27 012 420 2357, dewet.swanepoel@up.ac.za %K community-based rehabilitation %K community health care worker %K text message %K messaging %K motivational %K reminder %K acclimatization %K technology use %K hearing aid acclimatization %K hearing aid %K hearing loss %K low- and middle-income countries %K LMIC %K low income %K developing country %K low resource %K hearing %K audiology %K mobile health %K mHealth %K health care workers %K usability %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. Objective: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. Methods: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. Results: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. Conclusions: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care. %M 37610802 %R 10.2196/46043 %U https://formative.jmir.org/2023/1/e46043 %U https://doi.org/10.2196/46043 %U http://www.ncbi.nlm.nih.gov/pubmed/37610802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45986 %T A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience %A Edwards,Colin %A Borton,Rebecca %A Ross,Anita %A Molloy,Fiona %+ patientMpower Ltd, 10-13 Thomas St, The Digital Hub, Dublin, D08PX8H, Ireland, 353 872599131, colin.edwards@merlinconsulting.ie %K cervical dystonia %K electronic health journal %K user experience %K user acceptance testing %K botulinum toxin %K diary %K acceptability %K user testing %K symptom control %K spasm %K muscle pain %K spasmodic torticollis %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The mainstay of treatment for cervical dystonia (CD) is regular botulinum toxin injections every 3-4 months. Clinical evaluation of response is dependent on the patient’s recall of how well symptoms responded to the previous injection. A mobile health app could assist both patients and health care professionals to monitor treatment benefits and side effects to assist with the selection of muscle and toxin dose to be injected at the next visit. The DystoniaDiary is a bespoke electronic health journal for monitoring symptoms of CD and response to treatment. Objective: The objective of this study was to assess the acceptability and utility of the DystoniaDiary in patients with CD treated with botulinum toxins as part of their usual care. Methods: In this open-label, single-center, single-arm observational study, patients attending a botulinum toxin injection clinic were invited to download the DystoniaDiary app. Patients selected up to 3 of their most troublesome CD symptoms (from a predefined list) and were prompted every 3 days to rate the control of these symptoms on a scale from 0 (very badly) to 100 (very well). Dates of onset and wearing off of response to injected botulinum toxin and responses to the Cervical Dystonia Impact Profile (CDIP-58) questionnaire at baseline and week 6 were also recorded in the app. Results: A total of 34 patients installed DystoniaDiary. Twenty-five patients (25/34, 74%) recorded data for ≥12 weeks and 21 patients (21/34, 62%) for ≥16 weeks. Median time between the first and last data input was 140 days with a median of 13 recordings per patient. User experience questionnaires at weeks 4 and 12 (20 respondents) indicated that the majority of respondents found the DystoniaDiary app easy to install and use, liked using it, would recommend it to others (19/20), and wished to continue using it (16/20). A smaller proportion indicated that the DystoniaDiary gave a greater sense of control in managing their CD (13/20). There was interindividual variation in patients’ perceptions of control of their symptoms after botulinum toxin injection. Response to treatment was apparent in the symptom control scores for some patients, whereas the severity of other patients’ symptoms did not appear to change after treatment. Conclusions: This observational study demonstrated that the DystoniaDiary app was perceived as useful and acceptable for a large proportion of this sample of patients with CD attending a botulinum toxin clinic. Patients with CD appear to be willing to regularly record symptom severity for at least the duration of a botulinum injection treatment cycle (12-16 weeks). This app may be useful in monitoring and optimizing individual patient responses to botulinum toxin injection. %M 37610807 %R 10.2196/45986 %U https://formative.jmir.org/2023/1/e45986 %U https://doi.org/10.2196/45986 %U http://www.ncbi.nlm.nih.gov/pubmed/37610807 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46480 %T A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study %A Krafft,Jelena %A Barisch-Fritz,Bettina %A Krell-Roesch,Janina %A Trautwein,Sandra %A Scharpf,Andrea %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 608 ext 48513, jelena.krafft@kit.edu %K dementia %K individualized physical exercise %K tailored exercise %K physical activity %K older adults %K app %K mobile health %K mHealth %K usability %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Aging %G English %X Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as “good.” The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ≥50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. %M 37606974 %R 10.2196/46480 %U https://aging.jmir.org/2023/1/e46480 %U https://doi.org/10.2196/46480 %U http://www.ncbi.nlm.nih.gov/pubmed/37606974 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44290 %T Bridging the Communication Gap Between People With Cognitive Impairments and Their Caregivers Using mHealth Apps: User-Centered Design and Evaluation Study With People With 22q11 Deletion Syndrome %A Van Dooren,Martijn %A De Croon,Robin %A Swillen,Ann %A Verbert,Katrien %+ Department of Computer Science, KU Leuven, Celestijnenlaan 200A, Leuven, 3001, Belgium, 32 16 37 39 76, robin.decroon@kuleuven.be %K 22q11 deletion syndrome %K 22q11 DS %K cognitive impairments %K communication gap %K mHealth %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In families with children with cognitive impairments, both parents and children experience tension and have questions because of a lack of communication and adequate information. Therefore, there is a great need to develop tools that can help bridge the communication gap between patients and caregivers by stimulating conversations and providing psychoeducational tools. mHealth apps show great potential in this context. Objective: The objective of this research is to discover the specific ways young people with cognitive impairments and their families interact with mHealth apps in the context of bridging the communication gap. This newly discovered information leads to potentially more impactful mHealth interventions in the future. Therefore, this paper documents the design and development of a mHealth app for a specific group of people with cognitive impairments—people with 22q11 deletion syndrome (22q11 DS)—and their caregivers, as well as key learnings from the evaluation of this app. Methods: An iterative, user-centered design approach is used to design and develop the app. Design and evaluation happens in 2 phases. During the design phase, feedback is gathered from 2 medical experts and 3 human computer interaction (HCI) experts using a low-fidelity paper prototype. During the evaluation phase, feedback is gathered from 8 families with a child with 22q11 DS using a fully working proof of concept. This phase consists of a semistructured interview, a 2-4–week trial period, and a concluding semistructured interview. Results: The evaluation results of the fully working proof of concept led to design recommendations related to four different topics: (1) overcoming usage barriers, (2) stimulating conversation through a mHealth app, (3) providing information, and (4) bringing continual added value. Results are presented according to six different categories obtained in a thematic analysis: (1) feedback about the app “as is,” (2) difficulties, (3) comparison between physical and digital tool, (4) extensions, (5) intention, and (6) other. Conclusions: In this research, the need for apps that help bridge the communication gap between a person with cognitive impairment and their caregiver is confirmed. All participating families express their gratitude and mention the added value for other families. Therefore, it is highly encouraged for clinics and institutions to take action and develop an app to be used in practice. Furthermore, considerations when developing for people with 22q11 DS, or more broadly, people with cognitive impairments, are proposed. First, one should keep design principles in mind to overcome usage barriers. Next, recognition is a key concept when stimulating conversations through mobile apps. Third, information should be provided by a trusted source, and more than just clinical information can be considered valuable. Finally, having the possibility of using a digital tool that can be personalized brings continual added value. %M 37585257 %R 10.2196/44290 %U https://humanfactors.jmir.org/2023/1/e44290 %U https://doi.org/10.2196/44290 %U http://www.ncbi.nlm.nih.gov/pubmed/37585257 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42912 %T A Tailored mHealth App for Improving Health and Well-Being Behavioral Transformation in UK Police Workers: Usability Testing via a Mixed Methods Study %A Mehra,Richa %A Pulman,Andy %A Dogan,Huseyin %A Murphy,Jane %A Bitters,Fiona %+ Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, Lansdowne Campus, St. Pauls Lane, Bournemouth, Bournemouth, BH8 8GP, United Kingdom, 44 1202 961047, apulman@bournemouth.ac.uk %K nutrition %K activity %K behavior change %K telemedicine %K mobile health %K police %K lifestyle management %K management %K usability testing %K design %K build %K prototype %K testing %K survey %K interview %K development %K user center %K officer %K law enforcement %K cop %K detective %K policeman %K policing %K mobile phone %D 2023 %7 4.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: When considering the policing environment of 2022, many roles previously in the domain of warranted officers (police officer) are now performed by nonwarranted police staff equivalents. These police staff roles have expanded rapidly into other areas such as investigations, custody, and contact management, which were traditionally seen as police officer functions and put staff under some of the same stresses as police officers. A UK police force requested help in investigating technologies that could be used to improve health and well-being for both officers and staff. Objective: The aim of this study was to create a health and well-being app for police officers and staff, which considered the unique requirements of the users throughout the designing, building, prototyping, and testing stages. Methods: This study involved quantitative approaches (demographic web-based survey questions and the System Usability Scale) and qualitative approaches (open web-based survey questions and semistructured interviews). Unsupervised usability testing of a prototype app was undertaken by members (N=48) of the commissioning client using their smartphones. After completing a preregistration application for screening purposes, participants downloaded a trial version of the app. Then, they completed a web-based questionnaire after testing the app for 10 days. A subsample of participants (9/48, 19%) was interviewed. Deductive thematic analysis was undertaken to identify key themes and subthemes. Results: Data collected during usability testing concerned the 6 domains of the app—food and diet, activity, fluid intake, sleep, good mental health, and financial well-being—and informed the creation of improved design during prototyping. Some usability and design issues and suggestions for improvements were also addressed and implemented—including shift management and catch-up cards—during this cycle of development. Conclusions: This study highlights the importance of coparticipation with officers and staff across the entire development cycle, to coproduce a human-centered design methodology to enable the development of a considered and user-centered solution. It demonstrates the need for producing a multifunctional tool rather than focusing purely on an individual element for this user group. It also highlights how linking and being able to track optional, personalized elements of health data against one another, cross-referenced to individual shift patterns, might help to inform and provide users with a chance for reflection and therefore influence behavior change. %M 37540549 %R 10.2196/42912 %U https://humanfactors.jmir.org/2023/1/e42912 %U https://doi.org/10.2196/42912 %U http://www.ncbi.nlm.nih.gov/pubmed/37540549 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45079 %T The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study %A Severinsen,Frida %A Andersen,Lene Frost %A Paulsen,Mari Mohn %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Postboks 1046, Blindern, Oslo, 0317, Norway, 47 95772048, m.m.paulsen@medisin.uio.no %K dietary assessment %K malnutrition %K eHealth %K validation study %K older adults %K mobile phone %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ≥65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective: This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ≥65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods: Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants’ experiences with the app. Results: This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ≥80% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60% of the participants had ≥80% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74% (26/35) of the participants reported that the app was easy to navigate. Conclusions: The results showed that the MyFood app tended to underestimate the participants’ dietary intake compared with the 24-hour recalls at both the individual and group levels. The app’s ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake. %M 37535420 %R 10.2196/45079 %U https://mhealth.jmir.org/2023/1/e45079 %U https://doi.org/10.2196/45079 %U http://www.ncbi.nlm.nih.gov/pubmed/37535420 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44125 %T Potential Facilitators of and Barriers to Implementing the MINI Robot in Community-Based Meeting Centers for People With Dementia and Their Carers in the Netherlands and Spain: Explorative Qualitative Study %A Mahmoudi Asl,Aysan %A Kouters,Suzanne %A Castro-González,Álvaro %A Van der Roest,Henriëtte %A Franco Martin,Manuel %A Dröes,Rose-Marie %+ Psycho-Sciences Research Group of the Biomedical Research Institute of Salamanca, Salamanca University, Paseo de San Vicente, 58-182, Salamanca, Spain, 34 923 09 04 70, aysanmd@usal.es %K dementia %K meeting centers %K mild cognitive impairment %K social robots %D 2023 %7 2.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social robots, as a form of digital health technologies, are used to support emotional, cognitive, and physical care and have shown promising outcomes in enhancing social well-being in people with dementia (PwD) by boosting emotions, social interactions, and activity participation. Objective: The goal is to investigate the attitude of stakeholders and potential facilitators and the barriers to implementing the social robot MINI in community-based meeting centers (MCs) for PwD and carers in the Netherlands and Spain. Methods: Based on the British Medical Research Council guidance for process evaluation of the implementation of complex interventions and the model for tracing the facilitators of and barriers to the adaptive implementation of innovations in dementia care, an explorative qualitative study was conducted. Following the introduction of the MINI robot, 11 stakeholders were interviewed in 3 MCs in the Netherlands and 1 in Spain, as well as stakeholders in health and welfare organizations in both countries. In addition, 12 adults with dementia participated in focus groups. The data were thematically analyzed and narratively described. Results: Overall, the stakeholder opinion and interest in the MINI robot were positive. The most important (expected) facilitating factors mentioned by stakeholders appeared to be human resources, funding, the impact of the MINI robot on the users and programs of the MCs, characteristics of the innovation, and collaboration with other care and welfare organizations. However, the (expected) barriers mentioned concerned the physical context and functionalities of the MINI robot, the user context, and MC activity policies. Conclusions: The findings will inform professional stakeholders, such as MC directors and managers, as well as care and welfare organizations, on the practicality of using the MINI robot in MCs. Furthermore, our research will aid MINI robot developers in tailoring its features to PwD’s preferences and demands and MC policies, which will contribute to the MINI robot’s effective adoption and deployment. %M 37531190 %R 10.2196/44125 %U https://www.jmir.org/2023/1/e44125 %U https://doi.org/10.2196/44125 %U http://www.ncbi.nlm.nih.gov/pubmed/37531190 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e40891 %T Identification of the Needs and Preferences of Patients With Cancer for the Development of a Clinic App: Qualitative Study %A Weis,Joachim %A Wolf,Lucy Raphaela %A Boerries,Melanie %A Kassahn,Daniela %A Boeker,Martin %A Dresch,Carolin %+ Chair for Self-Help Research, Comprehensive Cancer Center, Medical Faculty, University Clinic Freiburg, Hugstetter Str. 49, Freiburg, 79106, Germany, 49 761270 ext 71561, joachim.weis@uniklinik-freiburg.de %K cancer %K mobile app %K mHealth %K mobile health %K needs assessment %K patient-centered care %K PROM %K patient-reported outcome measures %K qualitative methods %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Mobile health (mHealth) tools were developed during the past decades and are increasingly used by patients in cancer care too. Scientific research in the development of mHealth services is required in order to meet the various needs of patients and test usability. Objective: The aim of this study is to assess patients’ needs, preferences, and usability of an app (My University Clinic [MUC] app) developed by the Comprehensive Cancer Center Freiburg (CCCF) Germany. Methods: Based on a qualitative cross-sectional approach, we conducted semistructured interviews with patients with cancer, addressing their needs, preferences, and usability of the designed MUC app. Patients treated by the CCCF were recruited based on a purposive sampling technique focusing on age, sex, cancer diagnoses, and treatment setting (inpatient, outpatient). Data analysis followed the qualitative content analysis according to Kuckartz and was performed using computer-assisted software (MAXQDA). Results: For the interviews, 17 patients with cancer were selected, covering a broad range of sampling parameters. The results showed that patients expect benefits in terms of improved information about the disease and communication with the clinic staff. Demands for additional features were identified (eg, a list of contact persons and medication management). The most important concerns referred to data security and the potential restriction of personal contacts with health care professionals of the clinical departments of the CCCF. In addition, some features for improving the design of the MUC app with respect to usability or for inclusion of interacting tools were suggested by the patients. Conclusions: The results of this qualitative study were discussed within the multidisciplinary team and the MUC app providers. Patients’ perspectives and needs will be included in further development of the MUC app. There will be a second study phase in which patients will receive a test version of the MUC app and will be asked about their experiences with it. Trial Registration: Deutsches Register Klinischer Studien DRKS00022162; https://drks.de/search/de/trial/DRKS00022162 %M 37498653 %R 10.2196/40891 %U https://cancer.jmir.org/2023/1/e40891 %U https://doi.org/10.2196/40891 %U http://www.ncbi.nlm.nih.gov/pubmed/37498653 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e34629 %T Mixed Reality Technology to Deliver Psychological Interventions to Adolescents With Asthma: Qualitative Study Using the Theoretical Framework of Acceptability %A Sharrad,Kelsey %A Martini,Caitlin %A Tai,Andrew %A Spurrier,Nicola %A Smith,Ross %A Esterman,Adrian %A Gwilt,Ian %A Sandford,Debra %A Carson-Chahhoud,Kristin %+ Translational Medicine and Technology Group, Australian Centre for Precision Health, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 08 8302 2734, Kelsey.hibberd@live.com.au %K asthma %K augmented reality %K virtual reality %K mixed reality %K psychological distress %K adolescent %K cognitive behavioral therapies %K mental health %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Interactive, mixed reality technologies such as augmented reality, virtual reality, and holographic technology may provide a novel solution to fast-track the translation of evidence into practice. They may also help overcome barriers to both mental health and asthma management service uptake, such as cost, availability of appointments, fear of judgment, and quality of care. Objective: This study aimed to investigate if mixed reality technology is an acceptable mechanism for the delivery of a component of cognitive and behavioral therapies for the management of elevated psychological distress among young people with asthma. Methods: To explore the perceived acceptability of these technologies, mixed reality tools were evaluated via qualitative, 1-on-1 interviews with young people with asthma and symptoms of psychological distress, parents/caregivers of young people with asthma and symptoms of psychological distress, and relevant health professionals. The Theoretical Framework of Acceptability was used for the deductive coding of the recorded interview transcripts. Results: This study enrolled the following participants: (1) 3 adolescents with asthma and symptoms of psychological distress with a mean age of 14 (SD 1.7) years; (2) 4 parents/caregivers of adolescents with asthma with a mean age of 55 (SD 14.6) years; and (3) 6 health professionals with a mean age of 40.8 (SD 4.3) years. A total of 4 constructs—experienced affective attitude, experienced effectiveness, self-efficacy, and intervention coherence—were coded in all participant transcripts. The most frequently coded constructs were experienced affective attitude and intervention coherence, which were reported a total of 96 times. The least frequently coded construct was anticipated opportunity cost, which was reported a total of 5 times. Participants were mostly positive about the mixed reality resources. However, some concerns were raised regarding ethicality, particularly regarding privacy, accessibility, and messaging. Participants noted the need for technology to be used in conjunction with face-to-face engagement with health professionals and that some patients would respond to this type of delivery mechanism better than others. Conclusions: These results suggest that mixed reality technology to deliver psychological interventions may be an acceptable addition to current health care practices for young people with asthma and symptoms of psychological distress. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12620001109998; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380427 %M 37494096 %R 10.2196/34629 %U https://humanfactors.jmir.org/2023/1/e34629 %U https://doi.org/10.2196/34629 %U http://www.ncbi.nlm.nih.gov/pubmed/37494096 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46849 %T An Artificial Therapist (Manage Your Life Online) to Support the Mental Health of Youth: Co-Design and Case Series %A Wrightson-Hester,Aimee-Rose %A Anderson,Georgia %A Dunstan,Joel %A McEvoy,Peter M %A Sutton,Christopher J %A Myers,Bronwyn %A Egan,Sarah %A Tai,Sara %A Johnston-Hollitt,Melanie %A Chen,Wai %A Gedeon,Tom %A Mansell,Warren %+ Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent St, Perth, WA 6102, Australia, 61 452491337, aimee.wrightson-hester@curtin.edu.au %K mental health %K conversational agents %K chatbots %K young people %K acceptability %K feasibility %K co-design %K artificial therapist %K artificial intelligence %K youth %K child %K adolescent %K chatbot %K Manage Your Life Online %K MYLO %K support %K mobile phone %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The prevalence of child and adolescent mental health issues is increasing faster than the number of services available, leading to a shortfall. Mental health chatbots are a highly scalable method to address this gap. Manage Your Life Online (MYLO) is an artificially intelligent chatbot that emulates the method of levels therapy. Method of levels is a therapy that uses curious questioning to support the sustained awareness and exploration of current problems. Objective: This study aimed to assess the feasibility and acceptability of a co-designed interface for MYLO in young people aged 16 to 24 years with mental health problems. Methods: An iterative co-design phase occurred over 4 months, in which feedback was elicited from a group of young people (n=7) with lived experiences of mental health issues. This resulted in the development of a progressive web application version of MYLO that could be used on mobile phones. We conducted a case series to assess the feasibility and acceptability of MYLO in 13 young people over 2 weeks. During this time, the participants tested MYLO and completed surveys including clinical outcomes and acceptability measures. We then conducted focus groups and interviews and used thematic analysis to obtain feedback on MYLO and identify recommendations for further improvements. Results: Most participants were positive about their experience of using MYLO and would recommend MYLO to others. The participants enjoyed the simplicity of the interface, found it easy to use, and rated it as acceptable using the System Usability Scale. Inspection of the use data found evidence that MYLO can learn and adapt its questioning in response to user input. We found a large effect size for the decrease in participants’ problem-related distress and a medium effect size for the increase in their self-reported tendency to resolve goal conflicts (the proposed mechanism of change) in the testing phase. Some patients also experienced a reliable change in their clinical outcome measures over the 2 weeks. Conclusions: We established the feasibility and acceptability of MYLO. The initial outcomes suggest that MYLO has the potential to support the mental health of young people and help them resolve their own problems. We aim to establish whether the use of MYLO leads to a meaningful reduction in participants’ symptoms of depression and anxiety and whether these are maintained over time by conducting a randomized controlled evaluation trial. %M 37477969 %R 10.2196/46849 %U https://humanfactors.jmir.org/2023/1/e46849 %U https://doi.org/10.2196/46849 %U http://www.ncbi.nlm.nih.gov/pubmed/37477969 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42654 %T Workload, Usability, and Engagement with a Mobile App Supporting Video Observation of Methadone Take-Home Dosing: Usability Study %A Idrisov,Bulat %A Hallgren,Kevin A %A Michaels,Alyssa %A Soth,Sean %A Darnton,James %A Grekin,Paul %A Woolworth,Steve %A Saxon,Andrew J %A Tsui,Judith I %+ Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195-1621, United States, 1 2067937662, idrisov@uw.edu %K addiction %K direct observed therapy %K health app %K methadone %K mHealth %K mobile app %K mobile health %K opioid %K smartphone app %K substance use %K usability %K user engagement %K user testing %K workload %D 2023 %7 13.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Methadone, a cornerstone of opioid use disorder treatments for many decades, is an essential tool for combatting the opioid epidemic. However, requirements for observing methadone dosing in person through direct observed therapy (DOT) impose significant barriers for many patients. Digital technology can facilitate remote DOT, which could reduce barriers to methadone treatment. Currently, there are limited data on the usability of such technology among patients and counselors in methadone treatment settings. Objective: The primary objective of this study was to assess the workload, usability, and engagement of a video-based DOT mobile app for patients with opioid use disorder receiving methadone treatment. The secondary objective was to assess the workload, usability, and engagement of the provider-facing app portal used by counselors. Methods: Patients (n=12) and counselors (n=3) who previously tried video DOT for methadone through a smartphone app in an opioid treatment program participated in usability testing sessions. Participants completed essential tasks for video DOT, then provided ratings of workload (NASA Task Load Index), usability (modified System Usability Scale), and engagement (modified Engagement Scale) with the core features of the video DOT program Results: Patients and counselors reported low mental, physical, and temporal demands, successful performance, low effort, and low frustration associated with activities. Patients reported high usability (mean 85, SD 9.5) and engagement (mean 3.8, SD 1.1); counselors reported moderate usability (mean 43.3, SD 17.7) and engagement (mean 2.81, SD 0.63). Conclusions: A mobile health app that facilitates video-based DOT for methadone required a low workload for patients and counselors and was highly usable for patients in an opioid treatment program; however, there are opportunities to improve usability and engagement for the counselor-facing portal. %M 37440298 %R 10.2196/42654 %U https://humanfactors.jmir.org/2023/1/e42654 %U https://doi.org/10.2196/42654 %U http://www.ncbi.nlm.nih.gov/pubmed/37440298 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44442 %T Exploring the Feasibility and Usability of Smartphones for Monitoring Physical Activity in Orthopedic Patients: Prospective Observational Study %A Ghaffari,Arash %A Kildahl Lauritsen,Rikke Emilie %A Christensen,Michael %A Rolighed Thomsen,Trine %A Mahapatra,Harshit %A Heck,Robert %A Kold,Søren %A Rahbek,Ole %+ Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18 - 22, Aalborg, 9000, Denmark, 45 91483966, a.ghaffari@rn.dk %K remote monitoring %K physical activity %K step count %K smartphone application %K wearable sensors %K mixed effects modeling %K step count prediction %K mobile phone %D 2023 %7 4.7.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones are often equipped with inertial sensors that measure individuals’ physical activity (PA). However, their role in remote monitoring of the patients’ PAs in telemedicine needs to be adequately explored. Objective: This study aimed to explore the correlation between a participant’s actual daily step counts and the daily step counts reported by their smartphone. In addition, we inquired about the usability of smartphones for collecting PA data. Methods: This prospective observational study was conducted among patients undergoing lower limb orthopedic surgery and a group of nonpatients as control. The data from the patients were collected from 2 weeks before surgery until 4 weeks after the surgery, whereas the data collection period for the nonpatients was 2 weeks. The participant’s daily step count was recorded by PA trackers worn 24/7. In addition, a smartphone app collected the number of daily steps registered by the participants’ smartphones. We compared the cross-correlation between the daily steps time series obtained from the smartphones and PA trackers in different groups of participants. We also used mixed modeling to estimate the total number of steps, using smartphone step counts and the characteristics of the patients as independent variables. The System Usability Scale was used to evaluate the participants’ experience with the smartphone app and the PA tracker. Results: Overall, 1067 days of data were collected from 21 patients (n=11, 52% female patients) and 10 nonpatients (n=6, 60% female patients). The median cross-correlation coefficient on the same day was 0.70 (IQR 0.53-0.83). The correlation in the nonpatient group was slightly higher than that in the patient group (median 0.74, IQR 0.60-0.90 and median 0.69, IQR 0.52-0.81, respectively). The likelihood ratio tests on the models fitted by mixed effects methods demonstrated that the smartphone step count was positively correlated with the PA tracker’s total number of steps (χ21=34.7, P<.001). In addition, the median usability score for the smartphone app was 78 (IQR 73-88) compared with median 73 (IQR 68-80) for the PA tracker. Conclusions: Considering the ubiquity, convenience, and practicality of smartphones, the high correlation between the smartphones and the total daily step count time series highlights the potential usefulness of smartphones in detecting changes in the number of steps in remote monitoring of a patient’s PA. %M 37283228 %R 10.2196/44442 %U https://mhealth.jmir.org/2023/1/e44442 %U https://doi.org/10.2196/44442 %U http://www.ncbi.nlm.nih.gov/pubmed/37283228 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40173 %T Toward the Design of Sensing-Based Medication Adherence Aids That Support Individualized Activities of Daily Living: Survey and Interviews With Patients and Providers %A Biehl,Jacob T %A Patel,Ravi %A Lee,Adam J %+ School of Computing and Information, University of Pittsburgh, 135 N Bellefield Ave, Pittsburgh, PA, 15260, United States, biehl@pitt.edu %K sensing %K medication adherence %K active intervention %K self-management %K patient care %K medication %K qualitative study %K successful intervention %K patient support %D 2023 %7 4.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Nearly half of Americans taking prescription medications do not take them properly. The resulting implications have a broad impact. Nonadhering patients develop worsened medical conditions and increased comorbidity of disease or die. Objective: Clinical studies have shown that the most effective strategies for addressing adherence are those that are individualized to the context that each patient and situation require. However, existing aids for adherence are relatively ridged and poorly support adaptation to individual behaviors and lifestyles. The aim of our study was to better understand this design tension. Methods: A series of 3 qualitative studies was conducted: a web-based survey of 200 Americans that investigated existing adherence strategies and behaviors and perception of how hypothetical in-home tracking technologies would assist adherence; in-person semistructured interviews with 20 medication takers from Pittsburgh, PA, that investigated personal adherence behaviors, which included demonstration of medication locations and routines as well as an assessment of hypothetical technologies; and semistructured interviews with 6 pharmacists and 3 family physicians to gain a provider perspective on patient adherence strategies, which included feedback on hypothetical technologies in the context of their patient populations. Inductive thematic coding of all interview data was performed. Studies were conducted consecutively, with the results informing the subsequent studies. Results: Synthesized, the studies identified key medication adherence behaviors amenable to technological interventions, distilled important home-sensing literacy considerations, and detailed critical privacy considerations. Specifically, 4 key insights were obtained: medication routines are heavily influenced and adapted by and through the physical location and placement of medications relative to activities of daily living, routines are chosen to be inconspicuous to maintain privacy, the value of provider-involved routines is motivated by a desire to build trust in shared decision-making, and the introduction of new technologies can create further burden on patients and providers. Conclusions: There is considerable potential to improve individual medication adherence by creating behavior-focused interventions that leverage emerging artificial intelligence (AI), machine learning (ML), and in-home Internet of Things (IoT) sensing technologies. However, success will be dependent on the technology’s ability to learn effectively and accurately from individual behaviors, needs, and routines and tailor interventions accordingly. Patient routines and attitudes toward adherence will likely affect the use of proactive (eg, AI-assistant routine modification) versus reactive (eg, notification of associated behaviors with missed dosages) intervention strategies. Successful technological interventions must support the detection and tracking of patient routines that can adjust to variations in patient location, schedule, independence, and habituation. %M 37402141 %R 10.2196/40173 %U https://humanfactors.jmir.org/2023/1/e40173 %U https://doi.org/10.2196/40173 %U http://www.ncbi.nlm.nih.gov/pubmed/37402141 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44126 %T Barriers to and Facilitators of Using Remote Measurement Technology in the Long-Term Monitoring of Individuals With ADHD: Interview Study %A Denyer,Hayley %A Deng,Qigang %A Adanijo,Abimbola %A Asherson,Philip %A Bilbow,Andrea %A Folarin,Amos %A Groom,Madeleine J %A Hollis,Chris %A Wykes,Til %A Dobson,Richard JB %A Kuntsi,Jonna %A Simblett,Sara %+ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 20 7848 5308, hayley.denyer@kcl.ac.uk %K attention-deficit/hyperactivity disorder %K ADHD %K remote measurement technology %K engagement %K barriers and facilitators %K qualitative analysis %K mobile phone %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Remote measurement technology (RMT) has the potential to address current research and clinical challenges of attention-deficit/hyperactivity disorder (ADHD) symptoms and its co-occurring mental health problems. Despite research using RMT already being successfully applied to other populations, adherence and attrition are potential obstacles when applying RMT to a disorder such as ADHD. Hypothetical views and attitudes toward using RMT in a population with ADHD have previously been explored; however, to our knowledge, there is no previous research that has used qualitative methods to understand the barriers to and facilitators of using RMT in individuals with ADHD following participation in a remote monitoring period. Objective: We aimed to evaluate the barriers to and facilitators of using RMT in individuals with ADHD compared with a group of people who did not have a diagnosis of ADHD. We also aimed to explore participants’ views on using RMT for 1 or 2 years in future studies. Methods: In total, 20 individuals with ADHD and 20 individuals without ADHD were followed up for 10 weeks using RMT that involved active (questionnaires and cognitive tasks) and passive (smartphone sensors and wearable devices) monitoring; 10 adolescents and adults with ADHD and 12 individuals in a comparison group completed semistructured qualitative interviews at the end of the study period. The interviews focused on potential barriers to and facilitators of using RMT in adults with ADHD. A framework methodology was used to explore the data qualitatively. Results: Barriers to and facilitators of using RMT were categorized as health-related, user-related, and technology-related factors across both participant groups. When comparing themes that emerged across the participant groups, both individuals with and without ADHD experienced similar barriers and facilitators in using RMT. The participants agreed that RMT can provide useful objective data. However, slight differences between the participant groups were identified as barriers to RMT across all major themes. Individuals with ADHD described the impact that their ADHD symptoms had on participating (health-related theme), commented on the perceived cost of completing the cognitive tasks (user-related theme), and described more technical challenges (technology-related theme) than individuals without ADHD. Hypothetical views on future studies using RMT in individuals with ADHD for 1 or 2 years were positive. Conclusions: Individuals with ADHD agreed that RMT, which uses repeated measurements with ongoing active and passive monitoring, can provide useful objective data. Although themes overlapped with previous research on barriers to and facilitators of engagement with RMT (eg, depression and epilepsy) and with a comparison group, there are unique considerations for people with ADHD, for example, understanding the impact that ADHD symptoms may have on engaging with RMT. Researchers need to continue working with people with ADHD to develop future RMT studies for longer periods. %M 37389932 %R 10.2196/44126 %U https://formative.jmir.org/2023/1/e44126 %U https://doi.org/10.2196/44126 %U http://www.ncbi.nlm.nih.gov/pubmed/37389932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46062 %T Understanding Users’ Experiences of a Novel Web-Based Cognitive Behavioral Therapy Platform for Depression and Anxiety: Qualitative Interviews From Pilot Trial Participants %A Shkel,Jane %A Green,Gavin %A Le,Stacey %A Kaveladze,Benjamin %A Marcotte,Veronique %A Rushton,Kevin %A Nguyen,Theresa %A Schueller,Stephen M %+ Department of Psychological Science, University of California, Irvine, 4341 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 949 824 3850, s.schueller@uci.edu %K anxiety %K depression %K cognitive behavioral therapy %K clinical trial %K intervention %K qualitative research %K digital mental health intervention %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions (DMHIs) can help bridge the gap between the demand for mental health care and availability of treatment resources. The affordances of DMHIs have been proposed to overcome barriers to care such as accessibility, cost, and stigma. Despite these proposals, most evaluations of the DMHI focus on clinical effectiveness, with less consideration of users’ perspectives and experiences. Objective: We conducted a pilot randomized controlled trial of “Overcoming Thoughts,” a web-based platform that uses cognitive and behavioral principles to address depression and anxiety. The “Overcoming Thoughts” platform included 2 brief interventions—cognitive restructuring and behavioral experimentation. Users accessed either a version that included asynchronous interactions with other users (“crowdsourced” platform) or a completely self-guided version (control condition). We aimed to understand the users’ perspectives and experiences by conducting a subset of interviews during the follow-up period of the trial. Methods: We used purposive sampling to select a subset of trial participants based on group assignment (treatment and control) and symptom improvement (those who improved and those who did not on primary outcomes). We conducted semistructured interviews with 23 participants during the follow-up period that addressed acceptability, usability, and impact. We conducted a thematic analysis of the interviews until saturation was reached. Results: A total of 8 major themes were identified: possible opportunities to expand the platform; improvements in mental health because of using the platform; increased self-reflection skills; platform being more helpful for certain situations or domains; implementation of skills into users’ lives, even without direct platform use; increased coping skills because of using the platform; repetitiveness of platform exercises; and use pattern. Although no differences in themes were found among groups based on improvement status (all P values >.05, ranging from .12 to .86), there were 4 themes that differed based on conditions (P values from .01 to .046): helpfulness of self-reflection supported by an exercise summary (greater in control); aiding in slowing thoughts and feeling calmer (greater in control); overcoming patterns of avoidance (greater in control); and repetitiveness of content (greater in the intervention). Conclusions: We identified the different benefits that users perceived from a novel DMHI and opportunities to improve the platform. Interestingly, we did not note any differences in themes between those who improved and those who did not, but we did find some differences between those who received the control and intervention versions of the platform. Future research should continue to investigate users’ experiences with DMHIs to better understand the complex dynamics of their use and outcomes. %M 37338967 %R 10.2196/46062 %U https://formative.jmir.org/2023/1/e46062 %U https://doi.org/10.2196/46062 %U http://www.ncbi.nlm.nih.gov/pubmed/37338967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35858 %T Mobile Apps for Dietary and Food Timing Assessment: Evaluation for Use in Clinical Research %A Gioia,Siena %A Vlasac,Irma M %A Babazadeh,Demsina %A Fryou,Noah L %A Do,Elizabeth %A Love,Jessica %A Robbins,Rebecca %A Dashti,Hassan S %A Lane,Jacqueline M %+ Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA, EBRC104, United States, 1 617 525 7829, jlane@broadinstitute.org %K dietary assessment %K mobile phone %K smartphone %K nutrition apps %K dietary record %K circadian rhythms %K food diary %K food timing %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the last decade, health mobile apps have become an increasingly popular tool used by clinicians and researchers to track food consumption and exercise. However, many consumer apps lack the technological features for facilitating the capture of critical food timing details. Objective: This study aimed to introduce users to 11 apps from US app stores that recorded both dietary intake and food timing to establish which one would be the most appropriate for clinical research. Methods: To determine a viable app that recorded both dietary intake and food timing for use in a food timing–related clinical study, we evaluated the time stamp data, usability, privacy policies, the accuracy of nutrient estimates, and general features of 11 mobile apps for dietary assessment that were available on US app stores. The following apps were selected using a keyword search of related terms and reviewed: text entry apps—Cronometer, DiaryNutrition, DietDiary, FoodDiary, Macros, and MyPlate; image entry apps—FoodView and MealLogger; and text plus image entry apps—Bitesnap, myCircadianClock, and MyFitnessPal. Results: Our primary goal was to identify apps that recorded food time stamps, which 8 (73%) of the 11 reviewed apps did. Of the 11 apps, only 4 (36%) allowed users to edit the time stamps. Next, we sought to evaluate the usability of the apps using the System Usability Scale across 2 days, and 82% (9/11) of the apps received favorable scores for usability. To enable use in research and clinical settings, the privacy policies of each app were systematically reviewed using common criteria, with 1 (9%) Health Insurance Portability and Accountability Act–compliant app (Cronometer). Furthermore, protected health information was collected by 9 (82%) of the 11 apps. Finally, to assess the accuracy of the nutrient estimates generated by these apps, we selected 4 sample food items and a 3-day dietary record to input into each app. The caloric and macronutrient estimates of the apps were compared with the nutrient estimates provided by a registered dietitian using the Nutrition Data System for Research database. In terms of the 3-day food record, the apps were found to consistently underestimate daily calories and macronutrients compared with the Nutrition Data System for Research output. Conclusions: Overall, we found that the Bitesnap app provided flexible dietary and food timing functionality capable of being used in research and clinical settings, whereas most other apps lacked in the necessary food timing functionality or user privacy. %M 37327038 %R 10.2196/35858 %U https://formative.jmir.org/2023/1/e35858 %U https://doi.org/10.2196/35858 %U http://www.ncbi.nlm.nih.gov/pubmed/37327038 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42382 %T A Transgender Health Information Resource: Participatory Design Study %A Morse,Brad %A Soares,Andrey %A Kwan,Bethany M %A Allen,Marvyn %A Lee,Rita S %A Desanto,Kristen %A Holliman,Brooke Dorsey %A Ytell,Kate %A Schilling,Lisa M %+ Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 8th Floor, Academic Office 1-Office 8219, 12631 E 17th Ave, Aurora, CO, 80045, United States, 1 303 724 2254, lisa.schilling@cuanschutz.edu %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ %K transgender %K mobile app %K health information %K participatory design %K agile development %K mobile phone %D 2023 %7 15.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality. Objective: We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD. Methods: We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users’ needs and priorities. We used the Agile software development methodology to build the prototype. A medical librarian and physicians with expertise in transgender health curated a set of 97 information resources that constituted the foundational content of the prototype. To evaluate the prototype TGHIR app, we assessed the app with test users, using a single item from the System Usability Scale to assess feature usability, cognitive walk-throughs, and the user version of the Mobile Application Rating Scale to evaluate the app’s objective and subjective quality. Results: A total of 13 people who identified as TGD or TGD allies rated their satisfaction with 9 of 10 (90%) app features as good to excellent, and 1 (10%) of the features—the ability to filter to narrow TGHIR resources—was rated as okay. The overall quality score on the user version of the Mobile Application Rating Scale was 4.25 out of 5 after 4 weeks of use, indicating a good-quality mobile app. The information subscore received the highest rating, at 4.75 out of 5. Conclusions: Community partnership and participatory design were effective in the development of the TGHIR app, resulting in an information resource app with satisfactory features and overall high-quality ratings. Test users felt that the TGHIR app would be helpful for people who are TGD and their care partners. %M 37318836 %R 10.2196/42382 %U https://humanfactors.jmir.org/2023/1/e42382 %U https://doi.org/10.2196/42382 %U http://www.ncbi.nlm.nih.gov/pubmed/37318836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41919 %T Use and Acceptance of Smart Elderly Care Apps Among Chinese Medical Staff and Older Individuals: Web-Based Hybrid Survey Study %A Zhu,Jieting %A Weng,Huiting %A Ou,Peng %A Li,Lezhi %+ Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, China, 86 0731 85295888, lilezhi@csu.edu.cn %K smart elderly care app %K mobile health %K smartphone %D 2023 %7 13.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the advent of China’s aging population and the popularization of smartphones, there is a huge demand for smart elderly care apps. Along with older adults and their dependents, medical staff also need to use a health management platform to manage the health of patients. However, the development of health apps and the large and growing app market pose a problem of declining quality; in fact, important differences can be observed between apps, and patients currently do not have adequate information and formal evidence to discriminate among them. Objective: The aim of this study was to investigate the cognition and usage status of smart elderly care apps among older individuals and medical staff in China. Methods: From March 1, 2022, to March 30, 2022, we used the web survey tool Sojump to conduct snowball sampling through WeChat. The survey links were initially sent to communities in 23 representative major cities in China. We asked the medical staff of community clinics to post the survey link on their WeChat Moments. From April 1 to May 10, 2022, we contacted those who selected “Have used a smart elderly care app” in the questionnaire through WeChat for a request to participate in semistructured interviews. Participants provided informed consent in advance and interviews were scheduled. After the interviews, the audio recordings were transcribed into text and the emerging themes were analyzed and summarized. Results: A total of 810 individuals participated in this study, 54.8% (n=444) of whom were medical staff, 33.1% (n=268) were older people, and the remaining participants were certified nursing assistants (CNAs) and community workers. Overall, 60.5% (490/810) of the participants had used a smart elderly care app on their smartphone. Among the 444 medical staff who participated in the study, the vast majority (n=313, 70.5%) had never used a smart elderly care app, although 34.7% of them recommended elderly care–related apps to patients. Among the 542 medical staff, CNAs, and community workers that completed the questionnaire, only 68 (12.6%) had used a smart elderly care app. We further interviewed 23 people about their feelings and opinions about smart elderly care apps. Three themes emerged with eight subthemes, including functional design, operation interface, and data security. Conclusions: In this survey, there was a huge difference in the usage rate and demand for smart elderly care apps by the participants. Respondents are mainly concerned with app function settings, interface simplicity, and data security. %M 37310777 %R 10.2196/41919 %U https://formative.jmir.org/2023/1/e41919 %U https://doi.org/10.2196/41919 %U http://www.ncbi.nlm.nih.gov/pubmed/37310777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44500 %T Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers %A Varma,Deepthi S %A Mualem,Maya %A Goodin,Amie %A Gurka,Kelly K %A Wen,Tony Soo-Tung %A Gurka,Matthew J %A Roussos-Ross,Kay %+ Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, United States, 1 352 294 5941, dvarma@ufl.edu %K perinatal mental health %K mobile health %K mHealth %K mobile apps %K ecological momentary assessment %K EMA %K mobile phone %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population. %M 37285185 %R 10.2196/44500 %U https://formative.jmir.org/2023/1/e44500 %U https://doi.org/10.2196/44500 %U http://www.ncbi.nlm.nih.gov/pubmed/37285185 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43067 %T Acceptability and Usability of a Wearable Device for Sleep Health Among English- and Spanish-Speaking Patients in a Safety Net Clinic: Qualitative Analysis %A Purnell,Larissa %A Sierra,Maribel %A Lisker,Sarah %A Lim,Melissa S %A Bailey,Emma %A Sarkar,Urmimala %A Lyles,Courtney R %A Nguyen,Kim H %+ Division of General Internal Medicine, School of Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, United States, 1 6282066483, Courtney.Lyles@ucsf.edu %K health equity %K medical informatics %K sleep disorders %K user-centered design %K wearable electronic devices %D 2023 %7 5.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep disorders are common and disproportionately affect marginalized populations. Technology, such as wearable devices, holds the potential to improve sleep quality and reduce sleep disparities, but most devices have not been designed or tested with racially, ethnically, and socioeconomically diverse patients. Inclusion and engagement of diverse patients throughout digital health development and implementation are critical to achieving health equity. Objective: This study aims to evaluate the usability and acceptability of a wearable sleep monitoring device—SomnoRing—and its accompanying mobile app among patients treated in a safety net clinic. Methods: The study team recruited English- and Spanish-speaking patients from a mid-sized pulmonary and sleep medicine practice serving publicly insured patients. Eligibility criteria included initial evaluation of obstructed sleep apnea, which is most appropriate for limited cardiopulmonary testing. Patients with primary insomnia or other suspected sleep disorders were not included. Patients tested the SomnoRing over a 7-night period and participated in a 1-hour semistructured web-based qualitative interview covering perceptions of the device, motivators and barriers to use, and general experiences with digital health tools. The study team used inductive or deductive processes to code interview transcripts, guided by the Technology Acceptance Model. Results: A total of 21 individuals participated in the study. All participants owned a smartphone, almost all (19/21) felt comfortable using their phone, and few already owned a wearable (6/21). Almost all participants wore the SomnoRing for 7 nights and found it comfortable. The following four themes emerged from qualitative data: (1) the SomnoRing was easy to use compared to other wearable devices or traditional home sleep testing alternatives, such as the standard polysomnogram technology for sleep studies; (2) the patient’s context and environment, such as family and peer influence, housing status, access to insurance, and device cost affected the overall acceptance of the SomnoRing; (3) clinical champions motivated use in supporting effective onboarding, interpretation of data, and, ongoing technical support; and (4) participants desired more assistance and information to best interpret their own sleep data summarized in the companion app. Conclusions: Racially, ethnically, and socioeconomically diverse patients with sleep disorders perceived a wearable as useful and acceptable for sleep health. Participants also uncovered external barriers related to the perceived usefulness of the technology, such as housing status, insurance coverage, and clinical support. Future studies should further examine how to best address these barriers so that wearables, such as the SomnoRing, can be successfully implemented in the safety net health setting. %M 37098152 %R 10.2196/43067 %U https://formative.jmir.org/2023/1/e43067 %U https://doi.org/10.2196/43067 %U http://www.ncbi.nlm.nih.gov/pubmed/37098152 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43673 %T Evaluation of an mHealth Intervention (Growin’ Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study %A Perkes,Sarah Jane %A Huntriss,Belinda %A Skinner,Noelene %A Leece,Bernise %A Dobson,Rosie %A Mattes,Joerg %A Hall,Kerry %A Bonevski,Billie %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Health Sciences Building, Level 2, Sturt Road, Bedford Park, South Australia, 5042, Australia, 61 8 72218410, billie.bonevski@flinders.edu.au %K mobile health %K mHealth %K co-design %K Aboriginal and Torres Strait Islander %K mother %K baby %K young children %K mobile phone %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Aboriginal and Torres Strait Islander women have access to and interest in mobile health (mHealth), although few culturally relevant, evidence-based mHealth programs are available. We codeveloped an mHealth program in New South Wales with Aboriginal and Torres Strait Islander women, focusing on women’s and children's health and well-being. Objective: This study aims to assess the engagement with and acceptability of the Growin’ Up Healthy Jarjums program among mothers caring for Aboriginal and Torres Strait Islander children aged <5 years and assess the acceptability of the program among professionals. Methods: Women were given access to Growin’ Up Healthy Jarjums—a web-based application, a Facebook (Meta Platforms, Inc) page, and SMS text messages—for 4 weeks. Short videos of health professionals presenting health information were tested within the application and on the Facebook page. Engagement with the application was examined through the number of log-ins, page views, and links used on the application. Engagement with the Facebook page was examined through likes, follows, comments, and the reach of posts. Engagement with the SMS text messages was examined through the number of mothers who opted out, and engagement with the videos was examined through the number of plays and videos watched and duration of the video watched. The acceptability of the program was examined through posttest interviews with mothers and focus groups with professionals. Results: A total of 47 participants joined the study (n=41, 87%, mothers and n=6, 13%, health professionals). Interviews were completed by 78% (32/41) of the women and 100% (6/6) health professionals. Of the 41 mothers, 31 (76%) women accessed the application, 13 (42%) scrolled the main page only, and 18 (58%) clicked on other pages. There were 48 plays and 6 completions of the 12 videos. The Facebook page received 49 page likes and 51 followers. The post with the most reach was a supportive and affirming cultural post. No participants opted out of the SMS text messages. Almost all mothers (30/32, 94%) reported that Growin’ Up Healthy Jarjums was useful, and all mothers reported that the program was culturally appropriate and easy to use. Of the 32 mothers, 6 (19%) mothers reported technical problems with accessing the application. Moreover, 44% (14/32) of mothers suggested improvements to the application. All the women reported that they would recommend the program to other families. Conclusions: This study demonstrated that the Growin’ Up Healthy Jarjums program was perceived useful and culturally appropriate. SMS text messages had the highest engagement, followed by the Facebook page and then the application. This study identified areas for technical and engagement-related improvements to the application. A trial is needed to assess the effectiveness of the Growin’ Up Healthy Jarjums program at improving health outcomes. %M 37234043 %R 10.2196/43673 %U https://pediatrics.jmir.org/2023/1/e43673 %U https://doi.org/10.2196/43673 %U http://www.ncbi.nlm.nih.gov/pubmed/37234043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44838 %T An Overview of Chatbot-Based Mobile Mental Health Apps: Insights From App Description and User Reviews %A Haque,M D Romael %A Rubya,Sabirat %+ Department of Computer Science, Marquette University, 1313 W Wisconsin Ave, Milwaukee, WI, 53233, United States, 1 4144397646, mdromael.haque@marquette.edu %K chatbot %K mobile mental health apps %K consumer reviews %K health care app %K mental health app %K app development %K user experience %K mHealth intervention %K mobile health %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chatbots are an emerging technology that show potential for mental health care apps to enable effective and practical evidence-based therapies. As this technology is still relatively new, little is known about recently developed apps and their characteristics and effectiveness. Objective: In this study, we aimed to provide an overview of the commercially available popular mental health chatbots and how they are perceived by users. Methods: We conducted an exploratory observation of 10 apps that offer support and treatment for a variety of mental health concerns with a built-in chatbot feature and qualitatively analyzed 3621 consumer reviews from the Google Play Store and 2624 consumer reviews from the Apple App Store. Results: We found that although chatbots’ personalized, humanlike interactions were positively received by users, improper responses and assumptions about the personalities of users led to a loss of interest. As chatbots are always accessible and convenient, users can become overly attached to them and prefer them over interacting with friends and family. Furthermore, a chatbot may offer crisis care whenever the user needs it because of its 24/7 availability, but even recently developed chatbots lack the understanding of properly identifying a crisis. Chatbots considered in this study fostered a judgment-free environment and helped users feel more comfortable sharing sensitive information. Conclusions: Our findings suggest that chatbots have great potential to offer social and psychological support in situations where real-world human interaction, such as connecting to friends or family members or seeking professional support, is not preferred or possible to achieve. However, there are several restrictions and limitations that these chatbots must establish according to the level of service they offer. Too much reliance on technology can pose risks, such as isolation and insufficient assistance during times of crisis. Recommendations for customization and balanced persuasion to inform the design of effective chatbots for mental health support have been outlined based on the insights of our findings. %M 37213181 %R 10.2196/44838 %U https://mhealth.jmir.org/2023/1/e44838 %U https://doi.org/10.2196/44838 %U http://www.ncbi.nlm.nih.gov/pubmed/37213181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44945 %T The Implementation of a GPS-Based Location-Tracking Smartphone App in South Africa to Improve Engagement in HIV Care: Randomized Controlled Trial %A Clouse,Kate %A Noholoza,Sandisiwe %A Madwayi,Sindiswa %A Mrubata,Megan %A Camlin,Carol S %A Myer,Landon %A Phillips,Tamsin K %+ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 615 343 5351, kate.clouse@vanderbilt.edu %K mobile health %K mHealth %K smartphone %K mobile phone %K HIV/AIDS %K South Africa %K pregnancy %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health interventions are common in public health settings in Africa, and our preliminary work showed that smartphones are increasing in South Africa. We developed a novel smartphone app—CareConekta—that used GPS location data to characterize personal mobility to improve engagement in HIV care among pregnant and postpartum women living with HIV in South Africa. The app also used the user’s location to map nearby clinics. Objective: We aimed to describe the feasibility, acceptability, and initial efficacy of using the app in a real-world setting. Methods: We conducted a prospective randomized controlled trial at a public sector clinic near Cape Town, South Africa. We enrolled 200 pregnant (third trimester) women living with HIV who owned a smartphone that met the required specifications. All participants installed the app, designed to collect 2 GPS heartbeats per day to geolocate the participant within a random 1-km fuzzy radius (for privacy). We randomized (1:1) participants to a control arm to receive the app with no additional support or an intervention arm to receive supportive phone calls, WhatsApp (Meta Platforms, Inc) messages, or both from the study team when traveling >50 km from the study area for >7 days. In addition to mobility data collected daily through the phone, participants completed questionnaires at enrollment and follow-up (approximately 6 months post partum). Results: A total of 7 participants were withdrawn at enrollment or shortly after because of app installation failure (6/200, 3%) or changing to an unsuitable phone (1/200, 0.50%). During the study period, no participant’s smartphone recorded at least 1 heartbeat per day, which was our primary feasibility measure. Of the 171 participants who completed follow-up, only half (91/171, 53.2%) reported using the same phone as that used at enrollment, with the CareConekta app still installed on the phone and GPS usually enabled. The top reasons reported for the lack of heartbeat data were not having mobile data, uninstalling the app, and no longer having a smartphone. Acceptability measures were positive, but participants at follow-up demonstrated a lack of understanding of the app’s purpose and function. The clinic finder was a popular feature. Owing to the lack of consistent GPS heartbeats throughout the study, we were unable to assess the efficacy of the intervention. Conclusions: Several key challenges impeded our study feasibility. Although the app was designed to reverse bill participants for any data use, the lack of mobile data was a substantial barrier to our study success. Participants reported purchasing WhatsApp data, which could not support the app. Problems with the web-based dashboard meant that we could not consistently monitor mobility. Our study provides important lessons about implementing an ambitious GPS-based study under real-world conditions in a limited-resource setting. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4190-x %M 37204838 %R 10.2196/44945 %U https://mhealth.jmir.org/2023/1/e44945 %U https://doi.org/10.2196/44945 %U http://www.ncbi.nlm.nih.gov/pubmed/37204838 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44513 %T WeChat-Based HIV e-Report, a New Approach for HIV Serostatus Requests and Disclosures Among Men Who Have Sex With Men: Prospective Subgroup Analysis of a Randomized Controlled Trial %A Sun,Hai-Tong %A Fan,Xiao-Ru %A Gu,Yu-Zhou %A Lu,Yong-Heng %A Qiu,Jia-Ling %A Yang,Qing-Ling %A Li,Jing-Hua %A Gu,Jing %A Hao,Chun %+ Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd Yuexiu District, Guangzhou, 510080, China, 86 87332517, haochun@mail.sysu.edu.cn %K behavioral intervention %K HIV serostatus disclosure %K HIV testing %K men who have sex with men %K mHealth %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Requesting and disclosing HIV serostatus is associated with a reduction in HIV transmission among men who have sex with men (MSM). However, the reliability of common methods for HIV serostatus request and disclosure is inadequate. Validated approaches for requesting and disclosing HIV serostatus are necessary. Objective: The objective of this study was to investigate the use of the HIV e-report as authentic evidence of HIV serostatus among the MSM community in Guangzhou, China. Additionally, the study aimed to explore its correlation with HIV serostatus requesting and disclosure receiving behavior. Methods: This study is a subgroup analysis of a cluster randomized controlled trial (RCT) that enrolled 357 participants during the first year. Participants in this RCT were recruited from the WeChat-based HIV testing service miniprogram developed by Guangzhou Center for Disease Control and Prevention, China. Participants completed web-based questionnaires at baseline and at the month 3 follow-up, which covered sociodemographic characteristics, HIV-related, HIV serostatus requests, receiving HIV serostatus disclosures, and HIV e-report usage. Results: The WeChat-based HIV e-report was available in Guangzhou when the RCT project started. At the month 3 follow-up, 32.2% (115/357) of participants had their own HIV e-reports, and 37.8% (135/357) of them had received others’ HIV e-reports. In all, 13.1% (27/205) and 10.5% (16/153) of participants started to use HIV e-reports to request the HIV serostatus from regular and casual male sex partners, respectively. Moreover, 27.3% (42/154) and 16.5% (18/109) of the regular and casual male sex partners, respectively, chose HIV e-reports to disclose their HIV serostatus. Compared to MSM who did not have HIV e-reports, those who had HIV e-reports and stated, “I had had my own HIV e-report(s) but hadn’t sent to others” (multivariate odds ratio 2.71, 95% CI 1.19-6.86; P=.02) and “I had had my own HIV e-reports and had sent to others” (multivariate odds ratio 2.67, 95% CI 1.07-7.73; P=.048) were more likely to request HIV serostatus from their partners. However, no factor was associated with receiving an HIV serostatus disclosure from partners. Conclusions: The HIV e-report has been accepted by the MSM community in Guangzhou and could be applied as a new optional approach for HIV serostatus requests and disclosures. This innovative intervention could be effective in promoting infectious disease serostatus disclosure among the related high-risk population. Trial Registration: ClinicalTrials.gov NCT03984136; https://clinicaltrials.gov/show/NCT03984136 International Registered Report Identifier (IRRID): RR2-10.1186/s12879-021-06484-y %M 37155223 %R 10.2196/44513 %U https://mhealth.jmir.org/2023/1/e44513 %U https://doi.org/10.2196/44513 %U http://www.ncbi.nlm.nih.gov/pubmed/37155223 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43709 %T Health-Seeking Behavior and Its Associated Technology Use: Interview Study Among Community-Dwelling Older Adults %A Zhang,Yichi %A Lee,Edmund W J %A Teo,Wei-Peng %+ Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore, 637616, Singapore, 65 67903704, weipeng.teo@nie.edu.sg %K health %K health-seeking behavior %K aging %K technology %K telehealth %K mobile health %K mHealth %K eHealth %K health access %K qualitative study %K mobile phone %D 2023 %7 4.5.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Understanding older people’s health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people’s health-seeking activities. Objective: This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. Methods: This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ≥50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the individual as the unit of analysis to understand the patterns of behaviors. Results: In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services; information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults’ well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants’ observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. Conclusions: Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults’ health seeking. Our findings have implications for the design and implementation of health services and policies. %M 36996003 %R 10.2196/43709 %U https://aging.jmir.org/2023/1/e43709 %U https://doi.org/10.2196/43709 %U http://www.ncbi.nlm.nih.gov/pubmed/36996003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41225 %T Validation of an Interoperability Framework for Linking mHealth Apps to Electronic Record Systems in Botswana: Expert Survey Study %A Ndlovu,Kagiso %A Mars,Maurice %A Scott,Richard E %+ Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa, 27 0312601075, ndlovuk@ub.ac.bw %K mobile health %K mHealth %K electronic record systems %K eRecord systems %K mHealth-eRecord Interoperability Framework %K mHeRIF %K interoperability architecture %K validation %K Botswana %K mobile phone %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic record (eRecord) systems and mobile health (mHealth) apps have documented potential to improve health service delivery, resulting in increased global uptake. However, their interoperability remains a global challenge hindering diagnosis, monitoring of health conditions, and data access irrespective of geographic location. Given the widespread use of mobile devices by patients and health care providers, linking mHealth apps and eRecord systems could result in a comprehensive and seamless data exchange within a health care community. The Botswana National eHealth Strategy recognizes interoperability as an issue and mHealth as a potential solution for some health care needs but is silent on how to make mHealth apps interoperable with existing eRecord systems. A literature review and analysis of existing mHealth interoperability frameworks found none suitable for Botswana. As such, it was critical to conceptualize, design, and develop an mHealth-eRecord Interoperability Framework (mHeRIF) to enhance the interoperability pillar of the Botswana National eHealth Strategy and leverage the full benefits of linking mHealth apps with other health information systems. Objective: This study aimed to validate the developed mHeRIF and determine whether it requires further refinement before consideration towards enhancing the National eHealth Strategy. Methods: Published framework validation approaches guided the development of a survey administered to 12 purposively selected local and international eHealth experts. In total, 25% (3/12) of the experts were drawn from Botswana, 25% (3/12) were drawn from low- and middle-income countries in sub-Saharan Africa, 25% (3/12) were drawn from low- and middle-income countries outside Africa, and 25% (3/12) were drawn from high-income countries. Quantitative responses were collated in a Microsoft Excel (Microsoft Corp) spreadsheet for descriptive analysis, and the NVivo software (version 11; QSR International) was used to aid the thematic analysis of the qualitative open-ended questions. Results: The analysis of responses showed overall support for the content and format of the proposed mHeRIF. However, some experts’ suggestions led to 4 modest revisions of the mHeRIF. Conclusions: Overall, the experts’ reviews showed that the mHeRIF could contribute to the National eHealth Strategy by guiding the linking of mHealth apps to existing eRecord systems in Botswana. Similarly, the experts validated an architectural model derived from the mHeRIF in support of the first mobile telemedicine initiative considered for national rollout in Botswana. The mHeRIF helps identify key components to consider before and after linking mHealth apps to eRecord systems and is being considered for use as the foundation of such interoperability in Botswana. %M 37129939 %R 10.2196/41225 %U https://formative.jmir.org/2023/1/e41225 %U https://doi.org/10.2196/41225 %U http://www.ncbi.nlm.nih.gov/pubmed/37129939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37329 %T Evaluating Mobile Apps Targeting Older Adults: Descriptive Study %A Sweeney,Megan %A Barton,William %A Nebeker,Camille %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, United States, 1 858 534 7786, nebeker@ucsd.edu %K older adults %K mobile apps %K privacy %K data management, research ethics %K app %K aging %K environment %K safety %K smartphone %K personal information %K user knowledge %K user %K data %K data collection %K storage %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone use has increased dramatically and, in parallel, a market for mobile apps, including health apps, has emerged. The business model of targeted mobile app advertisements allows for the collection of personal and potentially sensitive information, often without user knowledge. Older adults comprise a rapidly growing demographic that is potentially vulnerable to exploitation by those accessing data collected via these apps. Objective: This research examined apps that claimed to be useful to older adults with a goal of (1) classifying the functionality of each app, (2) identifying whether a privacy policy existed and was accessible, and (3) evaluating evidence that could support claims of value to older adults. Methods: An environmental scan was conducted using the Google search engine and typing “apps for older adults.” The first 25 sites that this search returned comprised the primary data for this study. Data were organized by descriptive features of purpose (eg, health, finance, and utility), the existence of an electronically accessible privacy policy, price, and evidence supporting each recommended mobile app. Results: A total of 133 mobile apps were identified and promoted as being the best “apps for older adults.” Of these 133 mobile apps, 83% (n=110) included a privacy policy. Fewer apps designated in the “medical” category included a privacy policy than those classified otherwise. Conclusions: The results suggest that most mobile apps targeting older adults include a privacy policy. Research is needed to determine whether these privacy policies are readable, succinct, and incorporate accessible data use and sharing practices to mitigate potential risks, particularly when collecting potentially sensitive health information. %M 37103995 %R 10.2196/37329 %U https://formative.jmir.org/2023/1/e37329 %U https://doi.org/10.2196/37329 %U http://www.ncbi.nlm.nih.gov/pubmed/37103995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38545 %T Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial %A Tugault-Lafleur,Claire N %A De-Jongh González,Olivia %A Macdonald,Janice %A Bradbury,Jennifer %A Warshawski,Tom %A Ball,Geoff D C %A Morrison,Katherine %A Ho,Josephine %A Hamilton,Jill %A Buchholz,Annick %A Mâsse,Louise %+ School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, 4480 Oak Street, Rm F508, Vancouver, BC, V6H 3V4, Canada, 1 875 2000 ext 5563, lmasse@bcchr.ubc.ca %K mobile health %K mHealth %K childhood obesity %K lifestyle management %K adolescents %K randomized controlled trial %K RCT %K mobile phone %D 2023 %7 25.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. Objective: The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. Methods: A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents’ assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. Results: A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. Conclusions: The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. Trial Registration: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4080-2 %M 37097726 %R 10.2196/38545 %U https://www.jmir.org/2023/1/e38545 %U https://doi.org/10.2196/38545 %U http://www.ncbi.nlm.nih.gov/pubmed/37097726 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43164 %T Mobile Acceptance and Commitment Therapy in Bipolar Disorder: Microrandomized Trial %A Cochran,Amy %A Maronge,Jacob M %A Victory,Amanda %A Hoel,Sydney %A McInnis,Melvin G %A Thomas,Emily BK %+ Department of Population Health Sciences, University of Wisconsin Madison, 610 Walnut Street, Madison, WI, 53726, United States, 1 608 262 0772, cochran4@wisc.edu %K acceptance and commitment therapy %K bipolar disorder %K mobile applications %K randomized controlled trials %K micro-randomized trial %K precision medicine %K mindfulness %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile interventions promise to fill in gaps in care with their broad reach and flexible delivery. Objective: Our goal was to investigate delivery of a mobile version of acceptance and commitment therapy (ACT) for individuals with bipolar disorder (BP). Methods: Individuals with BP (n=30) participated in a 6-week microrandomized trial. Twice daily, participants logged symptoms in the app and were repeatedly randomized (or not) to receive an ACT intervention. Self-reported behavior and mood were measured as the energy devoted to moving toward valued domains or away from difficult emotions and with depressive d and manic m scores from the digital survey of mood in BP survey (digiBP). Results: Participants completed an average of 66% of in-app assessments. Interventions did not significantly impact the average toward energy or away energy but did significantly increase the average manic score m (P=.008) and depressive score d (P=.02). This was driven by increased fidgeting and irritability and interventions focused on increasing awareness of internal experiences. Conclusions: The findings of the study do not support a larger study on the mobile ACT in BP but have significant implications for future studies seeking mobile therapy for individuals with BP. Trial Registration: ClinicalTrials.gov NCT04098497; https://clinicaltrials.gov/ct2/show/NCT04098497 %M 37079363 %R 10.2196/43164 %U https://mental.jmir.org/2023/1/e43164 %U https://doi.org/10.2196/43164 %U http://www.ncbi.nlm.nih.gov/pubmed/37079363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41838 %T End Users' Perspectives on the Quality and Design of mHealth Technologies During the COVID-19 Pandemic in the Philippines: Qualitative Study %A Gonzales,Aldren %A Custodio,Razel %A Lapitan,Marie Carmela %A Ladia,Mary Ann %+ Medical Informatics Unit, College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila, 1000, Philippines, 63 2027511303, abgonzales2@up.edu.ph %K mHealth %K COVID-19 %K pandemic %K digital health %K mobile health %K end-user engagement %K focus group %K technology implementation %K Philippines %K technology use %K privacy %K user engagement %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has expanded the use of mobile health (mHealth) technologies in contact tracing, communicating COVID-19–related information, and monitoring the health conditions of the general population in the Philippines. However, the limited end-user engagement in the features and feedback along the development cycle of mHealth technologies results in risks in adoption. The World Health Organization (WHO) recommends user-centric design and development of mHealth technologies to ensure responsiveness to the needs of the end users. Objective: The goal of the study is to understand, using end users’ perspectives, the design and quality of mHealth technology implementations in the Philippines during the COVID-19 pandemic, with a focus on the areas identified by stakeholders: (1) utility, (2) technology readiness level, (3) design, (4) information, (5) usability, (6) features, and (7) security and privacy. Methods: Using a descriptive qualitative design, we conducted 5 interviews and 3 focus group discussions (FGDs) with a total of 16 participants (6, 37.5%, males and 10, 62.5%, females). Questions were based on the Mobile App Rating Scale (MARS). Using the cyclical coding approach, transcripts were analyzed with NVivo 12. Themes were identified. Results: The qualitative analysis identified 18 themes that were organized under the 7 focus areas: (1) utility: use of mHealth technologies and motivations in using mHealth; (2) technology readiness: mobile technology literacy and user segmentation; (3) design: user interface design, language and content accessibility, and technology design; (4) information: accuracy of information and use of information; (5) usability: design factors, dependency on human processes, and technical issues; (6) features: interoperability and data integration, other feature and design recommendations, and technology features and upgrades; and (7) privacy and security: trust that mHealth can secure data, lack of information, and policies. To highlight, accessibility, privacy and security, a simple interface, and integration are some of the design and quality areas that end users find important and consider in using mHealth tools. Conclusions: Engaging end users in the development and design of mHealth technologies ensures adoption and accessibility, making it a valuable tool in curbing the pandemic. The 6 principles for developers, researchers, and implementers to consider when scaling up or developing a new mHealth solution in a low-resource setting are that it should (1) be driven by value in its implementation, (2) be inclusive, (3) address users’ physical and cognitive restrictions, (4) ensure privacy and security, (5) be designed in accordance with digital health systems’ standards, and (6) be trusted by end users. %M 36943932 %R 10.2196/41838 %U https://formative.jmir.org/2023/1/e41838 %U https://doi.org/10.2196/41838 %U http://www.ncbi.nlm.nih.gov/pubmed/36943932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45309 %T Geolocation Patterns, Wi-Fi Connectivity Rates, and Psychiatric Symptoms Among Urban Homeless Youth: Mixed Methods Study Using Self-report and Smartphone Data %A Ilyas,Yousaf %A Hassanbeigi Daryani,Shahrzad %A Kiriella,Dona %A Pachwicewicz,Paul %A Boley,Randy A %A Reyes,Karen M %A Smith,Dale L %A Zalta,Alyson K %A Schueller,Stephen M %A Karnik,Niranjan S %A Stiles-Shields,Colleen %+ Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 3122730185, ecss@uic.edu %K mHealth %K mobile health %K smartphones %K geolocation %K Wi-Fi %K youth experiencing homelessness %K mobile phone %K homelessness %K youth %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite significant research done on youth experiencing homelessness, few studies have examined movement patterns and digital habits in this population. Examining these digital behaviors may provide useful data to design new digital health intervention models for youth experiencing homelessness. Specifically, passive data collection (data collected without extra steps for a user) may provide insights into lived experience and user needs without putting an additional burden on youth experiencing homelessness to inform digital health intervention design. Objective: The objective of this study was to explore patterns of mobile phone Wi-Fi usage and GPS location movement among youth experiencing homelessness. Additionally, we further examined the relationship between usage and location as correlated with depression and posttraumatic stress disorder (PTSD) symptoms. Methods: A total of 35 adolescent and young adult participants were recruited from the general community of youth experiencing homelessness for a mobile intervention study that included installing a sensor data acquisition app (Purple Robot) for up to 6 months. Of these participants, 19 had sufficient passive data to conduct analyses. At baseline, participants completed self-reported measures for depression (Patient Health Questionnaire-9 [PHQ-9]) and PTSD (PTSD Checklist for DSM-5 [PCL-5]). Behavioral features were developed and extracted from phone location and usage data. Results: Almost all participants (18/19, 95%) used private networks for most of their noncellular connectivity. Greater Wi-Fi usage was associated with a higher PCL-5 score (P=.006). Greater location entropy, representing the amount of variability in time spent across identified clusters, was also associated with higher severity in both PCL-5 (P=.007) and PHQ-9 (P=.045) scores. Conclusions: Location and Wi-Fi usage both demonstrated associations with PTSD symptoms, while only location was associated with depression symptom severity. While further research needs to be conducted to establish the consistency of these findings, they suggest that the digital patterns of youth experiencing homelessness offer insights that could be used to tailor digital interventions. %M 37071457 %R 10.2196/45309 %U https://formative.jmir.org/2023/1/e45309 %U https://doi.org/10.2196/45309 %U http://www.ncbi.nlm.nih.gov/pubmed/37071457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41726 %T Co-design Tensions Between Parents, Children, and Researchers Regarding Mobile Health Technology Design Needs and Decisions: Case Study %A Yip,Jason %A Wong,Kelly %A Oh,Isabella %A Sultan,Farisha %A Roldan,Wendy %A Lee,Kung Jin %A Huh,Jimi %+ Ewha Womans University, Ewha-POSCO Building (Social Sciences) #509, Seoul, 120-750, Republic of Korea, 82 02 3277 2227, kungjinlee@ewha.ac.kr %K just-in-time adaptive intervention %K JITAI %K mobile health %K mHealth %K participatory design %K co-design %K children and families %K Black, Indigenous, and people of color %K BIPOC %K child-computer interaction %K design %K children %K mobile intervention %K intervention %K development %K mobile phone %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Just-in-time adaptive interventions (JITAIs) in mobile health are an intervention design that provides behavior change support based on an individual’s changing and dynamic contextual state. However, few studies have documented how end users of JITAI technologies are involved in their development, particularly from historically marginalized families and children. Less is known for public health researchers and designers of the tensions that occur as families negotiate their needs. Objective: We aimed to broaden our understanding of how historically marginalized families are included in co-design from a public health perspective. We sought to address research questions surrounding JITAIs; co-design; and working with historically marginalized families, including Black, Indigenous, and people of color (BIPOC) children and adults, regarding improving sun protection behaviors. We sought to better understand value tensions in parents’ and children’s needs regarding mobile health technologies and how design decisions are made. Methods: We examined 2 sets of co-design data (local and web-based) pertaining to a larger study on mobile SunSmart JITAI technologies with families in Los Angeles, California, United States, who were predominantly of Latinx and multiracial backgrounds. In these co-design sessions, we conducted stakeholder analysis through perceptions of harms and benefits and an assessment of stakeholder views and values. We open coded the data and compared the developed themes using a value-sensitive design framework by examining value tensions to help organize our qualitative data. Our study is formatted through a narrative case study that captures the essential meanings and qualities that are difficult to present, such as quotes in isolation. Results: We presented 3 major themes from our co-design data: different experiences with the sun and protection, misconceptions about the sun and sun protection, and technological design and expectations. We also provided value flow (opportunities for design), value dam (challenges to design), or value flow or dam (a hybrid problem) subthemes. For each subtheme, we provided a design decision and a response we ended up making based on what was presented and the kinds of value tensions we observed. Conclusions: We provide empirical data to show what it is like to work with multiple BIPOC stakeholders in the roles of families and children. We demonstrate the use of the value tension framework to explain the different needs of multiple stakeholders and technology development. Specifically, we demonstrate that the value tension framework helps sort our participants’ co-design responses into clear and easy-to-understand design guidelines. Using the value tension framework, we were able to sort the tensions between children and adults, family socioeconomic and health wellness needs, and researchers and participants while being able to make specific design decisions from this organized view. Finally, we provide design implications and guidance for the development of JITAI mobile interventions for BIPOC families. %M 37058350 %R 10.2196/41726 %U https://formative.jmir.org/2023/1/e41726 %U https://doi.org/10.2196/41726 %U http://www.ncbi.nlm.nih.gov/pubmed/37058350 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41935 %T Comprehensive Senior Technology Acceptance Model of Daily Living Assistive Technology for Older Adults With Frailty: Cross-sectional Study %A Shin,Hye Ri %A Um,Sa Rang %A Yoon,Hee Jeong %A Choi,Eun Young %A Shin,Won Chul %A Lee,Hee Yun %A Kim,Young Sun %+ Department of Gerontology, AgeTech-Service Convergence Major, Kyung Hee University, 1732, Deogyeong-daero, Giheung-gu, Yongin, 17104, Republic of Korea, 82 1092317730, ysunkim@khu.ac.kr %K senior technology acceptance model %K daily living assistive technologies %K frailty %K older adults %D 2023 %7 10.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: There are considerable gaps between the need for assistive technologies and the actual adoption of these technologies among older adults, although older adults are among the groups that most need assistive technologies. Consequently, research is needed in this area because older adults’ technology acceptance and influencing factors may differ depending on their level of frailty. Objective: The objective of this study was to compare frail, prefrail, and robust groups of South Korean adults regarding their behavioral intention to use daily living assistive technologies and the affecting factors—namely, technological context factors, health contexts and abilities, and attitudinal factors—based on a comprehensive senior technology acceptance model. Methods: A nationwide sample of 500 older South Korean adults (aged 55-92 years) was analyzed, and multivariate linear regression analyses of the robust, prefrail, and frail groups were performed. The independent and dependent variables consisted of 3 factors based on previous studies. First, technological context factors consisted of gerontechnology self-efficacy, gerontechnology anxiety, and facilitating conditions. Second, health contexts and abilities consisted of self-reported health conditions, cognitive ability, social relationships, psychological function, and physical function. Third and last, attitudinal factors consisted of behavioral intention to use assistive technologies, attitude toward use, perceived usefulness (PU), and perceived ease of use (PEOU). Results: The results of the analyses showed that technological context factors such as gerontechnology self-efficacy, health contexts and abilities such as self-reported health conditions and psychological function, and attitudinal factors such as attitude toward use, PU, and PEOU had significant effects on behavioral intention to use daily living assistive technologies. In particular, gerontechnology self-efficacy had a significant relationship with behavioral intention to use these technologies in the robust (r=0.120; P=.03) and prefrail (r=0.331; P<.001) groups. Psychological function (life satisfaction) had a significant relationship with behavioral intention to use these technologies in the robust group (r=–0.040; P=.02). Self-reported health conditions had a significant relationship with behavioral intention to use these technologies in the prefrail group (r=–0.169; P=.01). Although each group had a different significant relationship with the variables, attitudinal factors such as attitude toward use affected all groups (robust group: r=0.190; P=.03; prefrail group: r=0.235; P=.006; and frail group: r=0.526; P=.002). In addition, PU and PEOU in the attitudinal factors had a significant relationship with behavioral intention to use assistive technologies in the robust (PU: r=0.160; P=.01; and PEOU: r=0.350; P<.001) and prefrail (PU: r=0.265; P<.001; and PEOU: r=0.120; P=.04) groups. Conclusions: This study found that the comprehensive senior technology acceptance model of daily living assistive technologies had different associations according to the frailty group. These findings provided insights into the consideration of interventions with daily living assistive technologies for older adults with varying levels of frailty. %M 37036760 %R 10.2196/41935 %U https://www.jmir.org/2023/1/e41935 %U https://doi.org/10.2196/41935 %U http://www.ncbi.nlm.nih.gov/pubmed/37036760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45920 %T Acceptability and Initial Adoption of the Heart Observation App for Infants With Congenital Heart Disease: Qualitative Study %A Hjorth-Johansen,Elin %A Børøsund,Elin %A Martinsen Østen,Ingeborg %A Holmstrøm,Henrik %A Moen,Anne %+ Neonatal Intensive Care Unit, Division of Children and Adolescent Medicine, Oslo University Hospital, E2 4th Floor, Sognsvannsveien 20, Oslo, 0372, Norway, 47 98676884, ehjorth@ous-hf.no %K congenital heart disease %K readiness for discharge %K mobile app %K follow-up, health services %K mHealth %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. Objective: This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents’ understanding and management of their child’s condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. Methods: A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant’s primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. Results: The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents’ receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an “everyday app” and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals’ attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant’s condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). Conclusions: This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents’ receptivity. By doing so, parents may be confident to know what to look for regarding their child’s health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system. %M 37018028 %R 10.2196/45920 %U https://formative.jmir.org/2023/1/e45920 %U https://doi.org/10.2196/45920 %U http://www.ncbi.nlm.nih.gov/pubmed/37018028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43823 %T The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a “No-Code” Mobile App Builder: Development and Usability Study %A Willms,Amanda %A Rhodes,Ryan E %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, awillms@uvic.ca %K mobile health %K mHealth %K usability study %K financial incentive %K physical activity %K mobile phone %K smartphone %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive–driven M-PAC mHealth programs aimed at hypertension prevention. Objective: We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. Methods: The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. Results: Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. Conclusions: The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the “no-code” app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process. %M 37018038 %R 10.2196/43823 %U https://formative.jmir.org/2023/1/e43823 %U https://doi.org/10.2196/43823 %U http://www.ncbi.nlm.nih.gov/pubmed/37018038 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41117 %T Collecting Food and Drink Intake Data With Voice Input: Development, Usability, and Acceptability Study %A Millard,Louise A C %A Johnson,Laura %A Neaves,Samuel R %A Flach,Peter A %A Tilling,Kate %A Lawlor,Deborah A %+ Medical Research Council (MRC) Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom, 44 0117 455 7676, louise.millard@bristol.ac.uk %K digital health %K data collection %K voice-based approaches %K Amazon Alexa %K self-reported data %K food and drink %D 2023 %7 31.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Voice-based systems such as Amazon Alexa may be useful for collecting self-reported information in real time from participants of epidemiology studies using verbal input. In epidemiological research studies, self-reported data tend to be collected using short, infrequent questionnaires, in which the items require participants to select from predefined options, which may lead to errors in the information collected and lack of coverage. Voice-based systems give the potential to collect self-reported information “continuously” over several days or weeks. At present, to the best of our knowledge, voice-based systems have not been used or evaluated for collecting epidemiological data. Objective: We aimed to demonstrate the technical feasibility of using Alexa to collect information from participants, investigate participant acceptability, and provide an initial evaluation of the validity of the collected data. We used food and drink information as an exemplar. Methods: We recruited 45 staff members and students at the University of Bristol (United Kingdom). Participants were asked to tell Alexa what they ate or drank for 7 days and to also submit this information using a web-based form. Questionnaires asked for basic demographic information, about their experience during the study, and the acceptability of using Alexa. Results: Of the 37 participants with valid data, most (n=30, 81%) were aged 20 to 39 years and 23 (62%) were female. Across 29 participants with Alexa and web entries corresponding to the same intake event, 60.1% (357/588) of Alexa entries contained the same food and drink information as the corresponding web entry. Most participants reported that Alexa interjected, and this was worse when entering the food and drink information (17/35, 49% of participants said this happened often; 1/35, 3% said this happened always) than when entering the event date and time (6/35, 17% of participants said this happened often; 1/35, 3% said this happened always). Most (28/35, 80%) said they would be happy to use a voice-controlled system for future research. Conclusions: Although there were some issues interacting with the Alexa skill, largely because of its conversational nature and because Alexa interjected if there was a pause in speech, participants were mostly willing to participate in future research studies using Alexa. More studies are needed, especially to trial less conversational interfaces. %M 37000476 %R 10.2196/41117 %U https://mhealth.jmir.org/2023/1/e41117 %U https://doi.org/10.2196/41117 %U http://www.ncbi.nlm.nih.gov/pubmed/37000476 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43867 %T A Mobile Self-Management App (CanSelfMan) for Children With Cancer and Their Caregivers: Usability and Compatibility Study %A Mehdizadeh,Hamed %A Asadi,Farkhondeh %A Nazemi,Eslam %A Mehrvar,Azim %A Yazdanian,Azade %A Emami,Hassan %+ Health Information Technology Department, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Farah Abad Blvd,, Sari, 4818911916, Iran, 98 1133543246, hamed13sep@gmail.com %K Digital health %K eHealth %K Telehealth %K mHealth %K Mobile app %K self-management %K cancer %K child %K parent %K caregiver %K usability evaluation %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. Objective: The objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. Methods: We performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. Results: During the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children’s evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD 0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). Conclusions: In this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease. %M 36995746 %R 10.2196/43867 %U https://pediatrics.jmir.org/2023/1/e43867 %U https://doi.org/10.2196/43867 %U http://www.ncbi.nlm.nih.gov/pubmed/36995746 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42092 %T Evaluating Barriers and Facilitators to the Uptake of mHealth Apps in Cancer Care Using the Consolidated Framework for Implementation Research: Scoping Literature Review %A Ardito,Vittoria %A Golubev,Georgi %A Ciani,Oriana %A Tarricone,Rosanna %+ Centre for Research on Health and Social Care Management (CERGAS), Government, Health and Not for Profit Division, SDA Bocconi School of Management, Via Sarfatti, 10, Milan, 20136, Italy, 39 3400631572, vittoria.ardito@sdabocconi.it %K mobile health %K mHealth %K smartphones %K mobile %K oncology %K cancer %K implementation science %K consolidated framework for implementation research %K CFIR %K mobile phones %D 2023 %7 30.3.2023 %9 Review %J JMIR Cancer %G English %X Background: Mobile health (mHealth) solutions have proven to be effective in a wide range of patient outcomes and have proliferated over time. However, a persistent challenge of digital health technologies, including mHealth, is that they are characterized by early dropouts in clinical practice and struggle to be used outside experimental settings or on larger scales. Objective: This study aimed to explore barriers and enablers to the uptake of mHealth solutions used by patients with cancer undergoing treatment, using a theory-guided implementation science model, that is, the Consolidated Framework for Implementation Research (CFIR). Methods: A scoping literature review was conducted using PubMed (MEDLINE), Web of Science, and ScienceDirect databases in March 2022. We selected studies that analyzed the development, evaluation, and implementation of mHealth solutions for patients with cancer that were used in addition to the standard of care. Only empirical designs (eg, randomized controlled trials, observational studies, and qualitative studies) were considered. First, information on the study characteristics, patient population, app functionalities, and study outcomes was extracted. Then, the CFIR model was used as a practical tool to guide data collection and interpretation of evidence on mHealth uptake. Results: Overall, 91 papers were included in the data synthesis. The selected records were mostly randomized controlled trials (26/91, 29%) and single-arm, noncomparative studies (52/91, 57%). Most of the apps (42/73, 58%) were designed for both patients and clinicians and could be used to support any type of cancer (29/73, 40%) and a range of oncological treatments. Following the CFIR scheme (intervention, outer setting, inner setting, individuals, process), multistakeholder co-design, codevelopment, and testing of mHealth interventions were identified as key enablers for later uptake. A variety of external drivers emerged, although the most relevant outer incentive fostering mHealth use was addressing patient needs. Among organizational factors likely to influence technology uptake, interoperability was the most prominent, whereas other providers’ dimensions such as managerial attitudes or organizational culture were not systematically discussed. Technology-related impediments that could hamper the use of mHealth at the individual level were considered least often. Conclusions: The hype surrounding mHealth in cancer care is hindered by several factors that can affect its use in real world and nonexperimental settings. Compared with the growing evidence on mHealth efficacy, knowledge to inform the uptake of mHealth solutions in clinical cancer care is still scarce. Although some of our findings are supported by previous implementation research, our analysis elaborates on the distinguishing features of mHealth apps and provides an integrated perspective on the factors that should be accounted for implementation efforts. Future syntheses should liaise these dimensions with strategies observed in successful implementation initiatives. %M 36995750 %R 10.2196/42092 %U https://cancer.jmir.org/2023/1/e42092 %U https://doi.org/10.2196/42092 %U http://www.ncbi.nlm.nih.gov/pubmed/36995750 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40834 %T Willingness to Use and Pay for Digital Health Care Services According to 4 Scenarios: Results from a National Survey %A Lee,Junbok %A Oh,Yumi %A Kim,Meelim %A Cho,Belong %A Shin,Jaeyong %+ Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea, 82 2 2228 1881, DRSHIN@yuhs.ac %K digital health intervention %K service experience %K willingness to pay %K willingness to use %K digital health %K health technology %D 2023 %7 29.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones and their associated technology have evolved to an extent where these devices can be used to provide digital health interventions. However, few studies have been conducted on the willingness to use (WTU) and willingness to pay (WTP) for digital health interventions. Objective: The purpose of this study was to investigate how previous service experience, the content of the services, and individuals’ health status affect WTU and WTP. Methods: We conducted a nationwide web-based survey in 3 groups: nonusers (n=506), public service users (n=368), and private service users (n=266). Participants read scenarios about an imagined health status (such as having a chronic illness) and the use of digital health intervention models (self-management, expert management, and medical management). They were then asked to respond to questions on WTU and WTP. Results: Public service users had a greater intention to use digital health intervention services than nonusers and private service users: scenario A (health-risk situation and self-management), nonusers=odd ratio [OR] .239 (SE .076; P<.001) and private service users=OR .138 (SE .044; P<.001); scenario B (health-risk situation and expert management), nonusers=OR .175 (SE .040; P<.001) and private service users=OR .219 (SE .053; P<.001); scenario C (chronic disease situation and expert management), nonusers=OR .413 (SE .094; P<.001) and private service users=OR .401 (SE .098; P<.001); and scenario D (chronic disease situation and medical management), nonusers=OR .480 (SE .120; P=.003) and private service users=OR .345 (SE .089; P<.001). In terms of WTP, in scenarios A and B, those who used the public and private services had a higher WTP than those who did not (scenario A: β=–.397, SE .091; P<.001; scenario B: β=–.486, SE .098; P<.001). In scenario C, private service users had greater WTP than public service users (β=.264, SE .114; P=.02), whereas public service users had greater WTP than nonusers (β=–.336, SE .096; P<.001). In scenario D, private service users were more WTP for the service than nonusers (β=–.286, SE .092; P=.002). Conclusions: We confirmed that the WTU and WTP for digital health interventions differed based on individuals’ prior experience with health care services, health status, and demographics. Recently, many discussions have been made to expand digital health care beyond the early adapters and fully into people’s daily lives. Thus, more understanding of people’s awareness and acceptance of digital health care is needed. %M 36989025 %R 10.2196/40834 %U https://mhealth.jmir.org/2023/1/e40834 %U https://doi.org/10.2196/40834 %U http://www.ncbi.nlm.nih.gov/pubmed/36989025 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42167 %T Perceptions of a Digital Mental Health Platform Among Participants With Depressive Disorder, Anxiety Disorder, and Other Clinically Diagnosed Mental Disorders in Singapore: Usability and Acceptability Study %A Phang,Ye Sheng %A Heaukulani,Creighton %A Martanto,Wijaya %A Morris,Robert %A Tong,Mian Mian %A Ho,Roger %+ MOH Office for Healthcare Transformation, 1 Maritime Square, #12-10 Harborfront Centre, Singapore, 099253, Singapore, 65 6679 3147, yesheng.phang@moht.com.sg %K mHealth %K mobile health %K CBT %K cognitive behavioral therapy %K cognitive behavioural therapy %K iCBT %K internet-based cognitive behavioral therapy %K usability %K Post-Study System Usability Questionnaire %K PSSUQ %K acceptability %K mental health %K Singapore %K depression disorder %K anxiety disorder %K mental illness %K anxiety %K depression %K depressive %D 2023 %7 29.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The website mindline.sg is a stress management and coping website that can be accessed anonymously in Singapore for free. Although designed to serve individuals who are well or have mild depression and anxiety symptoms, mindline.sg may potentially be used by clinicians as an adjunct therapeutic aid for patients with clinically diagnosed mental disorders. Objective: This study aims to determine the perceived usability, acceptability, and usefulness of mindline.sg among individuals with diagnosed mental disorders in a clinical setting. Methods: A cross-sectional study with 173 participants was conducted in the waiting room of a psychiatrist’s office at the National University Hospital in Singapore. Participants waiting for an appointment were given 30 minutes and a simple set of instructions to use three features of mindline.sg. They subsequently answered a set of web-based survey questions via their smartphones, including a 16-item subset of the Post-Study System Usability Questionnaire (PSSUQ) for usability measurement and 5 questions designed to understand the perceived usefulness and acceptability of mindline.sg. Multiple linear regression is used to determine the associated demographic factors with overall PSSUQ score. A chi-square test is performed to investigate associations of psychiatric condition with users’ responses on acceptability and perceived usefulness of mindline.sg. For this study, P<.05 is considered significant. Results: We observed that the overall (mean 2.86, SD 1.46), system usefulness (mean 2.74, SD 1.46), and information quality (mean 2.98, SD 1.33) subscores of the PSSUQ survey are within a 99% CI of a literature-derived norm, which all have the interpretation of having high perceived usability. However, interface quality (mean 2.98, SD 1.33) scored lower than the literature-derived norm, although it is still better than the neutral score of 4. We find participants with lower than a General Certificate of Education O-Level or N-Level education tend to give a lower usability score as compared to others (β=.49; P=.02). Participants who have not been hospitalized previously due to their condition are also more likely to give a lower PSSUQ score as compared to individuals who have been hospitalized (β=.18; P=.03). The platform mindline.sg is also deemed to be generally useful and acceptable with all the survey questions receiving more than a 60% positive response. We found no association between the type(s) of self-reported psychiatric disorder(s) and the perceived usefulness and acceptability of mindline.sg. Conclusions: Our results show that mindline.sg is generally perceived as usable and acceptable by individuals with a diagnosed mental disorder in Singapore. The study suggests improving usability among individuals with lower education levels. Particularly promising is the finding that previously hospitalized individuals have significantly higher perceived usability and satisfaction of the website, suggesting potential impact could be found among a moderately to severely at-risk clinical population. The effectiveness of mindline.sg as an adjunct therapy for individuals with diagnosed mental disorders should therefore be explored in future studies. %M 36989020 %R 10.2196/42167 %U https://humanfactors.jmir.org/2023/1/e42167 %U https://doi.org/10.2196/42167 %U http://www.ncbi.nlm.nih.gov/pubmed/36989020 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43197 %T Understanding Older Adults’ Experiences With Technologies for Health Self-management: Interview Study %A Garcia Reyes,Elsy Paola %A Kelly,Ryan %A Buchanan,George %A Waycott,Jenny %+ School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Parkville Victoria, Melbourne, 3010, Australia, 61 3 9035 5511, egarciareyes@student.unimelb.edu.au %K older adults %K technology %K health self-management %K motivator %K enabler %K barrier %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments. Objective: This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies. Methods: A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis. Results: The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar. Conclusions: This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them. %M 36943333 %R 10.2196/43197 %U https://aging.jmir.org/2023/1/e43197 %U https://doi.org/10.2196/43197 %U http://www.ncbi.nlm.nih.gov/pubmed/36943333 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41040 %T Attitudes of Physicians and Individuals Toward Digital Mental Health Tools: Protocol for a Web-Based Survey Research Project %A Nogueira-Leite,Diogo %A Cruz-Correia,Ricardo %+ Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal, 351 913667140, diogo.fdnl@gmail.com %K mental health %K mobile apps %K digital technology %K government regulation %D 2023 %7 14.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital transformation is impacting health care delivery. Great market dynamism is bringing opportunities and concerns alike into public discussion. Digital health apps are a vibrant segment where regulation is emerging, with Germany paving the way with its DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health apps) program. Simultaneously, mental ill-health constitutes a global health concern, and prevalence is expected to worsen due to the COVID-19 pandemic and its containment measures. Portugal and its National Health System may be a useful testbed for digital health interventions. Objective: The paper outlines the protocol for a research project on the attitudes of physicians and potential users toward digital mental health apps to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. Methods: Web surveys will be conducted to acquire data from the main stakeholders (physicians and the academic community). Data analysis will replicate the statistical analysis performed in the studies from Dahlhausen and Borghouts to derive conclusions regarding the relative acceptance and likelihood of successful implementation of digital mental health apps in Portugal. Results: The findings of the proposed studies will elicit important information on how physicians and individuals perceive digital mental health app interventions to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. Data collection ran between September 26 and November 6, 2022, for the first study and September 20 and October 20, 2022, for the second study. We obtained 160 responses to the first study’s survey and 539 answers to the second study’s survey. Data analysis is concluded, and both studies’ results are expected to be published in 2023. Conclusions: The results of the studies projected in this research protocol will have implications for researchers and academia, industry, and policy makers concerning the adoption and implementation of digital health mental apps and associated interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/41040 %M 36917172 %R 10.2196/41040 %U https://www.researchprotocols.org/2023/1/e41040 %U https://doi.org/10.2196/41040 %U http://www.ncbi.nlm.nih.gov/pubmed/36917172 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e34331 %T How Reflective Automated e-Coaching Can Help Employees Improve Their Capacity for Resilience: Mixed Methods Study %A Lentferink,Aniek %A Oldenhuis,Hilbrand %A Velthuijsen,Hugo %A van Gemert-Pijnen,Lisette %+ Department of Psychology, Health & Technology, University of Twente, De Zul 10, Enschede, 7522 NJ, Netherlands, 31 505956217, a.j.lentferink@utwente.nl %K self-reflection %K stress management %K resilience %K eHealth %K self-tracking %K e-Coaching %K mobile phone %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: An eHealth tool that coaches employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarize the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection. Objective: In this study, we aimed to examine the perceived effectiveness of the guidance offered by an automated e-Coach during employees’ self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities and the usefulness of the design elements of the e-Coach during this process. Methods: Of the 28 participants, 14 (50%) completed the 6-week BringBalance program that allowed participants to perform reflection via four phases: identification, strategy generation, experimentation, and evaluation. Data collection consisted of log data, ecological momentary assessment (EMA) questionnaires for reflection provided by the e-Coach, in-depth interviews, and a pre- and posttest survey (including the Brief Resilience Scale and the Perceived Stress Scale). The posttest survey also asked about the utility of the elements of the e-Coach for reflection. A mixed methods approach was followed. Results: Pre- and posttest scores on perceived stress and resilience were not much different among completers (no statistical test performed). The automated e-Coach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience (identification phase) and to learn the principles of useful strategies to improve their capacity for resilience (strategy generation phase). Design elements of the e-Coach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend (identification phase). However, users experienced difficulties integrating the chosen strategies into their daily life (experimentation phase). Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the e-Coach (identification phase), and the events did not recur, which consequently left users unable to sufficiently practice (strategy generation phase), experiment (experimentation phase), and evaluate (evaluation phase) the techniques during meaningful events. Conclusions: Participants were able to perform self-reflection under the guidance of the automated e-Coach, which often led toward gaining new insights. To improve the reflection process, more guidance should be offered by the e-Coach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated e-Coach. %M 36897635 %R 10.2196/34331 %U https://humanfactors.jmir.org/2023/1/e34331 %U https://doi.org/10.2196/34331 %U http://www.ncbi.nlm.nih.gov/pubmed/36897635 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42145 %T Acceptability of a Health Care App With 3 User Interfaces for Older Adults and Their Caregivers: Design and Evaluation Study %A Kim,Joo Chan %A Saguna,Saguna %A Åhlund,Christer %+ Division of Computer Science, Department of Computer Science, Electrical and Space Engineering, Luleå University of Technology, Forskargatan 1, Skellefteå, 931 77, Sweden, 46 722254785, joo.chan.kim@ltu.se %K Internet of Things %K health monitoring %K older adults %K augmented reality %K user experience %K independent living %K design study %K mobile phone %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The older population needs solutions for independent living and reducing the burden on caregivers while maintaining the quality and dignity of life. Objective: The aim of this study was to design, develop, and evaluate an older adult health care app that supports trained caregivers (ie, formal caregivers) and relatives (ie, informal caregivers). We aimed to identify the factors that affect user acceptance of interfaces depending on the user’s role. Methods: We designed and developed an app with 3 user interfaces that enable remote sensing of an older adult’s daily activities and behaviors. We conducted user evaluations (N=25) with older adults and their formal and informal caregivers to obtain an overall impression of the health care monitoring app in terms of user experience and usability. In our design study, the participants had firsthand experience with our app, followed by a questionnaire and individual interview to express their opinions on the app. Through the interview, we also identified their views on each user interface and interaction modality to identify the relationship between the user’s role and their acceptance of a particular interface. The questionnaire answers were statistically analyzed, and we coded the interview answers based on keywords related to a participant’s experience, for example, ease of use and usefulness. Results: We obtained overall positive results in the user evaluation of our app regarding key aspects such as efficiency, perspicuity, dependability, stimulation, and novelty, with an average between 1.74 (SD 1.02) and 2.18 (SD 0.93) on a scale of −3.0 to 3.0. The overall impression of our app was favorable, and we identified that “simple” and “intuitive” were the main factors affecting older adults’ and caregivers’ preference for the user interface and interaction modality. We also identified a positive user acceptance of the use of augmented reality by 91% (10/11) of the older adults to share information with their formal and informal caregivers. Conclusions: To address the need for a study to evaluate the user experience and user acceptance by older adults as well as both formal and informal caregivers regarding the user interfaces with multimodal interaction in the context of health monitoring, we designed, developed, and conducted user evaluations with the target user groups. Our results through this design study show important implications for designing future health monitoring apps with multiple interaction modalities and intuitive user interfaces in the older adult health care domain. %M 36884275 %R 10.2196/42145 %U https://humanfactors.jmir.org/2023/1/e42145 %U https://doi.org/10.2196/42145 %U http://www.ncbi.nlm.nih.gov/pubmed/36884275 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e44161 %T Smart Glasses for Supporting Distributed Care Work: Systematic Review %A Zhang,Zhan %A Bai,Enze %A Joy,Karen %A Ghelaa,Partth Naressh %A Adelgais,Kathleen %A Ozkaynak,Mustafa %+ School of Computer Science and Information Systems, Pace University, 1 Pace Plaza, New York, NY, 10078, United States, 1 3153992627, zzhang@pace.edu %K smart glass %K care coordination %K telemedicine %K distributed teamwork %K mobile phone %D 2023 %7 28.2.2023 %9 Review %J JMIR Med Inform %G English %X Background: Over the past 2 decades, various desktop and mobile telemedicine systems have been developed to support communication and care coordination among distributed medical teams. However, in the hands-busy care environment, such technologies could become cumbersome because they require medical professionals to manually operate them. Smart glasses have been gaining momentum because of their advantages in enabling hands-free operation and see-what-I-see video-based consultation. Previous research has tested this novel technology in different health care settings. Objective: The aim of this study was to review how smart glasses were designed, used, and evaluated as a telemedicine tool to support distributed care coordination and communication, as well as highlight the potential benefits and limitations regarding medical professionals’ use of smart glasses in practice. Methods: We conducted a literature search in 6 databases that cover research within both health care and computer science domains. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to review articles. A total of 5865 articles were retrieved and screened by 3 researchers, with 21 (0.36%) articles included for in-depth analysis. Results: All of the reviewed articles (21/21, 100%) used off-the-shelf smart glass device and videoconferencing software, which had a high level of technology readiness for real-world use and deployment in care settings. The common system features used and evaluated in these studies included video and audio streaming, annotation, augmented reality, and hands-free interactions. These studies focused on evaluating the technical feasibility, effectiveness, and user experience of smart glasses. Although the smart glass technology has demonstrated numerous benefits and high levels of user acceptance, the reviewed studies noted a variety of barriers to successful adoption of this novel technology in actual care settings, including technical limitations, human factors and ergonomics, privacy and security issues, and organizational challenges. Conclusions: User-centered system design, improved hardware performance, and software reliability are needed to realize the potential of smart glasses. More research is needed to examine and evaluate medical professionals’ needs, preferences, and perceptions, as well as elucidate how smart glasses affect the clinical workflow in complex care environments. Our findings inform the design, implementation, and evaluation of smart glasses that will improve organizational and patient outcomes. %M 36853760 %R 10.2196/44161 %U https://medinform.jmir.org/2023/1/e44161 %U https://doi.org/10.2196/44161 %U http://www.ncbi.nlm.nih.gov/pubmed/36853760 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43561 %T Interventions Aimed at Enhancing Health Care Providers’ Behavior Toward the Prescription of Mobile Health Apps: Systematic Review %A Alkhaldi,Ohoud %A McMillan,Brian %A Maddah,Noha %A Ainsworth,John %+ Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Vaughan House, Portsmouth St, Manchester, M13 9GB, United Kingdom, 44 7415085174, ohoud.alkhaldi@postgrad.manchester.ac.uk %K mHealth %K mobile apps %K prescription %K behavioral change %K mobile phone %D 2023 %7 27.2.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have great potential to support the management of chronic conditions. Despite widespread acceptance of mHealth apps by the public, health care providers (HCPs) are reluctant to prescribe or recommend such apps to their patients. Objective: This study aimed to classify and evaluate interventions aimed at encouraging HCPs to prescribe mHealth apps. Methods: A systematic literature search was conducted to identify studies published from January 1, 2008, to August 5, 2022, using 4 electronic databases: MEDLINE, Scopus, CINAHL, and PsycINFO. We included studies that evaluated interventions encouraging HCPs to prescribe mHealth apps. Two review authors independently assessed the eligibility of the studies. The “National Institute of Health’s quality assessment tool for before-and-after (pretest-posttest design) studies with no control group” and “the mixed methods appraisal tool (MMAT)” were used to assess the methodological quality. Owing to high levels of heterogeneity between interventions, measures of practice change, specialties of HCPs, and modes of delivery, we conducted a qualitative analysis. We adopted the behavior change wheel as a framework for classifying the included interventions according to intervention functions. Results: In total, 11 studies were included in this review. Most of the studies reported positive findings, with improvements in a number of outcomes, including increased knowledge of mHealth apps among clinicians, improved self-efficacy or confidence in prescribing, and an increased number of mHealth app prescriptions. On the basis of the behavior change wheel, 9 studies reported elements of environmental restructuring such as providing HCPs with lists of apps, technological systems, time, and resources. Furthermore, 9 studies included elements of education, particularly workshops, class lectures, individual sessions with HCPs, videos, or toolkits. Furthermore, training was incorporated in 8 studies using case studies or scenarios or app appraisal tools. Coercion and restriction were not reported in any of the interventions included. The quality of the studies was high in relation to the clarity of aims, interventions, and outcomes but weaker in terms of sample size, power calculations, and duration of follow-up. Conclusions: This study identified interventions to encourage app prescriptions by HCPs. Recommendations for future research should consider previously unexplored intervention functions such as restrictions and coercion. The findings of this review can help inform mHealth providers and policy makers regarding the key intervention strategies impacting mHealth prescriptions and assist them in making informed decisions to encourage this adoption. %M 36848202 %R 10.2196/43561 %U https://mhealth.jmir.org/2023/1/e43561 %U https://doi.org/10.2196/43561 %U http://www.ncbi.nlm.nih.gov/pubmed/36848202 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40207 %T Perceptions of Using Instant Messaging Apps for Alcohol Reduction Intervention Among University Student Drinkers: Semistructured Interview Study With Chinese University Students in Hong Kong %A Chau,Siu Long %A Wong,Yiu Cheong %A Zeng,Ying Pei %A Lee,Jung Jae %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, Hong Kong, 852 3917 6636, mpwang@hku.hk %K instant messaging apps %K mobile phone %K WhatsApp %K alcohol reduction intervention %K alcohol use %K university students %K young adults %K instant messaging %K alcohol reduction %K adverse lifestyle %K intervention %K health promotion %K text messages %K health behaviours %K health behaviors %K apps %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile instant messaging (IM) apps (eg, WhatsApp and WeChat) have been widely used by the general population and are more interactive than text-based programs (SMS text messaging) to modify unhealthy lifestyles. Little is known about IM app use for health promotion, including alcohol reduction for university students. Objective: This study aims to explore university student drinkers' perceptions of using IM apps for alcohol reduction as they had high alcohol exposure (eg, drinking invitations from peers and alcohol promotion on campus) and the proportion of IM app use in Hong Kong. Methods: A qualitative study was conducted with 20 Hong Kong Chinese university students (current drinkers) with Alcohol Use Disorder Identification test scores of ≥8 recruited using purposive sampling. Semistructured individual interviews were conducted from September to October 2019. Interview questions focused on drinking behaviors, quitting history, opinions toward IM app use as an intervention tool, perceived usefulness of IM apps for alcohol reduction, and opinions on the content and design of IM apps for alcohol reduction. Each interview lasted approximately 1 hour. All interviews were audio-taped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. Results: Participants considered IM apps a feasible and acceptable platform for alcohol reduction intervention. They preferred to receive IMs based on personalized problem-solving and drinking consequences with credible sources. Other perceived important components of instant messages included providing psychosocial support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of IM interventions, in which they preferred simple and concise messages, chat styles based on participants' preferences (eg, adding personalized emojis and stickers in the chat), and peers as counselors. Conclusions: Qualitative interviews with Chinese university student drinkers showed high acceptability, engagement, and perceived utility of IM apps for alcohol reduction intervention. IM intervention can be an alternative for alcohol reduction intervention apart from traditional text-based programs. The study has implications for developing the IM intervention for other unhealthy behaviors and highlights important topics that warrant future research, including substance use and physical inactivity. Trial Registration: ClinicalTrials.gov NCT04025151; https://clinicaltrials.gov/ct2/show/NCT04025151?term=NCT04025151 %M 36848207 %R 10.2196/40207 %U https://formative.jmir.org/2023/1/e40207 %U https://doi.org/10.2196/40207 %U http://www.ncbi.nlm.nih.gov/pubmed/36848207 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44468 %T Clinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability %A Shrestha,Roman %A Altice,Frederick L %A Khati,Antoine %A Azwa,Iskandar %A Gautam,Kamal %A Gupta,Sana %A Sullivan,Patrick Sean %A Ni,Zhao %A Kamarulzaman,Adeeba %A Phiphatkunarnon,Panyaphon %A Wickersham,Jeffrey A %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 8604862834, roman.shrestha@uconn.edu %K men who have sex with men %K mHealth %K HIV prevention %K pre-exposure prophylaxis %K mobile phone %K Malaysia %K MSM %K mobile health %K HIV %K prevention %K usability %K acceptability %K sexual minority %K gay %K homosexual %D 2023 %7 16.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV disproportionately affects men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, including in health care settings, mobile health (mHealth) platforms have the potential to open new frontiers in HIV prevention. Objective: We developed an innovative, clinic-integrated smartphone app called JomPrEP, which provides a virtual platform for Malaysian MSM to engage in HIV prevention services. In collaboration with the local clinics in Malaysia, JomPrEP offers a range of HIV prevention (ie, HIV testing and pre-exposure prophylaxis [PrEP]) and other support services (eg, referral to mental health support) without having to interface face to face with clinicians. This study evaluated the usability and acceptability of JomPrEP to deliver HIV prevention services for MSM in Malaysia. Methods: In total, 50 PrEP-naive MSM without HIV in Greater Kuala Lumpur, Malaysia, were recruited between March and April 2022. Participants used JomPrEP for a month and completed a postuse survey. The usability of the app and its features were assessed using self-report and objective measures (eg, app analytics, clinic dashboard). Acceptability was evaluated using the System Usability Scale (SUS). Results: The participants’ mean age was 27.9 (SD 5.3) years. Participants used JomPrEP for an average of 8 (SD 5.0) times during 30 days of testing, with each session lasting an average of 28 (SD 38.9) minutes. Of the 50 participants, 42 (84%) ordered an HIV self-testing (HIVST) kit using the app, of whom 18 (42%) ordered an HIVST more than once. Almost all participants (46/50, 92%) initiated PrEP using the app (same-day PrEP initiation: 30/46, 65%); of these, 16/46 (35%) participants chose PrEP e-consultation via the app (vs in-person consultation). Regarding PrEP dispensing, 18/46 (39%) participants chose to receive their PrEP via mail delivery (vs pharmacy pickup). The app was rated as having high acceptability with a mean score of 73.8 (SD 10.1) on the SUS. Conclusions: JomPrEP was found to be a highly feasible and acceptable tool for MSM in Malaysia to access HIV prevention services quickly and conveniently. A broader, randomized controlled trial is warranted to evaluate its efficacy on HIV prevention outcomes among MSM in Malaysia. Trial Registration: ClinicalTrials.gov NCT05052411; https://clinicaltrials.gov/ct2/show/NCT05052411 International Registered Report Identifier (IRRID): RR2-10.2196/43318 %M 36795465 %R 10.2196/44468 %U https://mhealth.jmir.org/2023/1/e44468 %U https://doi.org/10.2196/44468 %U http://www.ncbi.nlm.nih.gov/pubmed/36795465 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40867 %T Testing the Outcomes of a Smoking Cessation Smartphone App for Nondaily Smokers: Protocol for a Proof-of-concept Randomized Controlled Trial %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Dickerman,Sarah R %A Todi,Akshiti A %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K mobile health %K mHealth %K smartphone %K smartphone app %K smoking %K smoking cessation %K nondaily smoking %K positive psychology %K happiness %K positive affect %K clinical trial %K feasibility %K acceptability %K app use %K mobile phone %D 2023 %7 14.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nondaily smoking is a widespread, increasingly prevalent pattern of smoking, particularly in ethnic minority and vulnerable populations. To date, no effective treatment approach for this type of smokers has been identified. Objective: This study aims to use a randomized controlled trial to evaluate proof-of-concept markers of the Smiling instead of Smoking (SiS) app, a smoking cessation smartphone app designed specifically for nondaily smokers. This app was developed iteratively and is now in its third version. Previous studies have demonstrated acceptability and feasibility when participants were onboarded in person (study 1) and remotely (study 2) and showed within-person changes in line with hypothesized mechanisms of change. This is the first randomized test of this app. Methods: In total, 225 adult nondaily smokers will be asked to undertake a quit attempt while using smoking cessation support materials for a period of 7 weeks. Participants will be randomized to use the SiS smartphone app, the National Cancer Institute smartphone app QuitGuide, or the National Cancer Institute smoking cessation brochure “Clearing the Air.” Participants will take part in a 15-minute scripted onboarding phone call during which study staff will introduce participants to their support materials. Survey links will be sent 2, 6, 12, and 24 weeks after the participants’ initially chosen quit date. The primary outcome is self-efficacy to remain abstinent from smoking at treatment end, measured using the Smoking Self-Efficacy Questionnaire. Secondary outcomes cover several domains relevant to treatment development and implementation: treatment acceptability (eg, satisfaction with smoking cessation support, measured using the Client Satisfaction Questionnaire, and app usability, measured using the System Usability Scale); treatment feasibility (eg, measured using the number of days participants used the SiS or QuitGuide app during the prescribed treatment period); and, in an exploratory way, treatment efficacy assessed using self-reported 30-day point prevalence abstinence. Results: Recruitment began in January 2021 and ended June 2022. The final 24-week follow-up was completed in January 2023. This trial is funded by the American Cancer Society. Conclusions: This study is designed to test whether the prescribed use of the SiS app results in greater self-efficacy to abstain from smoking in nondaily smokers than commonly recommended alternative treatments and whether the SiS app treatment is acceptable and feasible. Positive results will mean that the SiS app warrants testing in a large-scale randomized controlled trial to test its effectiveness in supporting smoking cessation in nondaily smokers. The design of this study also provides insights into issues pertinent to smoking cessation smartphone app treatment development and implementation by measuring, in a randomized design, markers of treatment satisfaction, engagement with the technology and content of the treatment, and adherence to the treatment plan. Trial Registration: ClinicalTrials.gov NCT04672239; https://clinicaltrials.gov/ct2/show/NCT04672239 International Registered Report Identifier (IRRID): DERR1-10.2196/40867 %M 36787172 %R 10.2196/40867 %U https://www.researchprotocols.org/2023/1/e40867 %U https://doi.org/10.2196/40867 %U http://www.ncbi.nlm.nih.gov/pubmed/36787172 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40836 %T Improving Children’s Sleep Habits Using an Interactive Smartphone App: Community-Based Intervention Study %A Yoshizaki,Arika %A Murata,Emi %A Yamamoto,Tomoka %A Fujisawa,Takashi X %A Hanaie,Ryuzo %A Hirata,Ikuko %A Matsumoto,Sayuri %A Mohri,Ikuko %A Taniike,Masako %+ Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, 2-2-D5 Yamadaoka, Suita, Osaka, 5650871, Japan, 81 6 6879 3863, arika@kokoro.med.osaka-u.ac.jp %K infant sleep %K app %K mHealth %K mobile health %K behavioral intervention %K sleep health %K social implementation %K mobile phone %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sleep problems are quite common among young children and are often a challenge for parents and a hinderance to children’s development. Although behavioral therapy has proven effective in reducing sleep problems in children, a lack of access to professionals who can provide effective support is a major barrier for many caregivers. Therefore, pediatric sleep experts have begun developing apps and web-based services for caregivers. Despite the substantial influence of cultural and familial factors on children’s sleep, little effort has gone into developing cultural or family-tailored interventions. Objective: This study aimed to examine the effectiveness of the interactive smartphone app “Nenne Navi,” which provides culturally and family-tailored suggestions for improving sleep habits in young Japanese children through community-based long-term trials. The study also aimed to investigate the association between app-driven improvements in sleep and mental development in children. Methods: This study adopted a community-based approach to recruit individuals from the Higashi-Osaka city (Japan) who met ≥1 of the following eligibility criteria for sleep problems: sleeping after 10 PM, getting <9 hours of nighttime sleep, and experiencing frequent nighttime awakenings. A total of 87 Japanese caregivers with young children (mean 19.50, SD 0.70 months) were recruited and assigned to the app use group (intervention group) or the video-only group (control group). Both groups received educational video content regarding sleep health literacy. The caregivers in the intervention group used the app, which provides family-tailored suggestions, once per month for 1 year. Results: A total of 92% (33/36) of the caregivers in the app use group completed 1 year of the intervention. The participants’ overall evaluation of the app was positive. The wake-up time was advanced (base mean 8:06 AM; post mean 7:48 AM; F1,65=6.769; P=.01 and sleep onset latency was decreased (base mean 34.45 minutes; post mean 20.05 minutes; F1,65=23.219; P<.001) significantly in the app use group at the 13th month compared with the video-only group. Moreover, multiple regression analysis showed that decreased social jetlag (β=−0.302; P=.03) and increased sleep onset latency SD (β=.426; P=.02) in children predicted a significant enhancement in the development of social relationships with adults. At 6 months after the completion of the app use, all the caregivers reported continuation of the new lifestyle. Conclusions: The present findings suggest that the app “Nenne Navi” has high continuity in community use and can improve sleep habits in young Japanese children and that interventions for sleep habits of young children may lead to the enhancement of children’s social development. Future studies must focus on the effectiveness of the app in other regions with different regional characteristics and neuroscientific investigations on how changes in sleep impact brain development. %M 36641237 %R 10.2196/40836 %U https://mhealth.jmir.org/2023/1/e40836 %U https://doi.org/10.2196/40836 %U http://www.ncbi.nlm.nih.gov/pubmed/36641237 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e38435 %T Using Digital Communication Technology to Improve Neonatal Care: Two-Part Explorative Needs Assessment %A Tenfelde,Kim %A Antheunis,Marjolijn %A Krahmer,Emiel %A Bunt,Jan Erik %+ Department of Communication and Cognition, Tilburg University, Warandelaan 2, Tilburg, 5037AB, Netherlands, k.tenfelde@tilburguniversity.edu %K mobile health %K mHealth %K physician-patient communication %K questions asking %K needs assessment %K explorative %K mobile phone %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The birth of a premature infant and subsequent hospitalization are stressful events for parents. Therefore, accurate and easy-to-understand communication between parents and health care professionals is crucial during this period. Mobile health (mHealth) technologies have the potential to improve communication with parents at any time and place and possibly reduce their stress. Objective: We aimed to conduct a 2-part explorative needs assessment in which the interaction between the pediatrician and parents was examined along with their digital communication technology needs and interest in an mHealth app with the aim of improving interpersonal communication and information exchange. Methods: Overall, 19 consultations between parents of preterm infants and pediatricians were observed to determine which themes are discussed the most and the number of questions asked. Afterward, the parents and the pediatrician were interviewed to evaluate the process of communication and gauge their ideas about a neonatal communication mHealth app. Results: The observations revealed the following most prevalent themes: breastfeeding, criteria for discharge, medication, and parents’ personal life. Interview data showed that the parents were satisfied with the communication with their pediatrician. Furthermore, both parents and pediatricians expected that a neonatal mHealth app could further improve the communication process and the hospital stay. Parents valued app features such as asking questions, growth graphs, a diary function, hospital-specific information, and medical rounds reports. Conclusions: Both parents of hospitalized preterm infants and pediatricians expect that the hypothetical mHealth app has the potential to cater to the most prevalent themes and improve communication and information exchange. Recommendations for developing such an app and its possible features are also discussed. On the basis of these promising results, it is suggested to further develop and study the effects of the mHealth app together with all stakeholders. %M 36749606 %R 10.2196/38435 %U https://pediatrics.jmir.org/2023/1/e38435 %U https://doi.org/10.2196/38435 %U http://www.ncbi.nlm.nih.gov/pubmed/36749606 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41861 %T Evaluating Clinician Expectations of mHealth Solutions to Increase Rapid-Screening for HIV and Hepatitis in Migrant Populations in France: Qualitative Study %A Brown,Carter %A Roucoux,Guillaume %A Dimi,Svetlane %A Fahmi,Saleh %A Jeevan,Raj-Banou %A Chassany,Olivier %A Chaplin,John %A Duracinsky,Martin %+ Patient-Reported Outcomes Unit, UMR 1123, Inserm, Université de Paris, 1 Parvis Notre Dame - Place Jean-Paul II, Paris, 75004, France, 33 0140274664, carter.brown@inserm.fr %K app development %K acceptability %K mobile health %K mHealth %K user-centered design %K communication barriers %K migrants %K HIV %K AIDS %K hepatitis %K rapid diagnostic testing %K public health %K communication tool %K screening %K language barrier %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Migrants underuse screening opportunities for HIV, hepatitis B, and hepatitis C despite elevated risk factors for contracting these infections. Language barriers are an often given as reasons for limiting access to services. Translation and communication apps increase communication and overall patient satisfaction in the patient-provider relationship. In the development and adoption of new technology, expectations play an important role. Objective: This study aimed to explore health care professionals’ opinions and attitudes regarding their screening practices with migrants and their expectations for a new communication tool that could improve migrants’ screening use. Methods: In this qualitative study, a purposive (diverse) sampling method was used to invite doctors and nurses who conduct rapid screening tests with migrants from 4 centers of the French Office of Immigration and Integration in 3 geographic regions of France. Semistructured interviews were conducted to survey their opinions on the rapid testing of migrants, the use of telephone interpreters, the concept of health literacy, and their expectations of a new communication tool that could overcome language barriers and promote rapid screening in the new migrant population. Results: In all, 20 interviews were conducted with 11 doctors and 9 nurses with a median age of 58 (range 25-67) years. Participants favored the integration of an innovative communication tool in the context of rapid screening of migrants. However, there were concerns related to the implementation and added value of the tool while migrants were already reluctant to be screened. Expectations were for a tool that would present information in simplified French or a chosen language but also supports a positive attitude toward screening. Health professionals also expressed the wish that the technology could help with the collection of health data. Conclusions: Feedback from health professionals provides a better understanding of potential formats, characteristics, functions, content, and use of an innovative, digital method to communicate with migrants with limited French proficiency. Findings contribute to the conceptual development of an electronic app and its implementation within the ApiDé study, which aims to validate a digital app to address language barriers to increase the use of screening among migrants with limited French proficiency in France. %M 36735323 %R 10.2196/41861 %U https://humanfactors.jmir.org/2023/1/e41861 %U https://doi.org/10.2196/41861 %U http://www.ncbi.nlm.nih.gov/pubmed/36735323 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e39975 %T Engagement With Gamification Elements in a Smoking Cessation App and Short-term Smoking Abstinence: Quantitative Assessment %A Rajani,Nikita B %A Bustamante,Luz %A Weth,Dominik %A Romo,Lucia %A Mastellos,Nikolaos %A Filippidis,Filippos T %+ Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, United Kingdom, 44 7427615928, nikita.rajani14@imperial.ac.uk %K gamification %K smoking cessation %K smoking abstinence %K mHealth %K mobile apps %K mobile phone %K smartphone %K digital health %K user engagement %K cognitive outcome %K self-support %K in-app metrics %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report. Objective: This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term. Methods: Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engagement with the app using in-app metrics. A logistic regression model was used to investigate the association between engagement with gamification and 7-day smoking abstinence. Results: In total, data from 44 participants who used the Kwit app were analyzed. The majority of participants were male, married, and employed. Almost 30% (n=13) of participants self-reported successful 7-day abstinence at the end of the study. On average, the Kwit app was opened almost 31 (SD 39) times during the 4-week study period, with the diary feature used the most often (mean 22.8, SD 49.3). Moreover, it was found that each additional level unlocked was associated with approximately 22% higher odds of achieving 7-day abstinence after controlling for other factors such as age and gender (odds ratio 1.22, 95% CI 1.01-1.47). Conclusions: This study highlights the likely positive effects of certain gamification elements such as levels and achievements on short-term smoking abstinence. Although more robust research with a larger sample size is needed, this research highlights the important role that gamification features integrated into mobile apps can play in facilitating and supporting health behavior change. %M 36724003 %R 10.2196/39975 %U https://games.jmir.org/2023/1/e39975 %U https://doi.org/10.2196/39975 %U http://www.ncbi.nlm.nih.gov/pubmed/36724003 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40533 %T Usability and Credibility of a COVID-19 Vaccine Chatbot for Young Adults and Health Workers in the United States: Formative Mixed Methods Study %A Weeks,Rose %A Sangha,Pooja %A Cooper,Lyra %A Sedoc,João %A White,Sydney %A Gretz,Shai %A Toledo,Assaf %A Lahav,Dan %A Hartner,Anna-Maria %A Martin,Nina M %A Lee,Jae Hyoung %A Slonim,Noam %A Bar-Zeev,Naor %+ International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, MD, 21231, United States, 1 443 287 4832, rweeks@jhu.edu %K COVID-19 %K chatbot development %K risk communication %K vaccine hesitancy %K conversational agent %K health information %K chatbot %K natural language processing %K usability %K user feedback %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic raised novel challenges in communicating reliable, continually changing health information to a broad and sometimes skeptical public, particularly around COVID-19 vaccines, which, despite being comprehensively studied, were the subject of viral misinformation. Chatbots are a promising technology to reach and engage populations during the pandemic. To inform and communicate effectively with users, chatbots must be highly usable and credible. Objective: We sought to understand how young adults and health workers in the United States assessed the usability and credibility of a web-based chatbot called Vira, created by the Johns Hopkins Bloomberg School of Public Health and IBM Research using natural language processing technology. Using a mixed method approach, we sought to rapidly improve Vira’s user experience to support vaccine decision-making during the peak of the COVID-19 pandemic. Methods: We recruited racially and ethnically diverse young people and health workers, with both groups from urban areas of the United States. We used the validated Chatbot Usability Questionnaire to understand the tool’s navigation, precision, and persona. We also conducted 11 interviews with health workers and young people to understand the user experience, whether they perceived the chatbot as confidential and trustworthy, and how they would use the chatbot. We coded and categorized emerging themes to understand the determining factors for participants’ assessment of chatbot usability and credibility. Results: In all, 58 participants completed a web-based usability questionnaire and 11 completed in-depth interviews. Most questionnaire respondents said the chatbot was “easy to navigate” (51/58, 88%) and “very easy to use” (50/58, 86%), and many (45/58, 78%) said its responses were relevant. The mean Chatbot Usability Questionnaire score was 70.2 (SD 12.1) and scores ranged from 40.6 to 95.3. Interview participants felt the chatbot achieved high usability due to its strong functionality, performance, and perceived confidentiality and that the chatbot could attain high credibility with a redesign of its cartoonish visual persona. Young people said they would use the chatbot to discuss vaccination with hesitant friends or family members, whereas health workers used or anticipated using the chatbot to support community outreach, save time, and stay up to date. Conclusions: This formative study conducted during the pandemic’s peak provided user feedback for an iterative redesign of Vira. Using a mixed method approach provided multidimensional feedback, identifying how the chatbot worked well—being easy to use, answering questions appropriately, and using credible branding—while offering tangible steps to improve the product’s visual design. Future studies should evaluate how chatbots support personal health decision-making, particularly in the context of a public health emergency, and whether such outreach tools can reduce staff burnout. Randomized studies should also be conducted to measure how chatbots countering health misinformation affect user knowledge, attitudes, and behavior. %M 36409300 %R 10.2196/40533 %U https://humanfactors.jmir.org/2023/1/e40533 %U https://doi.org/10.2196/40533 %U http://www.ncbi.nlm.nih.gov/pubmed/36409300 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39479 %T Understanding the Subjective Experience of Long-term Remote Measurement Technology Use for Symptom Tracking in People With Depression: Multisite Longitudinal Qualitative Analysis %A White,Katie M %A Dawe-Lane,Erin %A Siddi,Sara %A Lamers,Femke %A Simblett,Sara %A Riquelme Alacid,Gemma %A Ivan,Alina %A Myin-Germeys,Inez %A Haro,Josep Maria %A Oetzmann,Carolin %A Popat,Priya %A Rintala,Aki %A Rubio-Abadal,Elena %A Wykes,Til %A Henderson,Claire %A Hotopf,Matthew %A Matcham,Faith %+ Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 de Crespigny Park, London, SE5 8AB, United Kingdom, 44 7850684847, katie.white@kcl.ac.uk %K remote measurement %K technology %K qualitative %K engagement %K telehealth %K depression %K mental health %K mobile phone %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Remote measurement technologies (RMTs) have the potential to revolutionize major depressive disorder (MDD) disease management by offering the ability to assess, monitor, and predict symptom changes. However, the promise of RMT data depends heavily on sustained user engagement over extended periods. In this paper, we report a longitudinal qualitative study of the subjective experience of people with MDD engaging with RMTs to provide insight into system usability and user experience and to provide the basis for future promotion of RMT use in research and clinical practice. Objective: We aimed to understand the subjective experience of long-term engagement with RMTs using qualitative data collected in a longitudinal study of RMTs for monitoring MDD. The objectives were to explore the key themes associated with long-term RMT use and to identify recommendations for future system engagement. Methods: In this multisite, longitudinal qualitative research study, 124 semistructured interviews were conducted with 99 participants across the United Kingdom, Spain, and the Netherlands at 3-month, 12-month, and 24-month time points during a study exploring RMT use (the Remote Assessment of Disease and Relapse-Major Depressive Disorder study). Data were analyzed using thematic analysis, and interviews were audio recorded, transcribed, and coded in the native language, with the resulting quotes translated into English. Results: There were 5 main themes regarding the subjective experience of long-term RMT use: research-related factors, the utility of RMTs for self-management, technology-related factors, clinical factors, and system amendments and additions. Conclusions: The subjective experience of long-term RMT use can be considered from 2 main perspectives: experiential factors (how participants construct their experience of engaging with RMTs) and system-related factors (direct engagement with the technologies). A set of recommendations based on these strands are proposed for both future research and the real-world implementation of RMTs into clinical practice. Future exploration of experiential engagement with RMTs will be key to the successful use of RMTs in clinical care. %M 36701179 %R 10.2196/39479 %U https://humanfactors.jmir.org/2023/1/e39479 %U https://doi.org/10.2196/39479 %U http://www.ncbi.nlm.nih.gov/pubmed/36701179 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42866 %T The Feasibility of Implementing Remote Measurement Technologies in Psychological Treatment for Depression: Mixed Methods Study on Engagement %A de Angel,Valeria %A Adeleye,Fadekemi %A Zhang,Yuezhou %A Cummins,Nicholas %A Munir,Sara %A Lewis,Serena %A Laporta Puyal,Estela %A Matcham,Faith %A Sun,Shaoxiong %A Folarin,Amos A %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Dobson,Richard %A Hotopf,Matthew %+ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, E3.08, 3rd Floor East Wing, de Crespigny park, London, SE5 8AF, United Kingdom, 44 20 7848 0002, valeria.de_angel@kcl.ac.uk %K depression %K anxiety %K digital health %K wearable devices %K smartphone %K passive sensing %K mobile health %K mHealth %K digital phenotyping %K mobile phone %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Remote measurement technologies (RMTs) such as smartphones and wearables can help improve treatment for depression by providing objective, continuous, and ecologically valid insights into mood and behavior. Engagement with RMTs is varied and highly context dependent; however, few studies have investigated their feasibility in the context of treatment. Objective: A mixed methods design was used to evaluate engagement with active and passive data collection via RMT in people with depression undergoing psychotherapy. We evaluated the effects of treatment on 2 different types of engagement: study attrition (engagement with study protocol) and patterns of missing data (engagement with digital devices), which we termed data availability. Qualitative interviews were conducted to help interpret the differences in engagement. Methods: A total of 66 people undergoing psychological therapy for depression were followed up for 7 months. Active data were gathered from weekly questionnaires and speech and cognitive tasks, and passive data were gathered from smartphone sensors and a Fitbit (Fitbit Inc) wearable device. Results: The overall retention rate was 60%. Higher-intensity treatment (χ21=4.6; P=.03) and higher baseline anxiety (t56.28=−2.80, 2-tailed; P=.007) were associated with attrition, but depression severity was not (t50.4=−0.18; P=.86). A trend toward significance was found for the association between longer treatments and increased attrition (U=339.5; P=.05). Data availability was higher for active data than for passive data initially but declined at a sharper rate (90%-30% drop in 7 months). As for passive data, wearable data availability fell from a maximum of 80% to 45% at 7 months but showed higher overall data availability than smartphone-based data, which remained stable at the range of 20%-40% throughout. Missing data were more prevalent among GPS location data, followed by among Bluetooth data, then among accelerometry data. As for active data, speech and cognitive tasks had lower completion rates than clinical questionnaires. The participants in treatment provided less Fitbit data but more active data than those on the waiting list. Conclusions: Different data streams showed varied patterns of missing data, despite being gathered from the same device. Longer and more complex treatments and clinical characteristics such as higher baseline anxiety may reduce long-term engagement with RMTs, and different devices may show opposite patterns of missingness during treatment. This has implications for the scalability and uptake of RMTs in health care settings, the generalizability and accuracy of the data collected by these methods, feature construction, and the appropriateness of RMT use in the long term. %M 36692937 %R 10.2196/42866 %U https://mental.jmir.org/2023/1/e42866 %U https://doi.org/10.2196/42866 %U http://www.ncbi.nlm.nih.gov/pubmed/36692937 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 8 %N %P e41076 %T Mobile Health Apps for the Control and Self-management of Type 2 Diabetes Mellitus: Qualitative Study on Users’ Acceptability and Acceptance %A Bults,Marloes %A van Leersum,Catharina Margaretha %A Olthuis,Theodorus Johannes Josef %A Bekhuis,Robin Enya Marije %A den Ouden,Marjolein Elisabeth Maria %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, M.H. Tromplaan 28, Enschede, 7513 AB, Netherlands, 31 620946213, m.bults@saxion.nl %K type 2 diabetes %K self-management %K mobile health %K mHealth %K mobile apps %K mobile phone %K acceptability %K acceptance %K diabetes %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Diabetes %G English %X Background: Mobile health apps are promising tools to help patients with type 2 diabetes mellitus (T2DM) improve their health status and thereby achieve diabetes control and self-management. Although there is a wide array of mobile health apps for T2DM available at present, apps are not yet integrated into routine diabetes care. Acceptability and acceptance among patients with T2DM is a major challenge and prerequisite for the successful implementation of apps in diabetes care. Objective: This study provides an in-depth understanding of the perceptions of patients with T2DM before use (acceptability) and after use (acceptance) regarding 4 different mobile health apps for diabetes control and self-management. Methods: A descriptive qualitative research design was used in this study. Participants could choose 1 of the 4 selected apps for diabetes control and self-management (ie, Clear.bio in combination with FreeStyle Libre, mySugr, MiGuide, and Selfcare). The selection was based on a systematic analysis of the criteria for (functional) requirements regarding monitoring, data collection, provision of information, coaching, privacy, and security. To explore acceptability, 25 semistructured in-depth interviews were conducted with patients with T2DM before use. This was followed by 4 focus groups to discuss the acceptance after use. The study had a citizen science approach, that is, patients with T2DM collaborated with researchers as coresearchers. All coresearchers actively participated in the preparation of the study, data collection, and data analysis. Data were collected between April and September 2021. Thematic analysis was conducted using a deductive approach using AtlasTi9. Results: In total, 25 coresearchers with T2DM participated in this study. Of them, 12 coresearchers tested Clear, 5 MiGuide, 4 mySugr, and 4 Selfcare. All coresearchers participated in semistructured interviews, and 18 of them attended focus groups. Personal health was the main driver of app use. Most coresearchers were convinced that a healthy lifestyle would improve blood glucose levels. Although most coresearchers did not expect that they need to put much effort into using the apps, the additional effort to familiarize themselves with the app use was experienced as quite high. None of the coresearchers had a health care professional who provided suggestions on using the apps. Reimbursement from insurance companies and the acceptance of apps for diabetes control and self-management by the health care system were mentioned as important facilitating conditions. Conclusions: The research showed that mobile health apps provide support for diabetes control and self-management in patients with T2DM. Integrating app use in care as usual and guidelines for health care professionals are recommended. Future research is needed on how to increase the implementation of mobile health apps in current care pathways. In addition, health care professionals need to improve their digital skills, and lifelong learning is recommended. %M 36692927 %R 10.2196/41076 %U https://diabetes.jmir.org/2023/1/e41076 %U https://doi.org/10.2196/41076 %U http://www.ncbi.nlm.nih.gov/pubmed/36692927 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42178 %T The Acceptability of Technology-Based Physical Activity Interventions in Postbariatric Surgery Women: Insights From Qualitative Analysis Using the Unified Theory of Acceptance and Use of Technology 2 Model %A Thérouanne,Pierre %A Hayotte,Meggy %A Halgand,Florent %A d'Arripe-Longueville,Fabienne %+ Université Côte d'Azur, LAPCOS, Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales Campus Saint Jean d'Angely / SJA3 / MSHS Sud-Est, 25 avenue François Mitterrand, Nice, 06300, France, 33 4 89 15 23 49, pierre.therouanne@univ-cotedazur.fr %K acceptability %K health technology %K physical activity %K obesity %K UTAUT2 %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Bariatric surgery offers an opportunity for physical activity (PA) promotion due to patients’ increased ability to engage in PA. Technology-based PA interventions are promising tools for promoting PA to support patients in this key period. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model is a recognized theoretical model for examining technology acceptability. Although a previous study reported that 92% of women with obesity have high acceptability of at least one technology-based PA intervention, little is known about the factors that lead to different levels of acceptability between technologies and therefore the reasons for choosing a preferred intervention. Objective: The purpose of this study was to (1) characterize the acceptability of 3 technology-based PA interventions (ie, telehealth, active video game, mobile app) in the context of bariatric surgery, and (2) explore patients’ preference motives. This study, using a qualitative design, examined the suitability of the UTAUT2 model in this specific context. Methods: Participants (n=26) read written French descriptions of the technology-based PA interventions with illustrations and chose their preferred intervention. Semidirective interviews were conducted to explore the reasons for their choice of the preferred intervention, notably using the UTAUT2 framework. Data were analyzed based on inductive and deductive approaches. Results: All participants who preferred a technology-based PA intervention (ie, active video game, n=10; mobile app, n=10; telehealth, n=6) expressed a behavioral intention to use it. In addition, some of them expressed a high behavioral intention to use another technology (ie, active video game, n=4; mobile app, n=1; telehealth, n=7). All the constructs of the UTAUT2 emerged during the qualitative interviews and were specified through subcategories. Additional constructs also emerged, especially other motivational factors. Conclusions: This study showed that, in the context of technology-based PA interventions for postbariatric patients, the UTAUT2 is suitable, although additional motivational factors (which were not considered by the UTAUT2 model) should be considered. %M 36689255 %R 10.2196/42178 %U https://humanfactors.jmir.org/2023/1/e42178 %U https://doi.org/10.2196/42178 %U http://www.ncbi.nlm.nih.gov/pubmed/36689255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40784 %T Increasing Engagement in the Electronic Framingham Heart Study: Factorial Randomized Controlled Trial %A Trinquart,Ludovic %A Liu,Chunyu %A McManus,David D %A Nowak,Christopher %A Lin,Honghuang %A Spartano,Nicole L %A Borrelli,Belinda %A Benjamin,Emelia J %A Murabito,Joanne M %+ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, 73 Mount Wayte Ave, Framingham, MA, 01702, United States, 1 5089353400, murabito@bu.edu %K smartphone notifications %K digital device use %K randomized trial %K smartphone %K apps %K mobile health %K mHealth %K devices %K cardiovascular %K data %K intervention %K blood pressure %K heart rate %K digital %K tool %K notification %K messaging %K prompt %K nudge %K behavior change %K self-monitoring %K self care %K cardiology %D 2023 %7 20.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps and mobile health devices offer innovative ways to collect longitudinal cardiovascular data. Randomized evidence regarding effective strategies to maintain longitudinal engagement is limited. Objective: This study aimed to evaluate smartphone messaging interventions on remote transmission of blood pressure (BP) and heart rate (HR) data. Methods: We conducted a 2 × 2 × 2 factorial blinded randomized trial with randomization implemented centrally to ensure allocation concealment. We invited participants from the Electronic Framingham Heart Study (eFHS), an e-cohort embedded in the FHS, and asked participants to measure their BP (Withings digital cuff) weekly and wear their smartwatch daily. We assessed 3 weekly notification strategies to promote adherence: personalized versus standard; weekend versus weekday; and morning versus evening. Personalized notifications included the participant’s name and were tailored to whether or not data from the prior week were transmitted to the research team. Intervention notification messages were delivered weekly automatically via the eFHS app. We assessed if participants transmitted at least one BP or HR measurement within 7 days of each notification after randomization. Outcomes were adherence to BP and HR transmission at 3 months (primary) and 6 months (secondary). Results: Of the 791 FHS participants, 655 (82.8%) were eligible and randomized (mean age 53, SD 9 years; 392/655, 59.8% women; 596/655, 91% White). For the personalized versus standard notifications, 38.9% (126/324) versus 28.8% (94/327) participants sent BP data at 3 months (difference=10.1%, 95% CI 2.9%-17.4%; P=.006), but no significant differences were observed for HR data transmission (212/324, 65.4% vs 209/327, 63.9%; P=.69). Personalized notifications were associated with increased BP and HR data transmission versus standard at 6 months (BP: 107/291, 36.8% vs 66/295, 22.4%; difference=14.4%, 95% CI 7.1- 21.7%; P<.001; HR: 186/281, 66.2% vs 158/281, 56.2%; difference=10%, 95% CI 2%-18%; P=.02). For BP and HR primary or secondary outcomes, there was no evidence of differences in data transmission for notifications sent on weekend versus weekday or morning versus evening. Conclusions: Personalized notifications increased longitudinal adherence to BP and HR transmission from mobile and digital devices among eFHS participants. Our results suggest that personalized messaging is a powerful tool to promote adherence to mobile health systems in cardiovascular research. Trial Registration: ClinicalTrials.gov NCT03516019; https://clinicaltrials.gov/ct2/show/NCT03516019 %M 36662544 %R 10.2196/40784 %U https://www.jmir.org/2023/1/e40784 %U https://doi.org/10.2196/40784 %U http://www.ncbi.nlm.nih.gov/pubmed/36662544 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43263 %T Medical Student Experiences of Engaging in a Psychological Flexibility Skill Training App for Burnout and Well-being: Pilot Feasibility Study %A Ditton,Elizabeth %A Knott,Brendon %A Hodyl,Nicolette %A Horton,Graeme %A Walker,Frederick Rohan %A Nilsson,Michael %+ Centre for Rehab Innovations, University of Newcastle, University Drive, Callaghan, 2300, Australia, 61 2 404 20738, elizabeth.ditton@uon.edu.au %K medical students %K burnout prevention %K app %K feasibility %K intervention engagement %K psychological flexibility %K acceptance and commitment therapy %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings. Objective: This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students. Methods: This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes. Results: Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills. Conclusions: This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field. %M 36626191 %R 10.2196/43263 %U https://formative.jmir.org/2023/1/e43263 %U https://doi.org/10.2196/43263 %U http://www.ncbi.nlm.nih.gov/pubmed/36626191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42053 %T The PTSD Family Coach App in Veteran Family Members: Pilot Randomized Controlled Trial %A van Stolk-Cooke,Katherine %A Wielgosz,Joseph %A Hallenbeck,Haijing Wu %A Chang,Andrew %A Rosen,Craig %A Owen,Jason %A Kuhn,Eric %+ Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Palo Alto, CA, 94304, United States, 1 860 335 2021, cvscooke@stanford.edu %K posttraumatic stress disorder %K PTSD %K veterans %K family %K mobile apps %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Posttraumatic stress disorder (PTSD) among US military veterans can adversely impact their concerned significant others (CSOs; eg, family members and romantic partners). Mobile apps can be tailored to support CSO mental health through psychoeducation, coping skills, and stress monitoring. Objective: This study assessed the feasibility, acceptability, and potential efficacy of PTSD Family Coach 1.0, a free, publicly available app that includes psychoeducation, stress management tools, self-assessments, and features for connecting to alternative supports, compared with a psychoeducation-only version of the app for cohabitating CSOs of veterans with PTSD. Methods: A total of 200 participants with an average age of 39 (SD 8.44) years, primarily female (193/200, 97%), and White (160/200, 80%) were randomized to self-guided use of either PTSD Family Coach 1.0 (n=104) or a psychoeducation-only app (n=96) for 4 weeks. Caregiver burden, stress, depression, anxiety, beliefs about treatment, CSO self-efficacy, and relationship functioning assessed using measures of dyadic adjustment, social constraints, and communication danger signs were administered via a web survey at baseline and after treatment. User satisfaction and app helpfulness were assessed after treatment. Data were analyzed using linear mixed methods. Results: Overall, 50.5% (101/200) of randomized participants used their allocated app. Participants found PTSD Family Coach 1.0 somewhat satisfying (mean 4.88, SD 1.11) and moderately helpful (mean 2.99, SD 0.97) to use. Linear mixed effects models revealed no significant differences in outcomes by condition for caregiver burden (P=.45; Cohen d=0.1, 95% CI −0.2 to 0.4), stress (P=.64; Cohen d=0.1, 95% CI −0.4 to 0.6), depression (P=.93; Cohen d= 0.0, 95% CI −0.3 to 0.3), anxiety (P=.55; Cohen d=−0.1, 95% CI −0.4 to 0.2), beliefs about treatment (P=.71; Cohen d=0.1, 95% CI −0.2 to 0.3), partner self-efficacy (P=.59; Cohen d=−0.1, 95% CI −0.4 to 0.2), dyadic adjustment (P=.08; Cohen d=−0.2, 95% CI −0.5 to 0.0), social constraints (P=.05; Cohen d=0.3, 95% CI 0.0-0.6), or communication danger signs (P=.90; Cohen d=−0.0, 95% CI −0.3 to 0.3). Post hoc analyses collapsing across conditions revealed a significant between-group effect on stress for app users versus nonusers (β=−3.62; t281=−2.27; P=.02). Conclusions: Approximately half of the randomized participants never used their allocated app, and participants in the PTSD Family Coach 1.0 condition only opened the app approximately 4 times over 4 weeks, suggesting limitations to this app version’s feasibility. PTSD Family Coach 1.0 users reported moderately favorable impressions of the app, suggesting preliminary acceptability. Regarding efficacy, no significant difference was found between PTSD Family Coach 1.0 users and psychoeducation app users across any outcome of interest. Post hoc analyses suggested that app use regardless of treatment condition was associated with reduced stress. Further research that improves app feasibility and establishes efficacy in targeting the domains most relevant to CSOs is warranted. Trial Registration: ClinicalTrials.gov NCT02486705; https://clinicaltrials.gov/ct2/show/NCT02486705 %M 36602852 %R 10.2196/42053 %U https://formative.jmir.org/2023/1/e42053 %U https://doi.org/10.2196/42053 %U http://www.ncbi.nlm.nih.gov/pubmed/36602852 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e41767 %T Factors Associated With Self-reported Use of Web and Mobile Health Apps Among US Military Veterans: Cross-sectional Survey %A Hogan,Timothy P %A Etingen,Bella %A Lipschitz,Jessica M %A Shimada,Stephanie L %A McMahon,Nicholas %A Bolivar,Derek %A Bixler,Felicia R %A Irvin,Dawn %A Wacks,Rachel %A Cutrona,Sarah %A Frisbee,Kathleen L %A Smith,Bridget M %+ Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA, 01730, United States, 1 781 687 3181, timothy.hogan@va.gov %K mobile health apps %K patient engagement %K consumer health informatics %K provider encouragement %K veterans %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite their prevalence and reported patient interest in their use, uptake of health-related apps is limited. The Veterans Health Administration (VHA) has developed a variety of apps to support veterans; however, uptake remains low nationally. Objective: We examined the prevalence of VHA health-related app use and how veterans learned about these apps in order to identify factors associated with their use. Methods: As part of a VHA quality improvement initiative, we recruited a national cohort of veterans to obtain feedback on their use of technology for health and collected data from them via a cross-sectional survey. The survey data were supplemented with VHA administrative data. We used descriptive statistics to examine demographic and health characteristics, health-related technology use, and how veterans learned about apps. We assessed factors associated with app use using bivariate analyses and multiple logistic regression models. Results: We had complete data on 1259 veterans. A majority of the sample was male (1069/1259, 84.9%), aged older than 65 years (740/1259, 58.8%), White (1086/1259, 86.3%), and non-Hispanic (1218/1259, 96.7%). Most respondents (1125/1259, 89.4%) reported being very comfortable and confident using computers, over half (675/1259, 53.6%) reported being an early adopter of technology, and almost half (595/1259, 47.3%) reported having used a VHA health-related app. Just over one-third (435/1259, 34.6%) reported that their VHA care team members encouraged them to use health-related apps. Respondents reported learning about available VHA health-related apps by reading about them on the VHA’s patient portal (468/1259, 37.2%), being told about them by their VHA health care team (316/1259, 25.1%), and reading about them on the VHA’s website (139/1259, 11%). Veterans who self-reported having used VHA health-related apps were more likely to receive care at the VHA (OR [odds ratio] 1.3, 95% CI 1.0-1.7), be in worse health (as assessed by Hierarchical Condition Community score; OR 1.1, 95% CI 1.0-1.2), report owning a desktop or laptop computer (OR 1.8, 95% CI 1.1-3.1), have posttraumatic stress disorder (OR 1.4, 95% CI 1.1-1.9), and report having VHA health care team members encourage them to use the apps (OR 2.7, 95% CI 2.1-3.4). Conclusions: We found strong associations between self-reported use by veterans of VHA health-related apps and multiple variables in our survey. The strongest association was observed between a veteran self-reporting app use and having received encouragement from their VHA health care team to use the apps. Veterans who reported receiving encouragement from their VHA care team members had nearly 3 times higher odds of using VHA apps than veterans who did not report receiving such encouragement. Our results add to growing evidence suggesting that endorsement of apps by a health care system or health care team can positively impact patient uptake and use. %M 36583935 %R 10.2196/41767 %U https://mhealth.jmir.org/2022/12/e41767 %U https://doi.org/10.2196/41767 %U http://www.ncbi.nlm.nih.gov/pubmed/36583935 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e40271 %T Assessing the Acceptability and Effectiveness of Mobile-Based Physical Activity Interventions for Midlife Women During Menopause: Systematic Review of the Literature %A AlSwayied,Ghada %A Guo,Haoyue %A Rookes,Tasmin %A Frost,Rachael %A Hamilton,Fiona L %+ UCL Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 02077940500 ext 31498, zczlgbi@ucl.ac.uk %K mobile app %K mobile health %K mHealth %K smartphone %K smartphone apps %K physical activity %K exercise %K midlife women %K menopause %K menopausal symptoms %K behavior change %K women’s health %K wearable %K activity tracker %K effectiveness %K acceptability %K review %K meta-analysis %K mobile phone %D 2022 %7 9.12.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Midlife women with menopausal symptoms are less likely to meet the recommended level of physical activity (PA). Promoting PA among women in midlife could reduce their risk of cardiovascular diseases and perhaps improve menopausal symptoms. Mobile PA interventions in the form of smartphone apps and wearable activity trackers can potentially encourage users to increase PA levels and address time and resource barriers to PA. However, evidence on the acceptability and effectiveness of these interventions among midlife women is unclear. Objective: This systematic review evaluated the effectiveness, acceptability, and active behavior change techniques (BCTs) of mobile PA technologies among midlife menopausal women. Methods: A mixed methods systematic review of qualitative and quantitative studies was conducted. MEDLINE (Ovid), Embase, Scopus, CINAHL, Web of Science, SPORTDiscus, CENTRAL, PsycINFO, and the ProQuest Sports Medicine and Education Index were systematically searched. Studies were selected and screened according to predetermined eligibility criteria. In total, 2 reviewers independently assessed the risk of bias using the Mixed Methods Appraisal Tool and completed BCT mapping of the included interventions using the BCT Taxonomy v1. Results: A total of 12 studies were included in this review. Overall risk of bias was “Moderate to high” in 58% (7/12) of the included studies and “low” in 42% (5/12) of the studies. Of the 12 studies, 7 (58%) assessed changes in PA levels. The pooled effect size of 2 randomized controlled trials resulted in a small to moderate increase in moderate to vigorous PA of approximately 61.36 weekly minutes among midlife women, at least in the short term (95% CI 17.70-105.01; P=.006). Although a meta-analysis was not feasible because of heterogeneity, positive improvements were also found in a range of menopause-related outcomes such as weight reduction, anxiety management, sleep quality, and menopause-related quality of life. Midlife women perceived mobile PA interventions to be acceptable and potentially helpful in increasing PA and daily steps. The average number of BCTs per mobile PA intervention was 8.8 (range 4-13) according to the BCT Taxonomy v1. “Self-monitoring of behaviour,” “Biofeedback,” and “Goal setting (behaviour)” were the most frequently described BCTs across the included interventions. Conclusions: This review demonstrated that mobile PA interventions in the form of smartphone apps and wearable trackers are potentially effective for small to moderate increases in moderate to vigorous PA among midlife women with menopausal symptoms. Although menopause is a natural condition affecting half the population worldwide, there is a substantial lack of evidence to support the acceptability and effectiveness of mobile PA interventions on menopause-related outcomes, which needs further investigation. Trial Registration: PROSPERO CRD42021273062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273062 %M 36485026 %R 10.2196/40271 %U https://mhealth.jmir.org/2022/12/e40271 %U https://doi.org/10.2196/40271 %U http://www.ncbi.nlm.nih.gov/pubmed/36485026 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36829 %T Perceptions and Attitudes Toward an Interactive Voice Response Tool (Call for Life Uganda) Providing Adherence Support and Health Information to HIV-Positive Ugandans: Qualitative Study %A Kajubi,Phoebe %A Parkes-Ratanshi,Rosalind %A Twimukye,Adelline %A Bwanika Naggirinya,Agnes %A Nabaggala,Maria Sarah %A Kiragga,Agnes %A Castelnuovo,Barbara %A King,Rachel %+ Infectious Diseases Institute, College of Health Sciences, Makerere University, PO Box 22418, Kampala, Uganda, 256 312 307000, phoebekajubi@yahoo.com %K mobile health %K mHealth %K mobile communication technologies %K people living with HIV %K antiretroviral therapy %K quality of life %K Uganda %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The continuing decline in AIDS-related deaths in the African region is largely driven by the steady scale-up of antiretroviral therapy. However, there are challenges to retaining people living with HIV on treatment. Call for Life Uganda (CFLU) is an interactive voice response tool using simple analogue phones. CFLU supports patients with daily pill reminders, preappointment reminders, symptom reporting and management, and weekly health promotion tips. Mobile health tools are being increasingly used in resource-limited settings but are often adopted without rigorous evaluation. Objective: This qualitative study conducted at 12 months after enrollment assessed patients’ experiences, perceptions, and attitudes regarding CLFU. Methods: We conducted a qualitative substudy within an open-label randomized controlled trial titled “Improving outcomes in HIV patients using mobile phone based interactive software support.” Data were collected through 6 focus group discussions with participants sampled based on proportion of calls responded to—<25%, between 25% and 50%, and >50%—conducted at the Infectious Diseases Institute, Mulago, and the Kasangati Health Centre IV. NVivo (version 11; QSR International) was used in the management of the data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis. Results: There was consensus across all groups that they had more positive than negative experiences with the CFLU system. Participants who responded to >50% of the calls reported more frequent use of the specific elements of the CFLU tool and, consequently, experienced more benefits from the system than those who responded to calls less frequently. Irrespective of calls responded to, participants identified pill reminders as the most important aspect in improved quality of life, followed by health promotion tips. The most common challenge faced was difficulty with the secret personal identification number. Conclusions: Findings showed participants’ appreciation, high willingness, and interest in the intervention, CFLU, that demonstrated great perceived potential to improve their access to health care; adherence to treatment; health awareness; and, consequently, quality of life. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 %M 36472904 %R 10.2196/36829 %U https://formative.jmir.org/2022/12/e36829 %U https://doi.org/10.2196/36829 %U http://www.ncbi.nlm.nih.gov/pubmed/36472904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42225 %T The Persian Version of the Mobile Application Rating Scale (MARS-Fa): Translation and Validation Study %A Barzegari,Saeed %A Sharifi Kia,Ali %A Bardus,Marco %A Stoyanov,Stoyan R %A GhaziSaeedi,Marjan %A Rafizadeh,Mouna %+ Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston campus, Edgbaston, B15 2TT, United Kingdom, 44 0121 414 3344, m.bardus@bham.ac.uk %K mobile application rating scale %K Farsi %K mobile apps %K validation %K smartphone addiction %K Persian %K Iran %K development %K mobile health %K mHealth %K scale %K validate %K reliability %K measurement tool %K assessment tool %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 110 million Farsi speakers worldwide have access to a growing mobile app market. Despite restrictions and international sanctions, Iran’s internal mobile health app market is growing, especially for Android-based apps. However, there is a need for guidelines for developing health apps that meet international quality standards. There are also no tools in Farsi that assess health app quality. Developers and researchers who operate in Farsi could benefit from such quality assessment tools to improve their outputs. Objective: This study aims to translate and culturally adapt the Mobile Application Rating Scale in Farsi (MARS-Fa). This study also evaluates the validity and reliability of the newly developed MARS-Fa tool. Methods: We used a well-established method to translate and back translate the MARS-Fa tool with a group of Iranian and international experts in Health Information Technology and Psychology. The final translated version of the tool was tested on a sample of 92 apps addressing smartphone addiction. Two trained reviewers completed an independent assessment of each app in Farsi and English. We reported reliability and construct validity estimates for the objective scales (engagement, functionality, aesthetics, and information quality). Reliability was based on the evaluation of intraclass correlation coefficients, Cronbach α and Spearman-Brown split-half reliability indicators (for internal consistency), as well as Pearson correlations for test-retest reliability. Construct validity included convergent and discriminant validity (through item-total correlations within the objective scales) and concurrent validity using Pearson correlations between the objective and subjective scores. Results: After completing the translation and cultural adaptation, the MARS-Fa tool was used to assess the selected apps for smartphone addiction. The MARS-Fa total scale showed good interrater reliability (intraclass correlation coefficient=0.83, 95% CI 0.74-0.89) and good internal consistency (Cronbach α=.84); Spearman-Brown split-half reliability for both raters was 0.79 to 0.93. The instrument showed excellent test-retest reliability (r=0.94). The correlations among the MARS-Fa subdomains and the total score were all significant and above r=0.40, suggesting good convergent and discriminant validity. The MARS-Fa was positively and significantly correlated with subjective quality (r=0.90, P<.001), and so were the objective subdomains of engagement (r=0.85, P<.001), information quality (r=0.80, P<.001), aesthetics (r=0.79, P<.001), and functionality (r=0.57, P<.001), indicating concurrent validity. Conclusions: The MARS-Fa is a reliable and valid instrument to assess mobile health apps. This instrument could be adopted by Farsi-speaking researchers and developers who want to evaluate the quality of mobile apps. While we tested the tool with a sample of apps addressing smartphone addiction, the MARS-Fa could assess other domains or issues since the Mobile App Rating Scale has been used to rate apps in different contexts and languages. %M 36469402 %R 10.2196/42225 %U https://formative.jmir.org/2022/12/e42225 %U https://doi.org/10.2196/42225 %U http://www.ncbi.nlm.nih.gov/pubmed/36469402 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e37684 %T Examining Use Behavior of a Goal-Supporting mHealth App in Primary Care Among Patients With Multiple Chronic Conditions: Qualitative Descriptive Study %A Tahsin,Farah %A Austin,Tujuanna %A McKinstry,Brian %A Mercer,Stewart W %A Loganathan,Mayura %A Thavorn,Kednapa %A Upshur,Ross %A Steele Gray,Carolyn %+ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 647 825 4684, farah.tahsin@mail.utoronto.ca %K mobile health %K mHealth %K multimorbidity %K chronic disease management %K goal-oriented care %K multimorbid %K app %K primary care %K telemedicine %K use %K usability %K human factors %K behavior %K sociobehavioral %K health technology %K mobile phone %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Although mobile health (mHealth) apps are increasingly being used to support patients with multiple chronic conditions (multimorbidity), most mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, when developing an mHealth program, it is important to understand the social-behavioral factors that affect patients’ use behavior. Objective: The aim of this study was to explore the social and behavioral factors contributing to patients’ use behavior of an mHealth app called the electronic Patient-Reported Outcome (ePRO). The ePRO app supports goal-oriented care delivery in interdisciplinary primary care models. Methods: A descriptive qualitative study was used to analyze interview data collected for a larger mixed methods pragmatic trial. The original 15-month trial was conducted in 6 primary care teams across Ontario, Canada, between 2018 and 2019. The eligibility criteria for patients were being aged ≥60 years with ≥10 visits within the previous 12 months of study enrollment. For this analysis, patients were classified as long-term or short-term users based on their length of use of the ePRO app during the trial. The Social Cognitive Theory by Bandura was used to categorize social-behavioral factors that contributed to patients’ decision to continue or discontinue using the app. Results: The patient-provider relationship emerged as a key factor that shaped patients’ experiences with the app and subsequent decision to continue using the app. Other factors that contributed to patients’ decision to continue using the app were personal and social circumstances, perceived usefulness, patients’ previous experience with goal-related behaviors, and confidence in one’s capability. There was an overlap of experience between long- and short-term app users but, in general, long-term users perceived the app to be more useful and their goals to be more meaningful than short-term app users. This observation was complicated by the fact that patient health-related goals were dynamic and changed over time. Conclusions: Complex patients’ use behavior of a goal-supporting mHealth app is shaped by an array of sociobehavioral factors that can evolve. To tackle this dynamism, there should be an emphasis on creating adaptable health technologies that are easily customizable by patients and able to respond to their changing contexts and needs. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 %M 36449335 %R 10.2196/37684 %U https://humanfactors.jmir.org/2022/4/e37684 %U https://doi.org/10.2196/37684 %U http://www.ncbi.nlm.nih.gov/pubmed/36449335 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e26925 %T Patients’ and Health Care Providers’ Perceptions on mHealth Use After High-Altitude Climate Therapy for Severe Asthma: Mixed Methods Study %A Khusial,Rishi %A van Koppen,Sophia %A Honkoop,Persijn %A Rijssenbeek-Nouwens,Lucia %A Fieten,Karin Berthine %A Keij,Sascha %A Drijver-Messelink,Marieke %A Sont,Jacob %+ Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, Netherlands, 31 7152 64574, r.j.khusial@lumc.nl %K eHealth %K mobile health %K mHealth %K asthma %K self-management %K home monitoring %K mobile phone %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a common chronic disease with various clinical presentations. Although most patients are able to reach good asthma control, some patients are not able to reach sufficient asthma control following the regular treatment guidelines and could be referred to high-altitude climate therapy (HACT). HACT includes environmental trigger avoidance in the alpine climate with multidisciplinary clinical treatment. Patients with severe and difficult-to-control asthma, who are unable to reach asthma control at sea level, can follow a 12-week lung rehabilitation program at 1600 m above sea level. Mobile health (mHealth) tools can be used to enhance self-management in these patients when they return home. For an mHealth system to be effective, it must meet the expectations of the end users. Objective: In this Davos@home study, we explored the attitudes toward mHealth aimed at supporting the self-management of patients with severe, difficult-to-control asthma who underwent HACT and asthma health care providers. Methods: In the first stage, interviews with referrers to HACT and focus groups with patients with asthma who participated in or completed HACT were conducted. The data were then analyzed thematically. On the basis of these results, a questionnaire was developed. In the second stage of the study, this questionnaire, combined with the Asthma Control Questionnaire and the Individual Innovativeness Questionnaire, was provided to patients who completed HACT. Results: In total, 11 interviews and 3 focus groups (n=18, age 47.6, SD 12.1 years, Asthma Control Questionnaire score 2.6, SD 1.0) were conducted. A total of 3 themes were identified: potential goals, useful measurements, and perceived barriers and facilitators. The questionnaire developed in stage 2 included items based on these results. The most agreed-upon goal among the 52 patients who completed the questionnaire was to increase their asthma control (45/52, 86% of the patients). Conclusions: Different patients reported that they would benefit the most from different functionalities. Therefore, it is important to tailor functionalities to individual (treatment) goals. When developing an mHealth intervention, it is important to allow personalization to avoid overwhelming the users. %M 36413384 %R 10.2196/26925 %U https://formative.jmir.org/2022/11/e26925 %U https://doi.org/10.2196/26925 %U http://www.ncbi.nlm.nih.gov/pubmed/36413384 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e32757 %T First-time Mothers’ Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry %A Bailey,Elizabeth %A Nightingale,Samantha %A Thomas,Nicky %A Coleby,Dawn %A Deave,Toity %A Goodenough,Trudy %A Ginja,Samuel %A Lingam,Raghu %A Kendall,Sally %A Day,Crispin %A Coad,Jane %+ School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Queens Medical Centre, Derby Rd, Lenton, Nottingham, NG7 2UH, United Kingdom, 44 07717416441, jane.coad@nottingham.ac.uk %K pregnancy %K antenatal support %K antenatal education %K communication %K digital %K pregnancy apps %K mobile phone %D 2022 %7 21.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. Objective: This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. Methods: This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. Results: The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. Conclusions: Although this study included a small sample, it elicited rich data and insights into first-time mothers’ app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. International Registered Report Identifier (IRRID): RR2-10.1017/S1463423618000294 %M 36409530 %R 10.2196/32757 %U https://mhealth.jmir.org/2022/11/e32757 %U https://doi.org/10.2196/32757 %U http://www.ncbi.nlm.nih.gov/pubmed/36409530 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e42385 %T Understanding the Technology Acceptance and Usability of a New Device for Hand Therapy: Qualitative Descriptive Study %A Rios Rincon,Adriana M %A Guptill,Christine %A Guevara Salamanca,Juan David %A Liubaoerjijin,Yilina %A Figeys,Mathieu %A Gregson,Geoff %A Miguel-Cruz,Antonio %+ Department of Occupational Therapy, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada, 1 7802246641, miguelcr@ualberta.ca %K usability %K technology acceptance %K hand therapy, rehabilitation, disability %K medical device %K limb disorder %K chronic disorder %K health care system %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Upper extremity function plays a critical role in completing activities of daily living, employment, and participating in recreational activities. The FEPSim device is a medical device for hand and wrist rehabilitation that can be adjusted according to the patient’s requirements in rehabilitation. Furthermore, the FEPSim can be used to assess the patient’s strength and range of motion of the forearm, wrist, and hand. At present, the acceptance and usability of the FEPSim have not been tested in a clinical setting, with limited perspectives from rehabilitation-providing clinicians. Objective: This study aims to understand the factors related to the acceptance and usability of the FEPSim device. Upper limb disorders are prevalent across populations. The impact of upper limb disorders, both acute and chronic, puts a significant burden on the Canadian health care system. Methods: A qualitative descriptive study was conducted that involved face-to-face semistructured interviews with hand therapists from hand therapy services who used the FEPSim device. We used purposive sampling to recruit 10 participants over a period of 14 months. Semistructured interview questions (topic-guided) examined the technology acceptance and usability of the FEPSim device. Results: We found 6 factors to be critical aspects of the acceptance and usability of the FEPSim device. These factors were (1) useful for therapy, (2) effortlessness, (3) environmental conditions, (4) internal encouragement, (5) technological aesthetics, and (6) use. Conclusions: The FEPSim device was widely accepted by the therapists. The use of the FEPSim device is a feasible alternative for supporting hand therapy. Trial Registration: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 %M 36355405 %R 10.2196/42385 %U https://rehab.jmir.org/2022/4/e42385 %U https://doi.org/10.2196/42385 %U http://www.ncbi.nlm.nih.gov/pubmed/36355405 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41689 %T Effectiveness of Mental Health Apps for Distress During COVID-19 in US Unemployed and Essential Workers: Remote Pragmatic Randomized Clinical Trial %A Comtois,Katherine Anne %A Mata-Greve,Felicia %A Johnson,Morgan %A Pullmann,Michael D %A Mosser,Brittany %A Arean,Patricia %+ Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 Pacific Stree NE, Seattle, WA, 98195, United States, 1 14152727222, parean@uw.edu %K COVID-19 %K COVID %K coronavirus %K pandemic %K SARS-CoV-2 %K essential worker %K suicide %K suicidal %K commercial app %K mental health apps %K health app %K mental health %K mHealth %K mobile health %K occupational health %K employee %K employment %K unemployed %K worker %K job %K depression %K anxiety %K stress %K distress %K mobile app %K RCT %K pragmatic trial %K randomized %K health care worker %K health care provider %K frontline staff %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, the general public was concerned about the mental health impacts of unemployment due to COVID-19 and the stress essential workers experienced during this time. Several reports indicated that people in distress were turning to digital technology, but there was little evidence about the impact of these tools on mitigating distress. Objective: This study seeks to determine the acceptability, feasibility, usability, and effectiveness of mobile mental health apps for decreasing mental health symptoms in essential workers and unemployed individuals with suicide risk. Methods: We recruited participants who indicated that they were unemployed because of COVID-19 or were COVID-19–designated essential workers. Participants were randomized to 1 of 4 free commercial mobile apps for managing distress that were (1) highly rated by PsyberGuide and (2) met the criteria for intervention features these participants indicated were desirable in a previous survey. Participants used the apps for 4 weeks and completed baseline and 4-week self-assessments of depression, anxiety emotional regulation, and suicide risk. Results: We found no differences between the apps in any outcome but did find significant changes in depression and anxiety over time (Patient Health Questionnaire [PHQ]-9: estimate=–1.5, SE 0.2, 95% CI –1.1 to –1.8, P<.001; Generalized Anxiety Disorder Scale [GAD]-7: estimate=–1.3, SE 0.2, 95% CI –1.0 to –1.6, P<.001). We found no significant changes in suicidal behavior (Suicide Behaviors Questionnaire-Revised [SBQ-R]) or emotional regulation (Difficulties in Emotion Regulation Scale – Short Form [DERS-SF]) for the 4 weeks. We did find a significant dose-response pattern for changes in depression and anxiety. Using the app at least once a week resulted in greater improvements in treatment conditions over time on depression (estimate=–0.6, SE 0.2, 95% CI 1.0-0.2, P=.003) and anxiety (estimate=0.1, SE 0.2, 95% CI 0.4-0.6, P=.78). There was no association between app frequency and changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF). We further found a significant difference between the conditions with regard to app usability, with the control app being the most usable (meanBeautiful Mood 72.9, SD 16.7; meanCOVID Coach 71.2, SD 15.4; meanCalm 66.8, SD 17.3; mean7 Cups 65.2, SD 17.7). We found no significant differences for app acceptability or appropriateness. Conclusions: Few studies have evaluated prospectively the utility and usability of commercial apps for mood. This study found that free, self-guided commercial mobile mental health apps are seen as usable, but no one app is superior to the other. Although we found that regular use is indicated for effects on depression and anxiety to occur in those who are more symptomatic, regression to the mean cannot be ruled out. Trial Registration: ClinicalTrials.gov NCT04536935; https://tinyurl.com/mr36zx3s %M 36191176 %R 10.2196/41689 %U https://mhealth.jmir.org/2022/11/e41689 %U https://doi.org/10.2196/41689 %U http://www.ncbi.nlm.nih.gov/pubmed/36191176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39637 %T Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics %A Timmers,Thomas %A van der Weegen,Walter %A Janssen,Loes %A Kremer,Jan %A Kool,Rudolf Bertijn %+ IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, Netherlands, 31 746446069, thomas@interactivestudios.nl %K eHealth %K qualitative research %K qualitative %K focus group %K knee %K surgery %K feedback %K user need %K patient need %K user centered %K content codevelopment %K patient involvement %K co-design %K participatory %K app design %K mobile health %K mHealth %K health app %K orthopedic %K mobile phone %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients’ priorities. Objective: In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods: Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results: The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app’s content. Conclusions: In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app’s content from the patient’s perspective. Given the growing emphasis on patients’ self-management, it is crucial that the information they receive is not only relevant from a health care provider’s perspective but also aligns with what really matters to patients. Trial Registration: Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295 %M 36326799 %R 10.2196/39637 %U https://formative.jmir.org/2022/11/e39637 %U https://doi.org/10.2196/39637 %U http://www.ncbi.nlm.nih.gov/pubmed/36326799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e36134 %T Interventions Including Smart Technology Compared With Face-to-face Physical Activity Interventions in Older Adults: Systematic Review and Meta-analysis %A D'Amore,Cassandra %A Reid,Julie C %A Chan,Matthew %A Fan,Samuel %A Huang,Amanda %A Louie,Jonathan %A Tran,Andy %A Chauvin,Stephanie %A Beauchamp,Marla K %+ School of Rehabilitation Science, McMaster University, 1400 Main Street West, Institute for Applied Health Sciences Building, Hamilton, ON, L8S 1C7, Canada, 1 905 525 9140 ext 21732, beaucm1@mcmaster.ca %K aging %K exercise %K mobile health %K mHealth %K wearables %K mobile phone %D 2022 %7 31.10.2022 %9 Review %J J Med Internet Res %G English %X Background: This is a systematic review of randomized controlled trials and a meta-analysis comparing smart technology with face-to-face physical activity (PA) interventions in community-dwelling older adults (mean age 60 years). Objective: This study aims to determine the effect of interventions including smart technology components compared with face-to-face PA interventions on PA and physical function in older adults. The secondary outcomes are depression, anxiety, and health-related quality of life. Methods: We searched MEDLINE, Embase, CINAHL, and AMED electronic databases from inception to February 2021. Two independent reviewers screened titles, abstracts, and full texts and performed data extraction and risk of bias assessments using the Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the evidence. We provided a narrative synthesis on all included studies and, where possible, performed meta-analyses for similar outcomes. Results: This review included 19 studies with a total of 3455 participants. Random effects meta-analyses showed that interventions with smart technology components resulted in improved step count (mean difference 1440 steps, 95% CI 500-2390) and total PA (standardized mean difference 0.17, 95% CI 0.02-0.32) compared with face-to-face alone. There was no difference between groups in terms of the measures of physical function. Smart technology alone did not show significant differences between groups in any outcome. The quality of the evidence was very low based on the Grading of Recommendations Assessment, Development and Evaluation criteria. Conclusions: Interventions that include smart technology may improve daily step counts by an average of 1440 steps in community-dwelling older adults; however, the quality of the evidence was very low. Future studies are needed to improve the certainty of these results. Trial Registration: PROSPERO CRD42020135232; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=135232 %M 36315229 %R 10.2196/36134 %U https://www.jmir.org/2022/10/e36134 %U https://doi.org/10.2196/36134 %U http://www.ncbi.nlm.nih.gov/pubmed/36315229 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38387 %T Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches %A Jarman,Hannah K %A McLean,Siân A %A Rodgers,Rachel %A Fuller-Tyszkiewicz,Matthew %A Paxton,Susan %A O'Gorman,Beth %A Harris,Emily %A Shatte,Adrian %A Bishop,Katie %A Baumann,Tahlia %A Mahoney,Danielle %A Daugelat,Melissa-Claire %A Yager,Zali %+ School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 9251 7777, h.jarman@deakin.edu.au %K eating disorders %K app-based intervention %K lived experience %K design thinking %K interviews %K young women %K co-design %K mobile health %K mHealth %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user’s personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. %M 36315225 %R 10.2196/38387 %U https://formative.jmir.org/2022/10/e38387 %U https://doi.org/10.2196/38387 %U http://www.ncbi.nlm.nih.gov/pubmed/36315225 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e37581 %T Evaluation of Breastfeeding App Features: Content Analysis Study %A Dinour,Lauren M %A Pole,Antoinette %+ Department of Nutrition and Food Studies, College of Education and Human Services, Montclair State University, 1 Normal Avenue, Montclair, NJ, 07043, United States, 1 973 655 5395, dinourl@montclair.edu %K breastfeeding %K breastmilk expression %K bottle feeding %K infant food %K infant health %K infant care %K consumer health informatics %K mobile apps %K smartphone %K cross-sectional study %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings. Objective: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated. Methods: Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings. Results: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times. Conclusions: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users. %M 36287596 %R 10.2196/37581 %U https://pediatrics.jmir.org/2022/4/e37581 %U https://doi.org/10.2196/37581 %U http://www.ncbi.nlm.nih.gov/pubmed/36287596 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e37772 %T Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach %A Tran-Nguyen,Kevin %A Berger,Caroline %A Bennett,Roxanne %A Wall,Michelle %A Morin,Suzanne N %A Rajabiyazdi,Fateme %+ Department of Systems and Computer Engineering, Carleton University, 1125 Colonel By Dr, Ottawa, ON, Canada, 1 (613) 520 2600 ext 8229, fateme.rajabiyazdi@carleton.ca %K older adults %K mobile app %K skeletal fracture %K usability %K patient-centered %K human-centered design %K digital health %K eHealth %K mobile health %K mHealth %K acute pain self-management %K mobile phone %D 2022 %7 17.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. %M 36251348 %R 10.2196/37772 %U https://aging.jmir.org/2022/4/e37772 %U https://doi.org/10.2196/37772 %U http://www.ncbi.nlm.nih.gov/pubmed/36251348 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e36987 %T Behavior Change App for Self-management of Gestational Diabetes: Design and Evaluation of Desirable Features %A Kytö,Mikko %A Koivusalo,Saila %A Ruonala,Antti %A Strömberg,Lisbeth %A Tuomonen,Heli %A Heinonen,Seppo %A Jacucci,Giulio %+ Helsinki University Hospital IT Management, Helsinki University Hospital, Paciuksenkatu 25, Helsinki, 00270, Finland, 358 94711, mikko.kyto@hus.fi %K gestational diabetes %K mobile app %K features %K behavior change %K digital health %K eHealth %K telehealth %K self-tracking %K self-management %K personalized health care %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother’s and the offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking. Objective: The aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature. Methods: We designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews. Results: We identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual occurs. In addition, we found 2 additional themes. First, basic functionalities that are fast to learn by women with GDM who have recently received the diagnosis should be provided, but there should also be deeper features to maintain interest for women with GDM at a later stage of pregnancy. Second, as women with GDM may have feelings of guilt, the app should have a tolerance for and a supporting approach to unfavorable behavior. Conclusions: The feedback on the GDM prototype app supported the need for desirable features and provided new insights into how these features should be incorporated into GDM apps. We expect that following the proposed designs and feedback will increase the efficacy of GDM self-management apps. Trial Registration: ClinicalTrials.gov NCT03941652; https://clinicaltrials.gov/ct2/show/NCT03941652 %M 36222806 %R 10.2196/36987 %U https://humanfactors.jmir.org/2022/4/e36987 %U https://doi.org/10.2196/36987 %U http://www.ncbi.nlm.nih.gov/pubmed/36222806 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e38940 %T The Current State of Mobile Apps Owned by Large Pediatric Hospitals in the United States: Systematic Search and Analysis on Google Play and Apple App Stores %A Lieser,Tyler %A Huang,Yungui %A Sezgin,Emre %+ The Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Xrd, Columbus, OH, 43215, United States, 1 6147222210, tyler.lieser@nationwidechildrens.org %K pediatric %K child %K hospital %K mobile app %K mobile health %K mHealth %K health app %K digital health %K eHealth %K hospital-owned app %K telehealth %K review %K app feature %K accessibility %K patient experience %K functionality %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pediatric hospitals in the United States are increasingly leveraging patient-facing mobile apps as their digital front doors for patients, families, and caretakers. These mobile health apps are sanctioned by pediatric hospitals to inform the public or populations about pediatric care to provide individualized information, to enhance communication, and to improve patient experience. Yet the functionalities and user feedback of these hospital mobile apps have not been systematically investigated. Objective: Our aim was to understand the current state of hospital-owned mobile apps provided by large pediatric hospitals, comparatively analyze and report the services provided, and identify potential gaps to inform developers and providers. The American Hospital Association defines large hospitals as those having a bed count of more than 400. Methods: We conducted a systematic search on Google Play and Apple App Store to identify all hospital-owned mobile apps from the large pediatric hospitals included in our review. Our inclusion criteria were (1) apps provided by large pediatric hospitals; (2) hospital-owned apps available in Apple App Store and Google Play; and (3) apps that are provided for general populations. Specialty apps that serve specific user groups or populations focusing on education, telehealth, specific conditions or procedures, or apps intended for research or clinician use were excluded. The features and functionality of the included apps were examined. Results: Of the 16 pediatric hospitals included in our review, 4 (25%) had no general patient-facing apps, 4 (25%) had one app, and 8 (50%) had more than one app available on Google Play or Apple App Store. The 12 hospitals with at least one mobile app had a combined total of 72 apps. Of these 72 apps, 61 (85%) were considered specialty and were excluded from our review, leaving a total of 11 (15%) apps to analyze. Among the 11 apps analyzed, the most common feature was appointment scheduling or reminder (n=9, 82%). Doctor search (n=8, 73%) and patient resources (n=8, 73%) were the second most common, followed by payment, billing, or claims (n=7, 64%), patient portal integration (n=6, 55%), personal health management (n=6, 55%), hospital way finding (n=5, 45%), message a provider (n=4, 36%), urgent care wait times (n=4, 36%), video chat (n=4, 36%), and health information access (n=4, 36%). Parking information (n=3, 27%) was the least common. Conclusions: Out of the 16 pediatric hospitals identified for our review, 75% (n=12) offer mobile apps. Based on the most common features, these apps were intended to help improve accessibility for patients and families in terms of finding providers, scheduling appointments, and accessing patient resources. We believe the findings will inform pediatric hospital administrators, developers, and other stakeholders to improve app feature offerings and increase their impact on service accessibility and patient experience. %M 36201385 %R 10.2196/38940 %U https://pediatrics.jmir.org/2022/4/e38940 %U https://doi.org/10.2196/38940 %U http://www.ncbi.nlm.nih.gov/pubmed/36201385 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e35592 %T Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study %A Villalobos,Jennifer Paola %A Bull,Sheana Salyers %A Portz,Jennifer Dickman %+ Colorado School of Public Health, University of Colorado, 13055 E 17th Ave, Mail Stop #F802, Aurora, CO, 80045, United States, 1 303 551 3823, jennifer.p.villalobos@gmail.com %K mHealth %K older adult %K symptom %K heart failure %K palliative care %K app %K digital health %K cardiology %K heart %K Convoy-Pal %K mobile %K tablet %K smartwatch %K adult %K aging %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Heart failure is a leading cause of death among older adults. Digital health can increase access to and awareness of palliative care for patients with advanced heart failure and their caregivers. However, few palliative care digital interventions target heart failure or patients’ caregivers, family, and friends, termed here as the social convoy. To address this need, the Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed to deliver self-management tools and palliative care resources to older adults with advanced heart failure and their social convoys. Objective: The goal of the research was to test the acceptability and usability of Convoy-Pal among older adults with advanced heart failure and their social convoys. Methods: Convoy-Pal includes tablet-based and smartwatch tools facilitating self-management and access to palliative care resources. Older adults and social convoy caregivers completed an acceptability and usability interview via Zoom, including open-ended questions and the Mobile Application Rating Scale: User Version (uMARS). Descriptive analysis was conducted to summarize the results of open-ended feedback and self-reported acceptability and usability. Results: A total of 26 participants (16 older adults and 10 social convoy caregivers) participated in the interview. Overall, the feedback from users was good (uMARS mean 3.96/5 [SD 0.81]). Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. Conclusions: Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers. %M 36201402 %R 10.2196/35592 %U https://aging.jmir.org/2022/4/e35592 %U https://doi.org/10.2196/35592 %U http://www.ncbi.nlm.nih.gov/pubmed/36201402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37474 %T Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study %A Proctor,Steven L %A Rigg,Khary K %A Tien,Allen Y %+ Thriving Mind South Florida, 7205 Corporate Center Drive, Suite 200, Miami, FL, 33126, United States, 1 305 858 3335, sproctor@thrivingmind.org %K opioids %K contingency management %K mHealth %K digital health %K mobile app %K innovation %K opioid use disorder %K recovery %K acceptability %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. Objective: This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. Methods: Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. Results: Participants were overwhelmingly in favor of microrewards (eg, US $1) to incentivize treatment participation (up to US $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. Conclusions: Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial. %M 36197705 %R 10.2196/37474 %U https://formative.jmir.org/2022/10/e37474 %U https://doi.org/10.2196/37474 %U http://www.ncbi.nlm.nih.gov/pubmed/36197705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38497 %T Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior Doctors’ Mental Health and Well-being: Examination of Symptom Progression, Usability, and Acceptability After 1 Month of Use %A Sanatkar,Samineh %A Counson,Isabelle %A Mackinnon,Andrew %A Bartholomew,Alexandra %A Glozier,Nick %A Harvey,Samuel %+ Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 61 02 9065 9179, s.sanatkar@unsw.edu.au %K digital mental health %K mobile health apps %K mHealth apps %K help seeking %K junior doctors %K depression %K mobile phone %D 2022 %7 21.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Shift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. Objective: This study aimed to conduct a preliminary investigation of the use and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool. Methods: Junior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the Shift app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle. Results: A total of 222 (n=156 female, 70.3%; mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected; however, physicians’ COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated Shift highly or very highly. Conclusions: Despite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner. %M 36129745 %R 10.2196/38497 %U https://www.jmir.org/2022/9/e38497 %U https://doi.org/10.2196/38497 %U http://www.ncbi.nlm.nih.gov/pubmed/36129745 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e38364 %T Evaluation of Diagnostic and Triage Accuracy and Usability of a Symptom Checker in an Emergency Department: Observational Study %A Fraser,Hamish S F %A Cohan,Gregory %A Koehler,Christopher %A Anderson,Jared %A Lawrence,Alexis %A Pateña,John %A Bacher,Ian %A Ranney,Megan L %+ Brown Center for Biomedical Informatics, Warren Alpert Medical School, Brown University, 233 Richmond Street, Providence, RI, 02912, United States, 1 401 863 1815, hamish_fraser@brown.edu %K mobile health %K mHealth %K symptom checker %K diagnosis %K user experience %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Symptom checkers are clinical decision support apps for patients, used by tens of millions of people annually. They are designed to provide diagnostic and triage advice and assist users in seeking the appropriate level of care. Little evidence is available regarding their diagnostic and triage accuracy with direct use by patients for urgent conditions. Objective: The aim of this study is to determine the diagnostic and triage accuracy and usability of a symptom checker in use by patients presenting to an emergency department (ED). Methods: We recruited a convenience sample of English-speaking patients presenting for care in an urban ED. Each consenting patient used a leading symptom checker from Ada Health before the ED evaluation. Diagnostic accuracy was evaluated by comparing the symptom checker’s diagnoses and those of 3 independent emergency physicians viewing the patient-entered symptom data, with the final diagnoses from the ED evaluation. The Ada diagnoses and triage were also critiqued by the independent physicians. The patients completed a usability survey based on the Technology Acceptance Model. Results: A total of 40 (80%) of the 50 participants approached completed the symptom checker assessment and usability survey. Their mean age was 39.3 (SD 15.9; range 18-76) years, and they were 65% (26/40) female, 68% (27/40) White, 48% (19/40) Hispanic or Latino, and 13% (5/40) Black or African American. Some cases had missing data or a lack of a clear ED diagnosis; 75% (30/40) were included in the analysis of diagnosis, and 93% (37/40) for triage. The sensitivity for at least one of the final ED diagnoses by Ada (based on its top 5 diagnoses) was 70% (95% CI 54%-86%), close to the mean sensitivity for the 3 physicians (on their top 3 diagnoses) of 68.9%. The physicians rated the Ada triage decisions as 62% (23/37) fully agree and 24% (9/37) safe but too cautious. It was rated as unsafe and too risky in 22% (8/37) of cases by at least one physician, in 14% (5/37) of cases by at least two physicians, and in 5% (2/37) of cases by all 3 physicians. Usability was rated highly; participants agreed or strongly agreed with the 7 Technology Acceptance Model usability questions with a mean score of 84.6%, although “satisfaction” and “enjoyment” were rated low. Conclusions: This study provides preliminary evidence that a symptom checker can provide acceptable usability and diagnostic accuracy for patients with various urgent conditions. A total of 14% (5/37) of symptom checker triage recommendations were deemed unsafe and too risky by at least two physicians based on the symptoms recorded, similar to the results of studies on telephone and nurse triage. Larger studies are needed of diagnosis and triage performance with direct patient use in different clinical environments. %M 36121688 %R 10.2196/38364 %U https://mhealth.jmir.org/2022/9/e38364 %U https://doi.org/10.2196/38364 %U http://www.ncbi.nlm.nih.gov/pubmed/36121688 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e40576 %T The Intersection of Persuasive System Design and Personalization in Mobile Health: Statistical Evaluation %A McGowan,Aleise %A Sittig,Scott %A Bourrie,David %A Benton,Ryan %A Iyengar,Sriram %+ University of Louisiana at Lafayette, PO Box 43565, Lafayette, LA, 70504, United States, 1 3374826160, scott.sittig@louisiana.edu %K persuasive technology %K personalization %K psychological characteristics %K self-efficacy %K health consciousness %K health motivation %K personality traits %K mobile health %K mHealth %K mobile phone %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Persuasive technology is an umbrella term that encompasses software (eg, mobile apps) or hardware (eg, smartwatches) designed to influence users to perform preferable behavior once or on a long-term basis. Considering the ubiquitous nature of mobile devices across all socioeconomic groups, user behavior modification thrives under the personalized care that persuasive technology can offer. However, there is no guidance for developing personalized persuasive technologies based on the psychological characteristics of users. Objective: This study examined the role that psychological characteristics play in interpreted mobile health (mHealth) screen perceived persuasiveness. In addition, this study aims to explore how users’ psychological characteristics drive the perceived persuasiveness of digital health technologies in an effort to assist developers and researchers of digital health technologies by creating more engaging solutions. Methods: An experiment was designed to evaluate how psychological characteristics (self-efficacy, health consciousness, health motivation, and the Big Five personality traits) affect the perceived persuasiveness of digital health technologies, using the persuasive system design framework. Participants (n=262) were recruited by Qualtrics International, Inc, using the web-based survey system of the XM Research Service. This experiment involved a survey-based design with a series of 25 mHealth app screens that featured the use of persuasive principles, with a focus on physical activity. Exploratory factor analysis and linear regression were used to evaluate the multifaceted needs of digital health users based on their psychological characteristics. Results: The results imply that an individual user’s psychological characteristics (self-efficacy, health consciousness, health motivation, and extraversion) affect interpreted mHealth screen perceived persuasiveness, and combinations of persuasive principles and psychological characteristics lead to greater perceived persuasiveness. The F test (ie, ANOVA) for model 1 was significant (F9,6540=191.806; P<.001), with an adjusted R2 of 0.208, indicating that the demographic variables explained 20.8% of the variance in perceived persuasiveness. Gender was a significant predictor, with women having higher perceived persuasiveness (P=.008) relative to men. Age was a significant predictor of perceived persuasiveness with individuals aged 40 to 59 years (P<.001) and ≥60 years (P<.001). Model 2 was significant (F13,6536=341.035; P<.001), with an adjusted R2 of 0.403, indicating that the demographic variables self-efficacy, health consciousness, health motivation, and extraversion together explained 40.3% of the variance in perceived persuasiveness. Conclusions: This study evaluates the role that psychological characteristics play in interpreted mHealth screen perceived persuasiveness. Findings indicate that self-efficacy, health consciousness, health motivation, extraversion, gender, age, and education significantly influence the perceived persuasiveness of digital health technologies. Moreover, this study showed that varying combinations of psychological characteristics and demographic variables affected the perceived persuasiveness of the primary persuasive technology category. %M 36103226 %R 10.2196/40576 %U https://mhealth.jmir.org/2022/9/e40576 %U https://doi.org/10.2196/40576 %U http://www.ncbi.nlm.nih.gov/pubmed/36103226 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38579 %T A Versatile and Scalable Platform That Streamlines Data Collection for Patient-Centered Studies: Usability and Feasibility Study %A Huang,Haley %A Aschettino,Sofia %A Lari,Nasim %A Lee,Ting-Hsuan %A Rosenberg,Sarah Stothers %A Ng,Xinyi %A Muthuri,Stella %A Bakshi,Anirudh %A Bishop,Korrin %A Ezzeldin,Hussein %+ Center for Biologics Evaluation and Research, United States Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, United States, 1 240 402 8629, hussein.ezzeldin@fda.hhs.gov %K mobile app %K patient experience data %K data-collection app %K mobile phone %K usability %K mHealth app %K feasibility %K user centered %K eHealth %K patient-generated data %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Food and Drug Administration Center for Biologics Evaluation and Research (CBER) established the Biologics Effectiveness and Safety (BEST) Initiative with several objectives, including the expansion and enhancement of CBER’s access to fit-for-purpose data sources, analytics, tools, and infrastructures to improve the understanding of patient experiences with conditions related to CBER-regulated products. Owing to existing challenges in data collection, especially for rare disease research, CBER recognized the need for a comprehensive platform where study coordinators can engage with study participants and design and deploy studies while patients or caregivers could enroll, consent, and securely participate as well. Objective: This study aimed to increase awareness and describe the design, development, and novelty of the Survey of Health and Patient Experience (SHAPE) platform, its functionality and application, quality improvement efforts, open-source availability, and plans for enhancement. Methods: SHAPE is hosted in a Google Cloud environment and comprises 3 parts: the administrator application, participant app, and application programming interface. The administrator can build a study comprising a set of questionnaires and self-report entries through the app. Once the study is deployed, the participant can access the app, consent to the study, and complete its components. To build SHAPE to be scalable and flexible, we leveraged the open-source software development kit, Ionic Framework. This enabled the building and deploying of apps across platforms, including iOS, Android, and progressive web applications, from a single codebase by using standardized web technologies. SHAPE has been integrated with a leading Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) application programming interface platform, 1upHealth, which allows participants to consent to 1-time data pull of their electronic health records. We used an agile-based process that engaged multiple stakeholders in SHAPE’s design and development. Results: SHAPE allows study coordinators to plan, develop, and deploy questionnaires to obtain important end points directly from patients or caregivers. Electronic health record integration enables access to patient health records, which can validate and enhance the accuracy of data-capture methods. The administrator can then download the study data into HL7® FHIR®–formatted JSON files. In this paper, we illustrate how study coordinators can use SHAPE to design patient-centered studies. We demonstrate its broad applicability through a hypothetical type 1 diabetes cohort study and an ongoing pilot study on metachromatic leukodystrophy to implement best practices for designing a regulatory-grade natural history study for rare diseases. Conclusions: SHAPE is an intuitive and comprehensive data-collection tool for a variety of clinical studies. Further customization of this versatile and scalable platform allows for multiple use cases. SHAPE can capture patient perspectives and clinical data, thereby providing regulators, clinicians, researchers, and patient advocacy organizations with data to inform drug development and improve patient outcomes. %M 36103218 %R 10.2196/38579 %U https://formative.jmir.org/2022/9/e38579 %U https://doi.org/10.2196/38579 %U http://www.ncbi.nlm.nih.gov/pubmed/36103218 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35693 %T The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review %A Duffy,Anthony %A Christie,Gregory J %A Moreno,Sylvain %+ School of Interactive Arts & Technology, Simon Fraser University, 13450 102 Ave #250, Surrey, BC, V3T 0A3, Canada, 1 7787829742, sylvain_moreno@sfu.ca %K digital health %K end users %K user experience %K health behavior %K intervention %K co-design %K mobile health %K mobile phone %D 2022 %7 9.9.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. Objective: In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. Methods: A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as “digital health design,” “mHealth design,” “e-Health design,” “agile health,” and “agile healthcare.” The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. Results: A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. Conclusions: Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos. %M 36083628 %R 10.2196/35693 %U https://humanfactors.jmir.org/2022/3/e35693 %U https://doi.org/10.2196/35693 %U http://www.ncbi.nlm.nih.gov/pubmed/36083628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37061 %T Digital Content-Free Speech Analysis Tool to Measure Affective Distress in Mental Health: Evaluation Study %A Tonn,Peter %A Seule,Lea %A Degani,Yoav %A Herzinger,Shani %A Klein,Amit %A Schulze,Nina %+ Neuropsychiatric Center of Hamburg, Stresemannstr 23, Hamburg, 22769, Germany, 49 40 5330738, tonn@npz-hamburg.de %K mobile health %K mHealth %K depression %K assessment %K voice analysis %K evaluation %K speech %K speech analysis %K tool %K distress %K mental health %K mood %K diagnosis %K measurement %K questionnaire %K mobile phone %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mood disorders and depression are pervasive and significant problems worldwide. These represent severe health and emotional impairments for individuals and a considerable economic and social burden. Therefore, fast and reliable diagnosis and appropriate treatment are of great importance. Verbal communication can clarify the speaker’s mental state—regardless of the content, via speech melody, intonation, and so on. In both everyday life and clinical conditions, a listener with appropriate previous knowledge or a trained specialist can grasp helpful knowledge about the speaker's psychological state. Using automated speech analysis for the assessment and tracking of patients with mental health issues opens up the possibility of remote, automatic, and ongoing evaluation when used with patients’ smartphones, as part of the current trends toward the increasing use of digital and mobile health tools. Objective: The primary aim of this study is to evaluate the measurements of the presence or absence of depressive mood in participants by comparing the analysis of noncontentual speech parameters with the results of the Patient Health Questionnaire-9. Methods: This proof-of-concept study included participants in different affective phases (with and without depression). The inclusion criteria included a neurological or psychiatric diagnosis made by a specialist and fluent use of the German language. The measuring instrument was the VoiceSense digital voice analysis tool, which enables the analysis of 200 specific speech parameters based on machine learning and the assessment of the findings using Patient Health Questionnaire-9. Results: A total of 292 psychiatric and voice assessments were performed with 163 participants (males: n=47, 28.8%) aged 15 to 82 years. Of the 163 participants, 87 (53.3%) were not depressed at the time of assessment, and 88 (53.9%) participants had clinically mild to moderate depressive phases. Of the 163 participants, 98 (32.5%) showed subsyndromal symptoms, and 19 (11.7%) participants were severely depressed. In the speech analysis, a clear differentiation between the individual depressive levels, as seen in the Patient Health Questionnaire-9, was also shown, especially the clear differentiation between nondepressed and depressed participants. The study showed a Pearson correlation of 0.41 between clinical assessment and noncontentual speech analysis (P<.001). Conclusions: The use of speech analysis shows a high level of accuracy, not only in terms of the general recognition of a clinically relevant depressive state in the participants. Instead, there is a high degree of agreement regarding the extent of depressive impairment with the assessment of experienced clinical practitioners. From our point of view, the application of the noncontentual analysis system in everyday clinical practice makes sense, especially with the idea of a quick and unproblematic assessment of the state of mind, which can even be carried out without personal contact. Trial Registration: ClinicalTrials.gov NCT03700008; https://clinicaltrials.gov/ct2/show/NCT03700008 %M 36040767 %R 10.2196/37061 %U https://formative.jmir.org/2022/8/e37061 %U https://doi.org/10.2196/37061 %U http://www.ncbi.nlm.nih.gov/pubmed/36040767 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e33772 %T Role of Social and App-Related Factors in Behavioral Engagement With mHealth for Improved Well-being Among Chronically Ill Patients: Scenario-Based Survey Study %A Van Baelen,Freek %A De Regge,Melissa %A Larivière,Bart %A Verleye,Katrien %A Schelfout,Sam %A Eeckloo,Kristof %+ Strategic Policy Cell, Ghent University Hospital, 10, Corneel Heymanslaan, Ghent, 9000, Belgium, 32 92643493, melissa.deregge@uzgent.be %K mHealth app %K engagement %K social influence %K app integration %K well-being %K Belgium %K mHealth %K behavioral %K behavioral engagement %K mobile health %K mobile health apps %K mobile phone %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The last decade has seen a considerable increase in the number of mobile health (mHealth) apps in everyday life. These mHealth apps have the potential to significantly improve the well-being of chronically ill patients. However, behavioral engagement with mHealth apps remains low. Objective: The aim of this study was to describe the behavioral engagement of chronically ill patients with mHealth apps by investigating (1) how it is affected by social factors (ie, physician recommendation) and app-related factors (ie, app integration) and (2) how it affects patient well-being. This study also considers the moderating effect of attachment to traditional health care and the mobile app experience among patients. Methods: We carried out a scenario-based survey study of chronically ill patients (N=521). A Bayesian structural equation modeling with mediation and moderation analysis was conducted in MPlus. Results: Both physician recommendations for mHealth app use and app integration have positive effects on the behavioral engagement of chronically ill patients with mHealth apps. Higher behavioral engagement positively affects the hedonic well-being (extent of pleasure) and the eudaemonic well-being (extent of self-efficacy) of chronically ill patients. Mobile app experience, however, positively moderates the relationship between app integration and behavioral engagement, whereas patient attachment to traditional care does not moderate the relationship between physician recommendation and behavioral engagement. Taken together, the proportion of variance explained (R²) equals 21% for behavioral engagement and 52.8% and 62.2% for hedonic and eudaemonic well-being, respectively, thereby providing support for the strong influence of app integration and physician recommendation via the mediation of the patients’ behavioral engagement on both patients’ hedonic and eudaemonic well-being. Conclusions: Physician recommendation and app integration enable behavioral engagement and promote well-being among chronically ill patients. It is thus important to take social and app-related factors into consideration during and after the development of mHealth apps. %M 36018618 %R 10.2196/33772 %U https://mhealth.jmir.org/2022/8/e33772 %U https://doi.org/10.2196/33772 %U http://www.ncbi.nlm.nih.gov/pubmed/36018618 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e37290 %T System Usability Scale Benchmarking for Digital Health Apps: Meta-analysis %A Hyzy,Maciej %A Bond,Raymond %A Mulvenna,Maurice %A Bai,Lu %A Dix,Alan %A Leigh,Simon %A Hunt,Sophie %+ School of Computing, Ulster University, Ulster University School Office, 16G24 Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 7526852505, maciejmarekzych@gmail.com %K mHealth SUS scores meta-analysis %K SUS for digital health %K digital health apps usability %K mHealth usability %K SUS meta-analysis %K mHealth %K mobile app %K mobile health %K digital health %K System Usability Scale %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The System Usability Scale (SUS) is a widely used scale that has been used to quantify the usability of many software and hardware products. However, the SUS was not specifically designed to evaluate mobile apps, or in particular digital health apps (DHAs). Objective: The aim of this study was to examine whether the widely used SUS distribution for benchmarking (mean 68, SD 12.5) can be used to reliably assess the usability of DHAs. Methods: A search of the literature was performed using the ACM Digital Library, IEEE Xplore, CORE, PubMed, and Google Scholar databases to identify SUS scores related to the usability of DHAs for meta-analysis. This study included papers that published the SUS scores of the evaluated DHAs from 2011 to 2021 to get a 10-year representation. In total, 117 SUS scores for 114 DHAs were identified. R Studio and the R programming language were used to model the DHA SUS distribution, with a 1-sample, 2-tailed t test used to compare this distribution with the standard SUS distribution. Results: The mean SUS score when all the collected apps were included was 76.64 (SD 15.12); however, this distribution exhibited asymmetrical skewness (–0.52) and was not normally distributed according to Shapiro-Wilk test (P=.002). The mean SUS score for “physical activity” apps was 83.28 (SD 12.39) and drove the skewness. Hence, the mean SUS score for all collected apps excluding “physical activity” apps was 68.05 (SD 14.05). A 1-sample, 2-tailed t test indicated that this health app SUS distribution was not statistically significantly different from the standard SUS distribution (P=.98). Conclusions: This study concludes that the SUS and the widely accepted benchmark of a mean SUS score of 68 (SD 12.5) are suitable for evaluating the usability of DHAs. We speculate as to why physical activity apps received higher SUS scores than expected. A template for reporting mean SUS scores to facilitate meta-analysis is proposed, together with future work that could be done to further examine the SUS benchmark scores for DHAs. %M 35980732 %R 10.2196/37290 %U https://mhealth.jmir.org/2022/8/e37290 %U https://doi.org/10.2196/37290 %U http://www.ncbi.nlm.nih.gov/pubmed/35980732 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e36872 %T App-Based Evaluation of Older People’s Fall Risk Using the mHealth App Lindera Mobility Analysis: Exploratory Study %A Strutz,Nicole %A Brodowski,Hanna %A Kiselev,Joern %A Heimann-Steinert,Anika %A Müller-Werdan,Ursula %+ Geriatrics Research Group, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Reinickendorfer Straße 61, Berlin, 13407, Germany, 49 030 450 553369, nicole.strutz@charite.de %K mobility %K fall risk %K smartphone %K app %K analysis %K older people %K accuracy %K mobility restriction %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Falls and the risk of falling in older people pose a high risk for losing independence. As the risk of falling progresses over time, it is often not adequately diagnosed due to the long intervals between contacts with health care professionals. This leads to the risk of falling being not properly detected until the first fall. App-based software able to screen fall risks of older adults and to monitor the progress and presence of fall risk factors could detect a developing fall risk at an early stage prior to the first fall. As smartphones become more common in the elderly population, this approach is easily available and feasible. Objective: The aim of the study is to evaluate the app Lindera Mobility Analysis (LIN). The reference standards determined the risk of falling and validated functional assessments of mobility. Methods: The LIN app was utilized in home- and community-dwelling older adults aged 65 years or more. The Berg Balance Scale (BBS), the Tinetti Test (TIN), and the Timed Up & Go Test (TUG) were used as reference standards. In addition to descriptive statistics, data correlation and the comparison of the mean difference of analog measures (reference standards) and digital measures were tested. Spearman rank correlation analysis was performed and Bland-Altman (B-A) plots drawn. Results: Data of 42 participants could be obtained (n=25, 59.5%, women). There was a significant correlation between the LIN app and the BBS (r=–0.587, P<.001), TUG (r=0.474, P=.002), and TIN (r=–0.464, P=.002). B-A plots showed only few data points outside the predefined limits of agreement (LOA) when combining functional tests and results of LIN. Conclusions: The digital app LIN has the potential to detect the risk of falling in older people. Further steps in establishing the validity of the LIN app should include its clinical applicability. Trial Registration: German Clinical Trials Register DRKS00025352; https://tinyurl.com/65awrd6a %M 35972785 %R 10.2196/36872 %U https://aging.jmir.org/2022/3/e36872 %U https://doi.org/10.2196/36872 %U http://www.ncbi.nlm.nih.gov/pubmed/35972785 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e34514 %T Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study %A Ma,Jennifer S %A O’Riordan,Megan %A Mazzer,Kelly %A Batterham,Philip J %A Bradford,Sally %A Kõlves,Kairi %A Titov,Nickolai %A Klein,Britt %A Rickwood,Debra J %+ Discipline of Psychology, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia, 61 (0)2 6201 2701, Debra.Rickwood@canberra.edu.au %K consumer %K community %K help-seeker %K perspective %K technology %K artificial intelligence %K crisis %K support %K acceptability %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. Objective: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline’s crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline’s crisis support services if technology and automation were implemented in the future. Methods: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline’s crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. Results: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline’s crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. Conclusions: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue. %M 35930334 %R 10.2196/34514 %U https://humanfactors.jmir.org/2022/3/e34514 %U https://doi.org/10.2196/34514 %U http://www.ncbi.nlm.nih.gov/pubmed/35930334 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35268 %T Just-in-Time Prompts for Running, Walking, and Performing Strength Exercises in the Built Environment: 4-Week Randomized Feasibility Study %A Sporrel,Karlijn %A Wang,Shihan %A Ettema,Dick D F %A Nibbeling,Nicky %A Krose,Ben J A %A Deutekom,Marije %A de Boer,Rémi D D %A Simons,Monique %+ Human Geography and Spatial Planning, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, Netherlands, 31 642514287, k.sporrel@uu.nl %K just-in-time interventions %K context-based %K prompts %K reminders %K physical activity %K mobile health %K mHealth %K exercise application %K Fogg Behavior Model %K user experience %K engagement %K feasibility study %K mobile phone %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: App-based mobile health exercise interventions can motivate individuals to engage in more physical activity (PA). According to the Fogg Behavior Model, it is important that the individual receive prompts at the right time to be successfully persuaded into PA. These are referred to as just-in-time (JIT) interventions. The Playful Active Urban Living (PAUL) app is among the first to include 2 types of JIT prompts: JIT adaptive reminder messages to initiate a run or walk and JIT strength exercise prompts during a walk or run (containing location-based instruction videos). This paper reports on the feasibility of the PAUL app and its JIT prompts. Objective: The main objective of this study was to examine user experience, app engagement, and users’ perceptions and opinions regarding the PAUL app and its JIT prompts and to explore changes in the PA behavior, intrinsic motivation, and the perceived capability of the PA behavior of the participants. Methods: In total, 2 versions of the closed-beta version of the PAUL app were evaluated: a basic version (Basic PAUL) and a JIT adaptive version (Smart PAUL). Both apps send JIT exercise prompts, but the versions differ in that the Smart PAUL app sends JIT adaptive reminder messages to initiate running or walking behavior, whereas the Basic PAUL app sends reminder messages at randomized times. A total of 23 participants were randomized into 1 of the 2 intervention arms. PA behavior (accelerometer-measured), intrinsic motivation, and the perceived capability of PA behavior were measured before and after the intervention. After the intervention, participants were also asked to complete a questionnaire on user experience, and they were invited for an exit interview to assess user perceptions and opinions of the app in depth. Results: No differences in PA behavior were observed (Z=−1.433; P=.08), but intrinsic motivation for running and walking and for performing strength exercises significantly increased (Z=−3.342; P<.001 and Z=−1.821; P=.04, respectively). Furthermore, participants increased their perceived capability to perform strength exercises (Z=2.231; P=.01) but not to walk or run (Z=−1.221; P=.12). The interviews indicated that the participants were enthusiastic about the strength exercise prompts. These were perceived as personal, fun, and relevant to their health. The reminders were perceived as important initiators for PA, but participants from both app groups explained that the reminder messages were often not sent at times they could exercise. Although the participants were enthusiastic about the functionalities of the app, technical issues resulted in a low user experience. Conclusions: The preliminary findings suggest that the PAUL apps are promising and innovative interventions for promoting PA. Users perceived the strength exercise prompts as a valuable addition to exercise apps. However, to be a feasible intervention, the app must be more stable. %M 35916693 %R 10.2196/35268 %U https://formative.jmir.org/2022/8/e35268 %U https://doi.org/10.2196/35268 %U http://www.ncbi.nlm.nih.gov/pubmed/35916693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35996 %T Using the PMAQ-AB Mobile App and Management System to Evaluate the Quality of Primary Health Care in Brazil: Qualitative Case Study %A Bay Júnior,Osvaldo de Goes %A Diniz Vieira Silva,Cícera Renata %A Santos Martiniano,Cláudia %A de Figueiredo Melo,Lygia Maria %A Barros de Souza,Marize %A Lopes,Monique da Silva %A Coelho,Ardigleusa Alves %A de Medeiros Rocha,Paulo %A de Albuquerque Pinheiro,Themis Xavier %A de Sá Pinto Dantas Rocha,Nadja %A da Costa Uchôa,Severina Alice %+ Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho., Lagoa Nova, Natal, 59064-630, Brazil, 55 84991343560, osvaldobay_jr@hotmail.com %K information technology %K information technology management %K program evaluation %K health evaluation %K meta-evaluation %K primary health care %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The application of cell phones, similar portable devices (ie, tablets), apps, the internet, and GPS in evaluation have established new ways of collecting, storing, retrieving, transmitting, and processing data or information. However, evidence is incipient as to which technological resources remain at the center of assessment practice and the factors that promote their use by the assessment community. Objective: This study aimed to analyze the relationship between the use of the National Program for Improving Primary Healthcare Access and Quality’s (PMAQ-AB; Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica) mobile app and management system and the external evaluation quality of Brazil’s PMAQ-AB. Methods: We conducted a qualitative case study during the external evaluation of Brazil’s PMAQ-AB. Data collection consisted of interviews, focus groups, and document analysis. A total of 7 members from the Department of Primary Care of the Ministry of Health and 47 researchers from various higher education and research institutions across the country participated in the study. Data were categorized using the ATLAS.ti software program, according to the quality standards of the Joint Committee on Standards for Educational Evaluation, following the content analysis approach by Bardin. Results: The results related to feasibility, thematic scope, field activity management, standardized data collection, data consistency, and transparency. They demonstrated improvements and opportunities for advancements in evaluation mediated by the use of information technology (IT), favored the emergence of new practices and remodeling of existing ones, and took into account the multiple components required by the complex assessment of access and quality in primary health care. Difficulties in technology operation, inoperative systems, and lack of investment in equipment and human resources posed challenges to increasing the effectiveness of IT in evaluation. Conclusions: The use of technology-based tools—the app and the management system—during the external evaluation offered evaluators a greater opportunity for stakeholder engagement. This also allowed the insertion of different organizational, operational, and methodological components that are capable of triggering influences and confluences. In addition, this allowed connections in collaborative and synergistic networks to increase the quality and allow the development of a more consistent and efficient evaluation process with greater possibility of incorporating the results into public health policies. %M 35904848 %R 10.2196/35996 %U https://formative.jmir.org/2022/7/e35996 %U https://doi.org/10.2196/35996 %U http://www.ncbi.nlm.nih.gov/pubmed/35904848 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37666 %T Improving Health Knowledge Through Provision of Free Digital Health Education to Rural Communities in Iringa, Tanzania: Nonrandomized Intervention Study %A Holst,Christine %A Stelzle,Dominik %A Diep,Lien My %A Sukums,Felix %A Ngowi,Bernard %A Noll,Josef %A Winkler,Andrea Sylvia %+ Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, PO Box 1130, Blinderen, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no %K digital health %K digital health promotion %K eHealth %K mobile health %K mHealth %K Tanzania %K health education %K HIV/AIDS %K tuberculosis %K cysticercosis %K tapeworm %K mobile phone %D 2022 %7 28.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Community health education is one of the most effective measures to increase health literacy worldwide and can contribute to the achievement of specific targets of the Sustainable Development Goal 3. Digitalized health education materials can improve health knowledge as a dimension of health literacy and play an important role in disease prevention in rural sub-Saharan settings. Objective: The objective of this research is to assess the effect of a digital health education intervention on the uptake and retention of knowledge related to HIV/AIDS, tuberculosis (TB), and Taenia solium (neuro)cysticercosis and taeniosis in rural communities in Iringa, Tanzania. Methods: We conducted a nonrandomized intervention study of participants aged 15 to 45 years, randomly selected from 4 villages in Iringa, Tanzania. The intervention consisted of 2 parts. After the baseline assessment, we showed the participants 3 animated health videos on a tablet computer. After a period of 6 months, free access to community information spots (InfoSpots) with an integrated digital health education platform was provided to the intervention villages. Participants in the control group did not receive the intervention. The primary outcome was the difference in disease knowledge between the intervention and control groups, 12 months after baseline. Data were collected using an open-ended questionnaire, with correct or incorrect answers before and after intervention. Results: Between April and May 2019, a total of 600 participants were recruited into the intervention (n=298, 49.7%) or control (n=302, 50.3%) groups. At baseline, no statistically significant differences in knowledge of the target diseases were observed. At 12 months after intervention, knowledge about HIV/AIDS, TB, and T. solium (neuro)cysticercosis and taeniosis was 10.2% (95% CI 5.0%-15.4%), 12% (95% CI 7.7%-16.2%), and 31.5% (95% CI 26.8%-36.2%) higher in the intervention group than in the control group, respectively. In all 4 domains (transmission, symptoms, treatment, and prevention), an increase in knowledge was observed in all the 3 diseases, albeit to varying degrees. The results were adjusted for potential confounders, and the significance of the primary results was maintained in the sensitivity analysis to assess dropouts. The participants who reported using the InfoSpots in the 12-month assessment further increased their knowledge about the target diseases by 6.8% (HIV/AIDS), 7.5% (TB), and 13.9% higher mean proportion of correct answers compared with the participants who did not use the InfoSpots. Conclusions: Digital health education based on animated health videos and the use of free InfoSpots has significant potential to improve health knowledge, especially in rural areas of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597 International Registered Report Identifier (IRRID): RR2-10.2196/25128 %M 35900820 %R 10.2196/37666 %U https://www.jmir.org/2022/7/e37666 %U https://doi.org/10.2196/37666 %U http://www.ncbi.nlm.nih.gov/pubmed/35900820 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35701 %T Effects of a Gamified, Behavior Change Technique–Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults With Autism Spectrum Disorder: Feasibility Randomized Controlled Trial %A Lee,Daehyoung %A Frey,Georgia C %A Cothran,Donetta J %A Harezlak,Jaroslaw %A Shih,Patrick C %+ Department of Applied Human Sciences, University of Minnesota Duluth, 123 Sports and Health Center, 1216 Ordean Court, Duluth, MN, 55812, United States, 1 2187267816, lee03284@d.umn.edu %K gamification %K behavior change techniques %K physical activity %K sedentary behavior %K anxiety %K autism %K mobile app %K mental health %K mHealth %K mobile phone %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD. Objective: This study aimed to compare the effectiveness of a gamified and behavior change technique–based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. Methods: A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI. Results: The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05). Conclusions: Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD. Trial Registration: ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617 %M 35900808 %R 10.2196/35701 %U https://formative.jmir.org/2022/7/e35701 %U https://doi.org/10.2196/35701 %U http://www.ncbi.nlm.nih.gov/pubmed/35900808 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36392 %T Assessing the Views and Needs of People at High Risk of Gestational Diabetes Mellitus for the Development of Mobile Health Apps: Descriptive Qualitative Study %A Duan,Beibei %A Liu,Zhe %A Liu,Weiwei %A Gou,Baohua %+ School of Nursing, Capital Medical University, No. 10, Xi Tou tiao, You'an Men Wai, Feng tai District, Beijing, 100069, China, 86 13581694127, lwwhlxy@ccmu.edu.cn %K gestational diabetes mellitus %K high-risk groups %K mobile health %K mHealth %K applications %K user-centered design %K qualitative research %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early prevention of gestational diabetes mellitus (GDM) can reduce the incidence of not only GDM, but also adverse perinatal pregnancy outcomes. Moreover, it is of great significance to prevent or reduce the occurrence of type 2 diabetes. Mobile health (mHealth) apps can help pregnant women effectively prevent GDM by providing risk prediction, lifestyle support, peer support, professional support, and other functions. Before designing mHealth apps, developers must understand the views and needs of pregnant women, and closely combine users’ needs to develop app functions, in order to better improve user experience and increase the usage rate of these apps in the future. Objective: The objective of this study was to understand the views of the high-risk population of gestational diabetes mellitus on the development of mobile health apps and the demand for app functions, so as to provide a basis for the development of gestational diabetes mellitus prevention apps. Methods: Fifteen pregnant women with at least one risk factor for gestational diabetes were recruited from July to September 2021, and were interviewed via a semistructured interview using the purpose sampling method. The transcribed data were analyzed by the traditional content analysis method, and themes were extracted. Results: Respondents wanted to develop user-friendly and fully functional mobile apps for the prevention of gestational diabetes mellitus. Pregnant women's requirements for app function development include: personalized customization, accurate information support, interactive design, practical tool support, visual presentation, convenient professional support, peer support, reasonable reminder function, appropriate maternal and infant auxiliary function, and differentiated incentive function.These function settings can encourage pregnant women to improve or maintain healthy living habits during their use of the app Conclusions: This study discusses the functional requirements of target users for gestational diabetes mellitus prevention apps, which can provide reference for the development of future applications. %M 35802414 %R 10.2196/36392 %U https://formative.jmir.org/2022/7/e36392 %U https://doi.org/10.2196/36392 %U http://www.ncbi.nlm.nih.gov/pubmed/35802414 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e34102 %T Awareness, Acceptability, and Perceived Effectiveness of Text-Based Therapy Among Graduate Students: Cross-sectional Study %A Blair,Samari A %A Brockmann,Andrea N %A Arroyo,Kelsey M %A Carpenter,Chelsea A %A Ross,Kathryn M %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 8433, kmross@phhp.ufl.edu %K mental health %K text-based therapy %K graduate students %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research has suggested that there is a mental health crisis occurring among graduate students in the United States. Moreover, many students go without effective treatment owing to the limited availability of mental and behavioral health resources on college campuses. Text-based therapy may represent a viable method for increasing access to mental health support for graduate students, but little is known regarding its acceptability in this population. Objective: The purpose of this study was to assess how graduate students perceive text-based therapy and their likelihood of seeking out this form of therapy. Methods: In total, 265 graduate students completed a cross-sectional web-based survey that included multiple-choice and open-ended questions assessing their perceptions of text-based therapy and the likelihood of seeking out this form of therapy. Chi-square tests, ANOVAs, and nonparametric Wilcoxon signed-rank tests were used to examine differences in multiple-choice questions. The constant comparative method was used for qualitative analyses of the open-ended question responses. Results: Participants (n=265) were predominately non-Hispanic White (166/265, 62.6%) and female (167/265, 63%) with a mean age of 28.3 (SD 5.1) years. Over half of the participants (139/265, 52.5%) were not aware that text-based therapy existed; however, 65.3% (173/265) reported that they would consider using text-based services, if available. In comparison to face-to-face therapy, participants reported being less likely to seek out text-based therapy and perceived it as less effective (P<.001). Qualitative results indicated that participants were concerned about the ability to effectively communicate and build rapport through text-based therapy and thought that this modality may be more effective for some mental and behavioral health concerns than others. Moreover, participants noted that text-based therapy would be best implemented as a way to supplement, rather than replace, face-to-face services. Conclusions: Altogether, the results of this study suggest that text-based therapy holds the potential to increase access to and use of mental and behavioral health services; however, graduate students remain concerned about its effectiveness and the optimal methods of implementation. Future research should investigate how therapeutic processes (eg, effective communication and rapport-building) can be facilitated in digital environments and how text-based therapy could be best implemented to supplement and extend, rather than replace, face-to-face services. %M 35797098 %R 10.2196/34102 %U https://mhealth.jmir.org/2022/7/e34102 %U https://doi.org/10.2196/34102 %U http://www.ncbi.nlm.nih.gov/pubmed/35797098 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37291 %T Optimization of the Chronic Kidney Disease–Peritoneal Dialysis App to Improve Care for Patients on Peritoneal Dialysis in Northeast Thailand: User-Centered Design Study %A Lukkanalikitkul,Eakalak %A Kongpetch,Sawinee %A Chotmongkol,Wijittra %A Morley,Michael G %A Anutrakulchai,Sirirat %A Srichan,Chavis %A Thinkhamrop,Bandit %A Chunghom,Theenatchar %A Wiangnon,Pongsai %A Thinkhamrop,Wilaiphorn %A Morley,Katharine E %+ Massachusetts General Hospital Center for Global Health, Harvard Medical School, 125 Nashua St. Suite 722, Boston, MA, 02114, United States, 1 617 726 2000, kemorley@mgh.harvard.edu %K peritoneal %K dialysis %K peritoneum %K mobile health %K mHealth %K rapid cycle process improvement methodology %K home monitoring %K near-field communication %K monitor %K kidney %K rapid cycle improvement %K quality improvement %K process improvement %K methodology %K nephrology %K nephrologist %K internal medicine %K computer program %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K usability %K interface %K metric capture %K barrier %K renal %K mobile phone %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part because of Thailand’s Peritoneal Dialysis First policy. PD is a home-based renal replacement therapy in which patients with chronic kidney disease perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in patients on PD and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume, from each dialysis cycle and enter this information into a PD logbook. This information is reviewed bimonthly at PD clinic appointments. The chronic kidney disease-PD (CKD-PD) app with near-field communication (NFC) and optical character recognition (OCR) was developed to automate hydration metric collection. The information was displayed in the app for self-monitoring and uploaded to a database for real-time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce the morbidity and mortality related to overhydration. Objective: This study aims to identify usability issues and technology adoption barriers for the CKD-PD app with NFC and OCR and a monitoring system and to use this information to make rapid cycle improvements. Methods: A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers, and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC and OCR and a monitoring system. The participants were observed using technology in their homes in 3 phases. The data collected included the Unified Theory of Acceptance and Use of Technology questionnaire, think-aloud observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app. Results: The CKD-PD app with NFC and OCR and a monitoring system underwent 3 rapid improvement cycles. Issues were identified regarding the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation, and display. NFC and OCR improved hydration metric capture; however, issues remained with their usability. App stability and user interface issues were corrected, and hydration metrics were successfully uploaded by the end of phase 3. Participants’ scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinical communication features. Conclusions: Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC and OCR and a monitoring system. We believe that this methodology can be accomplished with limited training in data collection, statistical analysis, and funding. %M 35793137 %R 10.2196/37291 %U https://formative.jmir.org/2022/7/e37291 %U https://doi.org/10.2196/37291 %U http://www.ncbi.nlm.nih.gov/pubmed/35793137 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e34685 %T Health Consumer Engagement, Enablement, and Empowerment in Smartphone-Enabled Home-Based Diagnostic Testing for Viral Infections: Mixed Methods Study %A LeRouge,Cynthia %A Durneva,Polina %A Lyon,Victoria %A Thompson,Matthew %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, 11200 S.W. 8th St., RB 206B, Miami, FL, 33199, United States, 1 305 348 4709, clerouge@fiu.edu %K smart HT %K mHealth %K patient engagement %K patient enablement %K patient empowerment %K diagnostic testing %K viral infection %K patient activation %K consumer health informatics %K influenza %K home testing %K mobile phone %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health consumers are increasingly taking a more substantial role in decision-making and self-care regarding their health. A range of digital technologies is available for laypeople to find, share, and generate health-related information that supports their health care processes. There is also innovation and interest in home testing enabled by smartphone technology (smartphone-supported home testing [smart HT]). However, few studies have focused on the process from initial engagement to acting on the test results, which involves multiple decisions. Objective: This study aimed to identify and model the key factors leading to health consumers’ engagement and enablement associated with smart HT. We also explored multiple levels of health care choices resulting from health consumer empowerment and activation from smart HT use. Understanding the factors and choices associated with engagement, enablement, empowerment, and activation helps both research and practice to support the intended and optimal use of smart HT. Methods: This study reports the findings from 2 phases of a more extensive pilot study of smart HT for viral infection. In these 2 phases, we used mixed methods (semistructured interviews and surveys) to shed light on the situated complexities of health consumers making autonomous decisions to engage with, perform, and act on smart HT, supporting the diagnostic aspects of their health care. Interview (n=31) and survey (n=282) participants underwent smart HT testing for influenza in earlier pilot phases. The survey also extended the viral infection context to include questions related to potential smart HT use for SARS-CoV-2 diagnosis. Results: Our resulting model revealed the smart HT engagement and enablement factors, as well as choices resulting from empowerment and activation. The model included factors leading to engagement, specifically various intrinsic and extrinsic influences. Moreover, the model included various enablement factors, including the quality of smart HT and the personal capacity to perform smart HT. The model also explores various choices resulting from empowerment and activation from the perspectives of various stakeholders (public vs private) and concerning different levels of impact (personal vs distant). Conclusions: The findings provide insight into the nuanced and complex ways health consumers make decisions to engage with and perform smart HT and how they may react to positive results in terms of public-private and personal-distant dimensions. Moreover, the study illuminates the role that providers and smart HT sources can play to better support digitally engaged health consumers in the smart HT decision process. %M 35771605 %R 10.2196/34685 %U https://mhealth.jmir.org/2022/6/e34685 %U https://doi.org/10.2196/34685 %U http://www.ncbi.nlm.nih.gov/pubmed/35771605 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36870 %T Monitoring and Managing Lifestyle Behaviors Using Wearable Activity Trackers: Mixed Methods Study of Views From the Huntington Disease Community %A Morgan-Jones,Philippa %A Jones,Annabel %A Busse,Monica %A Mills,Laura %A Pallmann,Philip %A Drew,Cheney %A Arnesen,Astri %A Wood,Fiona %A , %+ Division of Population Medicine, Cardiff University, 8th floor, Neuadd Meirionnydd, University Hospital of Wales, Cardiff, CF14 4YS, United Kingdom, 44 2920687185, wood@cardiff.ac.uk %K Huntington disease %K activity tracker %K perceptions %K digital technologies %K physical activity %K qualitative research %K survey %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There are early indications that lifestyle behaviors, specifically physical activity and sleep, may be associated with the onset and progression of Huntington disease (HD). Wearable activity trackers offer an exciting opportunity to collect long-term activity data to further investigate the role of lifestyle, physical activity, and sleep in disease modification. Given how wearable devices rely on user acceptance and long-term adoption, it is important to understand users’ perspectives on how acceptable any device might be and how users might engage over the longer term. Objective: This study aimed to explore the perceptions, motivators, and potential barriers relating to the adoption of wearable activity trackers by people with HD for monitoring and managing their lifestyle and sleep. This information intended to guide the selection of wearable activity trackers for use in a longitudinal observational clinical study. Methods: We conducted a mixed methods study; this allowed us to draw on the potential strengths of both quantitative and qualitative methods. Opportunistic participant recruitment occurred at 4 Huntington’s Disease Association meetings, including 1 international meeting and 3 United Kingdom–based regional meetings. Individuals with HD, their family members, and carers were invited to complete a user acceptance questionnaire and participate in a focus group discussion. The questionnaire consisted of 35 items across 8 domains using a 0 to 4 Likert scale, along with some additional demographic questions. Average questionnaire responses were recorded as positive (score>2.5), negative (score<1.5), or neutral (score between 1.5 and 2.5) opinions for each domain. Differences owing to demographics were explored using the Kruskal-Wallis and Wilcoxon rank sum tests. Focus group discussions (conducted in English) were driven by a topic guide, a vignette scenario, and an item ranking exercise. The discussions were audio recorded and then analyzed using thematic analysis. Results: A total of 105 completed questionnaires were analyzed (47 people with HD and 58 family members or carers). All sections of the questionnaire produced median scores >2.5, indicating a tendency toward positive opinions on wearable activity trackers, such as the devices being advantageous, easy and enjoyable to use, and compatible with lifestyle and users being able to understand the information from trackers and willing to wear them. People with HD reported a more positive attitude toward wearable activity trackers than their family members or caregivers (P=.02). A total of 15 participants participated in 3 focus groups. Device compatibility and accuracy, data security, impact on relationships, and the ability to monitor and self-manage lifestyle behaviors have emerged as important considerations in device use and user preferences. Conclusions: Although wearable activity trackers were broadly recognized as acceptable for both monitoring and management, various aspects of device design and functionality must be considered to promote acceptance in this clinical cohort. %M 35767346 %R 10.2196/36870 %U https://formative.jmir.org/2022/6/e36870 %U https://doi.org/10.2196/36870 %U http://www.ncbi.nlm.nih.gov/pubmed/35767346 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34278 %T User Perceptions of eHealth and mHealth Services Promoting Physical Activity and Healthy Diets: Systematic Review %A Bergevi,Julia %A Andermo,Susanne %A Woldamanuel,Yohannes %A Johansson,Unn-Britt %A Hagströmer,Maria %A Rossen,Jenny %+ Department of Health Promoting Science, Sophiahemmet University, Lindstedsvägen 8, Stockholm, 11486, Sweden, 46 701718634, jenny.rossen@shh.se %K acceptability %K behavior change %K engagement %K health technology %K noncommunicable diseases %K usability %K user feedback %K qualitative studies %K physical activity %K healthy diet %D 2022 %7 28.6.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Physical activity and a diet that follows general recommendations can help to prevent noncommunicable diseases. However, most adults do not meet current recommended guidelines, and support for behavior change needs to be strengthened. There is growing evidence that shows the benefits of eHealth and mobile health (mHealth) services in promoting healthy habits; however, their long-term effectiveness is uncertain because of nonadherence. Objective: We aimed to explore users’ perceptions of acceptability, engagement, and usability of eHealth and mHealth services that promote physical activity, healthy diets, or both in the primary or secondary prevention of noncommunicable diseases. Methods: We conducted a systematic review with a narrative synthesis. We performed the literature search in PubMed, PsycINFO, and CINAHL electronic databases in February 2021 and July 2021. The search was limited to papers published in English between 2016 and 2021. Papers on qualitative and mixed method studies that encompassed eHealth and mHealth services for adults with a focus on physical activity, healthy diet, or both in the primary or secondary prevention of noncommunicable diseases were included. Three authors screened the studies independently, and 2 of the authors separately performed thematic analysis of qualitative data. Results: With an initial finding of 6308 articles and the removal of 427 duplicates, 23 articles were deemed eligible for inclusion in the review. Based on users’ preferences, an overarching theme—eHealth and mHealth services provide value but need to be tailored to individual needs—and 5 subthemes—interactive and integrated; varying and multifunctional; easy, pedagogic, and attractive; individualized and customizable; and reliable—emerged. Conclusions: New evidence on the optimization of digital services that promote physical activity and healthy diets has been synthesized. The findings represent users’ perceptions of acceptability, engagement, and usability of eHealth and mHealth services and show that services should be personalized, dynamic, easily manageable, and reliable. These findings can help improve adherence to digital health-promoting services. %M 35763339 %R 10.2196/34278 %U https://humanfactors.jmir.org/2022/2/e34278 %U https://doi.org/10.2196/34278 %U http://www.ncbi.nlm.nih.gov/pubmed/35763339 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e38991 %T Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial %A Leightley,Daniel %A Williamson,Charlotte %A Rona,Roberto J %A Carr,Ewan %A Shearer,James %A Davis,Jordan P %A Simms,Amos %A Fear,Nicola T %A Goodwin,Laura %A Murphy,Dominic %+ Institute of Psychiatry, Psychology & Neuroscience, King’s Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 78485351, daniel.leightley@kcl.ac.uk %K military %K veteran %K digital health %K alcohol misuse %K smartphone %K mobile health %K mHealth %K alcohol intervention %K digital intervention %K mental health %K smartphone application %K health intervention %K alcohol consumption %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF. Objective: To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties. Methods: We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants’ motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score. Results: Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by –10.5 (95% CI –19.5 to –1.5) units in the control arm and –28.2 (95% CI –36.9 to –19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of –3.9 (95% CI –6.2 to –1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial. Conclusions: This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans. Trial Registration: ClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9f International Registered Report Identifier (IRRID): RR2-10.2196/19720 %M 35724966 %R 10.2196/38991 %U https://mhealth.jmir.org/2022/6/e38991 %U https://doi.org/10.2196/38991 %U http://www.ncbi.nlm.nih.gov/pubmed/35724966 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35342 %T Developing mHealth to the Context and Valuation of Injured Patients and Professionals in Hospital Trauma Care: Qualitative and Quantitative Formative Evaluations %A Houwen,Thymen %A Vugts,Miel A P %A Lansink,Koen W W %A Theeuwes,Hilco P %A Neequaye,Nicky %A Beerekamp,M Susan H %A Joosen,Margot C W %A de Jongh,Mariska A C %+ Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Hilvarenbeekseweg 60, Tilburg, 5022 GC, Netherlands, 31 132212103, t.houwen@etz.nl %K wounds and injuries %K telemedicine %K recovery of function %K rehabilitation %K patient care management %K qualitative research %K evaluation study %K holistic health %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients’ health experience. Systematic needs inquiries and collaborations with professional and patient end users are highly recommended to develop and prepare future implementations of such innovations. Objective: This study aimed to develop a trauma mHealth app for patient information and support in accordance with the Center for eHealth Research and Disease Management road map and describe experiences of unmet information and support needs among injured patients with trauma, barriers to and facilitators of the provision of information and support among trauma care professionals, and drivers of value of an mHealth app in patients with trauma and trauma care professionals. Methods: Formative evaluations were conducted using quantitative and qualitative methods. Ten semistructured interviews with patients with trauma and a focus group with 4 trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated for hypothetical mHealth products with various attributes. Panel data from the DCE were analyzed using conditional and mixed logit models. Results: Patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences, and future prospects. Health care professionals designated workload as an essential issue; a digital solution should not require additional time. The conditional logit model of DCE results suggested that access to patient app data through electronic medical record integration (odds ratio [OR] 3.3, 95% CI 2.55-4.34; P<.001) or a web viewer (OR 2.3, 95% CI 1.64-3.31; P<.001) was considered the most important for an mHealth solution by surgeons, followed by the inclusion of periodic self-measurements (OR 2, 95% CI 1.64-2.46; P<.001), the local adjustment of patient information (OR 1.8, 95% CI 1.42-2.33; P<.001), local hospital identification (OR 1.7, 95% CI 1.31-2.10; P<.001), complication detection (OR 1.5, 95% CI 1.21-1.84; P<.001), and the personalization of rehabilitation through artificial intelligence (OR 1.4, 95% CI 1.13-1.62; P=.001). Conclusions: In the context of trauma care, end users have many requirements for an mHealth solution that addresses psychosocial functioning; dependable information; and, possibly, a prediction of how a patient’s recovery trajectory is evolving. A structured development approach provided insights into value drivers and facilitated mHealth prototype enhancement. The findings imply that iterative development should move on from simple and easily implementable mHealth solutions to those that are suitable for broader innovations of care pathways that most—but plausibly not yet all—end users in trauma care will value. This study could inspire the trauma care community. %M 35723928 %R 10.2196/35342 %U https://humanfactors.jmir.org/2022/2/e35342 %U https://doi.org/10.2196/35342 %U http://www.ncbi.nlm.nih.gov/pubmed/35723928 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37008 %T Exploring Whether Addictions Counselors Recommend That Their Patients Use Websites, Smartphone Apps, or Other Digital Health Tools to Help Them in Their Recovery: Web-Based Survey %A Wray,Tyler B %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 14018636659, tyler_wray@brown.edu %K addiction %K alcohol %K drug use %K substance use %K adoption %K smartphone %K mobile health %K mHealth %K marketing %K dissemination %K counselor %K health care professional %K digital health %K eHealth %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hundreds of smartphone apps or websites claiming to help those with addictions are available, but few have been tested for efficacy in changing clinically relevant addictions outcomes. Although most of these products are designed for self-facilitation by users struggling with addictions, counselors and other addictions treatment providers will likely play a critical role in facilitating adoption by integrating their use into counseling or recommending them to their patients. Yet, few studies have explored the practices of addictions counselors in using or recommending addictions-focused digital health tools in their work. Objective: The aim of this study was to understand whether addiction counselors are recommending that their patients use addictions-focused apps to help them in their recovery, and the factors that affect their desire to do so. Methods: Licensed addiction counselors practicing in the United States (N=112) were recruited from professional and scientific organizations of alcohol or drug counselors to complete a web-based survey. Results: In total, 74% (83/112) of counselors had recommended that their patients use a website or smartphone app to assist them in recovery, and those that had done so reported recommending an app with an average of 54% of their patients. The most commonly recommended app or website was SMARTRecovery.org (9%), I am Sober (8%), In the Rooms (7%), Insight Timer (4%), Calm (4%), Sober Tool (4%), Recovery Box (3%), and Sober Grid (3%). The most important reason that counselors recommended the websites or apps was that colleagues or patients told them they found it helpful (55%), followed by their workplaces recommending it (20%) and professional organizations recommending it (10%). Counselors’ intentions to recommend a hypothetical app were strongest for apps that had been tested in rigorous, scientific studies that showed they helped users stay sober or reduce their substance use; 94% (105/112) reported that they would “definitely” or “probably” use such an app. Conclusions: Most addictions counselors surveyed are already recommending that their patients use apps or websites to help them in their recovery, despite the paucity of available products that have evidence supporting their efficacy for addictions outcomes. One way that product developers could increase adoption among addictions treatment providers is to make efficacy testing a priority and to disseminate results through professional organizations and clinics. %M 35723917 %R 10.2196/37008 %U https://formative.jmir.org/2022/6/e37008 %U https://doi.org/10.2196/37008 %U http://www.ncbi.nlm.nih.gov/pubmed/35723917 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33089 %T Feasibility of Using Games to Improve Healthy Lifestyle Knowledge in Youth Aged 9-16 Years at Risk for Type 2 Diabetes: Pilot Randomized Controlled Trial %A Maddison,Ralph %A Baghaei,Nilufar %A Calder,Amanda %A Murphy,Rinki %A Parag,Varsha %A Heke,Ihirangi %A Dobson,Rosie %A Marsh,Samantha %+ Institute for Physical Activity and Nutrition, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 392446218, ralph.maddison@deakin.edu.au %K children’s health %K diabetes mellitus %K type 2 diabetes %K experimental games %K recruitment %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile games can be effective and motivating tools for promoting children’s health. Objective: We aimed to determine the comparative use of 2 prototype serious games for health and assess their effects on healthy lifestyle knowledge in youth aged 9-16 years at risk for type 2 diabetes (T2D). Methods: A 3-arm parallel pilot randomized controlled trial was undertaken to determine the feasibility and preliminary effectiveness of 2 serious games. Feasibility aspects included recruitment, participant attitudes toward the games, the amount of time the participants played each game at home, and the effects of the games on healthy lifestyle and T2D knowledge. Participants were allocated to play Diabetic Jumper (n=7), Ari and Friends (n=8), or a control game (n=8). All participants completed healthy lifestyle and T2D knowledge questionnaires at baseline, immediately after game play, and 4 weeks after game play. Game attitudes and preferences were also assessed. The primary outcome was the use of the game (specifically, the number of minutes played over 4 weeks). Results: In terms of feasibility, we were unable to recruit our target of 60 participants. In total, 23 participants were recruited. Participants generally viewed the games positively. There were no statistical differences in healthy lifestyle knowledge or diabetes knowledge over time or across games. Only 1 participant accessed the game for an extended period, playing the game for a total of 33 min over 4 weeks. Conclusions: It was not feasible to recruit the target sample for this trial. The 2 prototype serious games were unsuccessful at sustaining long-term game play outside a clinic environment. Based on positive participant attitudes toward the games, it is possible to use these games or similar games as short-term stimuli to engage young people with healthy lifestyle and diabetes knowledge in a clinic setting; however, future research is required to explore this area. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619000380190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377123 %M 35713955 %R 10.2196/33089 %U https://formative.jmir.org/2022/6/e33089 %U https://doi.org/10.2196/33089 %U http://www.ncbi.nlm.nih.gov/pubmed/35713955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34882 %T Use of Smartphone Health Apps Among Patients Aged 18 to 69 Years in Primary Care: Population-Based Cross-sectional Survey %A Paradis,Sabrina %A Roussel,Jeremy %A Bosson,Jean-Luc %A Kern,Jean-Baptiste %+ Translational Innovation in Medicine and Complexity, National Institute of Health and Medical Research, Laboratoire TIMC, Bâtiment Taillefer, Rond-Point de la Croix de Vie, Domaine de la Merci, La Tronche, 38706, France, 33 678863377, sabrina.paradis@univ-grenoble-alpes.fr %K smartphone %K health applications %K mHealth %K apps %K mobile health %K digital health %K well-being %K epidemiology %K primary care %K population survey %K fitness %K physical activity %K health behavior %K patient %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization has defined mobile health (mHealth) as the “use of mobile and wireless technologies to support the achievement of health objectives.” Smartphones currently represent one of the main media forms for mHealth democratization. Health apps can be an interesting tool for changing health behaviors. However, their use in France is still poorly documented. Objective: The main aim of this study was to evaluate the frequency of use of health apps among patients consulting in the primary care setting in France. The secondary aims were to evaluate the use of health apps according to the sociodemographic and medical characteristics of patients and to determine their use. Methods: A population-based cross-sectional survey was carried out between November 2017 and January 2018 in the Grenoble area of France among patients aged between 18 and 69 years who were consulting at 13 primary care physician offices. Patients were provided with anonymous paper self-questionnaires. The main criterion for participation was the use of a smartphone health app, defined for the purpose of this study as any app supporting patients in efforts to be healthy. Results: The participation rate was 49.27% (739/1500; 95% CI 46.7%-51.8%). The smartphone use was estimated at 82.6% (597/723; 95% CI 79.6%-85.2%). Of 597 smartphone owners, 47.7% (283/595; CI 43.6%-51.6%) used at least one smartphone health app. Health apps identified in this study were mainly related to wellness, prevention, and fitness (66.1%), as well as medication, treatments, and follow-up care (50.0%). The main factors associated with health app use were: use of social networks (odds ratio [OR] 3.4, 95% CI 2.1-5.3), age under 30 years (OR 2.7, CI 1.4-4.9), city size between 5001 and 10,000 inhabitants (OR 1.8, CI 1.1-2.8), and city size more than 10,000 inhabitants (OR 2.1, CI 1.4-3.2). Conclusions: In this survey, nearly one out of two patients reported the use of smartphone health apps, which are currently focused on wellness, prevention, and fitness, and are largely used by the younger population. Trial Registration: ClinicalTrials.gov NCT03351491; https://clinicaltrials.gov/ct2/show/NCT03351491 %M 35708744 %R 10.2196/34882 %U https://formative.jmir.org/2022/6/e34882 %U https://doi.org/10.2196/34882 %U http://www.ncbi.nlm.nih.gov/pubmed/35708744 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e39198 %T Authors’ Response to: Additional Measurement Approaches for Sleep Disturbances. Comment on “Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study” %A Carney,Colleen E %A Carmona,Nicole E %+ Toronto Metropolitan University, Jorgenson Hall, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 4169795000 ext 552177, ccarney@ryerson.ca %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %K smartphone %K polysomnography %D 2022 %7 13.6.2022 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 35699990 %R 10.2196/39198 %U https://formative.jmir.org/2022/6/e39198 %U https://doi.org/10.2196/39198 %U http://www.ncbi.nlm.nih.gov/pubmed/35699990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35959 %T Additional Measurement Approaches for Sleep Disturbances. Comment on “A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study” %A Tsai,Wan-Tong %A Liu,Tzung-Liang %+ Chung Shan Medical University, No 110, Sec 1, Jianguo N Rd, South District, Taichung City, 40201, Taiwan, 886 968938360, science.tsai@gmail.com %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %K smartphone %K polysomnography %D 2022 %7 13.6.2022 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 35700003 %R 10.2196/35959 %U https://formative.jmir.org/2022/6/e35959 %U https://doi.org/10.2196/35959 %U http://www.ncbi.nlm.nih.gov/pubmed/35700003 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e31069 %T Viewing Mobile Health Technology Design Through the Lens of Amplification Theory %A Merid,Beza %A Robles,Maria Cielito %A Nallamothu,Brahmajee K %A Newman,Mark W %A Skolarus,Lesli E %+ School for the Future of Innovation in Society, Arizona State University, 1120 South Cady Mall, Tempe, AZ, 85281, United States, 1 (480) 727 8787, Beza.Merid@asu.edu %K mHealth %K digital health %K cardiovascular disease %K high blood pressure %K structural barriers to health %K racial health disparities %K Amplification Theory of Technology %D 2022 %7 10.6.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Digital health interventions designed to promote health equity can be valuable tools in the delivery of health care to hardly served patient populations. But if the design of these technologies and the interventions in which they are deployed do not address the myriad structural barriers to care that minoritized patients, patients in rural areas, and patients who have trouble paying for care often face, their impact may be limited. Drawing on our mobile health (mHealth) research in the arena of cardiovascular care and blood pressure management, this viewpoint argues that health care providers and researchers should tend to structural barriers to care as a part of their digital health intervention design. Our 3-step predesign framework, informed by the Amplification Theory of Technology, offers a model that interventionists can follow to address these concerns. %M 35687411 %R 10.2196/31069 %U https://mhealth.jmir.org/2022/6/e31069 %U https://doi.org/10.2196/31069 %U http://www.ncbi.nlm.nih.gov/pubmed/35687411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e23879 %T Feasibility and Acceptability of Internet-Based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis %A Bright,Katherine S %A Stuart,Scott %A Mcneil,Deborah A %A Murray,Lindsay %A Kingston,Dawn E %+ Faculty of Nursing, University of Calgary, PF2500B, 2500 University Drive NW,, Calgary, AB, T2N 1N4, Canada, 1 403 220 6262, ksbright@ucalgary.ca %K internet-based %K interpersonal psychotherapy %K mental health %K prenatal %K anxiety %K depression %K stress %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prenatal mental health is a global health concern. Despite the far-reaching impact of prenatal mental health issues, many women do not receive the psychological care they require. Women in their childbearing years are frequent users of the internet and smartphone apps. Prenatal women are prime candidates for internet-based support for mental health care. Objective: This study aimed to examine the feasibility and acceptability of internet-based interpersonal psychotherapy (IPT) for prenatal women. Methods: Semistructured interviews were conducted with women who had received internet-based IPT modules with guided support as a component of a randomized controlled trial evaluating the scale-up implementation of a digital mental health platform (The Healthy Outcomes of Pregnancy and Postpartum Experiences digital platform) for pregnant women. Qualitative thematic analysis was used to explore and describe women’s experiences. Data were analyzed for emerging themes, which were identified and coded. Results: A total of 15 prenatal women were interviewed to examine their experiences and views on the feasibility and acceptability of internet-based IPT modules. Participants found the content informative and appreciated the ways in which the digital mental health platform made the IPT modules accessible to users. Participants voiced some differing requirements regarding the depth and the way information was presented and accessed on the digital mental health platform. The important areas for improvement that were identified were acknowledging greater depth and clarity of content, the need for sociability and relationships, and refinement of the digital mental health platform to a smartphone app. Conclusions: This study provides useful evidence regarding treatment format and content preferences, which may inform future development. It also provides research data on the feasibility and acceptability of web-based applications for prenatal mental health care. Trial Registration: ClinicalTrials.gov NCT01901796; https://clinicaltrials.gov/ct2/show/NCT01901796 %M 35687403 %R 10.2196/23879 %U https://formative.jmir.org/2022/6/e23879 %U https://doi.org/10.2196/23879 %U http://www.ncbi.nlm.nih.gov/pubmed/35687403 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33972 %T Features and Components Preferred by Adolescents in Smartphone Apps for the Promotion of Physical Activity: Focus Group Study %A Domin,Alex %A Ouzzahra,Yacine %A Vögele,Claus %+ Research Group for Self-Regulation and Health, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 9389, alex.domin@uni.lu %K mHealth %K physical activity %K mobile phone %K health %K qualitative research %K focus groups %K smartphone apps %K behavior change %K mobile health %K adolescents %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: There is solid evidence that lack of physical activity (PA) is a risk factor for chronic diseases. Sufficient levels of PA in childhood and adolescence are particularly important, as they can set the standards for PA levels in adulthood. The latest reports show that only a small percentage of adolescents reach the recommended levels of PA in European Union countries at the age of 15 years. In view of the scale of the problem, it is crucial to develop interventions that promote and support PA in adolescents. Considering their low implementation costs and ubiquitous presence, smartphone apps could be advantageous as a part of PA interventions. Objective: This study aimed at investigating the attitudes and preferences of adolescents aged 16-18 years toward various PA app features and components that could (1) make the app more attractive for them and consequently (2) increase their interest and engagement with the app. Methods: Two separate focus group discussions were conducted in 2 groups of adolescents (n=4 each) aged 16-18 years. Focus groups were carried out online via video conference. The discussions were conducted using a semistructured interview. Participants (n=8; 4 males and 4 females) had a mean age of 17.25 years (SD 0.82 years). Transcripts were analyzed following the approach by Krueger and Casey, that is, categorizing participants’ answers and comments according to the questions and themes from the focus group schedule. Results: Features, such as “goal setting and planning,” “coaching and training programs,” “activity tracking,” “feedback,” and “location tracking” were appraised as attractive, motivating, and interesting. An “automatic activity recognition” feature was perceived as useful only under the condition that its precision was high. The “reminders” component was also deemed as useful only if a range of conditions was fulfilled (timeliness, opportunity for customization, etc). The features “mood and sleep tracking,” “sharing workout results via social networks,” “digital avatar and coach,” and “rewards” were generally perceived negatively and considered as useless and not motivating. In general, participants preferred features with an easy-to-navigate interface and a clear, simplistic, and straightforward layout with a modern design. Customization and personalization qualities were highly appreciated throughout an app, together with data precision. Conclusions: This study contributes to the understanding of the features and components preferred by adolescents in apps promoting PA. Such apps should provide users with precise data, and have a simplistic modern design and a straightforward easy-to-use interface. Apps should be personalized and customizable. Desired features to be included in an app are goal setting and planning, feedback, coaching and training programs, and activity tracking. The features should involve high levels of data precision and timely delivery while taking into consideration the real-life context. %M 35679113 %R 10.2196/33972 %U https://humanfactors.jmir.org/2022/2/e33972 %U https://doi.org/10.2196/33972 %U http://www.ncbi.nlm.nih.gov/pubmed/35679113 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e30960 %T Impact of the Moderating Effect of National Culture on Adoption Intention in Wearable Health Care Devices: Meta-analysis %A Zhang,Zhenming %A Xia,Enjun %A Huang,Jieping %+ School of Management and Economics, Beijing Institute of Technology, 5 South Zhongguancun Street, Haidian District, Beijing, 100081, China, 86 139 1085 0628, cindy@bit.edu.cn %K wearable health care devices %K national culture %K moderating effect %K meta-analysis %D 2022 %7 3.6.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Wearable health care devices have not yet been commercialized on a large scale. Additionally, people in different countries have different utilization rates. Therefore, more in-depth studies on the moderating effect of national culture on adoption intention in wearable health care devices are necessary. Objective: This study aims to explore the summary results of the relationships between perceived usefulness and perceived ease of use with adoption intention in wearable health care devices and the impact of the moderating effect of national culture on these two relationships. Methods: We searched for studies published before September 2021 in the Web of Science, EBSCO, Engineering Village, China National Knowledge Infrastructure, IEEE Xplore, and Wiley Online Library databases. CMA (version 2.0, Biostat Inc) software was used to perform the meta-analysis. We conducted publication bias and heterogeneity tests on the data. The random-effects model was used to estimate the main effect size, and a sensitivity analysis was conducted. A meta-regression analysis was used to test the moderating effect of national culture. Results: This meta-analysis included 20 publications with a total of 6128 participants. Perceived usefulness (r=0.612, P<.001) and perceived ease of use (r=0.462, P<.001) positively affect adoption intention. The relationship between perceived usefulness and adoption intention is positively moderated by individualism/collectivism (β=.003, P<.001), masculinity/femininity (β=.008, P<.001) and indulgence/restraint (β=.005, P<.001), and negatively moderated by uncertainty avoidance (β=-.005, P<.001). The relationship between perceived ease of use and adoption intention is positively moderated by individualism/collectivism (β=.003, P<.001), masculinity/femininity (β=.006, P<.001) and indulgence/restraint (β=.009, P<.001), and negatively moderated by uncertainty avoidance (β=-.004, P<.001). Conclusions: This meta-analysis provided comprehensive evidence on the positive relationship between perceived usefulness and perceived ease of use with adoption intention and the moderating effect of national culture on these two relationships. Regarding the moderating effect, perceived usefulness and perceived ease of use have a greater impact on adoption intention for people in individualistic, masculine, low uncertainty avoidance, and indulgence cultures, respectively. %M 35657654 %R 10.2196/30960 %U https://mhealth.jmir.org/2022/6/e30960 %U https://doi.org/10.2196/30960 %U http://www.ncbi.nlm.nih.gov/pubmed/35657654 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35478 %T Development of a Digital Tool for People With a Long-Term Condition Using Stroke as a Case Example: Participatory Design Approach %A Kjörk,Emma K %A Sunnerhagen,Katharina S %A Lundgren-Nilsson,Åsa %A Andersson,Anders K %A Carlsson,Gunnel %+ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3 floor, Gothenburg, 413 45, Sweden, 46 735124309, emma.kjork@gu.se %K eHealth %K digital tool %K Strokehälsa %K follow-up %K chronic care %K stroke %K Post-Stroke Checklist %K health literacy %K co-design %K shared decision making %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In patient care, demand is growing for digital health tools to enable remote services and enhance patient involvement. People with chronic conditions often have multiple health problems, and long-term follow-up is recommended to meet their needs and enable access to appropriate support. A digital tool for previsit preparation could enhance time efficiency and guide the conversation during the visit toward the patient’s priorities. Objective: This study aims to develop a digital previsit tool and explore potential end user’s perceptions, using a participatory approach with stroke as a case example. Methods: The digital tool was developed and prototyped according to service design principles, informed by qualitative participant data and feedback from an expert panel. All features were processed in workshops with a team that included a patient partner. The resulting tool presented questions about health problems and health information. Study participants were people with stroke recruited from an outpatient clinic and patient organizations in Sweden. Development and data collection were conducted in parallel. For conceptualization, the initial prototype was based on the Post-Stroke Checklist and research. Needs and relevance were explored in focus groups, and we used a web survey and individual interviews to explore perceived utility, ease of use, and acceptance. Data were thematically analyzed following the Framework Method. Results: The development process included 22 participants (9 women) with a median age of 59 (range 42-83) years and a median of 51 (range 4-228) months since stroke. Participants were satisfied or very satisfied with using the tool and recommended its use in clinical practice. Three main themes were constructed based on focus group data (n=12) and interviews (n=10). First, valuable accessible information illuminated the need for information to confirm experiences, facilitate responses, and invite engagement in their care. Amendments to the information in turn reconfigured their expectations. Second, utility and complexity in answering confirmed that the questions were relevant and comprehensible. Some participants perceived the answer options as limiting and suggested additional space for free text. Third, capturing needs and value of the tool highlighted the tool’s potential to identify health problems and the importance of encouraging further dialog. The resulting digital tool, Strokehälsa [Strokehealth] version 1.0, is now incorporated into a national health platform. Conclusions: The participatory approach to tool development yielded a previsit digital tool that the study group perceived as useful. The holistic development process used here, which integrated health information, validated questions, and digital functionality, offers an example that could be applicable in the context of other long-term conditions. Beyond its potential to identify care needs, the tool offers information that confirms experiences and supports answering the questions in the tool. The tool is freely shared for adaptation in different contexts. Trial Registration: researchweb 236341; https://www.researchweb.org/is/vgr/project/236341 %M 35657650 %R 10.2196/35478 %U https://humanfactors.jmir.org/2022/2/e35478 %U https://doi.org/10.2196/35478 %U http://www.ncbi.nlm.nih.gov/pubmed/35657650 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34279 %T Application of Spatial Risk Assessment Integrated With a Mobile App in Fighting Against the Introduction of African Swine Fever in Pig Farms in Thailand: Development Study %A Thanapongtharm,Weerapong %A Wongphruksasoong,Vilaiporn %A Sangrat,Waratida %A Thongsrimoung,Kittin %A Ratanavanichrojn,Nattavut %A Kasemsuwan,Suwicha %A Khamsiriwatchara,Amnat %A Kaewkungwal,Jaranit %A Leelahapongsathon,Kansuda %+ Faculty of Veterinary Medicine, Kasetsart University, Malaiman Rd, Kamphaeng Saen, Nakhon Pathom, 73140, Thailand, 66 34351901, fvetkul@ku.ac.th %K African swine fever %K multi-criteria decision analysis %K risk-based surveillance %K risk assessment %K spatial analysis %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: African swine fever (ASF), a highly contagious disease affecting both domestic and wild pigs, has been having a serious impact on the swine industry worldwide. This important transboundary animal disease can be spread by animals and ticks via direct transmission and by contaminated feed and fomites via indirect transmission because of the high environmental resistance of the ASF virus. Thus, the prevention of the introduction of ASF to areas free of ASF is essential. After an outbreak was reported in China, intensive import policies and biosecurity measures were implemented to prevent the introduction of ASF to pig farms in Thailand. Objective: Enhancing prevention and control, this study aims to identify the potential areas for ASF introduction and transmission in Thailand, develop a tool for farm assessment of ASF risk introduction focusing on smallholders, and develop a spatial analysis tool that is easily used by local officers for disease prevention and control planning. Methods: We applied a multi-criteria decision analysis approach with spatial and farm assessment and integrated the outputs with the necessary spatial layers to develop a spatial analysis on a web-based platform. Results: The map that referred to potential areas for ASF introduction and transmission was derived from 6 spatial risk factors; namely, the distance to the port, which had the highest relative importance, followed by the distance to the border, the number of pig farms using swill feeding, the density of small pig farms (<50 heads), the number of pigs moving in the area, and the distance to the slaughterhouse. The possible transmission areas were divided into 5 levels (very low, low, medium, high, and very high) at the subdistrict level, with 27 subdistricts in 10 provinces having very high suitability and 560 subdistricts in 34 provinces having high suitability. At the farm level, 17 biosecurity practices considered as useful and practical for smallholders were selected and developed on a mobile app platform. The outputs from the previous steps integrated with necessary geographic information system layers were added to a spatial analysis web-based platform. Conclusions: The tools developed in this study have been complemented with other strategies to fight against the introduction of ASF to pig farms in the country. The areas showing high and very high risk for disease introduction and transmission were applied for spatial information planning, for example, intensive surveillance, strict animal movement, and public awareness. In addition, farms with low biosecurity were improved in these areas, and the risk assessment developed on a mobile app in this study helped enhance this matter. The spatial analysis on a web-based platform helped facilitate disease prevention planning for the authorities. %M 35639455 %R 10.2196/34279 %U https://formative.jmir.org/2022/5/e34279/ %U https://doi.org/10.2196/34279 %U http://www.ncbi.nlm.nih.gov/pubmed/35639455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e29509 %T Key Drivers and Facilitators of the Choice to Use mHealth Technology in People With Neurological Conditions: Observational Study %A Simblett,Sara %A Pennington,Mark %A Quaife,Matthew %A Theochari,Evangelia %A Burke,Patrick %A Brichetto,Giampaolo %A Devonshire,Julie %A Lees,Simon %A Little,Ann %A Pullen,Angie %A Stoneman,Amanda %A Thorpe,Sarah %A Weyer,Janice %A Polhemus,Ashley %A Novak,Jan %A Dawe-Lane,Erin %A Morris,Daniel %A Mutepua,Magano %A Odoi,Clarissa %A Wilson,Emma %A Wykes,Til %+ Psychology Department, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 207 848 0762, sara.simblett@kcl.ac.uk %K mobile technology %K neurological conditions %K multiple sclerosis %K epilepsy %K discrete choice experiment %K digital health %K mHealth %K wearable technology %K wearable biosensors %K health economics %K health data %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is increasing interest in the potential uses of mobile health (mHealth) technologies, such as wearable biosensors, as supplements for the care of people with neurological conditions. However, adherence is low, especially over long periods. If people are to benefit from these resources, we need a better long-term understanding of what influences patient engagement. Previous research suggests that engagement is moderated by several barriers and facilitators, but their relative importance is unknown. Objective: To determine preferences and the relative importance of user-generated factors influencing engagement with mHealth technologies for 2 common neurological conditions with a relapsing-remitting course: multiple sclerosis (MS) and epilepsy. Methods: In a discrete choice experiment, people with a diagnosis of MS (n=141) or epilepsy (n=175) were asked to select their preferred technology from a series of 8 vignettes with 4 characteristics: privacy, clinical support, established benefit, and device accuracy; each of these characteristics was greater or lower in each vignette. These characteristics had previously been emphasized by people with MS and or epilepsy as influencing engagement with technology. Mixed multinomial logistic regression models were used to establish which characteristics were most likely to affect engagement. Subgroup analyses explored the effects of demographic factors (such as age, gender, and education), acceptance of and familiarity with mobile technology, neurological diagnosis (MS or epilepsy), and symptoms that could influence motivation (such as depression). Results: Analysis of the responses to the discrete choice experiment validated previous qualitative findings that a higher level of privacy, greater clinical support, increased perceived benefit, and better device accuracy are important to people with a neurological condition. Accuracy was perceived as the most important factor, followed by privacy. Clinical support was the least valued of the attributes. People were prepared to trade a modest amount of accuracy to achieve an improvement in privacy, but less likely to make this compromise for other factors. The type of neurological condition (epilepsy or MS) did not influence these preferences, nor did the age, gender, or mental health status of the participants. Those who were less accepting of technology were the most concerned about privacy and those with a lower level of education were prepared to trade accuracy for more clinical support. Conclusions: For people with neurological conditions such as epilepsy and MS, accuracy (ie, the ability to detect symptoms) is of the greatest interest. However, there are individual differences, and people who are less accepting of technology may need far greater reassurance about data privacy. People with lower levels of education value greater clinician involvement. These patient preferences should be considered when designing mHealth technologies. %M 35604761 %R 10.2196/29509 %U https://formative.jmir.org/2022/5/e29509 %U https://doi.org/10.2196/29509 %U http://www.ncbi.nlm.nih.gov/pubmed/35604761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34509 %T Development and Feasibility of a Mobile Asthma App for Children and Their Caregivers: Mixed Methods Study %A Iio,Misa %A Sato,Miori %A Narita,Masami %A Yamamoto-Hanada,Kiwako %A Oishi,Taku %A Kishino,Ai %A Kawaguchi,Takahiro %A Nishi,Rin %A Nagata,Mayumi %A Ohya,Yukihiro %+ College of Nursing, Kanto Gakuin University, 1-50-1 Mutsuurahigashi, Kanazawa-ward, Yokohama, 236-8503, Japan, 81 45 786 5641, misaiio@kanto-gakuin.ac.jp %K children %K caregivers %K asthma %K mobile app %K feasibility %K health app %K mHealth %K pediatric %K usability %K mobile phone %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health apps can support the self-management of pediatric asthma. Previous studies on mobile apps for children aged >7 years with asthma are limited, and most reports on asthma apps do not consider interactions between the children and their caregivers. Therefore, we developed an asthma app for children aged 0-12 years and their caregivers based on the results of our previous study regarding user needs. Objective: The aim of this study was to evaluate the feasibility of a developed mobile app for children with asthma and their caregivers and to modify and complete the app according to the feasibility results. Methods: We recruited children diagnosed with persistent asthma by an allergy specialist at 2 children’s hospitals, 1 university hospital, 2 general hospitals, and 1 pediatric clinic. Thereafter, the app usage was assessed, and questionnaires were administered. This study used convergent mixed methods, including providing user feedback about the pediatric asthma app, completing questionnaire surveys regarding preferences, and obtaining quantitative data about app usage. Quantitative data were analyzed based on the ratings provided for the app features used by the participants, and the usage of the app features was analyzed using descriptive statistics. Qualitative data were analyzed via a descriptive qualitative research analysis and were used to identify codes from the content-characteristic words. Results: In total, 30 pairs of children aged 2-12 years and their caregivers responded to the 3-month survey, and 20 pairs of children aged 4-12 years and their caregivers responded to the 6-month survey. In the 3- and 6-month surveys, “record” was the most commonly used feature by both caregivers and children. The average access logs per month among the 20 pairs ranged from 50 to 79 in the 6-month survey. The number of access logs decreased over time. In the qualitative results, app utilization difficulties were identified for 6 categories: record, preparing, alert settings, change settings, mobile phone owner, and display and motivation. Regarding app feasibility, 60% (12/20) of the caregivers strongly agreed or agreed for all evaluation items, while 63% (7/11) of the children strongly agreed or agreed for 6 items, excluding satisfaction. In the qualitative results, feasibility evaluation of the app was classified into 3 categories: high feasibility of the app, improvement points for the app, and personal factors preventing app utilization. Based on the results of the feasibility analysis, the final version of the app was modified and completed. Conclusions: The app feasibility among children with asthma and their caregivers was generally good. Children aged 7-12 years used elements such as record, quiz, and manga. This app can support the continuous self-management of pediatric asthma. However, efforts must be taken to maintain and improve the app quality. Trial Registration: UMIN Clinical Trials Registry UMIN000039058; https://tinyurl.com/3na9zyf8 %M 35594073 %R 10.2196/34509 %U https://formative.jmir.org/2022/5/e34509 %U https://doi.org/10.2196/34509 %U http://www.ncbi.nlm.nih.gov/pubmed/35594073 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e37521 %T Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study %A Miguel Cruz,Antonio %A Lopez Portillo,Hector Perez %A Daum,Christine %A Rutledge,Emily %A King,Sharla %A Liu,Lili %+ Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 1-45 Corbett Hall, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada, 1 7804926461, miguelcr@ualberta.ca %K usability %K technology acceptance %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K older adults %K caregivers %K health care aides %K mobile phone %D 2022 %7 18.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. Objective: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. Methods: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre– and post–paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs’ summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The α level of significance for all tests was set at P≤.05 (2-tailed). Results: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides’ strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. Conclusions: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues. %M 35583930 %R 10.2196/37521 %U https://aging.jmir.org/2022/2/e37521 %U https://doi.org/10.2196/37521 %U http://www.ncbi.nlm.nih.gov/pubmed/35583930 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34026 %T Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study %A Wetzel,Anna-Jasmin %A Koch,Roland %A Preiser,Christine %A Müller,Regina %A Klemmt,Malte %A Ranisch,Robert %A Ehni,Hans-Jörg %A Wiesing,Urban %A Rieger,Monika A %A Henking,Tanja %A Joos,Stefanie %+ Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstr. 5, Tübingen, 72076, Germany, 49 7071 29 85226, jasmin.wetzel@med.uni-tuebingen.de %K symptom checker apps %K self-diagnosis, self-triage, digitalization in primary care, general practitioners %K symptom checker %K app %K mobile app %K primary care %D 2022 %7 16.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts. Objective: We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs. Methods: Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark. Results: Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023. Conclusions: The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications. Trial Registration: German Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67 International Registered Report Identifier (IRRID): DERR1-10.2196/34026 %M 35576570 %R 10.2196/34026 %U https://www.researchprotocols.org/2022/5/e34026 %U https://doi.org/10.2196/34026 %U http://www.ncbi.nlm.nih.gov/pubmed/35576570 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35065 %T A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study %A Buss,Vera Helen %A Varnfield,Marlien %A Harris,Mark %A Barr,Margo %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 7, Surgical, Treatment and Rehabilitation Service, 296 Herston Road, Herston, 4029, Australia, 61 732533603, vera.buss@csiro.au %K mobile health %K behavior change intervention %K primary prevention %K health promotion %K cardiovascular disease %K diabetes mellitus, type 2 %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results: The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing. %M 35536603 %R 10.2196/35065 %U https://humanfactors.jmir.org/2022/2/e35065 %U https://doi.org/10.2196/35065 %U http://www.ncbi.nlm.nih.gov/pubmed/35536603 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e35163 %T Acceptance and Effect of Continuous Glucose Monitoring on Discharge From Hospital in Patients With Type 2 Diabetes: Open-label, Prospective, Controlled Study %A Depczynski,Barbara %A Poynten,Ann %+ Prince of Wales Hospital, Barker St, Randwick, NSW 2031, Australia, 61 293824600, barbaradepczynski@gmail.com %K CGM %K continuous glucose monitor %K hospital %K discharge %K T2DM %K type 2 diabetes %K diabetes %K glucose monitoring %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Continuous glucose monitors (CGM) can provide detailed information on glucose excursions. There is little information on safe transitioning from hospital back to the community for patients who have had diabetes therapies adjusted in hospital and it is unclear whether newer technologies may facilitate this process. Objective: Our aim was to determine whether offering CGM on discharge would be acceptable and if CGM initiated on hospital discharge in people with type 2 diabetes (T2DM) would reduce hospital re-presentations at 1 month. Methods: This was an open-label study. Adult inpatients with T2DM, who were to be discharged home and required postdischarge glycemic stabilization, were offered usual care consisting of clinic review at 2 weeks and at 3 months. In addition to usual care, participants in the intervention arm were provided with a Libre flash glucose monitoring system (Abbott Australia). An initial run-in phase for the first 20 participants was planned, where all consenting participants were enrolled in an active arm. Subsequently, all participants were to be randomized to the active arm or usual care control group. Results: Of 237 patients screened during their hospital admission, 34 had comorbidities affecting cognition that prevented informed consent and affected their ability to learn to use the CGM device. In addition, 21 were not able to be approached as the material was only in English. Of 101 potential participants who fulfilled eligibility criteria, 19 provided consent and were enrolled. Of the 82 patients who declined to participate, 31 advised that the learning of a new task toward discharge was overwhelming or too stressful and 26 were not interested, with no other details. Due to poor recruitment, the study was terminated without entering the randomization phase to determine whether CGM could reduce readmission rate. Conclusions: These results suggest successful and equitable implementation of telemedicine programs requires that any human factors such as language, cognition, and possible disengagement be addressed. Recovery from acute illness may not be the ideal time for introduction of newer technologies or may require more novel implementation frameworks. %M 35532995 %R 10.2196/35163 %U https://diabetes.jmir.org/2022/2/e35163 %U https://doi.org/10.2196/35163 %U http://www.ncbi.nlm.nih.gov/pubmed/35532995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35994 %T Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study %A Kumwichar,Ponlagrit %A Chongsuvivatwong,Virasakdi %A Prappre,Tagoon %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Rd, Hat Yai, Songkhla, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K app %K compliance %K usability %K remote monitoring %K therapy %K tuberculosis %K lung %K infectious disease %K user experience %K video directly observed therapy %K video-enhanced therapy %K video-observed therapy %K digital health %K health care system %K disease monitoring %K health monitoring %K video consultation %K online health %K virtual therapy %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Thailand, the health care system has struggled to cope with COVID-19, resulting in directly observed therapy for tuberculosis being de-emphasized. A video-observed therapy (VOT) system, or more specifically, the Thai VOT (TH VOT) system, was developed to replace directly observed therapy. According to the pilot study, the system needed notifications to improve usability and user compliance. The updated version of the TH VOT system thus enabled LINE (Line Corporation) notifications. Objective: This study aimed to reassess users’ compliance with and the usability of the updated TH VOT system. Methods: This study was conducted in the Hat Yai and Mueang Songkhla districts in Songkhla Province, Southern Thailand, from September 18 to December 1, 2021. The system was used by not only patients with tuberculosis but also tuberculosis staff, who acted as observers in primary health care settings. Some of the observers used the simulated VOT system instead of the actual system due to the lack of participating patients in their jurisdiction. After 30 days of using the system, VOT session records were analyzed to determine the compliance of the patients and observers. The User Experience Questionnaire was administered to reassess the usability of the system and compare the ratings of the participants with the general benchmark scores of the User Experience Questionnaire. The results were summarized to reveal the degree of user compliance and usability in the following three groups: the patients, actual VOT observers, and simulated VOT observers. Results: Of the 19 observers, 10 used the actual VOT system, and the remaining 9 used the simulated VOT system; there were also 10 patients with tuberculosis. The patients, actual VOT observers, and simulated VOT observers exhibited about 70%, 65%, and 50% compliance, respectively, in terms of following the standard operating procedures every day. The scores of all groups on all dimensions were well above the average scores. There was no significant difference in any of the dimensional scores among the three groups. Conclusions: The updated version of the TH VOT system was deemed usable by both the patients and the health care staff. Compliance with the use of the system was high among the patients but moderate among the observers. %M 35522469 %R 10.2196/35994 %U https://formative.jmir.org/2022/5/e35994 %U https://doi.org/10.2196/35994 %U http://www.ncbi.nlm.nih.gov/pubmed/35522469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34129 %T Implementation of a Personalized Digital App for Pediatric Preanesthesia Evaluation and Education: Ongoing Usability Analysis and Dynamic Improvement Scheme %A Connelly,Yaron %A Lotan,Roni %A Brzezinski Sinai,Yitzhak %A Rolls,Dan %A Beker,Amir %A Abensour,Eilone %A Neudorfer,Orit %A Stocki,Daniel %+ GistMD, Stricker St 16, Tel Aviv, 6200622, Israel, 972 8 9542573, yaron.connelly@gmail.com %K mHealth apps %K preanesthesia %K pediatric setting %K mHealth usability %K usability analysis %K mobile health %K mHealth %K pediatrics %K anesthesia %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Preanesthesia evaluation is a basic practice preceding any surgical procedure, aimed at tailoring individualized anesthetic plans for patients, improving safety, and providing patients with educational knowledge and tools in preparation for the surgery day. In the last 2 decades, eHealth and mobile health (mHealth) settings have gradually replaced part of the face-to-face encounters as the platform for preanesthesia communication between doctor and patient, yielding a range of benefits as demonstrated in recent publications. Nevertheless, there is a lack of studies examining the effectiveness of surgical mHealth apps focusing on the pediatric preanesthetic setting and addressing their usability among families. Objective: This study describes a dynamic approach for the development process of GistMD’s preanesthesia mHealth system, a mobile-based educational and management system designed for the pediatric setting. Methods: The study was conducted in 4 departments at a 1500-bed quaternary, academic medical center in Tel Aviv, Israel. During the study period, the link to the preanesthesia system was sent via SMS text messages to families whose children were about to undergo surgery. The system included preanesthesia questionnaires, educational videos, downloadable instructions, and consent forms. Continuous collection and examination of usability data were conducted during the implementation term including responsiveness, effectiveness, and satisfaction indicators. The information collected in each stage was used to draw conclusions regarding potential usability gaps of the system and to plan product adjustments for the following period. Results: During 141 days of implementation, the link to the GistMD preanesthesia management system was sent to 769 families, and product-fit actions were implemented during this term: (1) changing text message scheduling for addressing learnability and accessibility, resulting in a significant increase of 27% (χ21=12.65, P<.001) in view rates and 27.4% (χ21=30.01, P<.001) in satisfaction rates; (2) reducing the number of screens to increase efficiency and operability, leading to a significant decrease of 8.6% in cases where users did not perform any activity on the system after logging in (χ21=6.18, P=.02); (3) conducting a patient-focused campaign in 2 departments aimed at addressing memorability, leading to significant increases in 8 of the 12 usability indicators. Conclusions: Our results indicate that mHealth product-fit decisions originating from theory-based approaches and ongoing usability data analysis allow tailoring of the most appropriate responses for usability gaps, as reflected in increased use rates and satisfaction. In the case of the preanesthesia management system in the pediatric setting, increased usability conveyed important benefits for patients and families. This work suggests a framework and study methods that may also be applicable in other mHealth settings and domains. %M 35416171 %R 10.2196/34129 %U https://formative.jmir.org/2022/5/e34129 %U https://doi.org/10.2196/34129 %U http://www.ncbi.nlm.nih.gov/pubmed/35416171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e31102 %T Review and Analysis of German Mobile Apps for Inflammatory Bowel Disease Management Using the Mobile Application Rating Scale: Systematic Search in App Stores and Content Analysis %A Gerner,Maximilian %A Vuillerme,Nicolas %A Aubourg,Timothée %A Messner,Eva-Maria %A Terhorst,Yannik %A Hörmann,Verena %A Ganzleben,Ingo %A Schenker,Hannah %A Schett,Georg %A Atreya,Raja %A Neurath,Markus F %A Knitza,Johannes %A Orlemann,Till %+ Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 9131 8535000, max_gerner@web.de %K mHealth %K IBD %K ulcerative colitis %K Crohn disease %K inflammatory bowel disease %K telemedicine %K mobile apps %K rating %K rating scale %K quality %K usability %K chronic disease %K IBS %K app store %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients suffering from inflammatory bowel disease (IBD) frequently need long-term medical treatment. Mobile apps promise to complement and improve IBD management, but so far there has been no scientific analysis of their quality. Objective: This study evaluated the quality of German mobile apps targeting IBD patients and physicians treating IBD patients using the Mobile Application Rating Scale (MARS). Methods: The German Apple App Store and Google Play Store were systematically searched to identify German IBD mobile apps for patient and physician use. MARS was used by 6 physicians (3 using Android smartphones and 3 using iPhones) to independently assess app quality. Apps were randomly assigned so that the 4 apps with the most downloads were rated by all raters and the remaining apps were rated by 1 Android and 1 iOS user. Results: In total, we identified 1764 apps in the Apple App Store and Google Play Store. After removing apps that were not related to IBD (n=1386) or not available in German (n=317), 61 apps remained. After removing duplicates (n=3) and apps for congresses (n=7), journals (n=4), and clinical studies (n=6), as well as excluding apps that were available in only 1 of the 2 app stores (n=20) and apps that could only be used with an additional device (n=7), we included a total of 14 apps. The app “CED Dokumentation und Tipps” had the highest overall median MARS score at 4.11/5. On the whole, the median MARS scores of the 14 apps ranged between 2.38/5 and 4.11/5. As there was no significant difference between iPhone and Android raters, we used the Wilcoxon comparison test to calculate P values. Conclusions: The MARS ratings showed that the quality of German IBD apps varied. We also discovered a discrepancy between app store ratings and MARS ratings, highlighting the difficulty of assessing perceived app quality. Despite promising results from international studies, there is little evidence for the clinical benefits of German IBD apps. Clinical studies and patient inclusion in the app development process are needed to effectively implement mobile apps in routine care. %M 35503246 %R 10.2196/31102 %U https://mhealth.jmir.org/2022/5/e31102 %U https://doi.org/10.2196/31102 %U http://www.ncbi.nlm.nih.gov/pubmed/35503246 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35219 %T Determinants of Laypersons’ Trust in Medical Decision Aids: Randomized Controlled Trial %A Kopka,Marvin %A Schmieding,Malte L %A Rieger,Tobias %A Roesler,Eileen %A Balzer,Felix %A Feufel,Markus A %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitépl 1, Berlin, 10117, Germany, 49 30 450 581 052, marvin.kopka@charite.de %K symptom checkers %K disposition advice %K anthropomorphism %K artificial intelligence %K urgency assessment %K patient-centered care %K human-computer interaction %K consumer health %K information technology %K IT %K mobile phone %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Symptom checker apps are patient-facing decision support systems aimed at providing advice to laypersons on whether, where, and how to seek health care (disposition advice). Such advice can improve laypersons’ self-assessment and ultimately improve medical outcomes. Past research has mainly focused on the accuracy of symptom checker apps’ suggestions. To support decision-making, such apps need to provide not only accurate but also trustworthy advice. To date, only few studies have addressed the question of the extent to which laypersons trust symptom checker app advice or the factors that moderate their trust. Studies on general decision support systems have shown that framing automated systems (anthropomorphic or emphasizing expertise), for example, by using icons symbolizing artificial intelligence (AI), affects users’ trust. Objective: This study aims to identify the factors influencing laypersons’ trust in the advice provided by symptom checker apps. Primarily, we investigated whether designs using anthropomorphic framing or framing the app as an AI increases users’ trust compared with no such framing. Methods: Through a web-based survey, we recruited 494 US residents with no professional medical training. The participants had to first appraise the urgency of a fictitious patient description (case vignette). Subsequently, a decision aid (mock symptom checker app) provided disposition advice contradicting the participants’ appraisal, and they had to subsequently reappraise the vignette. Participants were randomized into 3 groups: 2 experimental groups using visual framing (anthropomorphic, 160/494, 32.4%, vs AI, 161/494, 32.6%) and a neutral group without such framing (173/494, 35%). Results: Most participants (384/494, 77.7%) followed the decision aid’s advice, regardless of its urgency level. Neither anthropomorphic framing (odds ratio 1.120, 95% CI 0.664-1.897) nor framing as AI (odds ratio 0.942, 95% CI 0.565-1.570) increased behavioral or subjective trust (P=.99) compared with the no-frame condition. Even participants who were extremely certain in their own decisions (ie, 100% certain) commonly changed it in favor of the symptom checker’s advice (19/34, 56%). Propensity to trust and eHealth literacy were associated with increased subjective trust in the symptom checker (propensity to trust b=0.25; eHealth literacy b=0.2), whereas sociodemographic variables showed no such link with either subjective or behavioral trust. Conclusions: Contrary to our expectation, neither the anthropomorphic framing nor the emphasis on AI increased trust in symptom checker advice compared with that of a neutral control condition. However, independent of the interface, most participants trusted the mock app’s advice, even when they were very certain of their own assessment. Thus, the question arises as to whether laypersons use such symptom checkers as substitutes rather than as aids in their own decision-making. With trust in symptom checkers already high at baseline, the benefit of symptom checkers depends on interface designs that enable users to adequately calibrate their trust levels during usage. Trial Registration: Deutsches Register Klinischer Studien DRKS00028561; https://tinyurl.com/rv4utcfb (retrospectively registered). %M 35503248 %R 10.2196/35219 %U https://humanfactors.jmir.org/2022/2/e35219 %U https://doi.org/10.2196/35219 %U http://www.ncbi.nlm.nih.gov/pubmed/35503248 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35886 %T Testing a Mobile App for Participatory Research to Identify Teen-Targeted Food Marketing: Mixed Methods Study %A Truman,Emily %A Elliott,Charlene %+ Department of Communication, Media and Film, University of Calgary, 2500 University Dr NW, Social Sciences Building, Calgary, AB, T2N 1N4, Canada, 1 403 220 3180, charlene.elliott@ucalgary.ca %K mHealth %K mobile app %K teenager %K adolescent %K monitoring %K participatory research %K feasibility %K usability %K food marketing %K food advertising %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps are not only effective tools for promoting health to teenagers but are also useful for engaging teenagers in participatory research on factors that influence their health. Given the impact of food marketing messages on teenagers’ food attitudes and consumption choices, it is important to develop effective methods for capturing the food advertisements targeted at this population to assess their content. Objective: The aim of this study was to test the feasibility and usability of a mobile app, “GrabFM!” (“Grab Food Marketing!”), designed for teenagers to facilitate monitoring of self-identified targeted food marketing messaging. Methods: A mixed methods approach, including quantitative user response rates and qualitative focus group discussion feedback, was used in the evaluation process. Results: A total of 62 teenagers (ages 13-17) completed GrabFM! app pilot testing over a 7-day data collection period. Teenagers submitted a total of 339 examples of food marketing, suggesting high feasibility for the app. Participants also took part in focus group discussions about their experience, providing positive feedback on usability, including ease of use and design aesthetic appeal. Conclusions: The GrabFM! app had high feasibility and usability, suggesting its efficacy in capturing accurate data relevant to the teenage population’s experience with food marketing messaging. %M 35503652 %R 10.2196/35886 %U https://formative.jmir.org/2022/5/e35886 %U https://doi.org/10.2196/35886 %U http://www.ncbi.nlm.nih.gov/pubmed/35503652 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35094 %T Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help? %A Pit,Sabrina %A Ramsden,Robyn %A Tan,Aaron JH %A Payne,Kristy %A Barr,James %A Eames,Benjamin %A Edwards,Mike %A Colbran,Richard %+ New South Wales Rural Doctors Network, 1/53 Cleary Street, Hamilton, 2308, Australia, 61 429455720, sabrina.pit@sydney.edu.au %K health %K wellness %K mobile apps %K persuasive strategies %K behavior change %K review %K health workforce %K capability %K career %K employment %K rural %K workforce planning %K mHealth %K mobile health %K digital health %K health professional %K user experience %K health application %K task support %K social support %K dialog support %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health professionals’ perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals’ perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini’s Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific–based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals’ perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. %M 35499866 %R 10.2196/35094 %U https://humanfactors.jmir.org/2022/2/e35094 %U https://doi.org/10.2196/35094 %U http://www.ncbi.nlm.nih.gov/pubmed/35499866 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e31815 %T The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design %A Robertson,Michael C %A Cox-Martin,Emily %A Shegog,Ross %A Markham,Christine M %A Fujimoto,Kayo %A Durand,Casey P %A Brewster,Abenaa %A Lyons,Elizabeth J %A Liao,Yue %A Flores,Sara A %A Basen-Engquist,Karen M %+ Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 3030, mcrobert@utmb.edu %K cancer survivors %K exercise %K mindfulness %K Acceptance and Commitment Therapy %K behavioral sciences %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results: The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness. %M 35486425 %R 10.2196/31815 %U https://cancer.jmir.org/2022/2/e31815 %U https://doi.org/10.2196/31815 %U http://www.ncbi.nlm.nih.gov/pubmed/35486425 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e30224 %T Digital Self-monitoring of Multiple Sclerosis: Interview Study With Dutch Health Care Providers on the Expected New Configuration of Roles and Responsibilities %A Wendrich,Karine %A Krabbenborg,Lotte %+ Institute for Science in Society, Radboud University Nijmegen, Heyendaalseweg 135, Nijmegen, 6525AJ, Netherlands, 31 024 3652269, Lotte.Krabbenborg@ru.nl %K digital self-monitoring %K smartphone apps %K multiple sclerosis %K technology assessment %K health care providers %K user participation %K mobile phone %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital self-monitoring allows patients to produce and share personal health data collected at home. This creates a novel situation in which health care providers and patients must engage in a reconfiguration of roles and responsibilities. Although existing research pays considerable attention to the perceptions of patients regarding digital self-monitoring, less attention has been paid to the needs, wishes, and concerns of health care providers. As several companies and public institutions are developing and testing digital self-monitoring at the time of writing, it is timely and relevant to explore how health care providers envision using these technologies in their daily work practices. Our findings can be considered in decision-making processes concerning the further development and implementation of digital self-monitoring. Objective: This study aims to explore how health care providers envisage using smartphone apps for digital self-monitoring of multiple sclerosis (MS) in their daily work practices, with a particular focus on physician-patient communication and on how health care providers respond to self-monitoring data and delegate tasks and responsibilities to patients. Methods: We conducted semistructured in-depth interviews with 14 MS health care providers: 4 neurologists, 7 MS specialist nurses, and 3 rehabilitation professionals. They are affiliated with 3 different hospitals in the Netherlands that will participate in a pilot study to assess the efficiency and effectiveness of a specific smartphone app for self-monitoring. Results: The interviewed health care providers seemed willing to use these smartphone apps and valued the quantitative data they produce that can complement the narratives that patients provide during medical appointments. The health care providers primarily want to use digital self-monitoring via prescription, meaning that they want a standardized smartphone app and want to act as its gatekeepers. Furthermore, they envisioned delegating particular tasks and responsibilities to patients via digital self-monitoring, such as sharing data with the health care providers or acting on the data, if necessary. The health care providers expected patients to become more proactive in the management of their disease. However, they also acknowledged that not all patients are willing or able to use digital self-monitoring apps and were concerned about the potential psychological and emotional burden on patients caused by this technology. Conclusions: Our findings show that health care providers envisage a particular type of patient empowerment and personalized health care in which tensions arise between health care providers acting as gatekeepers and patient autonomy, between patient empowerment and patient disempowerment, and between the weight given to quantitative objective data and that given to patients’ subjective experiences. In future research, it would be very interesting to investigate the actual experiences of health care providers with regard to digital self-monitoring to ascertain how the tensions mentioned in this paper play out in practice. %M 35475770 %R 10.2196/30224 %U https://mhealth.jmir.org/2022/4/e30224 %U https://doi.org/10.2196/30224 %U http://www.ncbi.nlm.nih.gov/pubmed/35475770 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e36702 %T Acceptance of an Internet-Based Team Development Tool Aimed at Improving Work-Related Well-being in Nurses: Cross-sectional Study %A Broetje,Sylvia %A Bauer,Georg F %A Jenny,Gregor J %+ Center of Salutogenesis, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland, 41 446344854, sylvia.libro@gmail.com %K digital intervention %K eHealth %K nurses %K online intervention %K organizational health %K technology acceptance %K UTAUT %K workplace health promotion %K mHealth %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Workplace health interventions can produce beneficial health- and business-related outcomes. However, such interventions have traditionally focused on lifestyle behaviors of individuals, mostly not considering the role of working conditions. The wecoach intervention is an internet-based tool that combines both a digital and a participatory team development approach aimed at addressing critical job demands and resources as key aspects of health-promoting working conditions. Nursing staff are particularly affected by challenging working conditions and could potentially benefit greatly. Understanding the acceptance of novel workplace health promotion approaches is a critical precursor to their successful implementation and use. Objective: This study aims to examine the factors influencing the acceptance of a digitally supported team development tool among nurse managers. Methods: A sample of 32 nurse managers from 3 German-speaking countries tested wecoach and completed our online questionnaire. Hypotheses were based on the unified theory of acceptance and use of technology (UTAUT) and the organizational health development (OHD) model and were tested using multiple regression analyses. Results: Our analyses found that merely capacities on the team level (CapTeam) significantly contributed to the acceptance of wecoach, although only after the other variables were excluded in the stepwise multiple regression analysis. The UTAUT predictors were unable to add significant variance explanation beyond that, and their inclusion masked the contribution of CapTeam. Conclusions: For the acceptance of a digitally supported participatory tool, the fit with the team, its culture, and its motivation are of critical importance, while aspects proposed by traditional acceptance models, such as the UTAUT, may not be applicable. %M 35452403 %R 10.2196/36702 %U https://nursing.jmir.org/2022/1/e36702 %U https://doi.org/10.2196/36702 %U http://www.ncbi.nlm.nih.gov/pubmed/35452403 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34704 %T A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study %A Kavanagh,Meaghan E %A Chiavaroli,Laura %A Glenn,Andrea J %A Heijmans,Genevieve %A Grant,Shannan M %A Chow,Chi-Ming %A Josse,Robert G %A Malik,Vasanti S %A Watson,William %A Lofters,Aisha %A Holmes,Candice %A Rackal,Julia %A Srichaikul,Kristie %A Sherifali,Diana %A Snelgrove-Clarke,Erna %A Udell,Jacob A %A Juni,Peter %A Booth,Gillian L %A Farkouh,Michael E %A Leiter,Lawrence A %A Kendall,Cyril W C %A Jenkins,David J A %A Sievenpiper,John L %+ Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 5th floor, room 5334, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 416 867 3732, john.sievenpiper@utoronto.ca %K portfolio diet %K dietary portfolio %K nutrition therapy %K dietary application %K eHealth %K usability testing %K quality improvement %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. Objective: The main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). Methods: We undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users’ perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. Results: A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. Conclusions: By undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users’ needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool. %M 35451981 %R 10.2196/34704 %U https://humanfactors.jmir.org/2022/2/e34704 %U https://doi.org/10.2196/34704 %U http://www.ncbi.nlm.nih.gov/pubmed/35451981 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34626 %T A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study %A Schöpfer,Céline %A Ehrler,Frederic %A Berger,Antoine %A Bollondi Pauly,Catherine %A Buytaert,Laurence %A De La Serna,Camille %A Hartheiser,Florence %A Fassier,Thomas %A Clavien,Christine %+ Institute for Ethics, History, and the Humanities, University Medical Center, University of Geneva, CMU/1 rue Michel Servet, Geneva, 1211, Switzerland, 41 22 379 46 00, celine.schopfer@etu.unige.ch %K usability %K mobile apps %K advance directives %K advance care planning %K mHealth %K mobile health %K palliative care %K mobile phone %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Advance care planning, including advance directives, is an important tool that allows patients to express their preferences for care if they are no longer able to express themselves. We developed Accordons-nous, a smartphone app that informs patients about advance care planning and advance directives, facilitates communication on these sensitive topics, and helps patients express their values and preferences for care. Objective: The first objective of this study is to conduct a usability test of this app. The second objective is to collect users’ critical opinions on the usability and relevance of the tool. Methods: We conducted a usability test by means of a think-aloud method, asking 10 representative patients to complete 7 browsing tasks. We double coded the filmed sessions to obtain descriptive data on task completion (with or without help), time spent, number of clicks, and the types of problems encountered. We assessed the severity of the problems encountered and identified the modifications needed to address these problems. We evaluated the readability of the app using Scolarius, a French equivalent of the Flesch Reading Ease test. By means of a posttest questionnaire, we asked participants to assess the app’s usability (System Usability Scale), relevance (Mobile App Rating Scale, section F), and whether they would recommend the app to the target groups: patients, health professionals, and patients’ caring relatives. Results: Participants completed the 7 think-aloud tasks in 80% (56/70) of the cases without any help from the experimenter, in 16% (11/70) of the cases with some help, and failed in 4% (3/70) of the cases. The analysis of failures and difficulties encountered revealed a series of major usability problems that could be addressed with minor modifications to the app. Accordons-nous obtained high scores on readability (overall score of 87.4 on Scolarius test, corresponding to elementary school level), usability (85.3/100 on System Usability Scale test), relevance (4.3/5 on the Mobile App Rating Scale, section F), and overall subjective endorsement on 3 I would recommend questions (4.7/5). Conclusions: This usability test helped us make the final changes to our app before its official launch. %M 35442206 %R 10.2196/34626 %U https://humanfactors.jmir.org/2022/2/e34626 %U https://doi.org/10.2196/34626 %U http://www.ncbi.nlm.nih.gov/pubmed/35442206 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e33992 %T Use of Mobile Apps in Heart Failure Self-management: Qualitative Study Exploring the Patient and Primary Care Clinician Perspective %A Bezerra Giordan,Leticia %A Ronto,Rimante %A Chau,Josephine %A Chow,Clara %A Laranjo,Liliana %+ Westmead Applied Research Centre, University of Sydney, Level 6, Block K, Entrance 10, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, 2145, Australia, 61 413461852, liliana.laranjo@sydney.edu.au %K mobile app %K mHealth %K heart failure %K self-management %K eHealth %K telehealth %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Mobile apps have the potential to support patients with heart failure and facilitate disease self-management, but this area of research is recent and rapidly evolving, with inconsistent results for efficacy. So far, most of the published studies evaluated the feasibility of a specific app or assessed the quality of apps available in app stores. Research is needed to explore patients’ and clinicians’ perspectives to guide app development, evaluation, and implementation into models of care. Objective: This study aims to explore the patient and primary care clinician perspective on the facilitators and barriers to using mobile apps, as well as desired features, to support heart failure self-management. Methods: This is a qualitative phenomenological study involving face-to-face semistructured interviews. Interviews were conducted in a general practice clinic in Sydney, Australia. Eligible participants were adult patients with heart failure and health care professionals who provided care to these patients at the clinic. Patients did not need to have previous experience using heart failure mobile apps to be eligible for this study. The interviews were audio-recorded, transcribed, and analyzed using inductive thematic data analysis in NVivo 12. Results: A total of 12 participants were interviewed: 6 patients (mean age 69 [SD 7.9] years) and 6 clinicians. The interviews lasted from 25 to 45 minutes. The main facilitators to the use of apps to support heart failure self-management were communication ability, personalized feedback and education, and automated self-monitoring. Patients mentioned that chat-like features and ability to share audio-visual information can be helpful for getting support outside of clinical appointments. Clinicians considered helpful to send motivational messages to patients and ask them about signs and symptoms of heart failure decompensation. Overall, participants highlighted the importance of personalization, particularly in terms of feedback and educational content. Automated self-monitoring with wireless devices was seen to alleviate the burden of tracking measures such as weight and blood pressure. Other desired features included tools to monitor patient-reported outcomes and support patients’ mental health and well-being. The main barriers identified were the patients’ unwillingness to engage in a new strategy to manage their condition using an app, particularly in the case of low digital literacy. However, clinicians mentioned this barrier could potentially be overcome by introducing the app soon after an exacerbation, when patients might be more willing to improve their self-management and avoid rehospitalization. Conclusions: The use of mobile apps to support heart failure self-management may be facilitated by features that increase the usefulness and utility of the app, such as communication ability in-between consultations and personalized feedback. Also important is facilitating ease of use by supporting automated self-monitoring through integration with wireless devices. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians. %M 35442205 %R 10.2196/33992 %U https://cardio.jmir.org/2022/1/e33992 %U https://doi.org/10.2196/33992 %U http://www.ncbi.nlm.nih.gov/pubmed/35442205 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e34035 %T Developing a Technology Acceptability and Usage Survey (TAUS) for mHealth Intervention Planning and Evaluation in Nigeria: Pilot Study %A Lynch,Kathleen A %A Atkinson,Thomas M %A Omisore,Adeleye D %A Famurewa,Olusola %A Olasehinde,Olalekan %A Odujoko,Oluwole %A Alatise,Olusegun I %A Egberongbe,Adedeji %A Kingham,T Peter %A Morris,Elizabeth A %A Sutton,Elizabeth %+ Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, Suite 727, New York, NY, 10065, United States, 1 646 888 5455, suttone@mskcc.org %K measure development %K survey methods %K technology acceptability and use %K global health %K mHealth %K Nigeria %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Technology acceptability and usage surveys (TAUS) are brief questionnaires that measure technology comfort, typical daily use, and access in a population. However, current measures are not adapted to low- and middle-income country (LMIC) contexts. Objective: The objective of this pilot study was to develop a TAUS that could be used to inform the implementation of a mobile health (mHealth) intervention in Nigeria. Methods: A literature review of validated technology comfort and usage scales was conducted to identify candidate items. The draft measure was reviewed for face validity by an expert panel comprised of clinicians and researchers with cultural, methodological, and clinical expertise. The measure was piloted by radiologists at an oncology symposium in Nigeria. Results: After expert review, the final measure included 18 items organized into 3 domains: (1) comfort with using mobile applications, (2) reliability of internet or electricity, and (3) attitudes toward using computers or mobile applications in clinical practice. The pilot sample (n=16) reported high levels of comfort and acceptability toward using mHealth applications in the clinical setting but faced numerous infrastructure challenges. Conclusions: Pilot results indicate that the TAUS may be a feasible and appropriate measure for assessing technology usage and acceptability in LMIC clinical contexts. Dedicating a domain to technology infrastructure and access yielded valuable insights for program implementation. %M 35442204 %R 10.2196/34035 %U https://formative.jmir.org/2022/4/e34035 %U https://doi.org/10.2196/34035 %U http://www.ncbi.nlm.nih.gov/pubmed/35442204 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e32628 %T Process and Information Needs When Searching for and Selecting Apps for Smoking Cessation: Qualitative Study Using Contextual Inquiry %A Hendriks,Ylva %A Peek,Sebastiaan %A Kaptein,Maurits %A Bongers,Inge %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, 5000 LE, Netherlands, 31 13 466 4892, ylva.hendriks@tilburguniversity.edu %K mHealth and eHealth %K contextual inquiry %K decision-making %K mobile app search and selection %K apps for smoking cessation %K mobile apps %K mobile phone %D 2022 %7 14.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hundreds of apps are available to support people in their quest to quit smoking. It has been hypothesized that selecting an app from a sizable volume without any aid can be overwhelming and difficult. However, little is known about how people choose apps for smoking cessation and what exactly people want to know about an app before choosing to install it. Understanding the decision-making process may ultimately be helpful in creating tools to help people meaningfully select apps. Objective: The aim of this study is to obtain insights into the process of searching and selecting mobile apps for smoking cessation and map the range of actions and the accompanying reasons during the search, focusing on the information needs and experiences of those who aim to find an app. Methods: Contextual inquiries were conducted with 10 Dutch adults wanting to quit smoking by using an app. During the inquiries, we observed people as they chose an app. In addition, 2 weeks later, there was a short semistructured follow-up interview over the phone. Through convenience and purposive sampling, we included participants differing in gender, age, and educational level. We used thematic analysis to analyze the transcribed interviews and leveraged a combination of video and audio recordings to understand what is involved in searching and selecting apps for smoking cessation. Results: The process of finding smoking cessation apps is comprehensive: participants explored, evaluated, and searched for information; imagined using functions; compared apps; assessed the trustworthiness of apps and information; and made several decisions while navigating the internet and app stores. During the search, the participants gained knowledge of apps and developed clearer ideas about their wishes and requirements. Confidence and trust in these apps to help quitting remained quite low or even decreased. Although the process was predominantly a positive experience, the whole process took time and energy and caused negative emotions such as frustration and disappointment for some participants. In addition, without the participants realizing it, errors in information processing occurred, which affected the choices they made. All participants chose an app with the explicit intention of using it. After 2 weeks, of the 10 participants, 6 had used the app, of whom only 1 extensively. Conclusions: Finding an app in the current app stores that contains functions and features expected to help in quitting smoking takes considerable time and energy, can be a negative experience, and is prone to errors in information processing that affect decision-making. Therefore, we advise the further development of decision aids, such as advanced filters, recommender systems and curated health app portals, and make a number of concrete recommendations for the design of such systems. %M 35436217 %R 10.2196/32628 %U https://humanfactors.jmir.org/2022/2/e32628 %U https://doi.org/10.2196/32628 %U http://www.ncbi.nlm.nih.gov/pubmed/35436217 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35668 %T Evaluating User Feedback for an Artificial Intelligence–Enabled, Cognitive Behavioral Therapy–Based Mental Health App (Wysa): Qualitative Thematic Analysis %A Malik,Tanya %A Ambrose,Adrian Jacques %A Sinha,Chaitali %+ Wysa Inc, 131 Dartmouth St, Boston, MA, United States, 1 9874803442, tanya@wysa.io %K digital mental health %K artificial intelligence %K user reviews %K cognitive behavioral therapy %K CBT %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital mental health apps are rapidly becoming a common source of accessible support across the world, but their effectiveness is often influenced by limited helpfulness and engagement. Objective: This study’s primary objective was to analyze feedback content to understand users’ experiences with engaging with a digital mental health app. As a secondary objective, an exploratory analysis captured the types of mental health app users. Methods: This study utilized a user-led approach to understanding factors for engagement and helpfulness in digital mental health by analyzing feedback (n=7929) reported on Google Play Store about Wysa, a mental health app (1-year period). The analysis of keywords in the user feedback categorized and evaluated the reported user experience into the core domains of acceptability, usability, usefulness, and integration. The study also captured key deficits and strengths of the app and explored salient characteristics of the types of users who benefit from accessible digital mental health support. Results: The analysis of user feedback found the app to be overwhelmingly positively reviewed (6700/7929, 84.50% 5-star rating). The themes of engaging exercises, interactive interface, and artificial intelligence (AI) conversational ability indicated the acceptability of the app, while the nonjudgmentality and ease of conversation highlighted its usability. The app’s usefulness was portrayed by themes such as improvement in mental health, convenient access, and cognitive restructuring exercises. Themes of privacy and confidentiality underscored users’ preference for the integrated aspects of the app. Further analysis revealed 4 predominant types of individuals who shared app feedback on the store. Conclusions: Users reported therapeutic elements of a comfortable, safe, and supportive environment through using the digital mental health app. Digital mental health apps may expand mental health access to those unable to access traditional forms of mental health support and treatments. %M 35249886 %R 10.2196/35668 %U https://humanfactors.jmir.org/2022/2/e35668 %U https://doi.org/10.2196/35668 %U http://www.ncbi.nlm.nih.gov/pubmed/35249886 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33581 %T Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study %A Win,Hninyee %A Russell,Samantha %A Wertheim,Betsy C %A Maizes,Victoria %A Crocker,Robert %A Brooks,Audrey J %A Mesa,Ruben %A Huberty,Jennifer %A Geyer,Holly %A Eckert,Ryan %A Larsen,Ashley %A Gowin,Krisstina %+ Department of Hematology, University of Arizona, 1501 N Campbell, Tucson, AZ, 85724, United States, 1 5206260662, gowink@email.arizona.edu %K myeloproliferative neoplasm %K mobile application %K symptom burden %K wellness %K self-management %K mobile phone %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective: This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine’s global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods: Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results: Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions: Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted. %M 35357315 %R 10.2196/33581 %U https://formative.jmir.org/2022/3/e33581 %U https://doi.org/10.2196/33581 %U http://www.ncbi.nlm.nih.gov/pubmed/35357315 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e33863 %T Quality of Mobile Apps for Care Partners of People With Alzheimer Disease and Related Dementias: Mobile App Rating Scale Evaluation %A Werner,Nicole E %A Brown,Janetta C %A Loganathar,Priya %A Holden,Richard J %+ Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, United States, 1 608 890 2578, nwerner3@wisc.edu %K Alzheimer disease and related dementias %K mobile app %K mHealth %K caregivers %K dementia caregiving %K eHealth %K telehealth %K mobile phone %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over 11 million care partners in the United States who provide care to people living with Alzheimer disease and related dementias (ADRD) cite persistent and pervasive unmet needs related to their caregiving role. The proliferation of mobile apps for care partners has the potential to meet care partners’ needs, but the quality of apps is unknown. Objective: This study aims to evaluate the quality of publicly available apps for care partners of people living with ADRD and identify design features of low- and high-quality apps to guide future research and user-centered app development. Methods: We searched the US Apple App and Google Play stores with the criteria that included apps needed to be available in the US Google Play or Apple App stores, accessible to users out of the box, and primarily intended for use by an informal (family or friend) care partner of a person living with ADRD. We classified and tabulated app functionalities. The included apps were then evaluated using the Mobile App Rating Scale (MARS) using 23 items across 5 dimensions: engagement, functionality, aesthetics, information, and subjective quality. We computed descriptive statistics for each rating. To identify recommendations for future research and app development, we categorized rater comments on score-driving factors for each MARS rating item and what the app could have done to improve the item score. Results: We evaluated 17 apps. We found that, on average, apps are of minimally acceptable quality. Functionalities supported by apps included education (12/17, 71%), interactive training (3/17, 18%), documentation (3/17, 18%), tracking symptoms (2/17, 12%), care partner community (3/17, 18%), interaction with clinical experts (1/17, 6%), care coordination (2/17, 12%), and activities for the person living with ADRD (2/17, 12%). Of the 17 apps, 8 (47%) had only 1 feature, 6 (35%) had 2 features, and 3 (18%) had 3 features. The MARS quality mean score across apps was 3.08 (SD 0.83) on the 5-point rating scale (1=inadequate to 5=excellent), with apps scoring highest on average on functionality (mean 3.37, SD 0.99) and aesthetics (mean 3.24, SD 0.92) and lowest on average on information (mean 2.95, SD 0.95) and engagement (mean 2.76, SD 0.89). The MARS subjective quality mean score across apps was 2.26 (SD 1.02). Conclusions: We identified apps whose mean scores were more than 1 point below minimally acceptable quality, whereas some were more than 1 point above. Many apps had broken features and were rated as below acceptable for engagement and information. Minimally acceptable quality is likely to be insufficient to meet care partner needs. Future research should establish minimum quality standards across dimensions for care partner mobile apps. Design features of high-quality apps identified in this study can provide the foundation for benchmarking these standards. %M 35348467 %R 10.2196/33863 %U https://mhealth.jmir.org/2022/3/e33863 %U https://doi.org/10.2196/33863 %U http://www.ncbi.nlm.nih.gov/pubmed/35348467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e31309 %T Smartphone Apps for Vaping Cessation: Quality Assessment and Content Analysis %A Sanchez,Sherald %A Kundu,Anasua %A Limanto,Elizabeth %A Selby,Peter %A Baskerville,Neill Bruce %A Chaiton,Michael %+ Institute of Medical Science, Termerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 416 535 8501 ext 32005, Sherald.Sanchez@utoronto.ca %K e-cigarettes %K vaping %K cessation %K mHealth interventions %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the prevalence of electronic cigarette (e-cigarette) use, or vaping, continues to grow, particularly among young people, so does the need for research and interventions to address vaping. Objective: This study examines the quality of free vaping cessation apps, their contents and features, popularity among users, and adherence to evidence-based principles. Methods: A systematic search of existing apps for vaping cessation was conducted in December 2020. Eligible apps were free, in English, and included features specifically targeting vaping cessation. Each app included in the analysis was used daily for at least seven consecutive days, assessed using the Mobile App Rating Scale, and rated by at least two authors (AK, EL, or SS) based on adherence to evidence-based practices. Intraclass correlation coefficient (ICC) estimates were computed to assess interrater reliability (excellent agreement; ICC 0.92; 95% CI 0.78-0.98). Results: A total of 8 apps were included in the quality assessment and content analysis: 3 were developed specifically for vaping cessation and 5 focused on smoking cessation while also claiming to address vaping cessation. The mean of app quality total scores was 3.66 out of 5. Existing vaping cessation apps employ similar approaches to smoking cessation apps. However, they are very low in number and have limited features developed specifically for vaping cessation. Conclusions: Given the lack of vaping cessation interventions at a time when they are urgently needed, smartphone apps are potentially valuable tools. Therefore, it is recommended that these apps apply evidence-based practices and undergo rigorous evaluations that can assess their quality, contents and features, and popularity among users. Through this process, we can improve our understanding of how apps can be effective in helping users quit vaping. %M 35343904 %R 10.2196/31309 %U https://mhealth.jmir.org/2022/3/e31309 %U https://doi.org/10.2196/31309 %U http://www.ncbi.nlm.nih.gov/pubmed/35343904 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30789 %T Impact of Masticatory Behaviors Measured With Wearable Device on Metabolic Syndrome: Cross-sectional Study %A Uehara,Fumiko %A Hori,Kazuhiro %A Hasegawa,Yoko %A Yoshimura,Shogo %A Hori,Shoko %A Kitamura,Mari %A Akazawa,Kohei %A Ono,Takahiro %+ Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Niigata, 9518514, Japan, 81 25 227 2891, hori@dent.niigata-u.ac.jp %K metabolic syndrome %K mastication behaviors %K wearable device %K daily meal %K energy intake %K chew %K internet of things %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It has been widely recognized that mastication behaviors are related to the health of the whole body and to lifestyle-related diseases. However, many studies were based on subjective questionnaires or were limited to small-scale research in the laboratory due to the lack of a device for measuring mastication behaviors during the daily meal objectively. Recently, a small wearable masticatory counter device, called bitescan (Sharp Co), for measuring masticatory behavior was developed. This wearable device is designed to assess objective masticatory behavior by being worn on the ear in daily life. Objective: This study aimed to investigate the relation between mastication behaviors in the laboratory and in daily meals and to clarify the difference in mastication behaviors between those with metabolic syndrome (MetS) and those without (non-MetS) measured using a wearable device. Methods: A total of 99 healthy volunteers (50 men and 49 women, mean age 36.4 [SD 11.7] years) participated in this study. The mastication behaviors (ie, number of chews and bites, number of chews per bite, and chewing rate) were measured using a wearable ear-hung device. Mastication behaviors while eating a rice ball (100 g) in the laboratory and during usual meals for an entire day were monitored, and the daily energy intake was calculated. Participants’ abdominal circumference, fasting glucose concentration, blood pressure, and serum lipids were also measured. Mastication behaviors in the laboratory and during meals for 1 entire day were compared. The participants were divided into 2 groups using the Japanese criteria for MetS (positive/negative for MetS or each MetS component), and mastication behaviors were compared. Results: Mastication behaviors in the laboratory and during daily meals were significantly correlated (number of chews r=0.36; P<.001; number of bites r=0.49; P<.001; number of chews per bite r=0.33; P=.001; and chewing rate r=0.51; P<.001). Although a positive correlation was observed between the number of chews during the 1-day meals and energy intake (r=0.26, P=.009), the number of chews per calorie ingested was negatively correlated with energy intake (r=–0.32, P=.002). Of the 99 participants, 8 fit the criteria for MetS and 14 for pre-MetS. The number of chews and bites for a rice ball in the pre-MetS(+) group was significantly lower than the pre-MetS(–) group (P=.02 and P=.04, respectively). Additionally, scores for the positive abdominal circumference and hypertension subgroups were also less than the counterpart groups (P=.004 and P=.01 for chews, P=.006 and P=.02 for bites, respectively). The number of chews and bites for an entire day in the hypertension subgroup were significantly lower than in the other groups (P=.02 and P=.006). Furthermore, the positive abdominal circumference and hypertension subgroups showed lower numbers of chews per calorie ingested for 1-day meals (P=.03 and P=.02, respectively). Conclusions: These results suggest a relationship between masticatory behaviors in the laboratory and those during daily meals and that masticatory behaviors are associated with MetS and MetS components. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry R000034453; https://tinyurl.com/mwzrhrua %M 35184033 %R 10.2196/30789 %U https://mhealth.jmir.org/2022/3/e30789 %U https://doi.org/10.2196/30789 %U http://www.ncbi.nlm.nih.gov/pubmed/35184033 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e29407 %T Reaching Patients With Noncommunicable Diseases in Rural Tanzania Using Mobile Devices and Community Trust: Qualitative Study %A Miyashita,Ayano %A Nakamura,Keiko %A Ohnishi,Mayumi %A Bintabara,Deogratius %A Shayo,Festo K %A Maro,Isaac I %A Sato,Hideko %A Seino,Kaoruko %A Kibusi,Stephen %+ Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8519, Japan, 81 3 5803 4048, nakamura.ith@tmd.ac.jp %K noncommunicable disease %K community health workers %K Tanzania %K communication %K rural %K community %K trust %K disease %K acceptability %K usability %K text message %K SMS %K mobile phone %K implementation %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A health service using mobile devices, mobile health (mHealth), has been widely applied to programs focusing on maternal and child health and communicable diseases in sub-Saharan African countries. However, mHealth apps for noncommunicable disease (NCD) services remain limited. Objective: This study aimed to explore the acceptability and potential usability of SMS text messaging for patients and health care providers for the management of NCDs as part of an implementation research in rural Tanzania. Methods: Nine focus group discussions were conducted with 56 participants (21 community health workers [CHWs], 17 patients, and 18 health care professionals [HPs]) in 3 districts in the Dodoma region, Tanzania. The interview guides were prepared in Swahili, and each session was recorded, transcribed, and translated into English. The focus group discussions consisted of the following topics: (1) perceptions of the participants about the possible use of mobile devices and SMS text messages as an mHealth platform in community health services; and (2) experiences of mobile device use in health activities or receiving health services via a mobile phone in the past. Results: CHWs and HPs reported having familiarity using mobile devices to provide health services, especially for reaching or tracing patients in remote settings; however, patients with NCDs were less familiar with the use of mobile devices compared with the other groups. Hesitation to receive health services via SMS text messaging was seen in the patient group, as they wondered who would send health advice to them. Some patients expected services beyond what mHealth could do, such as aiding in recovery from a disease or sending notifications about the availability of prescription medications. CHWs showed interest in using text messaging to provide health services in the community; however, the concerns raised by CHWs included the cost of using their own mobile devices. Moreover, they demanded training about NCD management before engaging in such an activity. Conclusions: This study explored views and experiences regarding the possible installation of an mHealth intervention for managing NCDs in rural Tanzania. Although HPs and CHWs had experience using mobile devices to provide health services in non-NCD projects, only a few patients (3/17, 17%) had heard about the use of mobile devices to receive health services. To improve the suitability and acceptability of the intervention design for patients with NCDs, their trust must be earned. Involving CHWs in the intervention is recommended because they have already been appointed in the community and already know how to communicate effectively with patients in the area. %M 35297772 %R 10.2196/29407 %U https://mhealth.jmir.org/2022/3/e29407 %U https://doi.org/10.2196/29407 %U http://www.ncbi.nlm.nih.gov/pubmed/35297772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31894 %T Testing Digital Methods of Patient-Reported Outcomes Data Collection: Prospective Cluster Randomized Trial to Test SMS Text Messaging and Mobile Surveys %A Agarwal,Anish K %A Ali,Zarina S %A Shofer,Frances %A Xiong,Ruiying %A Hemmons,Jessica %A Spencer,Evan %A Abdel-Rahman,Dina %A Sennett,Brian %A Delgado,Mucio K %+ Department of Emergency Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, United States, 1 6103042318, anish.agarwal@pennmedicine.upenn.edu %K patient-reported outcomes %K mobile surveys %K research methods %K text messaging %K mobile survey %K data collection %K patient engagement %K response rate %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care delivery continues to evolve, with an effort being made to create patient-centered care models using patient-reported outcomes (PROs) data. Collecting PROs has remained challenging and an expanding landscape of digital health offers a variety of methods to engage patients. Objective: The aim of this study is to prospectively investigate two common methods of remote PRO data collection. The study sought to compare response and engagement rates for bidirectional SMS text messaging and mobile surveys following orthopedic surgery. Methods: The study was a prospective, block randomized trial of adults undergoing elective orthopedic procedures over 6 weeks. The primary objective was to determine if the method of digital patient engagement would impact response and completion rates. The primary outcome was response rate and total completion of PRO questionnaires. Results: A total of 127 participants were block randomized into receiving a mobile survey (n=63) delivered as a hyperlink or responding to the same questions through an automated bidirectional SMS text messaging system (n=64). Gender, age, number of comorbidities, and opioid prescriptions were similar across messaging arms. Patients receiving the mobile survey were more likely to have had a knee-related surgery (n=50, 83.3% vs n=40, 62.5%; P=.02) but less likely to have had an invasive procedure (n=26, 41.3% vs n=39, 60.9%; P=.03). Overall engagement over the immediate postoperative period was similar. Prolonged engagement for patients taking opioids past postoperative day 4 was higher in the mobile survey arm at day 7 (18/19, 94.7% vs 9/16, 56.3%). Patients with more invasive procedures showed a trend toward being responsive at day 4 as compared to not responding (n=41, 59.4% vs n=24, 41.4%; P=.05). Conclusions: As mobile patient engagement becomes more common in health care, testing the various options to engage patients to gather data is crucial to inform future care and research. We found that bidirectional SMS text messaging and mobile surveys were comparable in response and engagement rates; however, mobile surveys may trend toward higher response rates over longer periods of time. Trial Registration: ClinicalTrials.gov NCT03532256; https://clinicaltrials.gov/ct2/show/NCT03532256 %M 35298394 %R 10.2196/31894 %U https://formative.jmir.org/2022/3/e31894 %U https://doi.org/10.2196/31894 %U http://www.ncbi.nlm.nih.gov/pubmed/35298394 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e24680 %T Acceptance of the Use of Artificial Intelligence in Medicine Among Japan’s Doctors and the Public: A Questionnaire Survey %A Tamori,Honoka %A Yamashina,Hiroko %A Mukai,Masami %A Morii,Yasuhiro %A Suzuki,Teppei %A Ogasawara,Katsuhiko %+ Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 0600812, Japan, 81 11 706 3409, oga@hs.hokudai.ac.jp %K artificial intelligence %K technology acceptance %K surveys and questionnaires %K doctors vs public %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of artificial intelligence (AI) in the medical industry promises many benefits, so AI has been introduced to medical practice primarily in developed countries. In Japan, the government is preparing for the rollout of AI in the medical industry. This rollout depends on doctors and the public accepting the technology. Therefore it is necessary to consider acceptance among doctors and among the public. However, little is known about the acceptance of AI in medicine in Japan. Objective: This study aimed to obtain detailed data on the acceptance of AI in medicine by comparing the acceptance among Japanese doctors with that among the Japanese public. Methods: We conducted an online survey, and the responses of doctors and members of the public were compared. AI in medicine was defined as the use of AI to determine diagnosis and treatment without requiring a doctor. A questionnaire was prepared referred to as the unified theory of acceptance and use of technology, a model of behavior toward new technologies. It comprises 20 items, and each item was rated on a five-point scale. Using this questionnaire, we conducted an online survey in 2018 among 399 doctors and 600 members of the public. The sample-wide responses were analyzed, and then the responses of the doctors were compared with those of the public using t tests. Results: Regarding the sample-wide responses (N=999), 653 (65.4%) of the respondents believed, in the future, AI in medicine would be necessary, whereas only 447 (44.7%) expressed an intention to use AI-driven medicine. Additionally, 730 (73.1%) believed that regulatory legislation was necessary, and 734 (73.5%) were concerned about where accountability lies. Regarding the comparison between doctors and the public, doctors (mean 3.43, SD 1.00) were more likely than members of the public (mean 3.23, SD 0.92) to express intention to use AI-driven medicine (P<.001), suggesting that optimism about AI in medicine is greater among doctors compared to the public. Conclusions: Many of the respondents were optimistic about the role of AI in medicine. However, when asked whether they would like to use AI-driven medicine, they tended to give a negative response. This trend suggests that concerns about the lack of regulation and about accountability hindered acceptance. Additionally, the results revealed that doctors were more enthusiastic than members of the public regarding AI-driven medicine. For the successful implementation of AI in medicine, it would be necessary to inform the public and doctors about the relevant laws and to take measures to remove their concerns about them. %M 35293878 %R 10.2196/24680 %U https://humanfactors.jmir.org/2022/1/e24680 %U https://doi.org/10.2196/24680 %U http://www.ncbi.nlm.nih.gov/pubmed/35293878 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31823 %T Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study %A Happe,Lisa %A Sgraja,Marie %A Hein,Andreas %A Diekmann,Rebecca %+ Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, Haarentor Campus, Building V04, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany, 49 441798 ext 2354, lisa.happe@uol.de %K older adults %K rehabilitation %K physical activity %K nutrition %K e-coach %K usability testing %K tablet computers %K health behavior %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one’s nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely. Objective: This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (≥65 years) based on individual health behavior change stages in a rehabilitation setting. Methods: Iterative testing was performed with patients aged ≥65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS). Results: In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%). Conclusions: The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change. %M 35293874 %R 10.2196/31823 %U https://humanfactors.jmir.org/2022/1/e31823 %U https://doi.org/10.2196/31823 %U http://www.ncbi.nlm.nih.gov/pubmed/35293874 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33152 %T An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Co-design and User Testing Study %A Mueller,Emily L %A Cochrane,Anneli R %A Campbell,Madison E %A Nikkhah,Sarah %A Miller,Andrew D %+ Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 705 Riley Hospital Dr, ROC 4340, Indianapolis, IN, 46202, United States, 1 312 399 0245, elmuelle@iu.edu %K child %K adolescent %K oncology %K supportive care %K mHealth %K mobile health %K cancer %K pediatrics %K children %K digital health %K health applications %K parent %K caregiver %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Caregivers face new challenges and tasks when their child is diagnosed with cancer, which can be overwhelming. Mobile technology has the capacity to provide immediate support at their fingertips to aid in tracking symptoms, managing medication, and planning for emergencies. Objective: The objective of this study is to engage directly with end users and proxies to co-design and create a mobile technology app to support caregivers in the medical management of their child with cancer. Methods: We engaged directly with caregivers of children with cancer and pediatric oncology nurse coordinators (proxy end users) to co-design and create the prototype of the Cope 360 mobile health app. Alpha testing was accomplished by walking the users through a series of predetermined tasks that encompassed all aspects of the app including tracking symptoms, managing medications, and planning or practicing for a medical emergency that required seeking care in the emergency department. Evaluation was accomplished through recorded semistructured interviews and quantitative surveys to capture demographic information and measure the system usability score. Interviews were transcribed and analyzed iteratively using NVivo (version 12; QSR International). Results: This study included 8 caregivers (aged 33-50 years) of children with cancer, with most children receiving chemotherapy, and 6 nurse coordinators, with 3 (50%) of them having 11 to 20 years of nursing experience. The mean system usability score given by caregivers was 89.4 (95% CI 80-98.8). Results were grouped by app function assessed with focus on specific attributes that were well received and those that required refinement. The major issues requiring refinement included clarity in the medical information and terminology, improvement in design of tasks, tracking of symptoms including adjusting the look and feel of certain buttons, and changing the visual graph used to monitor symptoms to include date anchors. Conclusions: The Cope 360 app was well received by caregivers of children with cancer but requires further refinement for clarity and visual representation. After refinement, testing among caregivers in a real-world environment is needed to finalize the Cope 360 app before its implementation in a randomized controlled trial. %M 35293867 %R 10.2196/33152 %U https://cancer.jmir.org/2022/1/e33152 %U https://doi.org/10.2196/33152 %U http://www.ncbi.nlm.nih.gov/pubmed/35293867 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e35879 %T Nutrition-Related Mobile Apps in the French App Stores: Assessment of Functionality and Quality %A Martinon,Prescilla %A Saliasi,Ina %A Bourgeois,Denis %A Smentek,Colette %A Dussart,Claude %A Fraticelli,Laurie %A Carrouel,Florence %+ Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, 11 Rue Guillaume Paradin, Lyon, 69008, France, 33 478785745, florence.carrouel@univ-lyon1.fr %K mobile apps %K behavior change %K diet %K healthy food %K nutrition %K prevention %K mHealth %K mobile health %K lifestyle %K French %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The global burden of disease attributes 20% of deaths to poor nutrition. Although hundreds of nutrition-related mobile apps have been created, and these have been downloaded by millions of users, the effectiveness of these technologies on the adoption of healthy eating has had mixed Objective: The aim of this study was to review which nutrition-related mobile apps are currently available on the French market and assess their quality. Methods: We screened apps on the Google Play Store and the French Apple App Store, from March 10 to 17, 2021, to identify those related to nutritional health. A shortlist of 15 apps was identified, and each was assessed using the French version of the Mobile App Rating Scale: 8 dietitians and nutritionists assessed 7 apps, and the remaining apps were randomly allocated to ensure 4 assessments per app. Intraclass correlation was used to evaluate interrater agreement. Means and standard deviations of scores for each section and each item were calculated. Results: The top scores for overall quality were obtained by Yazio - Régime et Calories (mean 3.84, SD 0.32), FeelEat (mean 3.71, SD 0.47), and Bonne App (mean 3.65, SD 0.09). Engagement scores ranged from a mean of 1.95 (SD 0.5) for iEatBetter: Journal alimentaire to a mean of 3.85 (SD 0.44) for FeelEat. Functionality scores ranged from a mean of 2.25 (SD 0.54) for Naor to a mean of 4.25 (SD 0.46) for Yazio. Aesthetics scores ranged from a mean of 2.17 (SD 0.34) for Naor to a mean of 3.88 (SD 0.47) for Yazio. Information scores ranged from a mean of 2.38 (SD 0.60) for iEatBetter to a mean of 3.73 (SD 0.29) for Yazio. Subjective quality scores ranged from a mean of 1.13 (SD 0.25) for iEatBetter to a mean of 2.28 (SD 0.88) for Compteur de calories FatSecret. Specificity scores ranged from a mean of 1.38 (SD 0.64) for iEatBetter to a mean of 3.50 (SD 0.91) for FeelEat. The app-specific score was always lower than the subjective quality score, which was always lower than the quality score, which was lower than the rating from the iOS or Android app stores. Conclusions: Although prevention and information messages in apps regarding nutritional habits are not scientifically verified before marketing, we found that app quality was good. Subjective quality and specificity were associated with lower ratings. Further investigations are needed to assess whether information from these apps is consistent with recommendations and to determine the long-term impacts of these apps on users. %M 35285817 %R 10.2196/35879 %U https://mhealth.jmir.org/2022/3/e35879 %U https://doi.org/10.2196/35879 %U http://www.ncbi.nlm.nih.gov/pubmed/35285817 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35402 %T Developing a Smartphone-Based Adjunct Intervention to Reduce Cannabis Use Among Juvenile Justice-Involved Adolescents: Protocol for a Multiphase Study %A Helseth,Sarah A %A Guigayoma,John %A Price,Dayna %A Spirito,Anthony %A Clark,Melissa A %A Barnett,Nancy P %A Becker,Sara J %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 5th Floor, Providence, RI, , United States, 1 401 863 6881, sarah_helseth@brown.edu %K mobile intervention %K juvenile justice %K justice %K court %K adolescent %K teenager %K substance use %K cannabis %K youth %K adolescence %K protocol %K mHealth %K mobile health %K substance use %K user design %K behavioral app %K health app %K development %K pilot %K prototype %K feasibility %K acceptability %K smartphone app %K marijuana %K mobile phone %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents involved in the juvenile justice system who use cannabis are at an increased risk of future substance use disorders and rearrest. Many court-involved, nonincarcerated (CINI) youth are referred for services in the community and often encounter multiple barriers to care, highlighting the need for minimally burdensome services that can be delivered in justice settings. Digital health interventions are accessible, easy to implement, and can provide ongoing support but have not been developed to address the unique needs of CINI youth who use cannabis. Objective: This multiphase study will aim to develop, implement, and pilot test a novel smartphone app, Teen Empowerment through Computerized Health (TECH), to reduce cannabis and other substance use among CINI youth. TECH is conceptualized as a digital adjunct to a brief computerized intervention delivered by our family court partner. Methods: Following the principles of user-centered design, phase I interviews with CINI youth aged 14-18 years (n=14-18), their caregivers (n=6-8), and behavioral health app developers (n=6-8) will guide the TECH design decisions. Next, in phase II, CINI youth (n=10) will beta test the TECH app prototype for 1 month; their feedback regarding feasibility and acceptability will directly inform the app refinement process. Finally, in phase III, CINI youth (n=60) will participate in a pilot randomized controlled trial for 6 months, comparing the preliminary effectiveness of the adjunctive TECH app on cannabis use outcomes. Results: Phase I data collection began in September 2020 and was completed in December 2021; 14 CINI youth, 8 caregivers, and 11 behavioral health app developers participated in the study. Phases II and III will occur in 2022 and 2023 and 2023 and 2025, respectively. Conclusions: This body of work will provide insight into the feasibility and acceptability of a smartphone-based adjunctive intervention designed for CINI youth. Phase III results will offer a preliminary indication of the effectiveness of the TECH app in reducing cannabis use among CINI youth. International Registered Report Identifier (IRRID): DERR1-10.2196/35402 %M 35275086 %R 10.2196/35402 %U https://www.researchprotocols.org/2022/3/e35402 %U https://doi.org/10.2196/35402 %U http://www.ncbi.nlm.nih.gov/pubmed/35275086 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32499 %T Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study %A Fradkin,Nick %A Zbikowski,Susan M %A Christensen,Trevor %+ Office of Healthy and Safe Communities, Division of Prevention and Community Health, Washington State Department of Health, PO Box 47848, Olympia, WA, 98504-7848, United States, 1 602 326 3439, nfradkin@gmail.com %K mobile applications %K mHealth %K eHealth %K smartphone app %K tobacco %K smoking cessation %K public health %K smoking %K application %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco “quitline” services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results: Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups. %M 35262491 %R 10.2196/32499 %U https://publichealth.jmir.org/2022/3/e32499 %U https://doi.org/10.2196/32499 %U http://www.ncbi.nlm.nih.gov/pubmed/35262491 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34918 %T Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study %A Schretzlmaier,Patrik %A Hecker,Achim %A Ammenwerth,Elske %+ Institute of Medical Informatics, UMIT – Private University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, Hall in Tirol, 6060, Austria, 49 17657875980, patrik.schretzlmaier@edu.umit-tirol.at %K mHealth %K mobile health %K mobile apps %K diabetes mellitus %K technology acceptance %K UTAUT2 %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing. Objective: This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance. Methods: In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches. Results: This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat. Conclusions: This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context. %M 35262493 %R 10.2196/34918 %U https://humanfactors.jmir.org/2022/1/e34918 %U https://doi.org/10.2196/34918 %U http://www.ncbi.nlm.nih.gov/pubmed/35262493 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33038 %T Lessons for Uptake and Engagement of a Smartphone App (SURE Recovery) for People in Recovery From Alcohol and Other Drug Problems: Interview Study of App Users %A Neale,Joanne %A Bowen,Alice May %+ National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom, 44 7511319855, alice.m.bowen@kcl.ac.uk %K apps %K digital literacy %K mHealth %K substance use %K recovery %K qualitative %K mobile phone %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health apps promoting health and well-being have substantial potential but low uptake and engagement. Barriers common to addiction treatment app uptake and engagement include poor access to mobile technology, Wi-Fi, or mobile data, plus low motivation among non–treatment-seeking users to cut down or quit. Working with people who used substances, we had previously designed and published an app to support recovery from alcohol and other drug problems. The app, which is available for free from the Apple App Store and Google Play, is called SURE Recovery. Objective: The aim of this paper is to undertake a qualitative study to ascertain end users’ views and experiences of the SURE Recovery app, including how it might be improved, and present the findings on uptake and engagement to assist other researchers and app developers working on similar apps for people experiencing alcohol and other drug problems. Methods: Semistructured telephone interviews were conducted with 20 people (n=12, 60%, men and n=8, 40%, women aged 25-63 years; all identifying as White British) who had varied patterns of using the app. The audio recordings were transcribed, and the data were coded and analyzed through Iterative Categorization. Results: Analyses identified three main factors relevant to uptake (discoverability of the app, personal relevance, and expectations and motivations) and three main factors relevant to engagement (the appeal and relevance of specific features, perceived benefits, and the need for improvements). The findings on uptake and engagement were largely consistent with our own earlier developmental work and with other published literature. However, we additionally found that uptake was strongly affected by first impressions, including trust and personal recommendations; that users were attracted to the app by their need for support and curiosity but had relatively modest expectations; that engagement increased if the app made users feel positive; and that people were unlikely to download, or engage with, the app if they could not relate to, or identify with, aspects of its content. Conclusions: Incorporating end-user views into app design and having a network of supportive partners (ie, credible organizations and individuals who will champion the app) seem to increase uptake and engagement among people experiencing alcohol and other drug problems. Although better digital literacy and access to devices and mobile data are needed if addiction recovery apps are to reach their full potential, we should not evaluate them based only on observable changes in substance use behaviors. How using an app makes a person feel is more transient and difficult to quantify but also relevant to uptake and engagement. %M 35258474 %R 10.2196/33038 %U https://humanfactors.jmir.org/2022/1/e33038 %U https://doi.org/10.2196/33038 %U http://www.ncbi.nlm.nih.gov/pubmed/35258474 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e28332 %T mHealth Intervention to Improve Treatment Outcomes Among People With HIV Who Use Cocaine: Protocol for a Pilot Randomized Controlled Trial %A Ranjit,Yerina S %A Krishnan,Archana %A Ghosh,Debarchana %A Cravero,Claire %A Zhou,Xin %A Altice,Frederick L %+ Department of Communication, University of Missouri, 108 Switzler Hall, Columbia, MO, 65211, United States, 1 573 822 0881, ranjity@missouri.edu %K smart pillbox %K smartphone %K mHealth intervention %K people with HIV %K cocaine use %K antiretroviral therapy %K description of feasibility and acceptability %K mobile phone %D 2022 %7 7.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Antiretroviral therapy is effective in reducing HIV-related morbidity, mortality, and transmission among people with HIV. However, adherence and persistence to antiretroviral therapy are crucial for successful HIV treatment outcomes. People with HIV who use cocaine have poor access to HIV services and lower retention in care. Objective: The primary goal of this paper is to provide a detailed description of a mobile health intervention. This study is designed to improve medication adherence among people with HIV who use cocaine. A secondary goal is to list the important challenges and adaptations incorporated in the study design. Methods: This study, titled Project SMART, used a wireless technology–based intervention, including cellular-enabled electronic pillboxes called TowerView Health and smartphones, to provide reminders and feedback on adherence behavior. The intervention design was based on the theoretical frameworks provided by the self-determination theory and the Motivation Technology Model. The 12-week pilot randomized controlled trial with four arms provided three types of feedback: automated feedback, automated+clinician feedback, and automated feedback+social network feedback. Results: The study was funded by the National Institute of Drug Abuse (R21DA039842) on August 1, 2016. The institutional review board for the study was approved by Yale University on March 21, 2017. Data collection lasted from June 2017 to January 2020. The final enrollment was 71 participants, of whom 57 (80%) completed the study. The data are currently undergoing analysis, and the manuscript is being developed for publication in early 2022. Conclusions: Implementing complex mobile health interventions for high-risk and marginalized populations with multicomponent interventions poses certain challenges, such as finding companies with adequate technology for clients and financial stability and minimizing the research-related burden for the study population. Conducting feasibility studies is important to recognize these challenges and the opportunity to address these challenges with solutions while keeping the design of a randomized controlled trial as true as possible. Trial Registration: Clinicaltrials.gov NCT04418076; https://clinicaltrials.gov/ct2/show/NCT04418076 International Registered Report Identifier (IRRID): DERR1-10.2196/28332 %M 35254270 %R 10.2196/28332 %U https://www.researchprotocols.org/2022/3/e28332 %U https://doi.org/10.2196/28332 %U http://www.ncbi.nlm.nih.gov/pubmed/35254270 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31376 %T Mobile Health to Support Community-Integration of Individuals With Disabilities Using iMHere 2.0: Focus Group Study %A Ward,Rebecca E %A Setiawan,I Made Agus %A Quinby,Eleanor %A Fair,Melva %A Ambadar,Zara %A Parmanto,Bambang %A Dicianno,Brad E %+ Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, VA Pittsburgh Healthcare System, 6425 Penn AVE, Suite 400, Pittsburgh, PA, 15206-4022, United States, 1 412 822 3700, dicianno@pitt.edu %K community integration %K self-care %K mobile health %K smartphone %K rehabilitation %K disability %K mobile phone %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) systems that support self-management can improve medical, functional, and psychosocial outcomes for individuals with disabilities and chronic conditions. The mHealth systems can potentially be expanded to support community integration. Objective: The purposes of this study were to (1) partner with a community-based organization that supports community integration of individuals with disabilities; (2) identify software requirements needed to support community participation; and (3) iteratively refine an existing mHealth application to include new requirements. Methods: Community Living and Support Services (CLASS), a nonprofit organization that serves individuals with disabilities in Pittsburgh, Pennsylvania, was identified as the focus group for this study. Key stakeholders within the Community Partners Program at CLASS proposed design requirements for an existing mHealth application, Interactive Mobile Health and Rehabilitation (iMHere) 2.0, that has been used to support self-management. Results: We gathered qualitative data from a focus group composed of CLASS members to develop and iteratively revise iMHere 2.0 to include new modules and features to support community integration. A caregiver app was also developed. The new system contains features to support finance, transportation, client and caregiver communication, calendar and checklist management, upcoming medical and nonmedical appointments, social engagement, pain management, and access to a personal profile. Modifications were made to the following existing modules: education, mood, personal health record, goals, medications, and nutrition. Conclusions: A successful partnership with a community-based organization that supports individuals with disabilities resulted in a newly designed mHealth system with features to support community integration. %M 35254274 %R 10.2196/31376 %U https://humanfactors.jmir.org/2022/1/e31376 %U https://doi.org/10.2196/31376 %U http://www.ncbi.nlm.nih.gov/pubmed/35254274 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30797 %T User-Centered Development and Testing of the Online Patient-Reported Outcomes, Burdens, and Experiences (PROBE) Survey and the myPROBE App and Integration With the Canadian Bleeding Disorder Registry: Mixed Methods Study %A Germini,Federico %A Borg Debono,Victoria %A Page,David %A Zuk,Victoria %A Kucher,Alexandra %A Cotoi,Chris %A Hobson,Nicholas %A Sevestre,Michael %A Skinner,Mark W %A Iorio,Alfonso %A , %+ Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 26771, germinif@mcmaster.ca %K health-related quality of life %K EQ-5D %K mobile app %K Patient-Reported Outcomes, Burdens, and Experiences (PROBE) %K hemophilia %K mobile health %K mHealth %K eHealth %K telehealth %K user-centered design %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Patient-Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire is a tool for assessing the quality of life and disease burden in people living with hemophilia. Objective: The objectives of our study were (1) to assess the needs of relevant stakeholders involved in the use of PROBE, (2) to develop the software infrastructure needed to meet these needs, and (3) to test the usability of the final product. Methods: We conducted a series of semistructured interviews of relevant stakeholders, including PROBE investigators, people with hemophilia, and representatives of the sponsor. Based on these, we developed an online survey and a mobile app for iOS and Android. A user group evaluated the final product using the System Usability Scale (SUS) and an open feedback framework. Results: The online survey was updated, and the myPROBE app for mobile devices and a new application programming interface were developed. The app was tested and modified according to user feedback over multiple cycles. The final version of the app was released in July 2019. Seventeen users aged 23 to 67 years evaluated the final version of the app using the SUS. The median (first, third quartile) SUS score for the app was 85 (68, 88) out of 100. The newly introduced functionalities were as follows: (1) capability to longitudinally track repeated fillings of the questionnaire at different time points by the same participant (as opposed to anonymous completion); (2) linking of the questionnaire with hemophilia registries, starting with the Canadian Bleeding Disorders Registry as a proof of concept; (3) removing or adding questions as needed; and (4) sending notifications to the users (eg, reminders). A new secure database was built for securely storing personal information separately from the questionnaire data. The PROBE online survey is currently available in 96 countries and 34 languages. Conclusions: The online survey was updated successfully, and the myPROBE app was developed, with a SUS score of 85 (out of 100). The app has been released in 81 countries and 34 languages. This will facilitate data collection for research and advocacy purposes, and the use of this tool in everyday clinical practice. %M 35234648 %R 10.2196/30797 %U https://humanfactors.jmir.org/2022/1/e30797 %U https://doi.org/10.2196/30797 %U http://www.ncbi.nlm.nih.gov/pubmed/35234648 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28697 %T Supporting Management of Noncommunicable Diseases With Mobile Health (mHealth) Apps: Experimental Study %A Kela,Neta %A Eytam,Eleanor %A Katz,Adi %+ Shamoon College of Engineering, 84 Jabotinsky St, Ashdod, 77245, Israel, 972 088519309, neta.kela@gmail.com %K mHealth %K digital health %K instrumentality %K aesthetics %K symbolic value %K preference %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications. Objective: This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users’ considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings. Methods: A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the “human touch” of a human physician regarding analyzing data collected by an mHealth app. Results: As shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03). Conclusions: Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value. %M 35234653 %R 10.2196/28697 %U https://humanfactors.jmir.org/2022/1/e28697 %U https://doi.org/10.2196/28697 %U http://www.ncbi.nlm.nih.gov/pubmed/35234653 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e35399 %T Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials %A Siebert,Johan N %A Gosetto,Laëtitia %A Sauvage,Manon %A Bloudeau,Laurie %A Suppan,Laurent %A Rodieux,Frédérique %A Haddad,Kevin %A Hugon,Florence %A Gervaix,Alain %A Lovis,Christian %A Combescure,Christophe %A Manzano,Sergio %A Ehrler,Frederic %A , %A , %+ Department of Pediatric Emergency Medicine, Geneva Children’s Hospital, Geneva University Hospitals, Avenue de la Roseraie, 47, Geneva, 1205, Switzerland, 41 795534072, Johan.Siebert@hcuge.ch %K cardiopulmonary resuscitation %K drugs %K emergency medical services %K medication errors %K mobile health %K mobile apps %K out-of-hospital cardiac arrest %K paramedics %K pediatrics %K System Usability Scale %K Unified Theory of Acceptance and Use of Technology %K smartphone %K mobile phone %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile apps are increasingly being used in various domains of medicine. Few are evidence-based, and their benefits can only be achieved if end users intend to adopt and use them. To date, only a small fraction of mobile apps have published data on their field usability and end user acceptance results, especially in emergency medicine. Objective: This study aims to determine the usability and acceptance of an evidence-based mobile app while safely preparing emergency drugs at the point of care during pediatric in- and out-of-hospital cardiopulmonary resuscitations by frontline caregivers. Methods: In 2 multicenter randomized controlled parent trials conducted at 6 pediatric emergency departments from March 1 to December 31, 2017, and 14 emergency medical services from September 3, 2019, to January 21, 2020, the usability and technology acceptance of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app were evaluated among skilled pediatric emergency nurses and advanced paramedics when preparing continuous infusions of vasoactive drugs and direct intravenous emergency drugs at pediatric dosages during standardized, simulation-based, pediatric in- and out-of-hospital cardiac arrest scenarios, respectively. Usability was measured using the 10-item System Usability Scale. A 26-item technology acceptance self-administered survey (5-point Likert-type scales), adapted from the Unified Theory of Acceptance and Use of Technology model, was used to measure app acceptance and intention to use. Results: All 100% (128/128) of nurses (crossover trial) and 49.3% (74/150) of paramedics (parallel trial) were assigned to the mobile app. Mean total scores on the System Usability Scale were excellent and reached 89.5 (SD 8.8; 95% CI 88.0-91.1) for nurses and 89.7 (SD 8.7; 95% CI 87.7-91.7) for paramedics. Acceptance of the technology was very good and rated on average >4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations. Conclusions: The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations. Trial Registration: ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3726-4 %M 35230243 %R 10.2196/35399 %U https://humanfactors.jmir.org/2022/1/e35399 %U https://doi.org/10.2196/35399 %U http://www.ncbi.nlm.nih.gov/pubmed/35230243 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e32554 %T A Smartphone-Based Model of Care to Support Patients With Cardiac Disease Transitioning From Hospital to the Community (TeleClinical Care): Pilot Randomized Controlled Trial %A Indraratna,Praveen %A Biswas,Uzzal %A McVeigh,James %A Mamo,Andrew %A Magdy,Joseph %A Vickers,Dominic %A Watkins,Elaine %A Ziegl,Andreas %A Liu,Hueiming %A Cholerton,Nicholas %A Li,Joan %A Holgate,Katie %A Fildes,Jennifer %A Gallagher,Robyn %A Ferry,Cate %A Jan,Stephen %A Briggs,Nancy %A Schreier,Guenter %A Redmond,Stephen J %A Loh,Eugene %A Yu,Jennifer %A Lovell,Nigel H %A Ooi,Sze-Yuan %+ Department of Cardiology, Prince of Wales Hospital, Barker Street, Randwick, 2031, Australia, 61 2 9382 2222, praveen@unsw.edu.au %K digital health %K telemedicine %K mHealth %K heart failure %K ischemic heart disease %K mobile phone %D 2022 %7 28.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients hospitalized with acute coronary syndrome (ACS) or heart failure (HF) are frequently readmitted. This is the first randomized controlled trial of a mobile health intervention that combines telemonitoring and education for inpatients with ACS or HF to prevent readmission. Objective: This study aims to investigate the feasibility, efficacy, and cost-effectiveness of a smartphone app–based model of care (TeleClinical Care [TCC]) in patients discharged after ACS or HF admission. Methods: In this pilot, 2-center randomized controlled trial, TCC was applied at discharge along with usual care to intervention arm participants. Control arm participants received usual care alone. Inclusion criteria were current admission with ACS or HF, ownership of a compatible smartphone, age ≥18 years, and provision of informed consent. The primary end point was the incidence of unplanned 30-day readmissions. Secondary end points included all-cause readmissions, cardiac readmissions, cardiac rehabilitation completion, medication adherence, cost-effectiveness, and user satisfaction. Intervention arm participants received the app and Bluetooth-enabled devices for measuring weight, blood pressure, and physical activity daily plus usual care. The devices automatically transmitted recordings to the patients’ smartphones and a central server. Thresholds for blood pressure, heart rate, and weight were determined by the treating cardiologists. Readings outside these thresholds were flagged to a monitoring team, who discussed salient abnormalities with the patients’ usual care providers (cardiologists, general practitioners, or HF outreach nurses), who were responsible for further management. The app also provided educational push notifications. Participants were followed up after 6 months. Results: Overall, 164 inpatients were randomized (TCC: 81/164, 49.4%; control: 83/164, 50.6%; mean age 61.5, SD 12.3 years; 130/164, 79.3% men; 128/164, 78% admitted with ACS). There were 11 unplanned 30-day readmissions in both groups (P=.97). Over a mean follow-up of 193 days, the intervention was associated with a significant reduction in unplanned hospital readmissions (21 in TCC vs 41 in the control arm; P=.02), including cardiac readmissions (11 in TCC vs 25 in the control arm; P=.03), and higher rates of cardiac rehabilitation completion (20/51, 39% vs 9/49, 18%; P=.03) and medication adherence (57/76, 75% vs 37/74, 50%; P=.002). The average usability rating for the app was 4.5/5. The intervention cost Aus $6028 (US $4342.26) per cardiac readmission saved. When modeled in a mainstream clinical setting, enrollment of 237 patients was projected to have the same expenditure compared with usual care, and enrollment of 500 patients was projected to save approximately Aus $100,000 (approximately US $70,000) annually. Conclusions: TCC was feasible and safe for inpatients with either ACS or HF. The incidence of 30-day readmissions was similar; however, long-term benefits were demonstrated, including fewer readmissions over 6 months, improved medication adherence, and improved cardiac rehabilitation completion. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001547235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375945 %M 35225819 %R 10.2196/32554 %U https://mhealth.jmir.org/2022/2/e32554 %U https://doi.org/10.2196/32554 %U http://www.ncbi.nlm.nih.gov/pubmed/35225819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34477 %T Participatory Design of a Mobile App to Safeguard Mental Resilience in the Context of Drug Use in Young Adults: Multi-Method Study %A Ben-Yehuda,Ofri %A Dreazen,Efrat %A Koren,Danny %A Peleg,Mor %+ Department of Information Systems, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 048288509, morpeleg@is.haifa.ac.il %K mobile health %K mHealth %K eHealth %K telehealth %K mental health %K mental resilience %K participatory design %K mobile phone %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing mental health apps are largely not aimed at generally healthy young people who may be experimenting with addictive substances and mind-altering experiences. Objective: The aim of this study is to examine the interest and expectations of young people regarding a proposed smartphone app designed to help protect and promote mental health and resilience in the face of risks associated with substance use. Methods: The study was based on agile system development and had 3 empirical substudies. Our feasibility study (study 1) included an anonymous questionnaire that examined the potential interest of young people in this type of app. It was answered by 339 Israelis aged 18-30 years. The second part of the feasibility study was a pilot study with 1.2% (4/339) of the people who answered the questionnaire and expressed interest in participating in a focus group. They tested and refined the elements planned for the focus groups. Study 2 was a participatory design study involving 7 focus groups of 5 to 7 participants each (young people aged 18-35 years, n=38). Persona development, open discussion, and a Technology Acceptance Model questionnaire were used to elicit user expectations and requirements for the app and to understand the perceived usefulness and usability of the proposed features. Study 3 comprised in-depth interviews with experts in the field of youth mental health and drug use to enlist their professional opinion regarding the value of such an app and recommendations about the features it should include. Results: The mock-up for the proposed app had five key features: personalized assessment of risk for a drug-associated mental crisis, support for self-monitoring, useful information (eg, warning signs and first-aid guidelines), resilience-building exercises, and a support center. Participants rated highly the usefulness of all 5 main features and 96% (24/25) of the specific features we proposed within those main categories. The participants also suggested additional features as well as a new user persona we had not considered: the parents or family members of the young person. The focus groups rated highly the perceived usability of the app. Most of the experts saw value in all the main features and suggested specific knowledge sources for the app’s content. Finally, participants of both the feasibility study and the participatory design study expressed moderate to high interest in using the app for self-help and high interest in using the app to help friends. Conclusions: The findings provide preliminary encouraging support for the 5 main features suggested by the research team and reinforce recommendations for mobile health apps found in the literature. The findings emphasize the insight that this kind of app should be designed primarily for use by individuals seeking to help others. %M 35212631 %R 10.2196/34477 %U https://formative.jmir.org/2022/2/e34477 %U https://doi.org/10.2196/34477 %U http://www.ncbi.nlm.nih.gov/pubmed/35212631 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e23794 %T User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study %A Chowdhary,Kuntal %A Yu,Daihua Xie %A Pramana,Gede %A Mesoros,Matthew %A Fairman,Andrea %A Dicianno,Brad Edward %A Parmanto,Bambang %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6052 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K cellular phone %K mobile apps %K telemedicine %K adaptive mHealth %K rehabilitation %K self-care %K spinal cord injury %K spina bifida %K chronic disease %K persons with disability %K accessibility %K dexterity impairments %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules—MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants’ dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. %M 35200144 %R 10.2196/23794 %U https://humanfactors.jmir.org/2022/1/e23794 %U https://doi.org/10.2196/23794 %U http://www.ncbi.nlm.nih.gov/pubmed/35200144 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31537 %T The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study %A Brown,Jacqueline Marie %A Franco-Arellano,Beatriz %A Froome,Hannah %A Siddiqi,Amina %A Mahmood,Amina %A Arcand,JoAnne %+ Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada, 1 905 721 8668, joanne.arcand@ontariotechu.ca %K mHealth %K children %K app quality %K behavior change techniques %K child nutrition %K mobile apps %K Canada %K mobile phone %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. Objective: The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). Methods: This analysis used a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50%) and as not recommended (8/16, 50%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9%). Results: A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5% (162/259) of apps were classified as food games, 27.4% (71/259) as didactic nutrition guides, 6.6% (17/259) as habit trackers, and 3.5% (9/259) as other. Most apps (198/259, 76.4%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps (β=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7%) displayed at least one BCT, with the most common BCT being information about health consequences. Conclusions: Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT. %M 35171100 %R 10.2196/31537 %U https://mhealth.jmir.org/2022/2/e31537 %U https://doi.org/10.2196/31537 %U http://www.ncbi.nlm.nih.gov/pubmed/35171100 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e28372 %T Willingness of French General Practitioners to Prescribe mHealth Apps and Devices: Quantitative Study %A Della Vecchia,Claire %A Leroy,Tanguy %A Bauquier,Charlotte %A Pannard,Myriam %A Sarradon-Eck,Aline %A Darmon,David %A Dufour,Jean-Charles %A Preau,Marie %+ Institut de Psychologie, Université Lyon 2, 5 Avenue Pierre Mendes France, Bron, 69676, France, 33 0672303682, dellavecchia.claire@gmail.com %K mHealth %K health applications %K connected health and wellness devices %K general practitioners %K patients %K prescription %K quantitative study %K mobile phone %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The field of mobile health (mHealth) is constantly expanding. Integrating mHealth apps and devices in clinical practice is a major and complex challenge. General practitioners (GPs) are an essential link in a patient’s care pathway. As they are patients’ preferred health care intermediaries, GPs play an important role in supporting patients’ transition to mHealth. Objective: This study aims to identify the factors associated with the willingness of French GPs to prescribe mHealth apps and devices to their patients. Methods: This study was part of the ApiAppS project whose overall objective was to help remove barriers GPs face when prescribing mHealth apps and devices by developing a custom-built platform to aid them. The study included GPs recruited from the general practice department of several medical faculties in France (Lyon, Nice, and Rouen) and mailing lists of academic GPs, health care professional associations, and social and professional networks. Participants were asked to complete a web-based questionnaire that collected data on various sociodemographic variables, indicators of their involvement in continued education programs and the amount of time they dedicated to promoting healthy behaviors during patient consultations, and indicators characterizing their patient population. Data on their perceptions of mHealth apps and devices were also collected. Finally, the questionnaire included items to measure GPs’ acceptability of prescribing mHealth apps and devices for several health-related dimensions. Results: Of the 174 GPs, 129 (74.1%) declared their willingness to prescribe mHealth apps and devices to their patients. In multivariate analysis, involvement in continued education programs (odds ratio [OR] 6.17, 95% CI 1.52-28.72), a better patient base command of the French language (OR 1.45, 95% CI 1.13-1.88), GP-perceived benefits of mHealth apps and devices for both patients and their medical practice and GP-perceived drivers for mHealth apps and device implementation in their medical practice (OR 1.04, 95% CI 1.01-1.07), and validation of mHealth apps and devices through randomized clinical trials (OR 1.02, 95% CI 1.00-1.04) were all associated with GPs’ willingness to prescribe mHealth apps and devices. In contrast, older GPs (OR 0.95, 95% CI 0.91-0.98), female GPs (OR 0.26, 95% CI 0.09-0.69), and those who perceived risks for the patient or their medical practice (OR 0.96, 95% CI 0.94-0.99) were less inclined to prescribe mHealth apps and devices. Conclusions: mHealth apps and devices were generally seen by GPs as useful in general medicine and were, for the most part, favorable to prescribing them. Their full integration in general medicine will be conditioned by the need for conclusive certification, transparency (reliable and precise data concerning mHealth app and device methods of construction and clinical validation), software aids to assist GPs prescribe them, and dedicated training programs. %M 35147508 %R 10.2196/28372 %U https://mhealth.jmir.org/2022/2/e28372 %U https://doi.org/10.2196/28372 %U http://www.ncbi.nlm.nih.gov/pubmed/35147508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31497 %T Defining the Enablers and Barriers to the Implementation of Large-scale, Health Care–Related Mobile Technology: Qualitative Case Study in a Tertiary Hospital Setting %A Aggarwal,Ravi %A Visram,Sheena %A Martin,Guy %A Sounderajah,Viknesh %A Gautama,Sanjay %A Jarrold,Kevin %A Klaber,Robert %A Maxwell,Shona %A Neal,John %A Pegg,Jack %A Redhead,Julian %A King,Dominic %A Ashrafian,Hutan %A Darzi,Ara %+ Institute of Global Health Innovation, Imperial College London, 10th Floor, Queen Elizabeth Queen Mother Building, St Marys Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 7799871597, h.ashrafian@imperial.ac.uk %K mHealth %K implementation science %K mobile technology %K mobile apps %K clinical applications %K smartphone apps %K health care industry %K stakeholders %K mobile phone %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. Objective: The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. Methods: Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants’ views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. Results: In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. Conclusions: Despite partnering with one of the world’s biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation. %M 35133287 %R 10.2196/31497 %U https://mhealth.jmir.org/2022/2/e31497 %U https://doi.org/10.2196/31497 %U http://www.ncbi.nlm.nih.gov/pubmed/35133287 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31877 %T Using Smartphones to Reduce Research Burden in a Neurodegenerative Population and Assessing Participant Adherence: A Randomized Clinical Trial and Two Observational Studies %A Beukenhorst,Anna L %A Burke,Katherine M %A Scheier,Zoe %A Miller,Timothy M %A Paganoni,Sabrina %A Keegan,Mackenzie %A Collins,Ella %A Connaghan,Kathryn P %A Tay,Anna %A Chan,James %A Berry,James D %A Onnela,Jukka-Pekka %+ Department of Biostatistics, Harvard T.H. Chan School of Public Health, 4th Floor, 677 Huntington Avenue, Boston, MA, MA 02115, United States, 1 (617) 4951000, beuk@hsph.harvard.edu %K digital phenotyping %K mobile health %K trial %K smartphones %K attrition %K mobile phone %D 2022 %7 4.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone studies provide an opportunity to collect frequent data at a low burden on participants. Therefore, smartphones may enable data collection from people with progressive neurodegenerative diseases such as amyotrophic lateral sclerosis at high frequencies for a long duration. However, the progressive decline in patients’ cognitive and functional abilities could also hamper the feasibility of collecting patient-reported outcomes, audio recordings, and location data in the long term. Objective: The aim of this study is to investigate the completeness of survey data, audio recordings, and passively collected location data from 3 smartphone-based studies of people with amyotrophic lateral sclerosis. Methods: We analyzed data completeness in three studies: 2 observational cohort studies (study 1: N=22; duration=12 weeks and study 2: N=49; duration=52 weeks) and 1 clinical trial (study 3: N=49; duration=20 weeks). In these studies, participants were asked to complete weekly surveys; weekly audio recordings; and in the background, the app collected sensor data, including location data. For each of the three studies and each of the three data streams, we estimated time-to-discontinuation using the Kaplan–Meier method. We identified predictors of app discontinuation using Cox proportional hazards regression analysis. We quantified data completeness for both early dropouts and participants who remained engaged for longer. Results: Time-to-discontinuation was shortest in the year-long observational study and longest in the clinical trial. After 3 months in the study, most participants still completed surveys and audio recordings: 77% (17/22) in study 1, 59% (29/49) in study 2, and 96% (22/23) in study 3. After 3 months, passively collected location data were collected for 95% (21/22), 86% (42/49), and 100% (23/23) of the participants. The Cox regression did not provide evidence that demographic characteristics or disease severity at baseline were associated with attrition, although it was somewhat underpowered. The mean data completeness was the highest for passively collected location data. For most participants, data completeness declined over time; mean data completeness was typically lower in the month before participants dropped out. Moreover, data completeness was lower for people who dropped out in the first study month (very few data points) compared with participants who adhered long term (data completeness fluctuating around 75%). Conclusions: These three studies successfully collected smartphone data longitudinally from a neurodegenerative population. Despite patients’ progressive physical and cognitive decline, time-to-discontinuation was higher than in typical smartphone studies. Our study provides an important benchmark for participant engagement in a neurodegenerative population. To increase data completeness, collecting passive data (such as location data) and identifying participants who are likely to adhere during the initial phase of a study can be useful. Trial Registration: ClinicalTrials.gov NCT03168711; https://clinicaltrials.gov/ct2/show/NCT03168711 %M 35119373 %R 10.2196/31877 %U https://mhealth.jmir.org/2022/2/e31877 %U https://doi.org/10.2196/31877 %U http://www.ncbi.nlm.nih.gov/pubmed/35119373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32193 %T An mHealth App for Fibromyalgia-like Post–COVID-19 Syndrome: Protocol for the Analysis of User Experience and Clinical Data %A Blanchard,Marc %A Backhaus,Lars %A Ming Azevedo,Pedro %A Hügle,Thomas %+ Department of Rheumatology, University Hospital of Lausanne, University of Lausanne, Avenue Pierre-Decker 4, Lausanne, Vaud, 1005, Switzerland, 41 794266883, marc_blanchard@bluewin.ch %K post–COVID-19 syndrome %K COVID-19 %K SARS-CoV-2 %K mobile health %K application %K user experience %K testing %K user interface %K long-covid syndrome %K mHealth %K app %K user interface %K protocol %K reinforcement %K learning %K strategy %K symptom %K outcome %K patient-reported outcome %K therapy %K rehabilitation %K monitoring %D 2022 %7 4.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Post–COVID-19 syndrome, also referred as “long covid,” describes persisting symptoms after SARS-CoV-2 infection, including myalgia, fatigue, respiratory, or neurological symptoms. Objective symptoms are often lacking, thus resembling a fibromyalgia-like syndrome. Digital therapeutics have shown efficiency in similar chronic disorders such as fibromyalgia, offering specific disease monitoring and interventions such as cognitive behavioral therapy or physical and respiratory exercise guidance. Objective: This protocol aims to study the requirements and features of a new mobile health (mHealth) app among patients with fibromyalgia-like post–COVID-19 syndrome in a clinical trial. Methods: We created a web application prototype for the post–COVID-19 syndrome called “POCOS,” as a web-based rehabilitation tool aiming to improve clinical outcomes. Patients without organ damage or ongoing inflammation will be included in the study. App use will be assessed through user experience questionnaires, focus groups, and clinical data analysis. Subsequently, we will analyze cross-sectional and longitudinal clinical data. Results: The developed mHealth app consists of a clinically adapted app interface with a simplified patient-reported outcome assessment, monitoring of medical interventions, and disease activity as well as web-based instructions for specific physical and respiratory exercises, stress reduction, and lifestyle instructions. The enrollment of participants is expected to be carried out in November 2021. Conclusions: User experience plays an important role in digital therapeutics and needs to be clinically tested to allow further improvement. We here describe this process for a new app for the treatment of the fibromyalgia-like post–COVID-19 syndrome and discuss the relevance of the potential outcomes such as natural disease course and disease phenotypes. International Registered Report Identifier (IRRID): PRR1-10.2196/32193 %M 34982039 %R 10.2196/32193 %U https://www.researchprotocols.org/2022/2/e32193 %U https://doi.org/10.2196/32193 %U http://www.ncbi.nlm.nih.gov/pubmed/34982039 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31565 %T Real-world Implementation of a Smartphone-Based Psychoeducation Program for Bipolar Disorder: Observational Ecological Study %A García-Estela,Aitana %A Cantillo,Jordi %A Angarita-Osorio,Natalia %A Mur-Milà,Estanislao %A Anmella,Gerard %A Pérez,Víctor %A Vieta,Eduard %A Hidalgo-Mazzei,Diego %A Colom,Francesc %+ Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Office 202, PRBB Building, Doctor Aiguader, 88, Barcelona, 08003, Spain, 34 933160400 ext 1493, fcolom@imim.es %K bipolar disorder %K psychoeducation %K smartphone %K app %K SIMPLe %K Intervention %K mobile phone %D 2022 %7 2.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: SIMPLe is an internet‐delivered self‐management mobile app for bipolar disorder (BD) designed to combine technology with evidence-based interventions and facilitate access to psychoeducational content. The SIMPLe app was launched to the real world to make it available worldwide within the context of BD treatment. Objective: The main aims of this study are as follows: to describe app use, engagement, and retention rates based on server data; to identify patterns of user retention over the first 6-month follow-up of use; and to explore potential factors contributing to discontinuation of app use. Methods: This was an observational ecological study in which we pooled available data from a real-world implementation of the SIMPLe app. Participation was open on the project website, and the data-collection sources were a web-based questionnaire on clinical data and treatment history administered at inclusion and at 6 months, subjective data gathered through continuous app use, and the use patterns captured by the app server. Characteristics and engagement of regular users, occasional users, and no users were compared using 2-tailed t tests or analysis of variance or their nonparametric equivalent. Survival analysis and risk functions were applied to regular users’ data to examine and compare use and user retention. In addition, a user evaluation analysis was performed based on satisfaction, perceived usefulness, and reasons to discontinue app use. Results: We included 503 participants with data collected between 2016 and 2018, of whom 77.5% (n=390) used the app. Among the app users, 44.4% (173/390) completed the follow-up assessment, and data from these participants were used in our analyses. Engagement declined gradually over the first 6 months of use. The probability of retention of the regular users after 1 month of app use was 67.4% (263/390; 95% CI 62.7%-72.4%). Age (P=.002), time passed since illness onset (P<.001), and years since diagnosis of BD (P=.048) correlate with retention duration. In addition, participants who had been diagnosed with BD for longer used the app on more days (mean 97.73, SD 69.15 days; P=.002) than those who had had a more recent onset (mean 66.49, SD 66.18 days; P=.002) or those who had been diagnosed more recently (mean 73.45, SD 66 days; P=.01). Conclusions: The user retention rate of the app decreased rapidly after each month until reaching only one-third of the users at 6 months. There exists a strong association between age and app engagement of individuals with BD. Other variables such as years lived with BD, diagnosis of an anxiety disorder, and taking antipsychotics seem relevant as well. Understanding these associations can help in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription, and management. %M 35107440 %R 10.2196/31565 %U https://www.jmir.org/2022/2/e31565 %U https://doi.org/10.2196/31565 %U http://www.ncbi.nlm.nih.gov/pubmed/35107440 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e26033 %T Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study %A Lalla-Edward,Samanta Tresha %A Mashabane,Nonkululeko %A Stewart-Isherwood,Lynsey %A Scott,Lesley %A Fyvie,Kyle %A Duncan,Dana %A Haile,Betiel %A Chugh,Kamal %A Zhou,Yiyong %A Reimers,Jacob %A Pan,Matteus %A Venkatraman,Maya %A Stevens,Wendy %+ Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Sunnyside Office Park, 32 Princess of Wales Terrace, Parktown, 2193, South Africa, 27 0826172490, slallaedward@ezintsha.org %K HIV %K virological suppression %K mHealth %K digital health %K South Africa %K patient-centric %K disease management %K mobile phone %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: South Africa has the largest HIV treatment program worldwide. Retention in care and medication adherence remain problematic necessitating innovative solutions for improving HIV care. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV. iThemba Life is a mobile health app designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. Objective: This study aimed to test the feasibility and acceptability of receiving HIV viral load (VL) results through the app and compare the time to HIV VL result return for study participants before and after app use. Methods: Using convenience sampling, adults having routine VL phlebotomy were recruited from 2 Johannesburg health facilities. After signed consent, the app was downloaded on their Android smartphones, phlebotomy was performed, and the sample barcode was scanned through their phone to link the sample and app. Participants received a notification of the result availability and logged into the app to view results, their explanation and recommended action. Results: Overall, 750 people were screened to enroll 500 participants. Of 750, 113 (15.1%) failed eligibility screening. 21.5% (137/637) had smartphone technical limitations preventing enrollment. Results were released to 92.2% (461/500) of participants’ phones. App technical issues and laboratory operational issues limited the number of released results. Approximately 78.1% (360/461) results were viewed in the app. Median time from notification of availability to result viewed being 15.5 hours (0.6; range 0-150 days). Turnaround time from phlebotomy to the result being received was 6 (range 1-167) days for users versus 56 days (range 10-430 days; P<.001) before app use. Overall, 4% (20/500) of participants received unsuppressed results (VL>1000 copies/mL). Turnaround time for unsuppressed results was 7 days for participants versus 37.5 days before app use (P<.001). The difference before and after app use in the suppressed and unsuppressed users for time from sample collection to result delivery was statistically significant. Of 20 participants, 12 (60%) returned for a confirmatory VL during the study period. The time from an unsuppressed VL to a confirmatory VL was 106 days for app users versus 203 days before app use (P<.001). Overall, 52.4% (262/500) of participants completed an exit survey; 23.2% (58/250) reported challenges in viewing their VL results. Moreover, 58% (35/60) reported that they overcame challenges with technical assistance from others, and 97.3% (255/262) wanted to continue using the app for VL results. Conclusions: Using iThemba Life for VL results was well-received despite limited smartphone access for some participants. App users received results 10 times sooner than before the app and 5 times sooner if their VL >1000 copies/mL. This increased notification speed led to participants wanting to continue using iThemba Life. %M 35107427 %R 10.2196/26033 %U https://formative.jmir.org/2022/2/e26033 %U https://doi.org/10.2196/26033 %U http://www.ncbi.nlm.nih.gov/pubmed/35107427 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30583 %T Investigating When, Which, and Why Users Stop Using a Digital Health Intervention to Promote an Active Lifestyle: Secondary Analysis With A Focus on Health Action Process Approach–Based Psychological Determinants %A Schroé,Helene %A Crombez,Geert %A De Bourdeaudhuij,Ilse %A Van Dyck,Delfien %+ Department of Movement and Sports Sciences, Faculty of Medicine and Health, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 9264 63 63, helene.schroe@ugent.be %K digital health %K psychosocial determinants %K health action process approach %K physical activity %K sedentary behavior %K attrition %K dropout %K mobile health %K healthy life style %K health behaviors %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health interventions have gained momentum to change health behaviors such as physical activity (PA) and sedentary behavior (SB). Although these interventions show promising results in terms of behavior change, they still suffer from high attrition rates, resulting in a lower potential and accessibility. To reduce attrition rates in the future, there is a need to investigate the reasons why individuals stop using the interventions. Certain demographic variables have already been related to attrition; however, the role of psychological determinants of behavior change as predictors of attrition has not yet been fully explored. Objective: The aim of this study was to examine when, which, and why users stopped using a digital health intervention. In particular, we aimed to investigate whether psychological determinants of behavior change were predictors for attrition. Methods: The sample consisted of 473 healthy adults who participated in the intervention MyPlan 2.0 to promote PA or reduce SB. The intervention was developed using the health action process approach (HAPA) model, which describes psychological determinants that guide individuals in changing their behavior. If participants stopped with the intervention, a questionnaire with 8 question concerning attrition was sent by email. To analyze when users stopped using the intervention, descriptive statistics were used per part of the intervention (including pre- and posttest measurements and the 5 website sessions). To analyze which users stopped using the intervention, demographic variables, behavioral status, and HAPA-based psychological determinants at pretest measurement were investigated as potential predictors of attrition using logistic regression models. To analyze why users stopped using the intervention, descriptive statistics of scores to the attrition-related questionnaire were used. Results: The study demonstrated that 47.9% (227/473) of participants stopped using the intervention, and drop out occurred mainly in the beginning of the intervention. The results seem to indicate that gender and participant scores on the psychological determinants action planning, coping planning, and self-monitoring were predictors of first session, third session, or whole intervention completion. The most endorsed reasons to stop using the intervention were the time-consuming nature of questionnaires (55%), not having time (50%), dissatisfaction with the content of the intervention (41%), technical problems (39%), already meeting the guidelines for PA/SB (31%), and, to a lesser extent, the experience of medical/emotional problems (16%). Conclusions: This study provides some directions for future studies. To decrease attrition, it will be important to personalize interventions on different levels, questionnaires (either for research purposes or tailoring) should be kept to a minimum especially in the beginning of interventions by, for example, using objective monitoring devices, and technical aspects of digital health interventions should be thoroughly tested in advance. Trial Registration: ClinicalTrials.gov NCT03274271; https://clinicaltrials.gov/ct2/show/NCT03274271 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3456-7 %M 35099400 %R 10.2196/30583 %U https://mhealth.jmir.org/2022/1/e30583 %U https://doi.org/10.2196/30583 %U http://www.ncbi.nlm.nih.gov/pubmed/35099400 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e32832 %T Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients %A Hennemann,Severin %A Kuhn,Sebastian %A Witthöft,Michael %A Jungmann,Stefanie M %+ Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Wallstr 3, Mainz, 55122, Germany, 49 61313939215, s.hennemann@uni-mainz.de %K mHealth %K symptom checker %K diagnostics %K mental disorders %K psychotherapy %K mobile phone %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital technologies have become a common starting point for health-related information-seeking. Web- or app-based symptom checkers aim to provide rapid and accurate condition suggestions and triage advice but have not yet been investigated for mental disorders in routine health care settings. Objective: This study aims to test the diagnostic performance of a widely available symptom checker in the context of formal diagnosis of mental disorders when compared with therapists’ diagnoses based on structured clinical interviews. Methods: Adult patients from an outpatient psychotherapy clinic used the app-based symptom checker Ada–check your health (ADA; Ada Health GmbH) at intake. Accuracy was assessed as the agreement of the first and 1 of the first 5 condition suggestions of ADA with at least one of the interview-based therapist diagnoses. In addition, sensitivity, specificity, and interrater reliabilities (Gwet first-order agreement coefficient [AC1]) were calculated for the 3 most prevalent disorder categories. Self-reported usability (assessed using the System Usability Scale) and acceptance of ADA (assessed using an adapted feedback questionnaire) were evaluated. Results: A total of 49 patients (30/49, 61% women; mean age 33.41, SD 12.79 years) were included in this study. Across all patients, the interview-based diagnoses matched ADA’s first condition suggestion in 51% (25/49; 95% CI 37.5-64.4) of cases and 1 of the first 5 condition suggestions in 69% (34/49; 95% CI 55.4-80.6) of cases. Within the main disorder categories, the accuracy of ADA’s first condition suggestion was 0.82 for somatoform and associated disorders, 0.65 for affective disorders, and 0.53 for anxiety disorders. Interrater reliabilities ranged from low (AC1=0.15 for anxiety disorders) to good (AC1=0.76 for somatoform and associated disorders). The usability of ADA was rated as high in the System Usability Scale (mean 81.51, SD 11.82, score range 0-100). Approximately 71% (35/49) of participants would have preferred a face-to-face over an app-based diagnostic. Conclusions: Overall, our findings suggest that a widely available symptom checker used in the formal diagnosis of mental disorders could provide clinicians with a list of condition suggestions with moderate-to-good accuracy. However, diagnostic performance was heterogeneous between disorder categories and included low interrater reliability. Although symptom checkers have some potential to complement the diagnostic process as a screening tool, the diagnostic performance should be tested in larger samples and in comparison with further diagnostic instruments. %M 35099395 %R 10.2196/32832 %U https://mental.jmir.org/2022/1/e32832 %U https://doi.org/10.2196/32832 %U http://www.ncbi.nlm.nih.gov/pubmed/35099395 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26652 %T Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal %A Domingos,Célia %A Costa,Patrício %A Santos,Nadine Correia %A Pêgo,José Miguel %+ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Largo do Paço, Braga, 4710-057, Portugal, 351 253 604 800, jmpego@med.uminho.pt %K user experience %K Technology Acceptance Model %K health monitoring %K fitness trackers %K aging %K seniors %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of activity trackers has significantly increased over the last few years. This technology has the potential to improve the levels of physical activity and health-related behaviors in older adults. However, despite the potential benefits, the rate of adoption remains low among older adults. Therefore, understanding how technology is perceived may potentially offer insight to promote its use. Objective: This study aimed to (1) assess acceptability, usability, and user satisfaction with the Xiaomi Mi Band 2 in Portuguese community-dwelling older adults in a real-world context; (2) explore the mediating effect of the usability on the relationship between user characteristics and satisfaction; and (3) examine the moderating effect of user characteristics on the relationship between usability and user satisfaction. Methods: Older adults used the Xiaomi Mi Band 2 over 15 days. The user experience was evaluated through the Technology Acceptance Model 3, System Usability Scale, and User Satisfaction Evaluation Questionnaire. An integrated framework for usability and user satisfaction was used to explore user experience. Statistical data analysis included descriptive data analysis, reliability analysis, confirmatory factor analysis, and mediation and moderation analyses. Results: A sample of 110 older adults with an average age of 68.41 years (SD 3.11) completed the user experience questionnaires. Mean user acceptance was very high—perceived ease of use: 6.45 (SD 0.78); perceptions of external control: 6.74 (SD 0.55); computer anxiety: 6.85 (SD 0.47); and behavioral intention: 6.60 (SD 0.97). The usability was excellent with an average score of 92.70 (SD 10.73), and user satisfaction was classified as a good experience 23.30 (SD 2.40). The mediation analysis confirmed the direct positive effect of usability on satisfaction (β=.530; P<.01) and the direct negative effect of depression on usability (β=–.369; P<.01). Lastly, the indirect effect of usability on user satisfaction was higher in individuals with lower Geriatric Depression Scale levels. Conclusions: Findings demonstrate that the Xiaomi Mi Band 2 is suitable for older adults. Furthermore, the results confirmed usability as a determinant of satisfaction with the technology and extended the existing knowledge about wearable activity trackers in older adults. %M 35080503 %R 10.2196/26652 %U https://www.jmir.org/2022/1/e26652 %U https://doi.org/10.2196/26652 %U http://www.ncbi.nlm.nih.gov/pubmed/35080503 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31857 %T Attitudes Toward Mobile Apps for Pandemic Research Among Smartphone Users in Germany: National Survey %A Buhr,Lorina %A Schicktanz,Silke %A Nordmeyer,Eike %+ Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, Göttingen, 37073, Germany, 49 5513969009, sschick@gwdg.de %K user %K pandemic %K smartphone apps %K mobile apps %K telephone-based survey %K Germany %K data sharing %K data donation %K ethics %K trust %K COVID-19 %K mHealth %K mobile applications %K digital health %K health applications %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, but also in the context of previous epidemic diseases, mobile apps for smartphones were developed with different goals and functions, such as digital contact tracing, test management, symptom monitoring, quarantine compliance, and epidemiological and public health research. Objective: The aim of this study was to explore the potential for the acceptance of research-orientated apps (ROAs) in the German population. To this end, we identified distinctive attitudes toward pandemic apps and data sharing for research purposes among smartphone users in general and with a focus on differences in attitudes between app users and nonusers in particular. Methods: We conducted a cross-sectional, national, telephone-based survey of 1003 adults in Germany, of which 924 were useable for statistical analysis. The 17-item survey assessed current usage of pandemic apps, motivations for using or not using pandemic apps, trust in app distributors and attitudes toward data handling (data storage and transmission), willingness to share coded data with researchers using a pandemic app, social attitudes toward app use, and demographic and personal characteristics. Results: A vast majority stated that they used a smartphone (778/924, 84.2%), but less than half of the smartphone users stated that they used a pandemic app (326/778, 41.9%). The study focused on the subsample of smartphone users. Interestingly, when asked about preferred organizations for data storage and app distribution, trust in governmental (federal or state government, regional health office), public-appointed (statutory health insurance), or government-funded organizations (research institutes) was much higher than in private organizations (private research institutions, clinics, health insurances, information technology [IT] companies). Having a university degree significantly (P<.001) increased the likelihood of using a pandemic app, while having a migration background significantly (P<.001) decreased it. The overwhelming majority (653/778, 83.9%) of smartphone users were willing to provide their app data for state-funded research. Regarding attitudes toward app usage, striking differences between users and nonusers were found. Almost all app users (317/327, 96.9%) stated they would be willing to share data, whereas only 74.3% (336/452) of nonusers supported data sharing via an app. Two-thirds (216/326, 66.3%) of app users fully or rather agreed with the statement that using a pandemic app is a social duty, whereas almost the same proportion of nonusers entirely or rather disagreed with that statement (273/451, 60.5%). Conclusions: These findings indicate a high potential for the adoption of ROAs among smartphone users in Germany as long as organizational providers engaged in development, operation, and distribution are state-funded or governmental institutions and transparency about data-using research institutions is provided. %M 35072646 %R 10.2196/31857 %U https://mhealth.jmir.org/2022/1/e31857 %U https://doi.org/10.2196/31857 %U http://www.ncbi.nlm.nih.gov/pubmed/35072646 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e28621 %T Validity and Reliability of the Korean Version of the Health Information Technology Usability Evaluation Scale: Psychometric Evaluation %A Lee,Jisan %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K mobile application %K menstruation %K survey %K questionnaire %K translations %K medical informatics %K app %K validity %K reliability %K usability %K assessment %K mHealth %K evaluation %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Rigorous development of mobile technologies requires the use of validated instruments to evaluate the usability of these tools, which has become more relevant with the expansion of these technologies. Although various usability evaluation tools have been developed, there are relatively few simple evaluation instruments that have been validated across diseases and languages in mobile health (mHealth) information technology for use in multiple diseases. Objective: The purpose of this study is to validate the Korean version of the Health Information Technology Usability Evaluation Scale (Korean Health-ITUES) and assess its applicability for different health conditions. Methods: To develop the Korean Health-ITUES, we used a validation process involving the following 3 steps: (1) customization of the Health-ITUES for menstrual symptoms, (2) translation of the Health-ITUES from English into Korean, and (3) examination of the reliability and validity of the instrument. The translation process adhered to the World Health Organization (WHO) guidelines for translation and back-translation, expert review, and reconciliation. Results: The Korean Health-ITUES showed reliable internal consistency with Cronbach α=.951; meanwhile, factor loadings of the 20 items in the 4 subscales ranged from 0.416 to 0.892. Conclusions: The Health-ITUES demonstrated reliability and validity for its use in assessing mHealth apps’ usability in young Korean women with menstrual discomfort. Given the strong psychometric properties of this tool in Korean and English and across 2 different health conditions, the Health-ITUES is a valid and reliable instrument for assessing the usability of mHealth apps. The Health-ITUES is also a valid instrument for evaluating mHealth technologies, which are widely used by patients to self-manage their health and by providers to improve health care delivery. %M 35072630 %R 10.2196/28621 %U https://medinform.jmir.org/2022/1/e28621 %U https://doi.org/10.2196/28621 %U http://www.ncbi.nlm.nih.gov/pubmed/35072630 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e28661 %T Listening to Stakeholders Involved in Speech-Language Therapy for Children With Communication Disorders: Content Analysis of Apple App Store Reviews %A Du,Yao %A Choe,Sarah %A Vega,Jennifer %A Liu,Yusa %A Trujillo,Adrienne %+ Monmouth University, 400 Cedar Ave, West Long Branch, NJ, 07764, United States, 1 7329234616, yadu@monmouth.edu %K eHealth %K mobile health %K mHealth %K mobile app %K communication disorders %K speech therapy %K language therapy %K children %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: With the plethora of mobile apps available on the Apple App Store, more speech-language pathologists (SLPs) have adopted apps for speech-language therapy services, especially for pediatric clients. App Store reviews are publicly available data sources that can not only create avenues for communication between technology developers and consumers but also enable stakeholders such as parents and clinicians to share their opinions and view opinions about the app content and quality based on user experiences. Objective: This study examines the Apple App Store reviews from multiple key stakeholders (eg, parents, educators, and SLPs) to identify and understand user needs and challenges of using speech-language therapy apps (including augmentative and alternative communication [AAC] apps) for pediatric clients who receive speech-language therapy services. Methods: We selected 16 apps from a prior interview study with SLPs that covered multiple American Speech-Language-Hearing Association Big Nine competencies, including articulation, receptive and expressive language, fluency, voice, social communication, and communication modalities. Using an automatic Python (Python Software Foundation) crawler developed by our research team and a Really Simple Syndication feed generator provided by Apple, we extracted a total of 721 app reviews from 2009 to 2020. Using qualitative coding to identify emerging themes, we conducted a content analysis of 57.9% (418/721) reviews and synthesized user feedback related to app features and content, usability issues, recommendations for improvement, and multiple influential factors related to app design and use. Results: Our analyses revealed that key stakeholders such as family members, educators, and individuals with communication disorders have used App Store reviews as a platform to share their experiences with AAC and speech-language apps. User reviews for AAC apps were primarily written by parents who indicated that AAC apps consistently exhibited more usability issues owing to violations of design guidelines in areas of aesthetics, user errors, controls, and customization. Reviews for speech-language apps were primarily written by SLPs and educators who requested and recommended specific app features (eg, customization of visuals, recorded feedback within the app, and culturally diverse character roles) based on their experiences working with a diverse group of pediatric clients with a variety of communication disorders. Conclusions: To our knowledge, this is the first study to compile and analyze publicly available App Store reviews to identify areas for improvement within mobile apps for pediatric speech-language therapy apps from children with communication disorders and different stakeholders (eg, clinicians, parents, and educators). The findings contribute to the understanding of apps for children with communication disorders regarding content and features, app usability and accessibility issues, and influential factors that impact both AAC apps and speech-language apps for children with communication disorders who need speech therapy. %M 35060912 %R 10.2196/28661 %U https://pediatrics.jmir.org/2022/1/e28661 %U https://doi.org/10.2196/28661 %U http://www.ncbi.nlm.nih.gov/pubmed/35060912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33449 %T An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study %A Zucchelli,Fabio %A Donnelly,Olivia %A Rush,Emma %A White,Paul %A Gwyther,Holly %A Williamson,Heidi %A , %+ Health and Applied Sciences, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, United Kingdom, 44 7816449143, fabio.zucchelli@uwe.ac.uk %K mobile health %K acceptance and commitment therapy %K appearance %K mixed methods %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions, which evoke appearance-based anxiety for many. Objective: In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness. Methods: To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program. Results: In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety. Conclusions: An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation. %M 35060908 %R 10.2196/33449 %U https://formative.jmir.org/2022/1/e33449 %U https://doi.org/10.2196/33449 %U http://www.ncbi.nlm.nih.gov/pubmed/35060908 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33716 %T Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation %A Hogan,Timothy P %A Etingen,Bella %A McMahon,Nicholas %A Bixler,Felicia R %A Am,Linda %A Wacks,Rachel E %A Shimada,Stephanie L %A Reilly,Erin D %A Frisbee,Kathleen L %A Smith,Bridget M %+ eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, United States, 1 781 687 3181, Timothy.Hogan@va.gov %K mobile health applications %K pain %K veterans %K usability %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1%). These veterans received our outreach program; 236 (236/393, 60.1%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2% (24/236) used Pain Coach, and 58% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study. %M 35049515 %R 10.2196/33716 %U https://formative.jmir.org/2022/1/e33716 %U https://doi.org/10.2196/33716 %U http://www.ncbi.nlm.nih.gov/pubmed/35049515 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27095 %T Applying an Extended UTAUT2 Model to Explain User Acceptance of Lifestyle and Therapy Mobile Health Apps: Survey Study %A Schomakers,Eva-Maria %A Lidynia,Chantal %A Vervier,Luisa Sophie %A Calero Valdez,André %A Ziefle,Martina %+ Human-Computer Interaction Center, RWTH Aachen University, Campus-Boulevard 57, Aachen, 52074, Germany, 49 17662315488, schomakers@comm.rwth-aachen.de %K technology acceptance %K UTAUT2 %K mHealth %K privacy concerns %K trust %D 2022 %7 18.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) care apps are a promising technology to monitor and control health individually and cost-effectively with a technology that is widely used, affordable, and ubiquitous in many people’s lives. Download statistics show that lifestyle apps are widely used by young and healthy users to improve fitness, nutrition, and more. While this is an important aspect for the prevention of future chronic diseases, the burdened health care systems worldwide may directly profit from the use of therapy apps by those patients already in need of medical treatment and monitoring. Objective: We aimed to compare the factors influencing the acceptance of lifestyle and therapy apps to better understand what drives and hinders the use of mHealth apps. Methods: We applied the established unified theory of acceptance and use of technology 2 (UTAUT2) technology acceptance model to evaluate mHealth apps via an online questionnaire with 707 German participants. Moreover, trust and privacy concerns were added to the model and, in a between-subject study design, the influence of these predictors on behavioral intention to use apps was compared between lifestyle and therapy apps. Results: The results show that the model only weakly predicted the intention to use mHealth apps (R2=0.019). Only hedonic motivation was a significant predictor of behavioral intentions regarding both app types, as determined by path coefficients of the model (lifestyle: 0.196, P=.004; therapy: 0.344, P<.001). Habit influenced the behavioral intention to use lifestyle apps (0.272, P<.001), while social influence (0.185, P<.001) and trust (0.273, P<.001) predicted the intention to use therapy apps. A further exploratory correlation analysis of the relationship between user factors on behavioral intention was calculated. Health app familiarity showed the strongest correlation to the intention to use (r=0.469, P<.001), stressing the importance of experience. Also, age (r=–0.15, P=.004), gender (r=–0.075, P=.048), education level (r=0.088, P=.02), app familiarity (r=0.142, P=.007), digital health literacy (r=0.215, P<.001), privacy disposition (r=–0.194, P>.001), and the propensity to trust apps (r=0.191, P>.001) correlated weakly with behavioral intention to use mHealth apps. Conclusions: The results indicate that, rather than by utilitarian factors like usefulness, mHealth app acceptance is influenced by emotional factors like hedonic motivation and partly by habit, social influence, and trust. Overall, the findings give evidence that for the health care context, new and extended acceptance models need to be developed with an integration of user diversity, especially individuals’ prior experience with apps and mHealth. %M 35040801 %R 10.2196/27095 %U https://mhealth.jmir.org/2022/1/e27095 %U https://doi.org/10.2196/27095 %U http://www.ncbi.nlm.nih.gov/pubmed/35040801 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e24483 %T Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study %A Fox,Sarah %A Brown,Laura J E %A Antrobus,Steven %A Brough,David %A Drake,Richard J %A Jury,Francine %A Leroi,Iracema %A Parry-Jones,Adrian R %A Machin,Matthew %+ Division of Informatics, Imaging & Data Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 (0)7917 520637, matthew.machin@manchester.ac.uk %K agile %K dementia %K co-design %K cognition %K mHealth %K patient public involvement %K software development %K mobile phone %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app. Objective: The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product. Methods: Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback. Results: This co-design approach resulted in multiple patient and care partner–led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic. Conclusions: We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing. %M 35029539 %R 10.2196/24483 %U https://mhealth.jmir.org/2022/1/e24483 %U https://doi.org/10.2196/24483 %U http://www.ncbi.nlm.nih.gov/pubmed/35029539 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e22113 %T Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study %A Walrave,Michel %A Waeterloos,Cato %A Ponnet,Koen %+ MIOS Research Group and GOVTRUST Centre of Excellence, Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, Antwerp, 2000, Belgium, 32 475459785, michel.walrave@uantwerp.be %K COVID-19 %K SARS-CoV-2 %K coronavirus %K contact tracing %K proximity tracing %K mHealth %K mobile app %K user acceptability %K surveillance %K privacy %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In several countries, contact tracing apps (CTAs) have been introduced to warn users if they have had high-risk contacts that could expose them to SARS-CoV-2 and could, therefore, develop COVID-19 or further transmit the virus. For CTAs to be effective, a sufficient critical mass of users is needed. Until now, adoption of these apps in several countries has been limited, resulting in questions on which factors prevent app uptake or stimulate discontinuation of app use. Objective: The aim of this study was to investigate individuals’ reasons for not using, or stopping use of, a CTA, in particular, the Coronalert app. Users’ and nonusers’ attitudes toward the app’s potential impact was assessed in Belgium. To further stimulate interest and potential use of a CTA, the study also investigated the population’s interest in new functionalities. Methods: An online survey was administered in Belgium to a sample of 1850 respondents aged 18 to 64 years. Data were collected between October 30 and November 2, 2020. Sociodemographic differences were assessed between users and nonusers. We analyzed both groups’ attitudes toward the potential impact of CTAs and their acceptance of new app functionalities. Results: Our data showed that 64.9% (1201/1850) of our respondents were nonusers of the CTA under study; this included individuals who did not install the app, those who downloaded but did not activate the app, and those who uninstalled the app. While we did not find any sociodemographic differences between users and nonusers, attitudes toward the app and its functionalities seemed to differ. The main reasons for not downloading and using the app were a perceived lack of advantages (308/991, 31.1%), worries about privacy (290/991, 29.3%), and, to a lesser extent, not having a smartphone (183/991, 18.5%). Users of the CTA agreed more with the potential of such apps to mitigate the consequences of the pandemic. Overall, nonusers found the possibility of extending the CTA with future functionalities to be less acceptable than users. However, among users, acceptability also tended to differ. Among users, functionalities relating to access and control, such as digital certificates or “green cards” for events, were less accepted (358/649, 55.2%) than functionalities focusing on informing citizens about the spread of the virus (453/649, 69.8%) or making an appointment to get tested (525/649, 80.9%). Conclusions: Our results show that app users were more convinced of the CTA’s utility and more inclined to accept new app features than nonusers. Moreover, nonusers had more CTA-related privacy concerns. Therefore, to further stimulate app adoption and use, its potential advantages and privacy-preserving mechanisms need to be stressed. Building further knowledge on the forms of resistance among nonusers is important for responding to these barriers through the app’s further development and communication campaigns. %M 34794117 %R 10.2196/22113 %U https://publichealth.jmir.org/2022/1/e22113 %U https://doi.org/10.2196/22113 %U http://www.ncbi.nlm.nih.gov/pubmed/34794117 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e29512 %T Human-Centered Design of Mobile Health Apps for Older Adults: Systematic Review and Narrative Synthesis %A Nimmanterdwong,Zethapong %A Boonviriya,Suchaya %A Tangkijvanich,Pisit %+ Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Padtayapatana Building, 11th Floor, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand, 66 868622188, zethapong@gmail.com %K connected health %K development %K elderly %K HCD %K mHealth %K older adults %K review %K telehealth %K UCD %K usability %K design %K human-centered %K app %D 2022 %7 14.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The world is aging. The number of older patients is on the rise, and along with it comes the burden of noncommunicable diseases, both clinical and economic. Attempts with mobile health (mHealth) have been made to remedy the situation with promising outcomes. Researchers have adopted human-centered design (HCD) in mHealth creation to ensure those promises become a reality. Objective: This systematic review aims to explore existing literature on relevant primary research and case studies to (1) illustrate how HCD can be used to create mHealth solutions for older adults and (2) summarize the overall process with recommendations specific to the older population. Methods: We conducted a systematic review to address the study objectives. IEEE Xplore, Medline via Ovid, PubMed, and Scopus were searched for HCD research of mHealth solutions for older adults. Two independent reviewers then included the papers if they (1) were written in English, (2) included participants equal to or older than 60 years old, (3) were primary research, and (4) reported about mHealth apps and their HCD developments from start to finish. The 2 reviewers continued to assess the included studies’ qualities using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was then carried out and completed. Results: Eight studies passed the eligibility criteria: 5 were mixed methods studies and 3 were case studies. Some studies were about the same mHealth projects with a total of 5 mHealth apps. The included studies differed in HCD goals, target groups, and details of their HCD methodologies. The HCD process was explored through narrative synthesis in 4 steps according to the International Standardization Organization (ISO) standard 9241-210: (1) understand and specify the context of use, (2) specify the user requirements, (3) produce design solutions to meet these requirements, and (4) evaluate the designs against requirements. The overall process and recommendations unique to older adults are summarized logically with structural order and time order based on the Minto pyramid principle and ISO 9241-210. Conclusions: Findings show that HCD can be used to create mHealth solutions for older adults with positive outcomes. This review has also summarized practical HCD steps and additional suggestions based on existing literature in the subfield. However, evidence-based results are still limited because most included studies lacked details about their sampling methods and did not set objective and quantifiable goals, leading to failure to draw significant conclusions. More studies of HCD application on mHealth for older adults with measurable design goals and rigorous research strategy are warranted. %M 35029535 %R 10.2196/29512 %U https://mhealth.jmir.org/2022/1/e29512 %U https://doi.org/10.2196/29512 %U http://www.ncbi.nlm.nih.gov/pubmed/35029535 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e31982 %T Smartphone Ownership and Interest in Mobile Health Technologies for Self-care Among Patients With Chronic Heart Failure: Cross-sectional Survey Study %A Leigh,Jonathan W %A Gerber,Ben S %A Gans,Christopher P %A Kansal,Mayank M %A Kitsiou,Spyros %+ Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 205 AHSB, 1919 W. Taylor, Chicago, IL, 60612, United States, 1 312 996 7337, skitsiou@uic.edu %K mHealth %K smartphone %K mobile phone %K heart failure %K self-care %K self-management %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Heart failure (HF) is a highly prevalent chronic condition that places a substantial burden on patients, families, and health care systems worldwide. Recent advances in mobile health (mHealth) technologies offer great opportunities for supporting many aspects of HF self-care. There is a need to better understand patients’ adoption of and interest in using mHealth for self-monitoring and management of HF symptoms. Objective: The purpose of this study is to assess smartphone ownership and patient attitudes toward using mHealth technologies for HF self-care in a predominantly minority population in an urban clinical setting. Methods: We conducted a cross-sectional survey of adult outpatients (aged ≥18 years) at an academic outpatient HF clinic in the Midwest. The survey comprised 34 questions assessing patient demographics, ownership of smartphones and other mHealth devices, frequently used smartphone features, use of mHealth apps, and interest in using mHealth technologies for vital sign and HF symptom self-monitoring and management. Results: A total of 144 patients were approached, of which 100 (69.4%) participated in the study (63/100, 63% women). The participants had a mean age of 61.3 (SD 12.25) years and were predominantly Black or African American (61/100, 61%) and Hispanic or Latino (18/100, 18%). Almost all participants (93/100, 93%) owned a cell phone. The share of patients who owned a smartphone was 68% (68/100). Racial and ethnic minorities that identified as Black or African American or Hispanic or Latino reported higher smartphone ownership rates compared with White patients with HF (45/61, 74% Black or African American and 11/18, 61% Hispanic or Latino vs 9/17, 53% White). There was a moderate and statistically significant association between smartphone ownership and age (Cramér V [ΦC]=0.35; P<.001), education (ΦC=0.29; P=.001), and employment status (ΦC=0.3; P=.01). The most common smartphone features used by the participants were SMS text messaging (51/68, 75%), internet browsing (43/68, 63%), and mobile apps (41/68, 60%). The use of mHealth apps and wearable activity trackers (eg, Fitbits) for self-monitoring of HF-related parameters was low (15/68, 22% and 15/100, 15%, respectively). The most popular HF-related self-care measures participants would like to monitor using mHealth technologies were physical activity (46/68, 68%), blood pressure (44/68, 65%), and medication use (40/68, 59%). Conclusions: Most patients with HF have smartphones and are interested in using commercial mHealth apps and connected health devices to self-monitor their condition. Thus, there is a great opportunity to capitalize on the high smartphone ownership among racial and ethnic minority patients to increase reach and enhance HF self-management through mHealth interventions. %M 35029533 %R 10.2196/31982 %U https://cardio.jmir.org/2022/1/e31982 %U https://doi.org/10.2196/31982 %U http://www.ncbi.nlm.nih.gov/pubmed/35029533 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27272 %T Assessing Elderly User Preference for Telehealth Solutions in China: Exploratory Quantitative Study %A Chen,Nuoya %A Liu,Pengqi %+ Faculty of Global Studies, Justice and Rights, University of Macerata, Crescimbeni 30-32, Macerata, 62100, Italy, 39 0733 2582418, cny0824@gmail.com %K telehealth solutions %K preference %K motivation %K elderly user %K China %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the next 15 to 20 years, the Chinese population will reach a plateau and start to decline. With the changing family structure and rushed urbanization policies, there will be greater demand for high-quality medical resources at urban centers and home-based elderly care driven by telehealth solutions. This paper describes an exploratory study regarding elderly users’ preference for telehealth solutions in the next 5 to 10 years in 4 cities, Shenzhen, Hangzhou, Wuhan, and Yichang. Objective: The goal is to analyze why users choose telehealth solutions over traditional health solutions based on a questionnaire study involving 4 age groups (50-60, 61-70, 71-80, and 80+) in 4 cities (Shenzhen, Hangzhou, Wuhan, and Yichang) in the next 10 to 20 years. The legal retirement age for female workers in China is 50 to 55 years and 60 years for male workers. To simulate reality in terms of elderly care in China, the authors use the Chinese definition of elderly for employees, defined as being 50 to 60 years old rather than 65 years, as defined by the World Health Organization. Methods: The questionnaires were collected from Shenzhen, Hangzhou, Wuhan, and Yichang randomly with 390 valid data samples. The questionnaire consists of 31 questions distributed offline on tablet devices by local investigators. Subsequently, Stata 16.0 and SPSS 24.0 were used to analyze the data. O-logit ordered regression and principal component analysis (PCA) were the main theoretical models used. The study is currently in the exploratory stage and therefore does not seek generalization of the results. Results: Approximately 71.09% (280/390) of the respondents reported having at least 1 type of chronic disease. We started with PCA and categorized all Likert scale variables into 3 factors. The influence of demographic variables on Factors 1, 2, and 3 was verified using analysis of variance (ANOVA) and t tests. The ordered logit regression results suggest that health-related motivations are positively related to the willingness to use telehealth solutions, and trust on data collected from telehealth solutions is negatively correlated with the willingness to use telehealth solutions. Conclusions: The findings suggest that there is a need to address the gap in community health care and ensure health care continuity between different levels of health care institutions in China by providing telehealth solutions. Meanwhile, telehealth solution providers must focus on improving users’ health awareness and lower health risk for chronic diseases by addressing lifestyle changes such as regular exercise and social activity. The interoperability between the electronic health record system and telehealth solutions remains a hurdle for telehealth solutions to add value in health care. The hurdle is that doctors neither adjust health care plans nor diagnose based on data collected by telehealth solutions. %M 35019852 %R 10.2196/27272 %U https://mhealth.jmir.org/2022/1/e27272 %U https://doi.org/10.2196/27272 %U http://www.ncbi.nlm.nih.gov/pubmed/35019852 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e26563 %T Prioritization of Quality Principles for Health Apps Using the Kano Model: Survey Study %A Malinka,Christin %A von Jan,Ute %A Albrecht,Urs-Vito %+ Peter L Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany, 49 511 532 ext 4412, ute.von.jan@plri.de %K Kano %K quality principles %K mobile apps %K physicians %K surveys and questionnaires %K evaluation studies %K mHealth %K health apps %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps are often used without adequately taking aspects related to their quality under consideration. This may partially be due to inadequate awareness about necessary criteria and how to prioritize them when evaluating an app. Objective: The aim of this study was to introduce a method for prioritizing quality attributes in the mobile health context. To this end, physicians were asked about their assessment of nine app quality principles relevant in health contexts and their responses were used as a basis for designing a method for app prioritization. Ultimately, the goal was to aid in making better use of limited resources (eg, time) by assisting with the decision as to the specific quality principles that deserve priority in everyday medical practice and those that can be given lower priority, even in cases where the overall principles are rated similarly. Methods: A total of 9503 members of two German professional societies in the field of orthopedics were invited by email to participate in an anonymous online survey over a 1-month period. Participants were asked to rate a set of nine app quality principles using a Kano survey with functional and dysfunctional (ie, positively and negatively worded) questions. The evaluation was based on the work of Kano (baseline), supplemented by a self-designed approach. Results: Among the 9503 invited members, 382 completed relevant parts of the survey (return rate of 4.02%). These participants were equally and randomly assigned to two groups (test group and validation group, n=191 each). Demographic characteristics did not significantly differ between groups (all P>.05). Participants were predominantly male (328/382, 85.9%) and older than 40 years (290/382, 75.9%). Given similar ratings, common evaluation strategies for Kano surveys did not allow for conclusive prioritization of the principles, and the same was true when using the more elaborate approach of satisfaction and dissatisfaction indices following the work of Timko. Therefore, an extended, so-called “in-line-of-sight” method was developed and applied for this evaluation. Modified from the Timko method, this approach is based on a “point of view” (POV) metric, which generates a ranking coefficient. Although the principles were previously almost exclusively rated as must-be (with the exception of resource efficiency), which was not conducive to their prioritization, the new method applied from the must-be POV resulted in identical rankings for the test and validation groups: (1) legal conformity, (2) content validity, (3) risk adequacy, (4) practicality, (5) ethical soundness, (6) usability, (7) transparency, (8) technical adequacy, and (9) resource efficiency. Conclusions: Established survey methodologies based on the work of Kano predominantly seek to categorize the attributes to be evaluated. The methodology presented here is an interesting option for prioritization, and enables focusing on the most important criteria, thus saving valuable time when reviewing apps for use in the medical field, even with otherwise largely similar categorization results. The extent to which this approach is applicable beyond the scenario presented herein requires further investigation. %M 35014965 %R 10.2196/26563 %U https://mhealth.jmir.org/2022/1/e26563 %U https://doi.org/10.2196/26563 %U http://www.ncbi.nlm.nih.gov/pubmed/35014965 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33438 %T Patients’ Expectations and Experiences With a Mental Health–Focused Supportive Text Messaging Program: Mixed Methods Evaluation %A Shalaby,Reham %A Vuong,Wesley %A Eboreime,Ejemai %A Surood,Shireen %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 17807144315, vincent.agyapong@nshealth.ca %K supportive text messages %K patients’ experience %K mental health %K mixed methods %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based services are an economical and easily scalable means of support that uses existing technology. Text4Support is a supportive, complementary text messaging service that supports people with different mental health conditions after they are discharged from inpatient psychiatric care. Objective: In this study, we aim to assess user satisfaction with the Text4Support service to gain a better understanding of subscribers’ experiences. Methods: This was a mixed methods study using secondary data from a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into 4 randomized groups. Out of the 4 study groups in the initial study, 2 groups who received supportive text messages (89/181, 49.2% of patients), either alone or alongside a peer support worker, were included. Thematic and descriptive analyses were also performed. Differences in feedback based on sex at birth and primary diagnosis were determined using univariate analysis. The study was registered with ClinicalTrials.gov (trial registration number: NCT03404882). Results: Out of 89 participants, 36 (40%) completed the follow-up survey. The principal findings were that Text4Support was well perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. Meanwhile, there was no statistically significant difference between satisfactory items based on the subscriber’s sex at birth or primary diagnosis. The patients’ initial expectations were either neutral or positive in relation to the expected nature or the impact of the text messages received on their mental well-being. In addition, the subscribers were satisfied with the frequency of the messages, which were received once daily for 6 consecutive months. The participants recommended more personalized messages or mutual interaction with health care personnel. Conclusions: Text4Support was generally well perceived by patients after hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended by participants that may need to be considered when designing similar future services. %M 35014972 %R 10.2196/33438 %U https://formative.jmir.org/2022/1/e33438 %U https://doi.org/10.2196/33438 %U http://www.ncbi.nlm.nih.gov/pubmed/35014972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29302 %T Users’ Experiences With the NoHoW Web-Based Toolkit With Weight and Activity Tracking in Weight Loss Maintenance: Long-term Randomized Controlled Trial %A Mattila,Elina %A Hansen,Susanne %A Bundgaard,Lise %A Ramsey,Lauren %A Dunning,Alice %A Silva,Marlene N %A Harjumaa,Marja %A Ermes,Miikka %A Marques,Marta M %A Matos,Marcela %A Larsen,Sofus C %A Encantado,Jorge %A Santos,Inês %A Horgan,Graham %A O'Driscoll,Ruairi %A Turicchi,Jake %A Duarte,Cristiana %A Palmeira,António L %A Stubbs,R James %A Heitmann,Berit Lilienthal %A Lähteenmäki,Liisa %+ VTT Technical Research Centre of Finland Ltd, Tekniikantie 21, Espoo, 02150, Finland, 358 407162230, elina.m.mattila@vtt.fi %K digital behavior change intervention %K user experience %K technology acceptance %K weight-loss maintenance %K focus groups %K mixed methods %K mobile phone %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. Objective: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)—a DBCI that targets weight loss maintenance—over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. Methods: An 18-month, 2×2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. Results: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. Conclusions: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content. Trial Registration: ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-029425 %M 35006081 %R 10.2196/29302 %U https://www.jmir.org/2022/1/e29302 %U https://doi.org/10.2196/29302 %U http://www.ncbi.nlm.nih.gov/pubmed/35006081 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31058 %T Russian-Language Mobile Apps for Reducing Alcohol Use: Systematic Search and Evaluation %A Bunova,Anna %A Wiemker,Veronika %A Gornyi,Boris %A Ferreira-Borges,Carina %A Neufeld,Maria %+ National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow, 101990, Russian Federation, 7 9151416154, asbunova@gmail.com %K alcohol %K mHealth %K mobile applications %K screening and brief intervention %K Mobile Application Rating Scale %K App Behavior Change Scale %K mobile phone %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated. Objective: This study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia. Methods: A systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS). Results: We identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing. Conclusions: Russian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458 %M 35006083 %R 10.2196/31058 %U https://mhealth.jmir.org/2022/1/e31058 %U https://doi.org/10.2196/31058 %U http://www.ncbi.nlm.nih.gov/pubmed/35006083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31875 %T Nutrient and Food Group Prediction as Orchestrated by an Automated Image Recognition System in a Smartphone App (CALO mama): Validation Study %A Sasaki,Yuki %A Sato,Koryu %A Kobayashi,Satomi %A Asakura,Keiko %+ Link & Communication Inc, Kioicho 4-1, Chiyoda-ku, Tokyo, 102-0094, Japan, 81 3 5210 2721, y.sasaki@linkncom.co.jp %K health app %K image recognition %K automatic calculation %K nutrient and food contents %K validity %K mobile phone %K mHealth %K validation %K nutrition %K diet %K food %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A smartphone image recognition app is expected to be a novel tool for measuring nutrients and food intake, but its performance has not been well evaluated. Objective: We assessed the accuracy of the performance of an image recognition app called CALO mama in terms of the nutrient and food group contents automatically estimated by the app. Methods: We prepared 120 meal samples for which the nutrients and food groups were calculated. Next, we predicted the nutrients and food groups included in the meals from their photographs by using (1) automated image recognition only and (2) manual modification after automatic identification. Results: Predictions generated using only image recognition were similar to the actual data on the weight of meals and were accurate for 11 out of 30 nutrients and 4 out of 15 food groups. The app underestimated energy, 19 nutrients, and 9 food groups, while it overestimated dairy products and confectioneries. After manual modification, the predictions were similar for energy, accurately capturing the nutrients for 29 out of 30 of meals and the food groups for 10 out of 15 meals. The app underestimated pulses, fruits, and meats, while it overestimated weight, vitamin C, vegetables, and confectioneries. Conclusions: The results of this study suggest that manual modification after prediction using image recognition improves the performance of the app in assessing the nutrients and food groups of meals. Our findings suggest that image recognition has the potential to achieve a description of the dietary intakes of populations by using “precision nutrition” (a comprehensive and dynamic approach to developing tailored nutritional recommendations) for individuals. %M 35006077 %R 10.2196/31875 %U https://formative.jmir.org/2022/1/e31875 %U https://doi.org/10.2196/31875 %U http://www.ncbi.nlm.nih.gov/pubmed/35006077 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30565 %T Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study %A Burn,Anne-Marie %A Ford,Tamsin J %A Stochl,Jan %A Jones,Peter B %A Perez,Jesus %A Anderson,Joanna K %+ Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, , Cambridge, CB2 0SZ, United Kingdom, 44 1223 465 192, amb278@medschl.cam.ac.uk %K mental health %K assessment %K young people %K youth %K schools %K computerized adaptive testing %K mobile apps %K user-centered design %K coproduction %K qualitative study %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles—an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. %M 35006079 %R 10.2196/30565 %U https://formative.jmir.org/2022/1/e30565 %U https://doi.org/10.2196/30565 %U http://www.ncbi.nlm.nih.gov/pubmed/35006079 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27809 %T Knowledge and Expectations of Hearing Aid Apps Among Smartphone Users and Hearing Professionals: Cross-sectional Survey %A Han,Jae Sang %A Park,Yong-Ho %A Song,Jae-Jun %A Moon,Il Joon %A Lee,Woojoo %A Kim,Yoonjoong %A Cho,Young Sang %A Seo,Jae-Hyun %A Park,Moo Kyun %+ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 2258 6210, revivalseo@catholic.ac.kr %K smartphone %K hearing aids %K app %K perception %K survey %K hearing loss %K mobile phone %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. Objective: The aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. Methods: This study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. Results: Among the 219 smartphone users and 42 hearing specialists, only 8 (3.7%) respondents recognized SHAAs, whereas 18% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P<.001), and an increased level of hearing impairment resulted in significantly higher points in the needs category (P<.001). Patients expected the cost of an annual app subscription to an SHAA to be approximately US $86, and the predicted cost was associated with economic status (P=.02) and was higher than the prices expected by hearing specialists (P<.001). Conclusions: Outpatients expected SHAAs to cost more than hearing specialists. However, the perception of the SHAA was relatively low. In this regard, enhanced awareness is required to popularize SHAAs. %M 34994699 %R 10.2196/27809 %U https://mhealth.jmir.org/2022/1/e27809 %U https://doi.org/10.2196/27809 %U http://www.ncbi.nlm.nih.gov/pubmed/34994699 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e27689 %T A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach %A Rao,Nema %A Perdomo,Sophy %A Jonassaint,Charles %+ Center for Behavioral Health and Smart Technology, Department of Medicine, University of Pittsburgh, 230 McKee Pl Suite 600, Pittsburgh, PA, 15213, United States, 1 4125869850, cjonassaint@pitt.edu %K pain %K pain measurement %K chronic pain %K animations %K mobile apps %K human-centered design %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients with chronic pain face several challenges in using clinical tools to help them monitor, understand, and make meaningful decisions about their pain conditions. Our group previously presented data on Painimation, a novel electronic tool for communicating and assessing pain. Objective: This paper describes the human-centered design and development approach (inspiration, ideation, and implementation) that led to the creation of Painimation. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and feedback from users. Stakeholders included patients with acute and chronic pain, health care providers, and design students. Target users were adults with acute or chronic pain who needed clinical assessment and tracking of the course of their pain over time. Phase I (inspiration) consisted of empathizing with users, understanding how patients experience pain, and identifying the barriers to accurately expressing and assessing pain. This phase involved understanding how patients communicate pain symptoms to providers, as well as defining limitations of current models of clinical pain assessment tools. In Phase II (ideate) we conceptualized and evaluated different approaches to expressing and assessing pain. The most promising concept was developed through an iterative process that involved end users and stakeholders. In Phase III (implementation), based on stakeholder feedback from initial designs and prototypes of abstract pain animations (painimations), we incorporated all concepts to test a minimally viable product, a fully functioning pain assessment app. We then gathered feedback through an agile development process and applied this feedback to finalizing a testable version of the app that could ultimately be used in a pain clinic. Results: Engaging intended users and stakeholders in an iterative, human-centered design process identified 5 criteria that a pain assessment tool would need to meet to be effective in the medical setting. These criteria were used as guiding design principles to generate a series of pain assessment concept ideas. This human-centered approach generated 8 highly visual painimations that were found to be acceptable and useable for communicating pain with medical providers, by both patients with general pain and patients with sickle cell disease (SCD). While these initial steps continued refinement of the tool, further data are needed. Agile development will allow us to continue to incorporate precision medicine tools that are validated in the clinical research arena. Conclusions: A multiphase, human-centered design approach successfully resulted in the development of an innovation that has potential to improve the quality of medical care, particularly for underserved populations. The use of Painimation may especially benefit the medical care of minority populations with chronic and difficult-to-treat pain, such as adults with SCD. The insights generated from this study can be applied to the development of patient-reported outcomes tools that are more patient-centered, engaging, and effective. %M 34994697 %R 10.2196/27689 %U https://humanfactors.jmir.org/2022/1/e27689 %U https://doi.org/10.2196/27689 %U http://www.ncbi.nlm.nih.gov/pubmed/34994697 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e31617 %T Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey %A Breil,Bernhard %A Salewski,Christel %A Apolinário-Hagen,Jennifer %+ Faculty of Health Care, Hochschule Niederrhein, University of Applied Sciences, Reinarzstraße 49, Krefeld, 47805, Germany, 49 21518226710, bernhard.breil@hs-niederrhein.de %K patient acceptance of health care %K mobile apps %K blood pressure %K mobile health %K health applications %K technology acceptance %K patients %K physicians %K digital health %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. Objective: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). Methods: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. Results: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. Conclusions: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research. %M 34989683 %R 10.2196/31617 %U https://cardio.jmir.org/2022/1/e31617 %U https://doi.org/10.2196/31617 %U http://www.ncbi.nlm.nih.gov/pubmed/34989683 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e27418 %T The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration %A Kenny,Lorna %A Moore,Kevin %A O' Riordan,Clíona %A Fox,Siobhan %A Barton,John %A Tedesco,Salvatore %A Sica,Marco %A Crowe,Colum %A Alamäki,Antti %A Condell,Joan %A Nordström,Anna %A Timmons,Suzanne %+ Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr's Hospital, Douglas Road, Cork, T12 XH60, Ireland, 353 851085070, lorna.kenny@ucc.ie %K Parkinson disease %K wearable devices %K technology %K mixed method %K focus group %K survey %K mobile phone %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease–related health barriers and the users’ confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management. %M 34989693 %R 10.2196/27418 %U https://formative.jmir.org/2022/1/e27418 %U https://doi.org/10.2196/27418 %U http://www.ncbi.nlm.nih.gov/pubmed/34989693 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e18083 %T A Smartphone Remote Monitoring App to Follow Up Colorectal Cancer Survivors: Requirement Analysis %A Ayyoubzadeh,Seyed Mohammad %A Shirkhoda,Mohammad %A R Niakan Kalhori,Sharareh %A Mohammadzadeh,Niloofar %A Zakerabasali,Somayyeh %+ Peter L. Reichertz Institute for Medical Informatics, Technical University Braunschweig and Hannover Medical School, Mühlenpfordtstraße 23, Braunschweig, 38106, Germany, 49 531 391 2125, sharareh.niakankalhori@plri.de %K eHealth %K app %K colorectal cancer %K survivors %K requirements analysis %K MoSCoW %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Colorectal cancer survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. Objective: In this study, we addressed the required features for apps designed to follow up colorectal cancer patients based on survivors’ and clinical experts’ views. Methods: A mixed methods study was conducted. Features of related apps were extracted through the literature; the features were categorized, and then, they were modified. A questionnaire was designed containing the features listed and prioritized based on the MoSCoW (Must have, Should have, Could have, Won’t have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using the content validity ratio (CVR), and based on the value of this measure, the minimum feature set of a monitoring app to follow up patients with colorectal cancer was addressed. In addition, a telephone interview with colorectal cancer survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. Results: The questionnaire contained 10 sections evaluating 9 categories of features. The questionnaire was completed by 18 experts. The minimum set of features in the app was identified as patient information registration, sign and symptom monitoring, education, reminders, and patient evaluation (0.42 < CVR < 0.85). Features including physical activity, personalized advice, and social network did not achieve the minimum score (–0.11 < CVR < 0.39). We interviewed 9 colorectal cancer survivors. Information registration, sign and symptom monitoring, education, and personalized advice were the features with high priority from the survivors’ perspectives. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. Conclusions: The requirement set could be used to design an app for the targeted population or patients affected by other cancers. As the views from both survivors and clinical experts were considered in this study, the remote system may more adequately fulfill the need for follow-up of survivors. This eases the patients’ and health care providers’ communication and interaction. %M 34989685 %R 10.2196/18083 %U https://cancer.jmir.org/2022/1/e18083 %U https://doi.org/10.2196/18083 %U http://www.ncbi.nlm.nih.gov/pubmed/34989685 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e22582 %T A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study %A Choo,Carol C %A Tan,Yi Zhuang %A Zhang,Melvyn W B %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18 Family Medicine and Primary Care, Singapore, 308322, Singapore, 65 63892000, melvynzhangweibin@gmail.com %K attentional bias retraining %K smartphone app %K mixed methods %K smoking %K mobile phone %D 2022 %7 3.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic. Objective: This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app. Methods: In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app. Results: The results of the quantitative analysis did not support this study’s hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement. Conclusions: Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary. %M 34982037 %R 10.2196/22582 %U https://formative.jmir.org/2022/1/e22582 %U https://doi.org/10.2196/22582 %U http://www.ncbi.nlm.nih.gov/pubmed/34982037 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e24792 %T Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial %A Koziol-McLain,Jane %A Wilson,Denise %A Vandal,Alain C %A Eruera,Moana %A Nada-Raja,Shyamala %A Dobbs,Terry %A Roguski,Michael %A Barbarich-Unasa,Te Wai %+ Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 211213474, jane.koziol-mclain@aut.ac.nz %K indigenous %K Māori %K young people %K relationships %K school %K mHealth %K smartphone app %K mobile phone %D 2021 %7 30.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or whānau (indigenous Māori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and Māori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the Māori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous Māori–centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 %M 34967750 %R 10.2196/24792 %U https://www.researchprotocols.org/2021/12/e24792 %U https://doi.org/10.2196/24792 %U http://www.ncbi.nlm.nih.gov/pubmed/34967750 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28086 %T The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study %A Ahadzadeh,Ashraf Sadat %A Wu,Shin Ling %A Ong,Fon Sim %A Deng,Ruolan %+ Department of Journalism, Xiamen University Malaysia, Bandar Sunsuria, Sepang, Selangor, 43900, Malaysia, 60 147393423, ahadzadeh1980@gmail.com %K mobile health %K mHealth %K internal health locus of control %K performance expectancy %K effort expectancy %K social influence %K mediation %D 2021 %7 29.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual’s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association. Objective: The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth. Methods: A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence). Results: The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (β=−0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (β=0.104, P<.001), effort expectancy (β=0.056, P=.02), and social influence (β=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%. Conclusions: This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption. %M 34964718 %R 10.2196/28086 %U https://www.jmir.org/2021/12/e28086 %U https://doi.org/10.2196/28086 %U http://www.ncbi.nlm.nih.gov/pubmed/34964718 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e30767 %T Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study %A Wang,Elizabeth Y %A Breyer,Benjamin N %A Lee,Austin W %A Rios,Natalie %A Oni-Orisan,Akinyemi %A Steinman,Michael A %A Sim,Ida %A Kenfield,Stacey A %A Bauer,Scott R %+ University of California San Francisco, 550 16th St, 6th floor, Box 1695, San Francisco, CA, 94121, United States, 1 4152214810 ext 24322, Scott.Bauer@ucsf.edu %K BPH %K mobile health %K mHealth %K telehealth %K telemedicine %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective: The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods: Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results: All 19 (100%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68%) reported that the daily questionnaires were the right length, with 32% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47% (n=9) of the men reported improved awareness of symptoms and 5% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions: We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients’ individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians’ visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully. %M 34951599 %R 10.2196/30767 %U https://humanfactors.jmir.org/2021/4/e30767 %U https://doi.org/10.2196/30767 %U http://www.ncbi.nlm.nih.gov/pubmed/34951599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30268 %T Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design %A Adams,Zachary %A Grant,Miyah %A Hupp,Samantha %A Scott,Taylor %A Feagans,Amanda %A Phillips,Meredith Lois %A Bixler,Kristina %A Nallam,Phani Teja %A La Putt,Dorothy %+ Department of Psychiatry, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN, 46202, United States, 1 317 278 0591, zwadams@iu.edu %K mobile health %K user-centered design %K adolescents %K substance use disorders %K mental health %K mHealth %K cognitive behavioral therapy %K homework %K technology acceptance model %K trauma %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. %M 34951593 %R 10.2196/30268 %U https://formative.jmir.org/2021/12/e30268 %U https://doi.org/10.2196/30268 %U http://www.ncbi.nlm.nih.gov/pubmed/34951593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28709 %T Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study %A Wilson-Howard,Danyell %A Vilaro,Melissa J %A Neil,Jordan M %A Cooks,Eric J %A Griffin,Lauren N %A Ashley,Taylor T %A Tavassoli,Fatemeh %A Zalake,Mohan S %A Lok,Benjamin C %A Odedina,Folakemi T %A Modave,Francois %A Carek,Peter J %A George,Thomas J %A Krieger,Janice L %+ Department of Natural Sciences, Bethune Cookman University, 640 Mary McLeod Blvd., Daytona, FL, 32114, United States, 1 3864812687, wilsonda@cookman.edu %K telehealth %K digital health %K eHealth %K colorectal cancer %K Black men %K virtual human %K technology %K cancer screening %K app %K cancer %K prevention %K development %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men. %M 34780346 %R 10.2196/28709 %U https://formative.jmir.org/2021/12/e28709 %U https://doi.org/10.2196/28709 %U http://www.ncbi.nlm.nih.gov/pubmed/34780346 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25330 %T Active Usage of Mobile Health Applications: Cross-sectional Study %A Wang,Yang %A Wu,Tailai %A Chen,Zhuo %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 13477072665, lncle2012@yahoo.com %K active usage %K mobile health %K 3-factor theory %K consumer satisfaction %K consumer dissatisfaction %K medical informatics %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34941545 %R 10.2196/25330 %U https://www.jmir.org/2021/12/e25330 %U https://doi.org/10.2196/25330 %U http://www.ncbi.nlm.nih.gov/pubmed/34941545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27599 %T A Comparison of the Use of Smart Devices, Apps, and Social Media Between Adults With and Without Hearing Impairment: Cross-sectional Web-Based Study %A van Wier,Marieke F %A Urry,Emily %A Lissenberg-Witte,Birgit I %A Kramer,Sophia E %+ Ear & Hearing, Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 20 4440952, m.vanwier1@amsterdamumc.nl %K hearing impairment %K social media use %K app use %K benefits from social media %K eHealth %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth and social media could be of particular benefit to adults with hearing impairment, but it is unknown whether their use of smart devices, apps, and social media is similar to that of the general population. Objective: Our aim is to study whether adults with normal hearing and those with impaired hearing differ in their weekly use of smart devices, apps, and social media; reasons for using social media; and benefits from using social media. Methods: We used data from a Dutch cohort, the National Longitudinal Study on Hearing. Data were collected from September 2016 to April 2020 using a web-based questionnaire and speech-in-noise test. The results from this test were used to categorize normal hearing and hearing impairment. Outcomes were compared using (multiple) logistic regression models. Results: Adults with impaired hearing (n=384) did not differ from normal hearing adults (n=341) in their use of a smartphone or tablet. They were less likely to make use of social media apps on a smartphone, tablet, or smartwatch (age-adjusted odds ratio [OR] 0.67, 95% CI 0.48-0.92; P=.02). Use of social media on all devices and use of other apps did not differ. Adults with hearing impairment were more likely to agree with using social media to stay in touch with family members (OR 1.54, 95% CI 1.16-2.07; P=.003) and friends (age-adjusted OR 1.35, 95% CI 1.01-1.81; P=.046). Furthermore, they were more likely to agree with using social media to perform their work (age-adjusted OR 1.51, 95% CI 1.04-2.18; P=.03). There were no differences in the experienced benefits from social media. Conclusions: The potential for eHealth is confirmed because adults with hearing impairment are not less likely to use smart devices than their normal hearing peers. Adults with hearing impairment are less likely to use social media apps on a smart device but not less likely to use social media on all types of internet-connected devices. This warrants further research on the types of social media platforms that adults with hearing impairment use and on the type of device on which they prefer to use social media. Given that participants with hearing impairment are more likely than their normal hearing peers to use social media to perform their work, use of social media may be seen as an opportunity to enhance vocational rehabilitation services for persons with hearing impairment. %M 34932013 %R 10.2196/27599 %U https://www.jmir.org/2021/12/e27599 %U https://doi.org/10.2196/27599 %U http://www.ncbi.nlm.nih.gov/pubmed/34932013 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e19543 %T Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study %A Davies,Karen %A Cheraghi-Sohi,Sudeh %A Ong,Bie Nio %A Cheraghi-Sohi,Sudeh %A Perryman,Katherine %A Sanders,Caroline %+ National Institute for Health Research Patient Safety Research Translation Centre, University of Manchester, Oxford Rd, Manchester, United Kingdom, 44 1612767665, sudeh.cheraghi-sohi@manchester.ac.uk %K design research %K co-design %K dementia %K mobile app %K communication %K safety %K mobile phone %D 2021 %7 20.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice—championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 %M 34932011 %R 10.2196/19543 %U https://www.researchprotocols.org/2021/12/e19543 %U https://doi.org/10.2196/19543 %U http://www.ncbi.nlm.nih.gov/pubmed/34932011 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e31130 %T Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study %A Choemprayong,Songphan %A Charoenlap,Chris %A Piromsopa,Krerk %+ Department of Orthopaedic, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand, 66 081 552 4224, chris.cha@chula.ac.th %K teleconsultation %K remote consultation %K mobile applications %K usability %K orthopedics %K physician-to-physician consultation %K electronic medical records %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective: This study aimed to explore usability issues emerging from users’ interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods: Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. Results: Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. Conclusions: The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated. %M 34931991 %R 10.2196/31130 %U https://humanfactors.jmir.org/2021/4/e31130 %U https://doi.org/10.2196/31130 %U http://www.ncbi.nlm.nih.gov/pubmed/34931991 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e29731 %T Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study %A Cooray,Nipuna %A Sun,Si Louise %A Ho,Catherine %A Adams,Susan %A Keay,Lisa %A Nassar,Natasha %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Level 5/1, King Street, Newtown, 2042, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K child injury %K Behaviour Change Wheel %K mobile app %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach. %M 34932004 %R 10.2196/29731 %U https://pediatrics.jmir.org/2021/4/e29731 %U https://doi.org/10.2196/29731 %U http://www.ncbi.nlm.nih.gov/pubmed/34932004 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e29098 %T Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative Interview Study %A Szinay,Dorothy %A Perski,Olga %A Jones,Andy %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ School of Health Sciences, University of East Anglia, Norwich Research Park, Earlham Road, Norwich, NR4 7TJ, United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K behavior change %K health apps %K mHealth %K smartphone app %K framework analysis %K COM-B %K TDF %K user engagement %K motivation %K usability %K engagement %K mobile phone %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general. Objective: The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps. Methods: A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences. Results: Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps. Conclusions: Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement. %M 34927597 %R 10.2196/29098 %U https://mhealth.jmir.org/2021/12/e29098 %U https://doi.org/10.2196/29098 %U http://www.ncbi.nlm.nih.gov/pubmed/34927597 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e22672 %T A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial %A Doyle,Julie %A Murphy,Emma %A Gavin,Shane %A Pascale,Alessandra %A Deparis,Stéphane %A Tommasi,Pierpaolo %A Smith,Suzanne %A Hannigan,Caoimhe %A Sillevis Smitt,Myriam %A van Leeuwen,Cora %A Lastra,Julia %A Galvin,Mary %A McAleer,Patricia %A Tompkins,Lorraine %A Jacobs,An %A M Marques,Marta %A Medina Maestro,Jaime %A Boyle,Gordon %A Dinsmore,John %+ NetwellCASALA, Dundalk Institute of Technology, Dublin Road, Dundalk, A91 K584, Ireland, 353 429370497, julie.doyle@dkit.ie %K digital health %K aging %K multimorbidity %K chronic disease %K self-management %K integrated care %K longitudinal study %K engagement %K usability %K mobile phone %D 2021 %7 15.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. Objective: The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. Methods: The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. Results: This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20%) withdrew before the end of the study, whereas 3 (2.5%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. Conclusions: This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. International Registered Report Identifier (IRRID): RR2-10.2196/22125 %M 34914612 %R 10.2196/22672 %U https://www.jmir.org/2021/12/e22672 %U https://doi.org/10.2196/22672 %U http://www.ncbi.nlm.nih.gov/pubmed/34914612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e22125 %T A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT): Protocol for an Action Research Proof-of-Concept Trial %A Dinsmore,John %A Hannigan,Caoimhe %A Smith,Suzanne %A Murphy,Emma %A Kuiper,Janneke M L %A O'Byrne,Emma %A Galvin,Mary %A Jacobs,An %A Sillevis Smitt,Myriam %A van Leeuwen,Cora %A McAleer,Patricia %A Tompkins,Lorraine %A Brady,Anne-Marie %A McCarron,Mary %A Doyle,Julie %+ Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, GAS Building, 24 D'Olier Street, Dublin, D02 T283, Ireland, 353 18964155 ext 4155, dinsmorj@tcd.ie %K multimorbidity %K digital health %K chronic disease %K self-management %K older adults %K integrated care %K behaviour change %K mobile phone %K smart phone %K smart device %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ≥65 years) living with multimorbidity. Objective: This paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN). Methods: Research was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50% in Ireland and 60/120, 50% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium. Results: The trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021. Conclusions: ProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care. International Registered Report Identifier (IRRID): RR1-10.2196/22125 %M 34914613 %R 10.2196/22125 %U https://www.researchprotocols.org/2021/12/e22125 %U https://doi.org/10.2196/22125 %U http://www.ncbi.nlm.nih.gov/pubmed/34914613 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e29197 %T A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study %A Markossian,Talar W %A Boyda,Jason %A Taylor,Jennifer %A Etingen,Bella %A Modave,François %A Price,Ron %A Kramer,Holly J %+ Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S First Avenue, Maywood, IL, 60153, United States, 1 7083279027, tmarkossian@luc.edu %K chronic kidney disease %K mobile app %K self-management %K mHealth %K mobile apps %K digital health %K kidney disease %K smartphone %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic kidney disease (CKD) is a common and costly condition that is usually accompanied by multiple comorbidities including type 2 diabetes, hypertension, and obesity. Proper management of CKD can delay or prevent kidney failure and help mitigate cardiovascular disease risk, which increases as kidney function declines. Smart device apps hold potential to enhance patient self-management of chronic conditions including CKD. Objective: The objective of this study was to develop a mobile app to facilitate self-management of nondialysis-dependent CKD. Methods: Our stakeholder team included 4 patients with stage 3-4 nondialysis-dependent CKD; a kidney transplant recipient; a caretaker; CKD care providers (pharmacists, a nurse, primary care physicians, a nephrologist, and a cardiologist); 2 health services and CKD researchers; a researcher in biomedical informatics, nutrition, and obesity; a system developer; and 2 programmers. Focus groups and in-person interviews with the patients and providers were conducted using a focus group and interview guide based on existing literature on CKD self-management and the mobile app quality criteria from the Mobile App Rating Scale. Qualitative analytic methods including the constant comparative method were used to analyze the focus group and interview data. Results: Patients and providers identified and discussed a list of requirements and preferences regarding the content, features, and technical aspects of the mobile app, which are unique for CKD self-management. Requirements and preferences centered along themes of communication between patients and caregivers, partnership in care, self-care activities, adherence to treatment regimens, and self-care self-efficacy. These identified themes informed the features and content of our mobile app. The mobile app user can enter health data including blood pressure, weight, and blood glucose levels. Symptoms and their severity can also be entered, and users are prompted to contact a physician as indicated by the symptom and its severity. Next, mobile app users can select biweekly goals from a set of predetermined goals with the option to enter customized goals. The user can also keep a list of medications and track medication use. Our app includes feedback mechanisms where in-range values for health data are depicted in green and out-of-range values are depicted in red. We ensured that data entered by patients could be downloaded into a user-friendly report, which could be emailed or uploaded to an electronic health record. The mobile app also includes a mechanism that allows either group or individualized video chat meetings with a provider to facilitate either group support, education, or even virtual clinic visits. The CKD app also includes educational material on CKD and its symptoms. Conclusions: Patients with CKD and CKD care providers believe that a mobile app can enhance CKD self-management by facilitating patient-provider communication and enabling self-care activities including treatment adherence. %M 34914614 %R 10.2196/29197 %U https://humanfactors.jmir.org/2021/4/e29197 %U https://doi.org/10.2196/29197 %U http://www.ncbi.nlm.nih.gov/pubmed/34914614 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31541 %T Validation of a Musculoskeletal Digital Assessment Routing Tool: Protocol for a Pilot Randomized Crossover Noninferiority Trial %A Lowe,Cabella %A Hanuman Sing,Harry %A Marsh,William %A Morrissey,Dylan %+ Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, United Kingdom, 44 07976315105, c.lowe@qmul.ac.uk %K mHealth %K mobile health %K eHealth %K digital health %K digital technology %K musculoskeletal %K triage %K physiotherapy triage %K validation %K mobile phone %D 2021 %7 13.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on millions of patients and an increasing demand for health care use. Digital technologies to improve health care outcomes and efficiency are considered a priority; however, innovations are rarely tested with sufficient rigor in clinical trials, which is the gold standard for clinical proof of safety and efficacy. We have developed a new musculoskeletal digital assessment routing tool (DART) that allows users to self-assess and be directed to the right care. DART requires validation in a real-world setting before implementation. Objective: This pilot study aims to assess the feasibility of a future trial by exploring the key aspects of trial methodology, assessing the procedures, and collecting exploratory data to inform the design of a definitive randomized crossover noninferiority trial to assess DART safety and effectiveness. Methods: We will collect data from 76 adults with a musculoskeletal condition presenting to general practitioners within a National Health Service (NHS) in England. Participants will complete both a DART assessment and a physiotherapist-led triage, with the order determined by randomization. The primary analysis will involve an absolute agreement intraclass correlation (A,1) estimate with 95% CI between DART and the clinician for assessment outcomes signposting to condition management pathways. Data will be collected to allow the analysis of participant recruitment and retention, randomization, allocation concealment, blinding, data collection process, and bias. In addition, the impact of trial burden and potential barriers to intervention delivery will be considered. The DART user satisfaction will be measured using the system usability scale. Results: A UK NHS ethics submission was done during June 2021 and is pending approval; recruitment will commence in early 2022, with data collection anticipated to last for 3 months. The results will be reported in a follow-up paper in 2022. Conclusions: This study will inform the design of a randomized controlled crossover noninferiority study that will provide evidence concerning mobile health DART system clinical signposting in an NHS setting before real-world implementation. Success should produce evidence of a safe, effective system with good usability, potentially facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This rigorous approach to mobile health system testing could be used as a guide for other developers of similar applications. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): PRR1-10.2196/31541 %M 34898461 %R 10.2196/31541 %U https://www.researchprotocols.org/2021/12/e31541 %U https://doi.org/10.2196/31541 %U http://www.ncbi.nlm.nih.gov/pubmed/34898461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32450 %T The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study %A Ryan,Kelly A %A Smith,Shawna N %A Yocum,Anastasia K %A Carley,Isabel %A Liebrecht,Celeste %A Navis,Bethany %A Vest,Erica %A Bertram,Holli %A McInnis,Melvin G %A Kilbourne,Amy M %+ Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI, 48105, United States, 1 734 936 5524, karyan@umich.edu %K self-management %K app %K bipolar disorder %K symptom management %K mental health %K feasibility %K usability %K acceptability %K intervention %K bipolar %K coping %K survey %K engagement %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app. Objective: We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months. Methods: A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction. Results: Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35% and 22% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60%) and easy to use (18/25, 72%), and they reported that the screen displayed the material adequately (22/25, 88%). However, less than half of the participants found the app helpful in managing their health (10/25, 40%) or in making progress on their wellness goals (9/25, 36%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being. Conclusions: The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments. %M 34898452 %R 10.2196/32450 %U https://formative.jmir.org/2021/12/e32450 %U https://doi.org/10.2196/32450 %U http://www.ncbi.nlm.nih.gov/pubmed/34898452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30762 %T Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study %A Lee,Austin W %A Kenfield,Stacey A %A Wang,Elizabeth Y %A Enriquez,Anthony %A Oni-Orisan,Akinyemi %A Steinman,Michael A %A Sim,Ida %A Breyer,Benjamin N %A Bauer,Scott R %+ Department of Urology, University of California, San Francisco, 550 16th Street, Box 1695, San Francisco, CA, 94158, United States, 1 415 221 4810 ext 24322, Scott.Bauer@ucsf.edu %K LUTS %K tamsulosin %K mobile %K app %K mobile phone %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men. Objective: We aim to evaluate the feasibility and usability of the PERSONAL (Placebo–Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy. Methods: We recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility. Results: We enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms. Conclusions: This pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men. %M 34889745 %R 10.2196/30762 %U https://formative.jmir.org/2021/12/e30762 %U https://doi.org/10.2196/30762 %U http://www.ncbi.nlm.nih.gov/pubmed/34889745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e19230 %T Creating a Digital Toolkit to Reduce Fatigue and Promote Quality of Life in Multiple Sclerosis: Participatory Design and Usability Study %A Thomas,Sarah %A Pulman,Andy %A Dogan,Huseyin %A Jiang,Nan %A Passmore,David %A Pretty,Keith %A Fairbanks,Beth %A Davies Smith,Angela %A Thomas,Peter W %+ Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, United Kingdom, 44 1202 961953, saraht@bournemouth.ac.uk %K multiple sclerosis %K fatigue %K self-management %K cognitive behavioral %K digital health %K mHealth %K eHealth %K development %K participatory design %K usability testing %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS. Objective: The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users’ unique requirements throughout the design, build, prototyping, and testing stages. Methods: Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality. Results: The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users’ needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle. Conclusions: This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue. %M 34889744 %R 10.2196/19230 %U https://formative.jmir.org/2021/12/e19230 %U https://doi.org/10.2196/19230 %U http://www.ncbi.nlm.nih.gov/pubmed/34889744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e17185 %T Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster %A Milgrom,Jeannette %A Danaher,Brian G %A Seeley,John R %A Holt,Christopher J %A Holt,Charlene %A Ericksen,Jennifer %A Tyler,Milagra S %A Gau,Jeff M %A Gemmill,Alan W %+ Parent-Infant Research Institute, Heidelberg Repatriation Hospital, 300 Waterdale Rd, Heidelberg Heights, 3081, Australia, 61 3 9496 4496, alan.gemmill@austin.org.au %K postnatal depression %K postpartum depression %K postnatal anxiety %K postpartum anxiety %K cognitive behavioral therapy %K internet intervention %K web-based intervention %K randomized controlled trial %K online intervention %K treatment %K mobile phone %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. Objective: This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). Methods: In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up. Results: Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups. Conclusions: In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment. Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true %M 34889742 %R 10.2196/17185 %U https://www.jmir.org/2021/12/e17185 %U https://doi.org/10.2196/17185 %U http://www.ncbi.nlm.nih.gov/pubmed/34889742 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29916 %T Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives %A Breland,Jessica Y %A Agha,Khizran %A Mohankumar,Rakshitha %+ Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, United States, 1 650 493 5000, jessica.breland@va.gov %K mHealth %K implementation %K adoption %K engagement %K weight management %K obesity %K weight loss %K mobile health %K veterans %K barriers %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for weight management can result in weight loss outcomes comparable to in-person treatments. However, there is little information on implementing these treatments in real-world settings. Objective: This work aimed to answer two implementation research questions related to mHealth for weight management: (1) what are barriers and facilitators to mHealth adoption (initial use) and engagement (continued use)? and (2) what are patient beliefs about the appropriateness (ie, perceived fit, relevance, or compatibility) of mHealth for weight management? Methods: We conducted semistructured interviews with patients with obesity at a single facility in an integrated health care system (the Veterans Health Administration). All participants had been referred to a new mHealth program, which included access to a live coach. We performed a rapid qualitative analysis of interviews to identify themes related to the adoption of, engagement with, and appropriateness of mHealth for weight management. Results: We interviewed 24 veterans, seven of whom used the mHealth program. Almost all participants were ≥45 years of age and two-thirds were White. Rapid analysis identified three themes: (1) coaching both facilitates and prevents mHealth adoption and engagement by promoting accountability but leading to guilt among those not meeting goals; (2) preferences regarding the mode of treatment delivery, usability, and treatment content were barriers to mHealth appropriateness and adoption, including preferences for in-person care and a dislike of self-monitoring; and (3) a single invitation was not sufficient to facilitate adoption of a new mHealth program. Themes were unrelated to participants’ age, race, or ethnicity. Conclusions: In a study assessing real-world use of mHealth in a group of middle-aged and older adults, we found that—despite free access to mHealth with a live coach—most did not complete the registration process. Our findings suggest that implementing mHealth for weight management requires more than one information session. Findings also suggest that focusing on the coaching relationship and how users’ lives and goals change over time may be an important way to facilitate engagement and improved health. Most participants thought mHealth was appropriate for weight management, with some nevertheless preferring in-person care. Therefore, the best way to guarantee equitable care will be to ensure multiple routes to achieving the same behavioral health goals. Veterans Health Administration patients have the option of using mHealth for weight management, but can also attend group weight management programs or single-session nutrition classes or access fitness facilities. Health care policy does not allow such access for most people in the United States; however, expanded access to behavioral weight management is an important long-term goal to ensure health for all. %M 34889761 %R 10.2196/29916 %U https://formative.jmir.org/2021/12/e29916 %U https://doi.org/10.2196/29916 %U http://www.ncbi.nlm.nih.gov/pubmed/34889761 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31917 %T A Theory-Based, Multidisciplinary Approach to Cocreate a Patient-Centric Digital Solution to Enhance Perioperative Health Outcomes Among Colorectal Cancer Patients and Their Family Caregivers: Development and Evaluation Study %A Wan,Su Wei %A Chong,Choon Seng %A Toh,Ee-Lin %A Lim,Siew Hoon %A Loi,Carol TT %A Lew,Yuen Foong Henry %A Chua,Matthew Chin Heng %A Jee,Xin Pei %A Liu,Guangyu %A Zhu,Lixia %A Pikkarainen,Minna %A He,Hong-Gu %+ Alice Lee Centre for Nursing Studies, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65167448, nurhhg@nus.edu.sg %K colorectal cancer %K digital solutions %K mobile health %K psychosocial %K mHealth %K smartphone app %K mobile phone app %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. Objective: The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. Methods: A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. Results: Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. Conclusions: This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. Trial Registration: ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363 %M 34878991 %R 10.2196/31917 %U https://www.jmir.org/2021/12/e31917 %U https://doi.org/10.2196/31917 %U http://www.ncbi.nlm.nih.gov/pubmed/34878991 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e23804 %T Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review %A Airola,Ella %+ Media Education Hub, Faculty of Education, University of Lapland, P.O. Box 122, Rovaniemi, FI-96101, Finland, 358 44 4744389, ella.airola@ulapland.fi %K aged %K barrier %K digital competence %K deinstitutionalization %K eHealth %K home care %K learning %K older adult %K rural health %D 2021 %7 2.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults’ needs for eHealth services, and thus, these health solutions require further exploration. Objective: The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults’ (aged ≥60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods: A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results: In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults’ learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults’ own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions: The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use. %M 34860664 %R 10.2196/23804 %U https://www.jmir.org/2021/12/e23804 %U https://doi.org/10.2196/23804 %U http://www.ncbi.nlm.nih.gov/pubmed/34860664 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29687 %T Initial Feasibility of the “Families Moving Forward Connect” Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach %A Petrenko,Christie Lynn McGee %A Kautz-Turnbull,Carson Christine %A Roth,Alicia Rose %A Parr,Jennifer Elizabeth %A Tapparello,Cristiano %A Demir,Utku %A Olson,Heather Carmichael %+ Mt. Hope Family Center, University of Rochester, 187 Edinburgh St, Rochester, NY, 14608, United States, 1 585 275 2991, christie.petrenko@rochester.edu %K fetal alcohol spectrum disorders %K fetal alcohol syndrome %K intervention %K mobile health %K mHealth %K parenting %K children %K prenatal alcohol %K digital health %K user-centered design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective: This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods: Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results: Across beta-test trials, 84% (38/45) of caregivers and 94% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers’ stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions: The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions. %M 34860661 %R 10.2196/29687 %U https://formative.jmir.org/2021/12/e29687 %U https://doi.org/10.2196/29687 %U http://www.ncbi.nlm.nih.gov/pubmed/34860661 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28628 %T Users’ Perceptions Toward mHealth Technologies for Health and Well-being Monitoring in Pregnancy Care: Qualitative Interview Study %A Li,Jane %A Silvera-Tawil,David %A Varnfield,Marlien %A Hussain,M Sazzad %A Math,Vanitha %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Cnr Vimiera and Pembroke Roads, Marsfield, 2122, Australia, 61 02 93724163, jane.li@csiro.au %K pregnancy care %K wearable sensors %K mobile health %K acceptance %K mHealth service %K design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) technologies, such as wearable sensors, smart health devices, and mobile apps, that are capable of supporting pregnancy care are emerging. Although mHealth could be used to facilitate the tracking of health changes during pregnancy, challenges remain in data collection compliance and technology engagement among pregnant women. Understanding the interests, preferences, and requirements of pregnant women and those of clinicians is needed when designing and introducing mHealth solutions for supporting pregnant women’s monitoring of health and risk factors throughout their pregnancy journey. Objective: This study aims to understand clinicians’ and pregnant women’s perceptions on the potential use of mHealth, including factors that may influence their engagement with mHealth technologies and the implications for technology design and implementation. Methods: A qualitative study using semistructured interviews was conducted with 4 pregnant women, 4 postnatal women, and 13 clinicians working in perinatal care. Results: Clinicians perceived the potential benefit of mHealth in supporting different levels of health and well-being monitoring, risk assessment, and care provision in pregnancy care. Most pregnant and postnatal female participants were open to the use of wearables and health monitoring devices and were more likely to use these technologies if they knew that clinicians were monitoring their data. Although it was acknowledged that some pregnancy-related medical conditions are suitable for an mHealth model of remote monitoring, the clinical and technical challenges in the introduction of mHealth for pregnancy care were also identified. Incorporating appropriate health and well-being measures, intelligently detecting any abnormalities, and providing tailored information for pregnant women were the critical aspects, whereas usability and data privacy were among the main concerns of the participants. Moreover, this study highlighted the challenges of engaging pregnant women in longitudinal mHealth monitoring, the additional work required for clinicians to monitor the data, and the need for an evidence-based technical solution. Conclusions: Clinical, technical, and practical factors associated with the use of mHealth to monitor health and well-being in pregnant women need to be considered during the design and feasibility evaluation stages. Technical solutions and appropriate strategies for motivating pregnant women are critical to supporting their long-term data collection compliance and engagement with mHealth technology during pregnancy. %M 34860665 %R 10.2196/28628 %U https://formative.jmir.org/2021/12/e28628 %U https://doi.org/10.2196/28628 %U http://www.ncbi.nlm.nih.gov/pubmed/34860665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27512 %T The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study %A Harrington,Katharine %A Zenk,Shannon N %A Van Horn,Linda %A Giurini,Lauren %A Mahakala,Nithya %A Kershaw,Kiarri N %+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 4014, k-kershaw@northwestern.edu %K ecological momentary assessment %K eating behaviors %K crowdsourcing %K food consumption images %K food image processing %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility—usability and acceptability—of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85%) and high agreement for all other food categories (871/1014, 85.89% for fruits; 847/1014, 83.53% for salty snacks, and 833/1014, 81.15% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. %M 34860666 %R 10.2196/27512 %U https://formative.jmir.org/2021/12/e27512 %U https://doi.org/10.2196/27512 %U http://www.ncbi.nlm.nih.gov/pubmed/34860666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e26370 %T Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing %A Counson,Isabelle %A Bartholomew,Alexandra %A Crawford,Joanna %A Petrie,Katherine %A Basarkod,Geetanjali %A Moynihan,Victoria %A Pires,Josie %A Cohen,Rachel %A Glozier,Nicholas %A Harvey,Samuel %A Sanatkar,Samineh %+ Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 1 02 9382 4368, s.sanatkar@unsw.edu.au %K digital mental health %K mHealth apps %K help-seeking %K junior physicians %K co-design %K user-centered design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were—needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians’ needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. %M 34860662 %R 10.2196/26370 %U https://formative.jmir.org/2021/12/e26370 %U https://doi.org/10.2196/26370 %U http://www.ncbi.nlm.nih.gov/pubmed/34860662 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e27208 %T Walking and Daily Affect Among Sedentary Older Adults Measured Using the StepMATE App: Pilot Randomized Controlled Trial %A Bisson,Alycia N %A Sorrentino,Victoria %A Lachman,Margie E %+ Psychiatry Department, Brigham and Women’s Hospital, Room 394, 221 Longwood Ave, Boston, MA, 02115, United States, 1 5082598151, alyciansullivan@brandeis.edu %K physical activity %K fitness technology %K intervention %K behavioral science %K aging %K mobile phone %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although fitness technology can track and encourage increases in physical activity, few smartphone apps are based on behavior change theories. Apps that do include behavioral components tend to be costly and often do not include strategies to help those who are unsure of how to increase their physical activity. Objective: The aim of this pilot study is to test the efficacy of a new app, StepMATE, for increasing daily walking in a sample of inactive adults and to examine daily relationships between walking and self-reported mood and energy. Methods: The participants were middle-aged and older adults aged ≥50 years (mean 61.64, SD 7.67 years). They were randomly assigned to receive either a basic, pedometer-like version of the app or a version with supports to help them determine where, when, and with whom to walk. Of the 96 participants randomized to 1 of 2 conditions, 87 (91%) completed pretest assessments and 81 (84%) successfully downloaded the app. Upon downloading the app, step data from the week prior were automatically recorded. The participants in both groups were asked to set a daily walking goal, which they could change at any point during the intervention. They were asked to use the app as much as possible over the next 4 weeks. Twice per day, pop-up notifications assessed mood and energy levels. Results: Although one group had access to additional app features, both groups used the app in a similar way, mainly using just the walk-tracking feature. Multilevel models revealed that both groups took significantly more steps during the 4-week study than during the week before downloading the app (γ=0.24; P<.001). During the study, the participants in both groups averaged 5248 steps per day compared with an average of 3753 steps per day during the baseline week. Contrary to predictions, there were no differences in step increases between the two conditions. Cognition significantly improved from pre- to posttest (γ=0.17; P=.02). Across conditions, on days in which the participants took more steps than average, they reported better mood and higher energy levels on the same day and better mood on the subsequent day. Daily associations among walking, mood, and energy were significant for women but not for men and were stronger for older participants (those aged ≥62 years) than for the younger participants. Conclusions: Both groups increased their steps to a similar extent, suggesting that setting and monitoring daily walking goals was sufficient for an initial increase and maintenance of steps. Across conditions, walking had benefits for positive mood and energy levels, particularly for women and older participants. Further investigations should identify other motivating factors that could lead to greater and more sustained increases in physical activity. Trial Registration: ClinicalTrials.gov NCT03124537; https://clinicaltrials.gov/ct2/show/NCT03124537 %M 34855609 %R 10.2196/27208 %U https://mhealth.jmir.org/2021/12/e27208 %U https://doi.org/10.2196/27208 %U http://www.ncbi.nlm.nih.gov/pubmed/34855609 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e15433 %T Tools for Evaluating the Content, Efficacy, and Usability of Mobile Health Apps According to the Consensus-Based Standards for the Selection of Health Measurement Instruments: Systematic Review %A Muro-Culebras,Antonio %A Escriche-Escuder,Adrian %A Martin-Martin,Jaime %A Roldán-Jiménez,Cristina %A De-Torres,Irene %A Ruiz-Muñoz,Maria %A Gonzalez-Sanchez,Manuel %A Mayoral-Cleries,Fermin %A Biró,Attila %A Tang,Wen %A Nikolova,Borjanka %A Salvatore,Alfredo %A Cuesta-Vargas,Antonio Ignacio %+ Grupo Clinimetría (F-14), University of Málaga, C/ Arquitecto Francisco Peñalosa 3, Málaga, 29071, Spain, 34 951952852, acuesta@uma.es %K mobile health %K mHealth %K eHealth %K mobile apps %K assessment %K rating %K smartphone %K questionnaire design %K mobile phone %D 2021 %7 1.12.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: There are several mobile health (mHealth) apps in mobile app stores. These apps enter the business-to-customer market with limited controls. Both, apps that users use autonomously and those designed to be recommended by practitioners require an end-user validation to minimize the risk of using apps that are ineffective or harmful. Prior studies have reviewed the most relevant aspects in a tool designed for assessing mHealth app quality, and different options have been developed for this purpose. However, the psychometric properties of the mHealth quality measurement tools, that is, the validity and reliability of the tools for their purpose, also need to be studied. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) initiative has developed tools for selecting the most suitable measurement instrument for health outcomes, and one of the main fields of study was their psychometric properties. Objective: This study aims to address and psychometrically analyze, following the COSMIN guideline, the quality of the tools that are used to measure the quality of mHealth apps. Methods: From February 1, 2019, to December 31, 2019, 2 reviewers searched PubMed and Embase databases, identifying mHealth app quality measurement tools and all the validation studies associated with each of them. For inclusion, the studies had to be meant to validate a tool designed to assess mHealth apps. Studies that used these tools for the assessment of mHealth apps but did not include any psychometric validation were excluded. The measurement tools were analyzed according to the 10 psychometric properties described in the COSMIN guideline. The dimensions and items analyzed in each tool were also analyzed. Results: The initial search showed 3372 articles. Only 10 finally met the inclusion criteria and were chosen for analysis in this review, analyzing 8 measurement tools. Of these tools, 4 validated ≥5 psychometric properties defined in the COSMIN guideline. Although some of the tools only measure the usability dimension, other tools provide information such as engagement, esthetics, or functionality. Furthermore, 2 measurement tools, Mobile App Rating Scale and mHealth Apps Usability Questionnaire, have a user version, as well as a professional version. Conclusions: The Health Information Technology Usability Evaluation Scale and the Measurement Scales for Perceived Usefulness and Perceived Ease of Use were the most validated tools, but they were very focused on usability. The Mobile App Rating Scale showed a moderate number of validated psychometric properties, measures a significant number of quality dimensions, and has been validated in a large number of mHealth apps, and its use is widespread. It is suggested that the continuation of the validation of this tool in other psychometric properties could provide an appropriate option for evaluating the quality of mHealth apps. %M 34855618 %R 10.2196/15433 %U https://mhealth.jmir.org/2021/12/e15433 %U https://doi.org/10.2196/15433 %U http://www.ncbi.nlm.nih.gov/pubmed/34855618 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e31985 %T Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis %A Cruz-Martínez,Roberto Rafael %A Wentzel,Jobke %A Bente,Britt Elise %A Sanderman,Robbert %A van Gemert-Pijnen,Julia EWC %+ Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Cubicus Bldg, 10, De Zul, Enschede, 7522 NJ, Netherlands, 31 683186149, r.cruzmartinez@utwente.nl %K eHealth %K self-management %K self-care %K cardiovascular diseases %K value sensitive design %K values %K content analysis %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients’ fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. Objective: This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. Methods: Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. Results: In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients’ values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. Conclusions: Positively, existing eHealth technologies could be connected with CVD patients’ values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions. %M 34855608 %R 10.2196/31985 %U https://cardio.jmir.org/2021/2/e31985 %U https://doi.org/10.2196/31985 %U http://www.ncbi.nlm.nih.gov/pubmed/34855608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e25071 %T An Electronic Patient-Reported Outcome Mobile App for Data Collection in Type A Hemophilia: Design and Usability Study %A Petracca,Francesco %A Tempre,Rosaria %A Cucciniello,Maria %A Ciani,Oriana %A Pompeo,Elena %A Sannino,Luigi %A Lovato,Valeria %A Castaman,Giancarlo %A Ghirardini,Alessandra %A Tarricone,Rosanna %+ Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Via Sarfatti, 10, Milan, 20136, Italy, 39 02 58365257, francesco.petracca@unibocconi.it %K mobile apps %K mHealth %K hemophilia A %K rare diseases %K usability %K user-centered design %K design science %K mobile phone %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. Objective: The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. Methods: We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app’s improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. Results: The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app’s layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. Conclusions: The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app’s users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. Trial Registration: ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT04165135 %M 34855619 %R 10.2196/25071 %U https://formative.jmir.org/2021/12/e25071 %U https://doi.org/10.2196/25071 %U http://www.ncbi.nlm.nih.gov/pubmed/34855619 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28678 %T Preferences for Using a Mobile App in Sickle Cell Disease Self-management: Descriptive Qualitative Study %A Mayo-Gamble,Tilicia L %A Quasie-Woode,Delores %A Cunningham-Erves,Jennifer %A Rollins,Margo %A Schlundt,David %A Bonnet,Kemberlee %A Murry,Velma McBride %+ Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Dr, PO Box 8015, Statesboro, GA, 30458, United States, 1 912 478 1249, tmayogamble@georgiasouthern.edu %K sickle cell disease %K digital technology %K rural %K mHealth app %K patient-centered technology %K mobile health %K health outcomes %K hematology %K mobile phone %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with sickle cell disease (SCD) and their caregivers may benefit from technology-based resources to improve disease self-management. Objective: This study explores the preferences regarding a mobile health (mHealth) app to facilitate self-management in adults with SCD and their caregivers living in urban and rural communities. Methods: Five community listening sessions were conducted in 2 urban and rural communities among adults with SCD and their caregivers (N=43). Each session comprised 4 to 15 participants. Participants were asked questions on methods of finding information about SCD self-care, satisfaction with current methods for finding SCD management information, support for SCD management, important features for development of an mHealth app, and areas of benefit for using an mHealth app for SCD self-management. An inductive-deductive content analysis approach was implemented to identify the critical themes. Results: Seven critical themes emerged, including the current methods for receiving self-management information, desired information, recommendations for communicating sickle cell self-management information, challenges of disease management, types of support received for disease management, barriers to and facilitators of using an mHealth app, and feature preferences for an mHealth app. In addition, we found that the participants were receptive to using mHealth apps in SCD self-management. Conclusions: This study expands our knowledge on the use of mHealth technology to reduce information access barriers pertaining to SCD. The findings can be used to develop a patient-centered, user-friendly mHealth app to facilitate disease self-management, thus increasing access to resources for families of patients with SCD residing in rural communities. %M 34851295 %R 10.2196/28678 %U https://formative.jmir.org/2021/11/e28678 %U https://doi.org/10.2196/28678 %U http://www.ncbi.nlm.nih.gov/pubmed/34851295 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e28652 %T An App-Based Mindfulness-Based Self-compassion Program to Support Caregivers of People With Dementia: Participatory Feasibility Study %A Goodridge,Donna %A Reis,Nathan %A Neiser,Jenna %A Haubrich,Tim %A Westberg,Bev %A Erickson-Lumb,Laura %A Storozinski,Jo %A Gonzales,Cesar %A Michael,Joanne %A Cammer,Allison %A Osgood,Nathaniel %+ Department of Medicine, University of Saskatchewan, Room E1216, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 2Z4, Canada, 1 3069664209, donna.goodridge@usask.ca %K virtual support programs %K caregivers %K dementia %K mindfulness %K self-compassion %K mobile health %K mobile applications %K elderly %K older adults %K usability %K feasibility %K smartphone app %K mobile phone %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: The number of persons with dementia is steadily growing, as is the number of individuals supporting persons with dementia. Primary caregivers of persons with dementia are most often family members or spouses of the persons with dementia, and they are more likely to experience increased stress and other negative effects than individuals who are not primary caregivers. Although in-person support groups have been shown to help buffer the negative impacts of caregiving, some caregivers live in isolated or rural communities and are unable to make the burdensome commitment of traveling to cities. Using an interdisciplinary approach, we developed a mobile smartphone support app designed for primary caregivers of persons with dementia, with the goal of reducing caregiver burden and easing stress. The app features a 12-week intervention, largely rooted in mindfulness-based self-compassion (MBSC), because MBSC has been linked to minimizing stress, depression, and anxiety. Objective: The primary objectives of our program are twofold: to explore the feasibility of a 12-week mobile support program and to conduct an initial efficacy evaluation of changes in perceived caregiver burden, coping styles, and emotional well-being of caregivers before and after the program. Methods: Our feasibility study used a 2-phase participatory pretest and posttest design, focusing on acceptability, demand, practicality, implementation, and efficacy. At phase I, we recruited 57 primary caregivers of persons with dementia (mean age 76.3, SD 12.9 years), comprising spouses (21/57, 37%), children (21/57, 37%), and friends or relatives (15/57, 26%) of persons with dementia, of whom 29 (51%) completed all measures at both pre- and postprogram. The content of the program featured a series of MBSC podcasts. Our primary outcome measure was caregiver burden, with secondary outcome measures including coping styles and emotional well-being. Daily ecological momentary assessments enabled us to ask participants, “How are you feeling today?” Phase II of our study involved semistructured follow-up interviews with most participants (n=21) who completed phase I. Results: Our findings suggest that our app or program meets the feasibility criteria examined. Notably, participants generally accepted the program and believed it could be a useful resource. Emotional well-being increased significantly (P=.04), and emotion-based coping significantly decreased (P=.01). Participants generally considered the app or program to be a helpful resource. Conclusions: Although there were no significant changes in caregiver burden, we were encouraged by the increased emotional well-being of our participants following the completion of our program. We also conclude that our app or program demonstrated feasibility (ie, acceptability, practicality, implementation, and efficacy) and can provide a much-needed resource for primary caregivers of persons with dementia. In the subsequent version of the program, we will respond to participant feedback by incorporating web-based weekly sessions and incorporating an outcome measure of self-compassion. %M 34842530 %R 10.2196/28652 %U https://aging.jmir.org/2021/4/e28652 %U https://doi.org/10.2196/28652 %U http://www.ncbi.nlm.nih.gov/pubmed/34842530 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28577 %T Feasibility, Usability, and Effectiveness of a Machine Learning–Based Physical Activity Chatbot: Quasi-Experimental Study %A To,Quyen G %A Green,Chelsea %A Vandelanotte,Corneel %+ Physical Activity Research Group, Appleton Institute, Central Queensland University, 554-700 Yaamba Rd, Norman Gardens, Rockhampton, 4701, Australia, 61 7 4930 6456, q.to@cqu.edu.au %K conversational agent %K virtual coach %K intervention %K exercise %K acceptability %K mobile phone %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Behavioral eHealth and mobile health interventions have been moderately successful in increasing physical activity, although opportunities for further improvement remain to be discussed. Chatbots equipped with natural language processing can interact and engage with users and help continuously monitor physical activity by using data from wearable sensors and smartphones. However, a limited number of studies have evaluated the effectiveness of chatbot interventions on physical activity. Objective: This study aims to investigate the feasibility, usability, and effectiveness of a machine learning–based physical activity chatbot. Methods: A quasi-experimental design without a control group was conducted with outcomes evaluated at baseline and 6 weeks. Participants wore a Fitbit Flex 1 (Fitbit LLC) and connected to the chatbot via the Messenger app. The chatbot provided daily updates on the physical activity level for self-monitoring, sent out daily motivational messages in relation to goal achievement, and automatically adjusted the daily goals based on physical activity levels in the last 7 days. When requested by the participants, the chatbot also provided sources of information on the benefits of physical activity, sent general motivational messages, and checked participants’ activity history (ie, the step counts/min that were achieved on any day). Information about usability and acceptability was self-reported. The main outcomes were daily step counts recorded by the Fitbit and self-reported physical activity. Results: Among 116 participants, 95 (81.9%) were female, 85 (73.3%) were in a relationship, 101 (87.1%) were White, and 82 (70.7%) were full-time workers. Their average age was 49.1 (SD 9.3) years with an average BMI of 32.5 (SD 8.0) kg/m2. Most experienced technical issues were due to an unexpected change in Facebook policy (93/113, 82.3%). Most of the participants scored the usability of the chatbot (101/113, 89.4%) and the Fitbit (99/113, 87.6%) as at least “OK.” About one-third (40/113, 35.4%) would continue to use the chatbot in the future, and 53.1% (60/113) agreed that the chatbot helped them become more active. On average, 6.7 (SD 7.0) messages/week were sent to the chatbot and 5.1 (SD 7.4) min/day were spent using the chatbot. At follow-up, participants recorded more steps (increase of 627, 95% CI 219-1035 steps/day) and total physical activity (increase of 154.2 min/week; 3.58 times higher at follow-up; 95% CI 2.28-5.63). Participants were also more likely to meet the physical activity guidelines (odds ratio 6.37, 95% CI 3.31-12.27) at follow-up. Conclusions: The machine learning–based physical activity chatbot was able to significantly increase participants’ physical activity and was moderately accepted by the participants. However, the Facebook policy change undermined the chatbot functionality and indicated the need to use independent platforms for chatbot deployment to ensure successful delivery of this type of intervention. %M 34842552 %R 10.2196/28577 %U https://mhealth.jmir.org/2021/11/e28577 %U https://doi.org/10.2196/28577 %U http://www.ncbi.nlm.nih.gov/pubmed/34842552 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e28259 %T Experiences and Perceptions of Patients and Providers Participating in Remote Titration of Heart Failure Medication Facilitated by Telemonitoring: Qualitative Study %A Artanian,Veronica %A Ware,Patrick %A Rac,Valeria E %A Ross,Heather J %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada, 1 6 978 4326, art.vt@outlook.com %K telemonitoring %K remote %K titration %K monitoring %K mHealth %K heart failure %K qualitative %K mobile phone %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: Guideline-directed medical therapy (GDMT), optimized to target doses, improves health outcomes in patients with heart failure. However, GDMT remains underused, with <25% of patients receiving target doses in clinical practice. A randomized controlled trial was conducted at the Peter Munk Cardiac Centre in Toronto to compare a remote GDMT titration intervention with standard in-office titration. This randomized controlled trial found that remote titration increased the proportion of patients who achieved optimal GDMT doses, decreased the time to dose optimization, and reduced the number of essential clinic visits. This paper presents findings from the qualitative component of the mixed methods study, which evaluated the implementation of the remote titration intervention. Objective: The objective of the qualitative component is to assess the perceptions and experiences of clinicians and patients with heart failure who participated in the remote titration intervention to identify factors that affected the implementation of the intervention. Methods: We conducted semistructured interviews with clinicians (n=5) and patients (n=11) who participated in the remote titration intervention. Questions probed the experiences of the participants to identify factors that can serve as barriers and facilitators to its implementation. Conventional content analysis was first used to analyze the interviews and gain direct information based on the participants’ unique perspectives. Subsequently, the generated themes were delineated and mapped following a multilevel framework. Results: Patients and clinicians indicated that the intervention was easy to use, integrated well into their routines, and removed practical barriers to titration. Key implementation facilitators from the patients’ perspective included the reduction in clinic visits and daily monitoring of their condition, whereas clinicians emphasized the benefits of rapid drug titration and efficient patient management. Key implementation barriers included the resources necessary to support the intervention and lack of physician remuneration. Conclusions: This study presents results from a real-world implementation assessment of remote titration facilitated by telemonitoring. It is among the first to provide insight into the perception of the remote titration process by clinicians and patients. Our findings indicate that the relative advantages that remote titration presents over standard care strongly appeal to both clinicians and patients. However, to ensure uptake and adherence, it is important to ensure that suitable patients are enrolled and the impact on the physicians’ workload is minimized. The implementation of remote titration is now more critical than ever, as it can help provide access to care for patients during times when physical distancing is required. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): RR2-10.2196/19705 %M 34842546 %R 10.2196/28259 %U https://cardio.jmir.org/2021/2/e28259 %U https://doi.org/10.2196/28259 %U http://www.ncbi.nlm.nih.gov/pubmed/34842546 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30495 %T Patients’ Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study %A Shewchuk,Brittany %A Green,Lee A %A Barber,Tanya %A Miller,Jean %A Teare,Sylvia %A Campbell-Scherer,Denise %A Mrklas,Kelly J %A Li,Linda C %A Marlett,Nancy %A Wasylak,Tracy %A Lopatina,Elena %A McCaughey,Deirdre %A Marshall,Deborah A %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3C58 Health Research Innovation Centre, 3230 Hospital Drive, Calgary, AB, T2N 4Z6, Canada, 1 403 210 6377, damarsha@ucalgary.ca %K mobile health %K mHealth %K app %K self-management %K osteoarthritis %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA). Objective: This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs). Methods: Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ≥20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients’ perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype. Results: Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=−0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability. Conclusions: This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality. %M 34842526 %R 10.2196/30495 %U https://formative.jmir.org/2021/11/e30495 %U https://doi.org/10.2196/30495 %U http://www.ncbi.nlm.nih.gov/pubmed/34842526 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28146 %T How Identification With the Social Environment and With the Government Guide the Use of the Official COVID-19 Contact Tracing App: Three Quantitative Survey Studies %A Scholl,Annika %A Sassenberg,Kai %+ Social Processes Lab, Leibniz-Institut fuer Wissensmedien, Schleichstr 6, Tuebingen, 72076, Germany, 49 7071979 ext 257, a.scholl@iwm-tuebingen.de %K COVID-19 %K SARS-CoV-2 %K contact tracing app %K social identification %K technology acceptance %K pandemic %K outbreak %K health technology %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Official contact tracing apps have been implemented and recommended for use across nations to track and contain the spread of COVID-19. Such apps can be effective if people are willing to use them. Accordingly, many attempts are being made to motivate citizens to make use of the officially recommended apps. Objective: The aim of this research was to contribute to an understanding of the preconditions under which people are willing to use a COVID-19 contact tracing app (ie, their use intentions and use). To go beyond personal motives in favor of app use, it is important to take people’s social relationships into account, under the hypothesis that the more people identify with the beneficiaries of app use (ie, people living close by in their social environment) and with the source recommending the app (ie, members of the government), the more likely they will be to accept the officially recommended contact tracing app. Methods: Before, right after, and 5 months after the official contact tracing app was launched in Germany, a total of 1044 people participated in three separate surveys. Structural equation modeling was used to test the hypotheses, examining the same model in all studies at these critical points in time. Results: Across the three surveys, both identification with the beneficiaries (people living in their social environment) and with the source recommending the app (members of the government) predicted greater intention to use and use (installation) of the official contact tracing app. Trust in the source (members of the government) served as a mediator. Other types of identification (with people in Germany or people around the world) did not explain the observed results. The findings were highly consistent across the three surveys. Conclusions: Attempts to motivate people to use new health technology (or potentially new measures more generally) not only for their personal benefit but also for collective benefits should take the social context into account (ie, the social groups people belong to and identify with). The more important the beneficiaries and the sources of such measures are to people’s sense of the self, the more willing they will likely be to adhere to and support such measures. %M 34662289 %R 10.2196/28146 %U https://mhealth.jmir.org/2021/11/e28146 %U https://doi.org/10.2196/28146 %U http://www.ncbi.nlm.nih.gov/pubmed/34662289 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29267 %T Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study %A ter Harmsel,Annemieke %A van der Pol,Thimo %A Swinkels,Lise %A Goudriaan,Anna E %A Popma,Arne %A Noordzij,Matthijs L %+ Inforsa, Forensic Mental Health Care, Vlaardingenlaan 5, Amsterdam, 1059 GL, Netherlands, 31 653810776, annemieke.ter.harmsel@inforsa.nl %K biocueing %K biosensing %K biofeedback %K aggression %K forensic psychiatry %K wearable technology %K mobile apps %K usability %K evaluation %K mHealth %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. Objective: The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior. Methods: First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures. Results: The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended. Conclusions: This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy. %M 34821567 %R 10.2196/29267 %U https://formative.jmir.org/2021/11/e29267 %U https://doi.org/10.2196/29267 %U http://www.ncbi.nlm.nih.gov/pubmed/34821567 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e26397 %T A Mobile Intervention for Self-Efficacious and Goal-Directed Smartphone Use in the General Population: Randomized Controlled Trial %A Keller,Jan %A Roitzheim,Christina %A Radtke,Theda %A Schenkel,Konstantin %A Schwarzer,Ralf %+ Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 8385 4906, jan.keller@fu-berlin.de %K problematic smartphone use %K smartphone unlocks %K smartphone time %K behavior change %K self-efficacy %K action planning %K digital detox %K time-out %K randomized controlled trial %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People spend large parts of their everyday life using their smartphones. Despite various advantages of the smartphone for daily life, problematic forms of smartphone use exist that are related to negative psychological and physiological consequences. To reduce problematic smartphone use, existing interventions are oftentimes app-based and include components that help users to monitor and restrict their smartphone use by setting timers and blockers. These kinds of digital detox interventions, however, fail to exploit psychological resources, such as through promoting self-efficacious and goal-directed smartphone use. Objective: The aim of this study is to evaluate the theory-based smartphone app “Not Less But Better” that was developed to make people aware of psychological processes while using the smartphone and to support them in using their smartphone in accordance with their goals and values. Methods: In a randomized controlled trial, effects of a 20-day intervention app consisting of five 4-day training modules to foster a goal-directed smartphone use were evaluated. In the active control condition (treatment as usual), participants received a digital detox treatment and planned daily time-outs of at least 1 hour per day. Up to a 3-week follow-up, self-reported problematic smartphone use, objectively measured daily smartphone unlocks, time of smartphone use, self-efficacy, and planning towards goal-directed smartphone use were assessed repeatedly. Linear 2-level models tested intervention effects. Mediation models served to analyze self-efficacy and planning as potential mechanisms of the intervention. Results: Out of 232 enrolled participants, 110 (47.4%; 55 participants in each condition) provided data at postintervention and 88 (37.9%; 44 participants in each condition) at 3-week follow-up. Both conditions manifested substantial reductions in problematic smartphone use and in the amount of time spent with the smartphone. The number of daily unlocks did not change over time. Further, modelling changes in self-efficacy as a mediator between the intervention and problematic smartphone use at follow-up fit well to the data and showed an indirect effect (b=–0.09; 95% bias-corrected bootstrap CI –0.26 to –0.01), indicating that self-efficacy was an important intervention mechanism. Another mediation model revealed an indirect effect from changes in planning via smartphone unlocks at postintervention on problematic smartphone use at follow-up (b=–0.029, 95% bias-corrected bootstrap CI –0.078 to –0.003). Conclusions: An innovative, theory-based intervention app on goal-directed smartphone use has been found useful in lowering problematic smartphone use and time spent with the smartphone. However, observed reductions in both outcomes were not superior to the active control condition (ie, digital detox treatment). Nonetheless, the present findings highlight the importance in promoting self-efficacy and planning goal-directed smartphone use to achieve improvements in problematic smartphone use. This scalable intervention app appears suitable for practical use and as an alternative to common digital detox apps. Future studies should address issues of high attrition by adding just-in-time procedures matched to smartphone users’ needs. Trial Registration: German Clinical Trials Register DRKS00017606; https://tinyurl.com/27c9kmwy %M 34817388 %R 10.2196/26397 %U https://mhealth.jmir.org/2021/11/e26397 %U https://doi.org/10.2196/26397 %U http://www.ncbi.nlm.nih.gov/pubmed/34817388 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e33012 %T Physicians’ Attitudes Toward Prescribable mHealth Apps and Implications for Adoption in Germany: Mixed Methods Study %A Dahlhausen,Florian %A Zinner,Maximillian %A Bieske,Linn %A Ehlers,Jan P %A Boehme,Philip %A Fehring,Leonard %+ Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, Witten, 58448, Germany, 49 2302 926 78608, leonard.fehring@uni-wh.de %K mobile health %K mHealth %K digital health %K apps %K physicians %K general practitioners %K technology acceptance %K adoption %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In October 2020, Germany became the first country, worldwide, to approve certain mobile health (mHealth) apps, referred to as DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health applications), for prescription with costs covered by standard statutory health insurance. Yet, this option has only been used to a limited extent so far. Objective: The aim of this study was to investigate physicians’ and psychotherapists’ current attitudes toward mHealth apps, barriers to adoption, and potential remedies. Methods: We conducted a two-stage sequential mixed methods study. In phase one, semistructured interviews were conducted with physicians and psychotherapists for questionnaire design. In phase two, an online survey was conducted among general practitioners, physicians, and psychotherapists. Results: A total of 1308 survey responses by mostly outpatient-care general practitioners, physicians, and psychotherapists from across Germany who could prescribe DiGA were recorded, making this the largest study on mHealth prescriptions to date. A total of 62.1% (807/1299) of respondents supported the opportunity to prescribe DiGA. Improved adherence (997/1294, 77.0%), health literacy (842/1294, 65.1%), and disease management (783/1294, 60.5%) were most frequently seen as benefits of DiGA. However, only 30.3% (393/1299) of respondents planned to prescribe DiGA, varying greatly by medical specialty. Professionals are still facing substantial barriers, such as insufficient information (1135/1295, 87.6%), reimbursement for DiGA-related medical services (716/1299, 55.1%), medical evidence (712/1298, 54.9%), legal uncertainties (680/1299, 52.3%), and technological uncertainties (658/1299, 50.7%). To support professionals who are unsure of prescribing DiGA, extended information campaigns (1104/1297, 85.1%) as well as recommendations from medical associations (1041/1297, 80.3%) and medical colleagues (1024/1297, 79.0%) were seen as the most impactful remedies. Conclusions: To realize the benefits from DiGA through increased adoption, additional information sharing about DiGA from trusted bodies, reimbursement for DiGA-related medical services, and further medical evidence are recommended. %M 34817385 %R 10.2196/33012 %U https://mhealth.jmir.org/2021/11/e33012 %U https://doi.org/10.2196/33012 %U http://www.ncbi.nlm.nih.gov/pubmed/34817385 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e27873 %T Perceptions of Patients and Physicians on Teleconsultation at Home for Diabetes Mellitus: Survey Study %A Rego,Nazaré %A Pereira,Helena Silva %A Crispim,José %+ Escola de Economia e Gestão, Universidade do Minho, Campus de Gualtar, Braga, 4710 - ​057, Portugal, 351 253604565, nazare@eeg.uminho.pt %K teleconsultation %K diabetes mellitus %K telemedicine %K eHealth %K mobile phone %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Diabetes mellitus (DM) is one of the most challenging diseases in the 21st century and is the sixth leading cause of death. Telemedicine has increasingly been implemented in the care of patients with DM. Although teleconsultations at home have shown to be more effective for inducing HbA1c reduction than other telemedicine options, before the 2019 coronavirus disease crisis, their use had been lagging behind. Studies on physicians’ or patients’ perceptions about telemedicine have been performed independently of each other, and very few have focused on teleconsultations. In a time of great pressure for health systems and when an important portion of health care has to be assured at a distance, obtaining insights about teleconsultations at home from the stakeholders directly involved in the health care interaction is particularly important. Objective: The perceptions of patients and physicians about their intentions to use home synchronous teleconsultations for DM care are examined to identify drivers and barriers inherent to programs that involve home teleconsultations. Methods: Two identical questionnaires integrating the technology acceptance model and the unified theory of acceptance and use of technology and assessing the confidence in information and communication technology use of patients and physicians were developed. Responses by patients (n=75) and physicians (n=68) were analyzed using canonical correlation analysis. Results: Associations between predictor constructs (performance, effort, social influence, facilitating conditions, and attitude) and intention to use yielded significant functions, with a canonical R2 of 0.95 (for physicians) and 0.98 (patients). The main identified barriers to patient intention to use were the expected effort to explain the medical problem, and privacy and confidentiality issues. The major drivers were the facilitation of contact with the physician, which is beneficial to patient disease management and treatment, time savings, and reciprocity concerning physicians’ willingness to perform teleconsultations. Responses from physicians revealed an association between intention to use and the expected performance of home teleconsultations. The major barrier to intention to use expressed in physicians’ answers was doubts concerning the quality of patient examination. The major drivers were time savings, productivity increases, improvements in patient’s health and patient management, National Health System costs reduction, and reciprocity relative to patients’ willingness to engage in teleconsultations. Conclusions: To promote the use of home teleconsultations for DM, decision makers should improve patients’ health literacy so the physician–patient communication is more effective; explore information and communication technology developments to reduce current limitations of non–face-to-face examinations; ensure patient privacy and data confidentiality; and demonstrate the capabilities of home teleconsultations to physicians. %M 34817394 %R 10.2196/27873 %U https://humanfactors.jmir.org/2021/4/e27873 %U https://doi.org/10.2196/27873 %U http://www.ncbi.nlm.nih.gov/pubmed/34817394 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29181 %T To Use or Not to Use a COVID-19 Contact Tracing App: Mixed Methods Survey in Wales %A Jones,Kerina %A Thompson,Rachel %+ Swansea University, Population Data Science, Swansea University Medical School, Singleton Park, Swansea, SA28PP, United Kingdom, 44 01792602764, k.h.jones@swansea.ac.uk %K COVID-19 %K survey %K Wales %K contact tracing %K app %K mHealth %K mobile apps %K digital health %K public health %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many countries remain in the grip of the COVID-19 global pandemic, with a considerable journey still ahead toward normalcy and free mobility. Contact tracing smartphone apps are among a raft of measures introduced to reduce spread of the virus, but their uptake depends on public choice. Objective: The objective of this study was to ascertain the views of citizens in Wales on their intended use of a COVID-19 contact tracing smartphone app, including self-proposed reasons for or against use and what could lead to a change of decision. Methods: We distributed an anonymous survey among 4000 HealthWise Wales participants in May 2020. We adopted a mixed methods approach: responses to closed questions were analyzed using descriptive and inferential statistics; open question responses were analyzed and grouped into categories. Results: A total of 976 (24.4%) people completed the survey. Smartphone usage was 91.5% overall, but this varied among age groups. In total, 97.1% were aware of contact tracing apps, but only 67.2% felt sufficiently informed. Furthermore, 55.7% intended to use an app, 23.3% refused, and 21.0% were unsure. The top reasons for app use were as follows: controlling the spread of the virus, mitigating risks for others and for oneself, and increasing freedoms. The top reasons against app use were as follows: mistrusting the government, concerns about data security and privacy, and doubts about efficacy. The top response for changing one’s mind about app use from being willing to being unwilling was that nothing would; that is, they felt that nothing would cause them to become unwilling to use a contact tracing app. This was also the top response for changing one’s mind from being unwilling to being willing to use contact tracing apps. Among those who were unsure of using contact tracing apps, the top response was the need for more information. Conclusions: Respondents demonstrated a keenness to help themselves, others, society, and the government to avoid contracting the virus and to control its spread. However, digital inclusion varied among age groups, precluding participation for some people. Nonetheless, unwillingness was significant, and considering the nature of the concerns raised and the perceived lack of information, policy and decision-makers need to do more to act openly, increase communication, and demonstrate trustworthiness if members of the public are to be confident in using an app. %M 34698645 %R 10.2196/29181 %U https://mhealth.jmir.org/2021/11/e29181 %U https://doi.org/10.2196/29181 %U http://www.ncbi.nlm.nih.gov/pubmed/34698645 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e32306 %T A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): Qualitative Study on User Experiences of the Behavior Change Process %A Jonathan,Geneva K %A Dopke,Cynthia A %A Michaels,Tania %A Martin,Clair R %A Ryan,Chloe %A McBride,Alyssa %A Babington,Pamela %A Goulding,Evan H %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr Suite 1520, Chicago, IL, 60660, United States, 1 312 503 1189, e-goulding@fsm.northwestern.edu %K behavioral intervention technology %K mHealth %K bipolar disorder %K depression %K illness management %K smartphone %K behavior change %K early warning signs %K self-management %K qualitative %K behavior %K intervention %K management %K user experience %K perception %K utilization %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Bipolar disorder is a severe mental illness characterized by recurrent episodes of depressed, elevated, and mixed mood states. The addition of psychotherapy to pharmacological management can decrease symptoms, lower relapse rates, and improve quality of life; however, access to psychotherapy is limited. Mental health technologies such as smartphone apps are being studied as a means to increase access to and enhance the effectiveness of adjunctive psychotherapies for bipolar disorder. Individuals with bipolar disorder find this intervention format acceptable, but our understanding of how people utilize and integrate these tools into their behavior change and maintenance processes remains limited. Objective: The objective of this study was to explore how individuals with bipolar disorder perceive and utilize a smartphone intervention for health behavior change and maintenance. Methods: Individuals with bipolar disorder were recruited via flyers placed at university-affiliated and private outpatient mental health practices to participate in a pilot study of LiveWell, a smartphone-based self-management intervention. At the end of the study, all participants completed in-depth qualitative exit interviews. The behavior change framework developed to organize the intervention design was used to deductively code behavioral targets and determinants involved in target engagement. Inductive coding was used to identify themes not captured by this framework. Results: In terms of behavioral targets, participants emphasized the importance of managing mood episode–related signs and symptoms. They also discussed the importance of maintaining regular routines, sleep duration, and medication adherence. Participants emphasized that receiving support from a coach as well as seeking and receiving assistance from family, friends, and providers were important for managing behavioral targets and staying well. In terms of determinants, participants stressed the important role of monitoring for their behavior change and maintenance efforts. Monitoring facilitated self-awareness and reflection, which was considered valuable for staying well. Some participants also felt that the intervention facilitated learning information necessary for managing bipolar disorder but others felt that the information provided was too basic. Conclusions: In addition to addressing acceptability, satisfaction, and engagement, a person-based design of mental health technologies can be used to understand how people experience the impact of these technologies on their behavior change and maintenance efforts. This understanding may then be used to guide ongoing intervention development. The participants’ perceptions aligned with the intervention’s primary behavioral targets and use of a monitoring tool as a core intervention feature. Participant feedback further indicates that developing additional content and tools to address building and engaging social support may be an important avenue for improving LiveWell. A comprehensive behavior change framework to understand participant perceptions of their behavior change and maintenance efforts may help facilitate ongoing intervention development. %M 34813488 %R 10.2196/32306 %U https://mental.jmir.org/2021/11/e32306 %U https://doi.org/10.2196/32306 %U http://www.ncbi.nlm.nih.gov/pubmed/34813488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26480 %T Willingness of Chinese Men Who Have Sex With Men to Use Smartphone-Based Electronic Readers for HIV Self-testing: Web-Based Cross-sectional Study %A Marley,Gifty %A Fu,Gengfeng %A Zhang,Ye %A Li,Jianjun %A Tucker,Joseph D %A Tang,Weiming %A Yu,Rongbin %+ School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 13851545125, rongbinyu@njmu.edu.cn %K smartphone-based electronic reader %K electronic readers %K HIV self-testing %K HIVST %K self-testing %K cellular phone–based readers %K mHealth %D 2021 %7 19.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for strategies to encourage user-initiated reporting of results after HIV self-testing (HIVST) persists. Smartphone-based electronic readers (SERs) have been shown capable of reading diagnostics results accurately in point-of-care diagnostics and could bridge the current gaps between HIVST and linkage to care. Objective: Our study aimed to assess the willingness of Chinese men who have sex with men (MSM) in the Jiangsu province to use an SER for HIVST through a web-based cross-sectional study. Methods: From February to April 2020, we conducted a convenience web-based survey among Chinese MSM by using a pretested structured questionnaire. Survey items were adapted from previous HIVST feasibility studies and modified as required. Prior to answering reader-related questions, participants watched a video showcasing a prototype SER. Statistical analysis included descriptive analysis, chi-squared test, and multivariable logistic regression. P values less than .05 were deemed statistically significant. Results: Of 692 participants, 369 (53.3%) were aged 26-40 years, 456 (65.9%) had ever self-tested for HIV, and 493 (71.2%) were willing to use an SER for HIVST. Approximately 98% (483/493) of the willing participants, 85.3% (459/538) of ever self-tested and never self-tested, and 40% (46/115) of unwilling participants reported that SERs would increase their HIVST frequency. Engaging in unprotected anal intercourse with regular partners compared to consistently using condoms (adjusted odds ratio [AOR] 3.04, 95% CI 1.19-7.74) increased the odds of willingness to use an SER for HIVST. Participants who had ever considered HIVST at home with a partner right before sex compared to those who had not (AOR 2.99, 95% CI 1.13-7.90) were also more willing to use an SER for HIVST. Playing receptive roles during anal intercourse compared to playing insertive roles (AOR 0.05, 95% CI 0.02-0.14) was associated with decreased odds of being willing to use an SER for HIVST. The majority of the participants (447/608, 73.5%) preferred to purchase readers from local Centers of Disease Control and Prevention offices and 51.2% (311/608) of the participants were willing to pay less than US $4.70 for a reader device. Conclusions: The majority of the Chinese MSM, especially those with high sexual risk behaviors, were willing to use an SER for HIVST. Many MSM were also willing to self-test more frequently for HIV with an SER. Further research is needed to ascertain the diagnostic and real-time data-capturing capacity of prototype SERs during HIVST. %M 34806988 %R 10.2196/26480 %U https://www.jmir.org/2021/11/e26480 %U https://doi.org/10.2196/26480 %U http://www.ncbi.nlm.nih.gov/pubmed/34806988 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e30420 %T Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation %A Pan,Jing %A Dong,Hua %A Bryan-Kinns,Nick %+ Brunel Design School, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, London, United Kingdom, 44 01895 257254, Hua.Dong@brunel.ac.uk %K older adults %K mHealth %K initial adoption %K technology acceptance %K design %K mobile phone %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults’ perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults’ perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults’ perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults’ adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. %M 34807836 %R 10.2196/30420 %U https://aging.jmir.org/2021/4/e30420 %U https://doi.org/10.2196/30420 %U http://www.ncbi.nlm.nih.gov/pubmed/34807836 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e27016 %T Usability and Perceived Usefulness of the AFib 2gether Mobile App in a Clinical Setting: Single-Arm Intervention Study %A Kapoor,Alok %A Hayes,Anna %A Patel,Jay %A Patel,Harshal %A Andrade,Andreza %A Mazor,Kathleen %A Possidente,Carl %A Nolen,Kimberly %A Hegeman-Dingle,Rozelle %A McManus,David %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 North Lake Ave, Worcester, MA, 01655, United States, 1 9178564538, alok.kapoor@umassmemorial.org %K shared decision-making %K mobile health %K stroke risk %K anticoagulation risk %K anticoagulation %K atrial fibrillation %K anticoagulation therapy %K atrial flutter %K mobile phone %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: Although the American Heart Association and other professional societies have recommended shared decision-making as a way for patients with atrial fibrillation (AF) or atrial flutter to make informed decisions about using anticoagulation (AC), the best method for facilitating shared decision-making remains uncertain. Objective: The aim of this study is to assess the AFib 2gether mobile app for usability, perceived usefulness, and the extent and nature of shared decision-making that occurred for clinical encounters between patients with AF and their cardiology providers in which the app was used. Methods: We identified patients visiting a cardiology provider between October 2019 and May 2020. We measured usability from patients and providers using the Mobile App Rating Scale. From the 8 items of the Mobile App Rating Scale, we reported the average score (out of 5) for domains of functionality, esthetics, and overall quality. We administered a 3-item questionnaire to patients relating to their perceived usefulness of the app and a separate 3-item questionnaire to providers to measure their perceived usefulness of the app. We performed a chart review to track the occurrence of AC within 6 months of the index visit. We also audio recorded a subset of the encounters to identify evidence of shared decision-making. Results: We facilitated shared decision-making visits for 37 patients visiting 13 providers. In terms of usability, patients’ average ratings of functionality, esthetics, and overall quality were 4.51 (SD 0.61), 4.26 (SD 0.51), and 4.24 (SD 0.89), respectively. In terms of usefulness, 41% (15/37) of patients agreed that the app improved their knowledge regarding AC, and 62% (23/37) agreed that the app helped clarify to their provider their preferences regarding AC. Among providers, 79% (27/34) agreed that the app helped clarify their patients’ preferences, 82% (28/34) agreed that the app saved them time, and 59% (20/34) agreed that the app helped their patients make decisions about AC. In addition, 32% (12/37) of patients started AC after their shared decision-making visits. We audio recorded 25 encounters. Of these, 84% (21/25) included the mention of AC for AF, 44% (11/25) included the discussion of multiple options for AC, 72% (18/25) included a provider recommendation for AC, and 48% (12/25) included the evidence of patient involvement in the discussion. Conclusions: Patients and providers rated the app with high usability and perceived usefulness. Moreover, one-third of the patients began AC, and approximately 50% (12/25) of the encounters showed evidence of patient involvement in decision-making. In the future, we plan to study the effect of the app on a larger sample and with a controlled study design. Trial Registration: ClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270 International Registered Report Identifier (IRRID): RR2-21986 %M 34806997 %R 10.2196/27016 %U https://cardio.jmir.org/2021/2/e27016 %U https://doi.org/10.2196/27016 %U http://www.ncbi.nlm.nih.gov/pubmed/34806997 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 4 %P e33027 %T Use of an iPad App (Aid for Decision-making in Occupational Choice) for Collaborative Goal Setting in Interprofessional Rehabilitation: Qualitative Descriptive Study %A Strubbia,Carla %A Levack,William MM %A Grainger,Rebecca %A Takahashi,Kayoko %A Tomori,Kounosuke %+ Department of Medicine, University of Otago, 23A Mein street, Wellington, 6242, New Zealand, 64 02041604900, carla.strubbia@postgrad.otago.ac.nz %K rehabilitation %K goals %K digital technology %K mobile health %K mobile phone %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Goal setting is a key part of the rehabilitation process. The use of technology and electronic tools such as smartphone apps and websites has been suggested as a way of improving the engagement of users in meaningful goal setting and facilitating shared decision-making between patients and health professionals. Objective: This study aims to describe experiences of health professionals and patients in the use of the English language version of the iPad app Aid for Decision-making in Occupational Choice (ADOC) to facilitate collaborative goal setting in rehabilitation. Methods: We recruited participants from 3 acute and postacute care rehabilitation wards in both public and private organizations in New Zealand. Participants were registered allied health professionals, including physiotherapists, occupational therapists, and speech-language therapists, who engage in goal setting as part of their normal work, and their adult patients. We collected data via semistructured interviews to gather information about the experiences of the participants in the use of ADOC for goal setting. Data were analyzed with thematic analysis. Results: A total of 8 health professionals and 8 patients participated in the study. Six main themes emerged from the data: changing patients’ perspective on what is possible, changing health professionals’ perspective on what is important, facilitating shared decision-making, lack of guides for users, logistic and organizational barriers, and app-related and technical issues. Conclusions: Health professionals and patients found ADOC to be a valuable tool when setting shared rehabilitation goals. The use of ADOC promoted a patient-centered approach that empowered patients to engage in collaborative goal setting. The technological limitations of the app that negatively impacted experiences can be addressed in the future implementation of ADOC in rehabilitation settings. %M 34792475 %R 10.2196/33027 %U https://rehab.jmir.org/2021/4/e33027 %U https://doi.org/10.2196/33027 %U http://www.ncbi.nlm.nih.gov/pubmed/34792475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29760 %T A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Carlon,Hannah A %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K nondaily %K smoking cessation %K smartphone app %K positive psychology %K mHealth %K happiness %K mobile phone %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective: This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods: In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results: Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ≥84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=−1.5, 95% CI −1.9 to −1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI −27.2 to −14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=−0.8, 95% CI −1.0 to −0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions: The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial. %M 34787577 %R 10.2196/29760 %U https://formative.jmir.org/2021/11/e29760 %U https://doi.org/10.2196/29760 %U http://www.ncbi.nlm.nih.gov/pubmed/34787577 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29207 %T Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study %A Alessa,Tourkiah %A Hawley,Mark %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield City Centre, Sheffield, S1 4DA, United Kingdom, 44 114 222 1726, talessa@KSU.EDU.SA %K app %K hypertension %K self-management %K mHealth %K blood pressure %K support %K Saudi Arabia %K cardiology %K heart %K effective %K security %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts. Objective: The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system. Methods: This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants’ attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis. Results: In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users’ data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants. Conclusions: Only 5 apps were deemed potentially effective and secure. Patients’ and doctors’ discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall. %M 34787586 %R 10.2196/29207 %U https://mhealth.jmir.org/2021/11/e29207 %U https://doi.org/10.2196/29207 %U http://www.ncbi.nlm.nih.gov/pubmed/34787586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30572 %T Evaluating a Strengths-Based mHealth Tool (MyStrengths): Explorative Feasibility Trial %A Jessen,Stian %A Mirkovic,Jelena %A Halvorsen Brendmo,Elanor %A Solberg Nes,Lise %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital HF, Aker Sykehus, Trondheimsveien 23, Oslo, 0586, Norway, 47 9804 9759, stian.jessen@rr-research.no %K mHealth %K personal strengths %K gameful design %K gamification %K user engagement %K explorative %K feasibility %K usefulness %K usability %K design %K self-management %K chronic illness %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the number of people living with chronic illnesses increases, providing wide-reaching and easy-to-use support tools is becoming increasingly important. Supporting people in this group to recognize and use more of their personal strengths has the potential to improve their quality of life. With this in mind, we have developed the MyStrengths app prototype, a gamefully designed app aimed at aiding users in both identifying their strengths and using these strengths more actively in their daily life. Objective: The goal of this study was to evaluate the user-reported feasibility and usefulness of the MyStrengths app. The study additionally aimed to explore whether the use of MyStrengths could be associated with selected psychosocial outcomes. Methods: A 31-day explorative feasibility trial with a pretest-posttest design and an optional end of study interview was conducted. Data collection included system-use log data, demographic information, pre– and post–psychosocial measures (ie, strengths use, self-efficacy, health-related quality of life, depression), user experience measures (ie, usability, engagement, flow), and interview data. Results: In total, 34 people with at least 1 chronic condition were enrolled in the study, with 26 participants (mean age 48 years, range 29-62 years; 1 male) completing the trial. Among these individuals, 18 were also interviewed posttrial. Participants used the MyStrengths app an average of 6 days during the trial period, with 54% (14/26) using the app over a period of at least 19 days. In total, 8738 unique app actions were registered. Of the psychosocial outcome measures, only 1 subscale, general health in the RAND 36-Item Health Survey, yielded significant pre- and posttest changes. Posttrial interviews showed that the number of participants who considered the MyStrengths app to be useful, somewhat useful, or not useful was evenly distributed across 3 groups. However, every participant did voice support for the strengths approach. All participants were able to identify a multitude of personal strengths using the MyStrengths app. Most participants that reported it to be useful had little or no previous experience with the personal strengths approach. A multitude of users welcomed the gameful design choices, particularly the rolling die feature, suggesting strengths exercises, activities that use a specific strength, were well received. Conclusions: Although the reported usefulness and feedback from use varied, most participants were favorable to the strengths-focused approach to care and support. Consequently, low-threshold and wide-reaching mobile health tools that use a strengths-focused approach, such as MyStrengths, hold the potential to support people living with chronic illness in performing self-management and achieving mastery of their life. %M 34787580 %R 10.2196/30572 %U https://formative.jmir.org/2021/11/e30572 %U https://doi.org/10.2196/30572 %U http://www.ncbi.nlm.nih.gov/pubmed/34787580 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29128 %T A Two-Minute Walking Test With a Smartphone App for Persons With Multiple Sclerosis: Validation Study %A van Oirschot,Pim %A Heerings,Marco %A Wendrich,Karine %A den Teuling,Bram %A Dorssers,Frank %A van Ee,René %A Martens,Marijn Bart %A Jongen,Peter Joseph %+ Orikami Digital Health Products, Ridderstraat 29, Nijmegen, 6511 TM, Netherlands, 31 24 301 0100, pim@mssherpa.nl %K multiple sclerosis %K relapsing remitting %K mobility %K mobile phone %K 2-Minute Walking Test %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking disturbances are a common dysfunction in persons with multiple sclerosis (MS). The 2-Minute Walking Test (2MWT) is widely used to quantify walking speed. We implemented a smartphone-based 2MWT (s2MWT) in MS sherpa, an app for persons with MS. When performing the s2MWT, users of the app are instructed to walk as fast as safely possible for 2 minutes in the open air, while the app records their movement and calculates the distance walked. Objective: The aim of this study is to investigate the concurrent validity and test-retest reliability of the MS sherpa s2MWT. Methods: We performed a validation study on 25 persons with relapsing-remitting MS and 79 healthy control (HC) participants. In the HC group, 21 participants were matched to the persons with MS based on age, gender, and education and these followed the same assessment schedule as the persons with MS (the HC-matched group), whereas 58 participants had a less intense assessment schedule to determine reference values (the HC-normative group). Intraclass correlation coefficients (ICCs) were determined between the distance measured by the s2MWT and the distance measured using distance markers on the pavement during these s2MWT assessments. ICCs were also determined for test-retest reliability and derived from 10 smartphone tests per study participant, with 3 days in between each test. We interviewed 7 study participants with MS regarding their experiences with the s2MWT. Results: In total, 755 s2MWTs were completed. The adherence rate for the persons with MS and the participants in the HC-matched group was 92.4% (425/460). The calculated distance walked on the s2MWT was, on average, 8.43 m or 5% (SD 18.9 m or 11%) higher than the distance measured using distance markers (n=43). An ICC of 0.817 was found for the concurrent validity of the s2MWT in the combined analysis of persons with MS and HC participants. Average ICCs of 9 test-retest reliability analyses of the s2MWT for persons with MS and the participants in the HC-matched group were 0.648 (SD 0.150) and 0.600 (SD 0.090), respectively, whereas the average ICC of 2 test-retest reliability analyses of the s2MWT for the participants in the HC-normative group was 0.700 (SD 0.029). The interviewed study participants found the s2MWT easy to perform, but they also expressed that the test results can be confronting and that a pressure to reach a certain distance can be experienced. Conclusions: The high correlation between s2MWT distance and the conventional 2MWT distance indicates a good concurrent validity. Similarly, high correlations underpin a good test-retest reliability of the s2MWT. We conclude that the s2MWT can be used to measure the distance that the persons with MS walk in 2 minutes outdoors near their home, from which both clinical studies and clinical practice can benefit. %M 34787581 %R 10.2196/29128 %U https://formative.jmir.org/2021/11/e29128 %U https://doi.org/10.2196/29128 %U http://www.ncbi.nlm.nih.gov/pubmed/34787581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25824 %T The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences %A Oladele,David %A Iwelunmor,Juliet %A Gbajabiamila,Titilola %A Obiezu-Umeh,Chisom %A Okwuzu,Jane Ogoamaka %A Nwaozuru,Ucheoma %A Musa,Adesola Zaidat %A Idigbe,Ifeoma %A Tahlil,Kadija %A Tang,Weiming %A Conserve,Donaldson F %A Rosenberg,Nora E %A David,Agatha N %A Tucker,Joseph %A Ezechi,Oliver %+ Department of Behavioral Science and Health Education, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, United States, 1 3149773280, juliet.iwelunmor@slu.edu %K HIV self-testing %K adolescents %K young people %K photo verification %K mobile app %K Nigeria %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the global expansion of HIV self-testing (HIVST), many research studies still rely on self-reported outcomes. New HIVST verification methods are needed, especially in resource-limited settings. Objective: This study aims to evaluate the user experience of a mobile health (mHealth) app to enhance HIVST result reporting and verification. Methods: Semistructured, in-depth interviews were used to evaluate the user experience of the 4 Youth By Youth mHealth photo verification app for HIVST. We used a think-aloud approach, and participants performed usability tasks and completed a qualitative exit interview. The app included HIV educational resources, step-by-step video instructions for performing HIVST, a 20-minute timer, a guide on interpreting results with linkages to care, an offline version, and a photo verification system. Demographic characteristics were reported by using descriptive statistics. Qualitative data were analyzed by using thematic analysis. Results: A total of 19 users—12 women and 7 men—with a mean age of 22 years, participated in the study. The users completed the usability tasks and successfully uploaded a photo of their test results by using the app without assistance. Four main themes were identified in the data. First, in terms of user-friendly design, the participants noted the user-friendly features of the offline version and the app’s low data use. However, some wanted the app to work in the background when using their mobile phone, and the font used should be more youth friendly. Second, in terms of ease of use, participants remarked that the app’s self-explanatory nature and instructions that guided them on how to use the app enhanced its use. Third, in terms of a user’s privacy, many participants reinforced the importance of privacy settings and tools that protect confidentiality among users. Finally, in terms of linkage to care, participants noted that the app’s linkage to care features were useful, particularly in relation to referrals to trained counselors upon the completion of the test. All the participants noted that the app provided a convenient and private means of verifying the HIV test results. Conclusions: Our findings demonstrated the importance of engaging end users in the development phase of health technology innovations that serve youth. Clinical trials are needed to determine the efficacy of using an mHealth app to verify HIVST results among young people. %M 34787579 %R 10.2196/25824 %U https://formative.jmir.org/2021/11/e25824 %U https://doi.org/10.2196/25824 %U http://www.ncbi.nlm.nih.gov/pubmed/34787579 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e26212 %T A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp %A Whale,Katie %A Beasant,Lucy %A Wright,Anne J %A Yardley,Lucy %A Wallace,Louise M %A Moody,Louise %A Joinson,Carol %+ Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom, 44 0117 4147995, katie.whale@bristol.ac.uk %K incontinence %K urinary incontinence %K digital intervention %K child health %K pediatric %K pediatric incontinence %K smartphone %K intervention development %K mobile phone %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life. %M 34779780 %R 10.2196/26212 %U https://pediatrics.jmir.org/2021/4/e26212 %U https://doi.org/10.2196/26212 %U http://www.ncbi.nlm.nih.gov/pubmed/34779780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29201 %T A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE %A Ben-Zeev,Dror %A Chander,Ayesha %A Tauscher,Justin %A Buck,Benjamin %A Nepal,Subigya %A Campbell,Andrew %A Doron,Guy %+ Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 685 9655, dbenzeev@uw.edu %K mobile health %K schizophrenia %K bipolar disorder %K depression %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: People with serious mental illness (SMI) have significant unmet mental health needs. Development and testing of digital interventions that can alleviate the suffering of people with SMI is a public health priority. Objective: The aim of this study is to conduct a fully remote randomized waitlist-controlled trial of CORE, a smartphone intervention that comprises daily exercises designed to promote reassessment of dysfunctional beliefs in multiple domains. Methods: Individuals were recruited via the web using Google and Facebook advertisements. Enrolled participants were randomized into either active intervention or waitlist control groups. Participants completed the Beck Depression Inventory-Second Edition (BDI-II), Generalized Anxiety Disorder-7 (GAD-7), Hamilton Program for Schizophrenia Voices, Green Paranoid Thought Scale, Recovery Assessment Scale (RAS), Rosenberg Self-Esteem Scale (RSES), Friendship Scale, and Sheehan Disability Scale (SDS) at baseline (T1), 30-day (T2), and 60-day (T3) assessment points. Participants in the active group used CORE from T1 to T2, and participants in the waitlist group used CORE from T2 to T3. Both groups completed usability and accessibility measures after they concluded their intervention periods. Results: Overall, 315 individuals from 45 states participated in this study. The sample comprised individuals with self-reported bipolar disorder (111/315, 35.2%), major depressive disorder (136/315, 43.2%), and schizophrenia or schizoaffective disorder (68/315, 21.6%) who displayed moderate to severe symptoms and disability levels at baseline. Participants rated CORE as highly usable and acceptable. Intent-to-treat analyses showed significant treatment×time interactions for the BDI-II (F1,313=13.38; P<.001), GAD-7 (F1,313=5.87; P=.01), RAS (F1,313=23.42; P<.001), RSES (F1,313=19.28; P<.001), and SDS (F1,313=10.73; P=.001). Large effects were observed for the BDI-II (d=0.58), RAS (d=0.61), and RSES (d=0.64); a moderate effect size was observed for the SDS (d=0.44), and a small effect size was observed for the GAD-7 (d=0.20). Similar changes in outcome measures were later observed in the waitlist control group participants following crossover after they received CORE (T2 to T3). Approximately 41.5% (64/154) of participants in the active group and 60.2% (97/161) of participants in the waitlist group were retained at T2, and 33.1% (51/154) of participants in the active group and 40.3% (65/161) of participants in the waitlist group were retained at T3. Conclusions: We successfully recruited, screened, randomized, treated, and assessed a geographically dispersed sample of participants with SMI entirely via the web, demonstrating that fully remote clinical trials are feasible in this population; however, study retention remains challenging. CORE showed promise as a usable, acceptable, and effective tool for reducing the severity of psychiatric symptoms and disability while improving recovery and self-esteem. Rapid adoption and real-world dissemination of evidence-based mobile health interventions such as CORE are needed if we are to shorten the science-to-service gap and address the significant unmet mental health needs of people with SMI during the COVID-19 pandemic and beyond. Trial Registration: ClinicalTrials.gov NCT04068467; https://clinicaltrials.gov/ct2/show/NCT04068467 %M 34766913 %R 10.2196/29201 %U https://www.jmir.org/2021/11/e29201 %U https://doi.org/10.2196/29201 %U http://www.ncbi.nlm.nih.gov/pubmed/34766913 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28024 %T Improvements in Diet and Physical Activity–Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study %A Cyriac,Jissy %A Jenkins,Sarah %A Patten,Christi A %A Hayes,Sharonne N %A Jones,Clarence %A Cooper,Lisa A %A Brewer,LaPrincess C %+ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, United States, 1 507 266 1376, brewer.laprincess@mayo.edu %K African Americans %K cardiovascular health disparities %K mHealth lifestyle intervention %K diet %K physical activity %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. Objective: This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. Methods: This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory–informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. Results: Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=−0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). Conclusions: Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans. %M 34766917 %R 10.2196/28024 %U https://mhealth.jmir.org/2021/11/e28024 %U https://doi.org/10.2196/28024 %U http://www.ncbi.nlm.nih.gov/pubmed/34766917 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e26424 %T Acceptance of an Informational Antituberculosis Chatbot Among Korean Adults: Mixed Methods Research %A Kim,Agnes Jihae %A Yang,Jisun %A Jang,Yihyun %A Baek,Joon Sang %+ Department of Human Environment and Design, Yonsei University, Samsung Hall, 7th Fl., Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2123 3137, joonsbaek@yonsei.ac.kr %K tuberculosis %K chatbot %K technology acceptance model %K mobile phone %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tuberculosis (TB) is a highly infectious disease. Negative perceptions and insufficient knowledge have made its eradication difficult. Recently, mobile health care interventions, such as an anti-TB chatbot developed by the research team, have emerged in support of TB eradication programs. However, before the anti-TB chatbot is deployed, it is important to understand the factors that predict its acceptance by the population. Objective: This study aims to explore the acceptance of an anti-TB chatbot that provides information about the disease and its treatment to people vulnerable to TB in South Korea. Thus, we are investigating the factors that predict technology acceptance through qualitative research based on the interviews of patients with TB and homeless facility personnel. We are then verifying the extended Technology Acceptance Model (TAM) and predicting the factors associated with the acceptance of the chatbot. Methods: In study 1, we conducted interviews with potential chatbot users to extract the factors that predict user acceptance and constructed a conceptual framework based on the TAM. In total, 16 interviews with patients with TB and one focus group interview with 10 experts on TB were conducted. In study 2, we conducted surveys of potential chatbot users to validate the extended TAM. Survey participants were recruited among late-stage patients in TB facilities and members of web-based communities sharing TB information. A total of 123 responses were collected. Results: The results indicate that perceived ease of use and social influence were significantly predictive of perceived usefulness (P=.04 and P<.001, respectively). Perceived usefulness was predictive of the attitude toward the chatbot (P<.001), whereas perceived ease of use (P=.88) was not. Behavioral intention was positively predicted by attitude toward the chatbot and facilitating conditions (P<.001 and P=.03, respectively). The research model explained 55.4% of the variance in the use of anti-TB chatbots. The moderating effect of TB history was found in the relationship between attitude toward the chatbot and behavioral intention (P=.01) and between facilitating conditions and behavioral intention (P=.02). Conclusions: This study can be used to inform future design of anti-TB chatbots and highlight the importance of services and the environment that empower people to use the technology. %M 34751667 %R 10.2196/26424 %U https://mhealth.jmir.org/2021/11/e26424 %U https://doi.org/10.2196/26424 %U http://www.ncbi.nlm.nih.gov/pubmed/34751667 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e32847 %T Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial %A Bricker,Jonathan B %A Levin,Michael %A Lappalainen,Raimo %A Mull,Kristin %A Sullivan,Brianna %A Santiago-Torres,Margarita %+ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K mediation %K engagement %K digital %K mHealth: smartphone %K acceptance %K smoking %K cessation %K app %K randomized controlled trial %K model %K intervention %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. Objective: This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. Methods: In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention. Results: There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. Conclusions: In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. Trial Registration: Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462 %M 34751662 %R 10.2196/32847 %U https://mhealth.jmir.org/2021/11/e32847 %U https://doi.org/10.2196/32847 %U http://www.ncbi.nlm.nih.gov/pubmed/34751662 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e29788 %T Clinicians and Older Adults’ Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study %A Kim,Ben %A Ghasemi,Peyman %A Stolee,Paul %A Lee,Joon %+ Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 403 220 2968, joonwu.lee@ucalgary.ca %K mobile health %K mHealth %K older adults %K wearables %K patient generated health data %K chronic disease management %K home care %K self-care %K activities of daily living %K sleep %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults’ perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults’ perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians’ perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. %M 34738913 %R 10.2196/29788 %U https://aging.jmir.org/2021/4/e29788 %U https://doi.org/10.2196/29788 %U http://www.ncbi.nlm.nih.gov/pubmed/34738913 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e23852 %T Adaptation of a Theory-Based Social Networking and Gamified App-Based Intervention to Improve Pre-Exposure Prophylaxis Adherence Among Young Men Who Have Sex With Men in Bangkok, Thailand: Qualitative Study %A Songtaweesin,Wipaporn Natalie %A LeGrand,Sara %A Bandara,Shashika %A Piccone,Caitlin %A Wongharn,Prissana %A Moonwong,Juthamanee %A Jupimai,Thidarat %A Saisaengjan,Chutima %A Theerawit,Tuangtip %A Muessig,Kathryn %A Hightow-Weidman,Lisa %A Puthanakit,Thanyawee %A Phanuphak,Nittaya %A Tangmunkongvorakul,Arunrat %+ Research Institute for Health Sciences, Chiang Mai University, 110 Intavarorot Road, Tambol Siphum, Amphur Muang, Chiang Mai, 50200, Thailand, 66 815942773, arunrat@rihes.org %K mobile health %K young men who have sex with men %K pre-exposure prophylaxis %K adherence %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV disproportionately affects young Thai men who have sex with men (YMSM). Recent studies report a high incidence and prevalence of HIV among Thai YMSM. The Thai national guidelines have recommended pre-exposure prophylaxis (PrEP) since 2014 for key populations; free PrEP has been piloted since 2019. Smartphone-based mobile health (mHealth) interventions provide an optimal platform for innovative PrEP adherence interventions for Thai YMSM. Objective: This study aims to adapt the P3 (Prepared, Protected, emPowered) app, developed with YMSM and transwomen in the United States to improve PrEP adherence and persistence for YMSM in Thailand. The app aims to provide daily adherence support and addresses gaps in staff available for large-scale PrEP rollout needed to see population-level effects of HIV prevention. Methods: We conducted focus group discussions (FGDs) with YMSM and key informant interviews (KIIs) with PrEP care providers in Bangkok, Thailand, to investigate PrEP adherence facilitators and barriers, preferences for functions and features in mHealth apps among YMSM, and how to best adapt the P3 app to the Thai context. We conducted four FGDs with 4-8 participants per group and 15 KIIs. Results: For FGDs, 23 YMSM participated with a mean age of 20 years (range 18-21), 96% (22/23) enrolled in full-time education, and all owned smartphones. The mean age of KII participants was 40 (range 26-60) years; most were state health service providers, with the majority being counselors (6/15, 40%) and physicians (6/15, 40%). Overall, the facilitators and barriers for PrEP adherence identified were similar to those of MSM and YMSM globally including the United States. Key themes included general recommendations for improving mHealth apps in Thailand, such as presenting reliable information in an appealing format, minimizing privacy risks, and addressing connectivity challenges. Additional themes focused on P3 Thailand adaptations and were related to cultural and stylistic preferences, engagement strategies, and recommendations for new functions. To develop the adapted app, P3 Thailand, these findings were balanced with resource limitations resulting in the prioritization of minor modifications: changes in app esthetics (color scheme, iconography, and imagery) and changes in the presentation of information in two of the app’s features. FGDs identified similar PrEP adherence facilitators and barriers to those already addressed within the app. Conclusions: The core elements of the P3 app address major PrEP facilitators and barriers for Thai YMSM; however, changes to the app features, including stylistic presentation, were needed to appropriately customize the app to the Thai context. Given the similarities of facilitators and barriers for PrEP adherence globally, adapting existing PrEP mHealth solutions based on input from end users and key informants provides a promising approach. However, partnerships with local app designers and developers can improve the adaptation process and final product. Trial Registration: ClinicalTrials.gov NCT04413708; http://clinicaltrials.gov/ct2/show/NCT04413708 %M 34734828 %R 10.2196/23852 %U https://www.jmir.org/2021/11/e23852 %U https://doi.org/10.2196/23852 %U http://www.ncbi.nlm.nih.gov/pubmed/34734828 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29815 %T App Designs and Interactive Features to Increase mHealth Adoption: User Expectation Survey and Experiment %A Lazard,Allison J %A Babwah Brennen,J Scott %A Belina,Stephanie P %+ Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, 384 Carroll Hall, Chapel Hill, NC, 27599, United States, 1 3173317807, lazard@unc.edu %K smartphone %K interactive design %K mobile apps %K preventive health %K mental models %K prototypicality %K attention %K affordances %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the ubiquity of smartphones, there is little guidance for how to design mobile health apps to increase use. Specifically, knowing what features users expect, grab their attention, encourage use (via predicted use or through positive app evaluations), and signal beneficial action possibilities can guide and focus app development efforts. Objective: We investigated what features users expect and how the design (prototypicality) impacts app adoption. Methods: In a web-based survey, we elicited expectations, including presence and placement, for 12 app features. Thereafter, participants (n=462) viewed 2 health apps (high prototypicality similar to top downloaded apps vs low prototypicality similar to research interventions) and reported willingness to download, attention, and predicted use of app features. Participants rated both apps (high and low) for aesthetics, ease of use, usefulness, perceived affordances, and intentions to use. Results: Most participants (425/462, 92%) expected features for navigation or personal settings (eg, menu) in specific regions (eg, top corners). Features with summary graphs or statics were also expected by many (395-396 of 462, 86%), with a center placement expectation. A feature to “share with friends” was least expected among participants (203/462, 44%). Features fell into 4 unique categories based on attention and predicted use, including essential features with high (>50% or >231 of 462) predicted use and attention (eg, calorie trackers), flashy features with high attention but lower predicted use (eg, links to specific diets), functional features with modest attention and low use (eg, settings), and mundane features with low attention and use (eg, discover tabs). When given a choice, 347 of 462 (75%) participants would download the high-prototypicality app. High prototypicality apps (vs low) led to greater aesthetics, ease of use, usefulness, and intentions, (for all, P<.001). Participants thought that high prototypicality apps had more perceived affordances. Conclusions: Intervention designs that fail to meet a threshold of mHealth expectations will be dismissed as less usable or beneficial. Individuals who download health apps have shared expectations for features that should be there, as well as where these features should appear. Meeting these expectations can improve app evaluations and encourage use. Our typology should guide presence and placement of expected app features to signal value and increase use to impact preventive health behaviors. Features that will likely be used and are attention-worthy—essential, flashy, and functional—should be prioritized during app development. %M 34734829 %R 10.2196/29815 %U https://mhealth.jmir.org/2021/11/e29815 %U https://doi.org/10.2196/29815 %U http://www.ncbi.nlm.nih.gov/pubmed/34734829 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e25553 %T GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study %A Moczygemba,Leticia R %A Thurman,Whitney %A Tormey,Kyler %A Hudzik,Anthony %A Welton-Arndt,Lauren %A Kim,Elizabeth %+ Health Outcomes Division, College of Pharmacy, University of Texas at Austin, 1 University Station, Austin, TX, 78712, United States, 1 5122326880, lrmoczygemba@austin.utexas.edu %K GPS %K mHealth %K care coordination %K people experiencing homelessness %K homelessness %K emergency department %K health outcomes %K health care costs %K mobile phone %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. Objective: This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. Methods: This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. Results: In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. Conclusions: mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. %M 34730550 %R 10.2196/25553 %U https://mhealth.jmir.org/2021/11/e25553 %U https://doi.org/10.2196/25553 %U http://www.ncbi.nlm.nih.gov/pubmed/34730550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31649 %T Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study %A Reichold,Michael %A Heß,Miriam %A Kolominsky-Rabas,Peter %A Gräßel,Elmar %A Prokosch,Hans-Ulrich %+ Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Wetterkreuz 15, Erlangen, 91058, Germany, 49 91318526720, michael.reichold@fau.de %K dementia %K usability %K evaluation %K mobile device %K registry %K electronic data collection %K offline %K mobile app %K digital health %K usability testing %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project “Digital Dementia Registry Bavaria (digiDEM Bayern),” interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. Objective: The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. Methods: An exploratory mixed method design was employed in the form of an on-site usability test with the “Thinking Aloud” method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. Results: Using the “Thinking Aloud” method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents “good” usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. Conclusions: The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry–based research project. %M 34730543 %R 10.2196/31649 %U https://formative.jmir.org/2021/11/e31649 %U https://doi.org/10.2196/31649 %U http://www.ncbi.nlm.nih.gov/pubmed/34730543 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25749 %T A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial %A Paquette,Catherine E %A Rubalcava,Dillon T %A Chen,Yun %A Anand,Deepika %A Daughters,Stacey B %+ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3270, United States, 1 919 962 9924, daughter@unc.edu %K substance use disorder %K smartphone app %K mHealth %K behavioral activation %K mobile phone %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Group-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions. Objective: This study aims to describe the features of the app and its use and integration into treatment, report the participants’ self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD. Methods: A total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time. Results: Participant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% (39/54) of participants reported using the app at posttreatment, decreasing to 69% (37/54) at the 1-month follow-up and 37% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse. Conclusions: This study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages. Trial Registration: ClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887 %M 34730535 %R 10.2196/25749 %U https://formative.jmir.org/2021/11/e25749 %U https://doi.org/10.2196/25749 %U http://www.ncbi.nlm.nih.gov/pubmed/34730535 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e30674 %T Analysis of Apps With a Medication List Functionality for Older Adults With Heart Failure Using the Mobile App Rating Scale and the IMS Institute for Healthcare Informatics Functionality Score: Evaluation Study %A Diaz-Skeete,Yohanca Maria %A McQuaid,David %A Akinosun,Adewale Samuel %A Ekerete,Idongesit %A Carragher,Natacha %A Carragher,Lucia %+ NetwellCASALA Advanced Research Centre, Dundalk Institute of Technology, Dublin Road, Marshes Upper, Dundalk, A91 K584, Ireland, 353 429370497 ext 2592, yohanca.diaz@dkit.ie %K mobile app %K mHealth %K medication app %K heart failure %K Mobile App Rating Scale %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient’s medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored. Objective: The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. Methods: A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. Results: Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps. Conclusions: The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication. %M 34726613 %R 10.2196/30674 %U https://mhealth.jmir.org/2021/11/e30674 %U https://doi.org/10.2196/30674 %U http://www.ncbi.nlm.nih.gov/pubmed/34726613 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e26181 %T Usability-In-Place—Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review %A Hill,Jordan R %A Brown,Janetta C %A Campbell,Noll L %A Holden,Richard J %+ Department of Pharmacy Practice, College of Pharmacy, Purdue University, 640 Eskenazi Ave, Indianapolis, IN, 46202, United States, 1 7655438559, hill265@purdue.edu %K mobile usability testing %K usability inspection %K methods %K aging %K literature synthesis %K usability study %K mobile usability %K elderly %K older adults %K remote usability %K mobility restriction %D 2021 %7 2.11.2021 %9 Review %J JMIR Form Res %G English %X Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely. Objective: Our objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults. Methods: We performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature. Results: Critically, we identified a gap in the literature—a lack of remote usability testing methods, tools, and strategies for older adults, despite this population’s increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults. Conclusions: We call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals. %M 34726604 %R 10.2196/26181 %U https://formative.jmir.org/2021/11/e26181 %U https://doi.org/10.2196/26181 %U http://www.ncbi.nlm.nih.gov/pubmed/34726604 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25392 %T A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study %A Carmona,Nicole E %A Usyatynsky,Aleksandra %A Kutana,Samlau %A Corkum,Penny %A Henderson,Joanna %A McShane,Kelly %A Shapiro,Colin %A Sidani,Souraya %A Stinson,Jennifer %A Carney,Colleen E %+ Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 552177, ccarney@ryerson.ca %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz’s with Empirical Support). Objective: This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods: Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results: In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode≥4) on the items “easy to use,” “easy to understand,” “time commitment,” and “overall satisfaction” and was rated as credible (mode≥4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions: Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration: ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294 %M 34723820 %R 10.2196/25392 %U https://formative.jmir.org/2021/11/e25392 %U https://doi.org/10.2196/25392 %U http://www.ncbi.nlm.nih.gov/pubmed/34723820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30637 %T Factors Affecting the Extent of Patients’ Electronic Medical Record Use: An Empirical Study Focusing on System and Patient Characteristics %A Agrawal,Lavlin %A Ndabu,Theophile %A Mulgund,Pavankumar %A Sharman,Raj %+ The State University of New York at Buffalo, School of Management, 160 Jacobs Management Center, Buffalo, NY, 14260-4000, United States, 1 (716) 645 3204, lavlinag@buffalo.edu %K electronic medical record %K patient safety %K caregiver %K chronic conditions %K HINTS dataset %K patient technology acceptance model %D 2021 %7 28.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients’ access to and use of electronic medical records (EMRs) places greater information in their hands, which helps them better comanage their health, leading to better clinical outcomes. Despite numerous benefits that promote health and well-being, patients’ acceptance and use of EMRs remains low. We study the impact of predictors that affect the use of EMR by patients to understand better the underlying causal factors for the lower use of EMR. Objective: This study aims to examine the critical system (eg, performance expectancy and effort expectancy) and patient characteristics (eg, health condition, issue involvement, preventive health behaviors, and caregiving status) that influence the extent of patients’ EMR use. Methods: We used secondary data collected by Health Information National Trends Survey 5 cycle 3 and performed survey data analysis using structural equation modeling technique to test our hypotheses. Structural equation modeling is a technique commonly used to measure and analyze the relationships of observed and latent variables. We also addressed common method bias to understand if there was any systematic effect on the observed correlation between the measures for the predictor and predicted variables. Results: The statistically significant drivers of the extent of EMR use were performance expectancy (β=.253; P<.001), perceived behavior control (β=.236; P<.001), health knowledge (β=–.071; P=.007), caregiving status (β=.059; P=.013), issue involvement (β=.356; P<.001), chronic conditions (β=.071; P=.016), and preventive health behavior (β=.076; P=.005). The model accounted for 32.9% of the variance in the extent of EMR use. Conclusions: The study found that health characteristics, such as chronic conditions and patient disposition (eg, preventive health behavior and issue involvement), directly affect the extent of EMR use. The study also revealed that issue involvement mediates the impact of preventive health behaviors and the presence of chronic conditions on the extent of patients’ EMR use. %M 34709181 %R 10.2196/30637 %U https://www.jmir.org/2021/10/e30637 %U https://doi.org/10.2196/30637 %U http://www.ncbi.nlm.nih.gov/pubmed/34709181 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31086 %T Pilot Evaluations of Two Bluetooth Contact Tracing Approaches on a University Campus: Mixed Methods Study %A Shelby,Tyler %A Caruthers,Tyler %A Kanner,Oren Y %A Schneider,Rebecca %A Lipnickas,Dana %A Grau,Lauretta E %A Manohar,Rajit %A Niccolai,Linda %+ Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, United States, 1 6202284003, tyler.shelby@yale.edu %K mHealth %K digital contact tracing %K Bluetooth %K COVID-19 %K mixed methods %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many have proposed the use of Bluetooth technology to help scale up contact tracing for COVID-19. However, much remains unknown about the accuracy of this technology in real-world settings, the attitudes of potential users, and the differences between delivery formats (mobile app vs carriable or wearable devices). Objective: We pilot tested 2 separate Bluetooth contact tracing technologies on a university campus to evaluate their sensitivity and specificity, and to learn from the experiences of the participants. Methods: We used a convergent mixed methods study design, and participants included graduate students and researchers working on a university campus during June and July 2020. We conducted separate 2-week pilot studies for each Bluetooth technology. The first was for a mobile phone app (“app pilot”), and the second was for a small electronic “tag” (“tag pilot”). Participants validated a list of Bluetooth-identified contacts daily and reported additional close contacts not identified by Bluetooth. We used these data to estimate sensitivity and specificity. Participants completed a postparticipation survey regarding appropriateness, usability, acceptability, and adherence, and provided additional feedback via free text. We used tests of proportions to evaluate differences in survey responses between participants from each pilot, paired t tests to measure differences between compatible survey questions, and qualitative analysis to evaluate the survey’s free-text responses. Results: Among 25 participants in the app pilot, 53 contact interactions were identified by Bluetooth and an additional 61 by self-report. Among 17 participants in the tag pilot, 171 contact interactions were identified by Bluetooth and an additional 4 by self-report. The tag had significantly higher sensitivity compared with the app (46/49, 94% vs 35/61, 57%; P<.001), as well as higher specificity (120/126, 95% vs 123/141, 87%; P=.02). Most participants felt that Bluetooth contact tracing was appropriate on campus (26/32, 81%), while significantly fewer participants felt that using other technologies, such as GPS or Wi-Fi, was appropriate (17/31, 55%; P=.02). Most participants preferred technology developed and managed by the university rather than a third party (27/32, 84%) and preferred not to have tracing apps on their personal phones (21/32, 66%), due to “concerns with privacy.” There were no significant differences in self-reported adherence rates across pilots. Conclusions: Convenient and carriable Bluetooth technology may improve tracing efficiency while alleviating privacy concerns by shifting data collection away from personal devices. With accuracy comparable to, and in this case, superior to, mobile phone apps, such approaches may be suitable for workplace or school settings with the ability to purchase and maintain physical devices. %M 34586078 %R 10.2196/31086 %U https://formative.jmir.org/2021/10/e31086 %U https://doi.org/10.2196/31086 %U http://www.ncbi.nlm.nih.gov/pubmed/34586078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30093 %T A Decision Support Tool for Allogeneic Hematopoietic Stem Cell Transplantation for Children With Sickle Cell Disease: Acceptability and Usability Study %A Veludhandi,Anirudh %A Ross,Diana %A Sinha,Cynthia B %A McCracken,Courtney %A Bakshi,Nitya %A Krishnamurti,Lakshmanan %+ School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, United States, 1 404 727 5671, lkrishn@emory.edu %K decision support tool %K sickle cell disease %K mobile application %K mHealth %K pediatrics %K transplant %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals living with sickle cell disease (SCD) may benefit from a variety of disease-modifying therapies, including hydroxyurea, voxelotor, crizanlizumab, L-glutamine, and chronic blood transfusions. However, allogeneic hematopoietic stem cell transplantation (HCT) remains the only nonexperimental treatment with curative intent. As HCT outcomes can be influenced by the complex interaction of several risk factors, HCT can be a difficult decision for health care providers to make for their patients with SCD. Objective: The aim of this study is to determine the acceptability and usability of a prototype decision support tool for health care providers in decision-making about HCT for SCD, together with patients and their families. Methods: On the basis of published transplant registry data, we developed the Sickle Options Decision Support Tool for Children, which provides health care providers with personalized transplant survival and risk estimates for their patients to help them make informed decisions regarding their patients’ management of SCD. To evaluate the tool for its acceptability and usability, we conducted beta tests of the tool and surveys with physicians using the Ottawa Decision Support Framework and mobile health app usability questionnaire, respectively. Results: According to the mobile health app usability questionnaire survey findings, the overall usability of the tool was high (mean 6.15, SD 0.79; range 4.2-7). According to the Ottawa Decision Support Framework survey findings, acceptability of the presentation of information on the decision support tool was also high (mean 2.94, SD 0.63; range 2-4), but the acceptability regarding the amount of information was mixed (mean 2.59, SD 0.5; range 2-3). Most participants expressed that they would use the tool in their own patient consults (13/15, 87%) and suggested that the tool would ease the decision-making process regarding HCT (8/9, 89%). The 4 major emergent themes from the qualitative analysis of participant beta tests include user interface, data content, usefulness during a patient consult, and potential for a patient-focused decision aid. Most participants supported the idea of a patient-focused decision aid but recommended that it should include more background on HCT and a simplification of medical terminology. Conclusions: We report the development, acceptability, and usability of a prototype decision support tool app to provide individualized risk and survival estimates to patients interested in HCT in a patient consultation setting. We propose to finalize the tool by validating predictive analytics using a large data set of patients with SCD who have undergone HCT. Such a tool may be useful in promoting physician-patient collaboration in making shared decisions regarding HCT for SCD. Further incorporation of patient-specific measures, including the HCT comorbidity index and the quality of life after transplant, may improve the applicability of the decision support tool in a health care setting. %M 34709190 %R 10.2196/30093 %U https://formative.jmir.org/2021/10/e30093 %U https://doi.org/10.2196/30093 %U http://www.ncbi.nlm.nih.gov/pubmed/34709190 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e27131 %T Stakeholders’ Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study %A Sekandi,Juliet Nabbuye %A Kasiita,Vicent %A Onuoha,Nicole Amara %A Zalwango,Sarah %A Nakkonde,Damalie %A Kaawa-Mafigiri,David %A Turinawe,Julius %A Kakaire,Robert %A Davis-Olwell,Paula %A Atuyambe,Lynn %A Buregyeya,Esther %+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 100 Foster Road, Athens, GA, 30602, United States, 1 17063387993, jsekandi@uga.edu %K tuberculosis %K adherence %K mHealth %K video directly observed therapy %K Uganda %K mobile phone %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonadherence to treatment remains a barrier to tuberculosis (TB) control. Directly observed therapy (DOT) is the standard for monitoring adherence to TB treatment worldwide, but its implementation is challenging, especially in resource-limited settings. DOT is labor-intensive and inconvenient to both patients and health care workers. Video DOT (VDOT) is a novel patient-centered alternative that uses mobile technology to observe patients taking medication remotely. However, the perceptions and acceptability of potential end users have not been evaluated in Africa. Objective: This study explores stakeholders’ acceptability of, as well as perceptions of potential benefits of and barriers to, using VDOT to inform a pilot study for monitoring patients with TB in urban Uganda. Methods: An exploratory, qualitative, cross-sectional study with an exit survey was conducted in Kampala, Uganda, from April to May 2018. We conducted 5 focus group discussions, each comprising 6 participants. Groups included patients with TB (n=2 groups; male and female), health care providers (n=1), caregivers (n=1), and community DOT volunteer workers (n=1). The questions that captured perceived benefits and barriers were guided by domains adopted from the Technology Acceptance Model. These included perceived usefulness, ease of use, and intent to use technology. Eligible participants were aged ≥18 years and provided written informed consent. For patients with TB, we included only those who had completed at least 2 months of treatment to minimize the likelihood of infection. A purposive sample of patients, caregivers, health care providers, and community DOT workers was recruited at 4 TB clinics in Kampala. Trained interviewers conducted unstructured interviews that were audio-recorded, transcribed, and analyzed using inductive content analysis to generate emerging themes. Results: The average age of participants was 34.5 (SD 10.7) years. VDOT was acceptable to most participants on a scale of 1 to 10. Of the participants, 70% (21/30) perceived it as highly acceptable, with scores ≥8, whereas 30% (9/30) scored between 5 and 7. Emergent themes on perceived benefits of VDOT were facilitation of easy adherence monitoring, timely follow-up on missed doses, patient-provider communication, and saving time and money because of minimal travel to meet in person. Perceived barriers included limited technology usability skills, inadequate cellular connectivity, internet access, availability of electricity, cost of the smartphone, and use of the internet. Some female patients raised concerns about the disruption of their domestic work routines to record videos. The impact of VDOT on privacy and confidentiality emerged as both a perceived benefit and barrier. Conclusions: VDOT was acceptable and perceived as beneficial by most study participants, despite potential technical and cost barriers. Mixed perceptions emerged about the impact of VDOT on privacy and confidentiality. Future efforts should focus on training users, ensuring adequate technical infrastructure, assuring privacy, and performing comparative cost analyses in the local context. %M 34704961 %R 10.2196/27131 %U https://mhealth.jmir.org/2021/10/e27131 %U https://doi.org/10.2196/27131 %U http://www.ncbi.nlm.nih.gov/pubmed/34704961 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30169 %T A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study %A Wong,Jill %A Foussat,Agathe C %A Ting,Steven %A Acerbi,Enzo %A van Elburg,Ruurd M %A Mei Chien,Chua %+ Department of Neonatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore, 65 6394 1240, chua.mei.chien@singhealth.com.sg %K chatbot %K parental stress %K parental sleep %K infant feeding %K preterm infants %K term infants %K sleep %K stress %K eHealth %K support %K anxiety %K usability %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications. Objective: The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants. Methods: Parents aged ≥21 years with infants aged ≤6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics. Results: Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as “easy” to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were “satisfied” (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to “discomfort” and “tiredness” were more prevalent in preterm group conversations, whereas the topic of “positive feelings” occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents’ ability to get adequate sleep or rest. Conclusions: The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns. Trial Registration: ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679 %M 34544679 %R 10.2196/30169 %U https://pediatrics.jmir.org/2021/4/e30169 %U https://doi.org/10.2196/30169 %U http://www.ncbi.nlm.nih.gov/pubmed/34544679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32382 %T Usability of a Technology-Based Bystander Bullying Intervention for Middle School Students in Rural, Low-Income Communities: Mixed Methods Study %A Doumas,Diana M %A Midgett,Aida %A Myers,Valerie %A Buller,Mary Klein %+ Institute for the Study of Behavioral Health and Addiction, Boise State Universtiy, 1910 University Drive, Boise, ID, 83702, United States, 1 2084261219, dianadoumas@boisestate.edu %K technology-based bullying intervention %K STAC-T %K usability testing %K middle school %K rural %K low-income %K mobile phone %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Students who are targets of bullying and who witness bullying are at high risk for negative mental health outcomes. Bystander training is essential to reduce bullying and the negative associated consequences for targets and bystanders. Resources necessary for program delivery, however, pose significant barriers for schools, particularly those in rural, low-income communities. Technology-based programs can reduce health disparities for students in these communities through cost-effective, easy-to-disseminate programming. Objective: The aim of this study is to conduct usability testing of a bystander bullying web app prototype, STAC-T (technology-based STAC, which stands for the 4 bystander strategies Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion) as an initial step in the development of a full-scale STAC-T intervention. Objectives include assessing usability and acceptability of the STAC-T prototype, understanding school needs and barriers to program implementation, and assessing differences in usability between school personnel and students. Methods: A sample of 16 participants, including school personnel and students recruited from 3 middle schools in rural, low-income communities, completed usability testing followed by a qualitative interview. Descriptive statistics, 2-tailed independent sample t tests, and consensual qualitative research were used to assess usability and program satisfaction and to extract themes related to acceptability, feasibility, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the app was easy to use, acceptable, and feasible. Both school personnel (mean rating 89.6, SD 5.1) and students (mean rating 91.8, SD 7.0) rated the app well above the standard cutoff score for above-average usability (ie, 68), and both school personnel (mean rating 5.83, SD 0.41) and students (mean rating 6.10, SD 0.57) gave the app high user-friendliness ratings (0-7 scale, with 7 as high user-friendliness). The overall ratings also suggested that school personnel and students were satisfied with the program. Of the 6 school personnel who said they would recommend the program, 1 (17%), 4 (66%), and 1 (17%) rated the program as 3, 4, and 5 stars, respectively; 80% (8/10) of students said they would recommend the program; and 60% (6/10) and 40% (4/10) rated the program as 4 stars and 5 stars, respectively. Qualitative data revealed that school personnel and students found the STAC-T app to be useful, user-friendly, and relevant, while providing feedback related to the importance of digital learning activities that engage the user. Data from school personnel also indicated positive perceptions regarding program feasibility and probability of program adoption, with the most significant barrier being cost, suggesting the importance of considering the financial resources available to schools in rural, low-income communities when setting the price point for the full-scale STAC-T intervention. Conclusions: This study provides support for the full-scale development of the STAC-T app and provides key information for revision to enhance used engagement. Trial Registration: ClinicalTrials.gov NCT04681495; https://clinicaltrials.gov/ct2/show/NCT04681495 %M 34582355 %R 10.2196/32382 %U https://formative.jmir.org/2021/10/e32382 %U https://doi.org/10.2196/32382 %U http://www.ncbi.nlm.nih.gov/pubmed/34582355 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e26233 %T A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial %A Payne Riches,Sarah %A Piernas,Carmen %A Aveyard,Paul %A Sheppard,James P %A Rayner,Mike %A Albury,Charlotte %A Jebb,Susan A %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865 289300, susan.jebb@phc.ox.ac.uk %K salt reduction %K behavior change %K mobile health %K mHealth %K smartphone app %K mobile phone %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs. Objective: The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention’s effectiveness. Methods: This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated. Results: A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96%), intervention fidelity (25/31, 81%), and app use (27/31, 87%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors. Conclusions: The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962 %M 34673535 %R 10.2196/26233 %U https://mhealth.jmir.org/2021/10/e26233 %U https://doi.org/10.2196/26233 %U http://www.ncbi.nlm.nih.gov/pubmed/34673535 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25777 %T Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial %A Chirambo,Griphin Baxter %A Thompson,Matthew %A Hardy,Victoria %A Ide,Nicole %A Hwang,Phillip H %A Dharmayat,Kanika %A Mastellos,Nikolaos %A Heavin,Ciara %A O'Connor,Yvonne %A Muula,Adamson S %A Andersson,Bo %A Carlsson,Sven %A Tran,Tammy %A Hsieh,Jenny Chen-Ling %A Lee,Hsin-Yi %A Fitzpatrick,Annette %A Joseph Wu,Tsung-Shu %A O'Donoghue,John %+ Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu 2, Mzuzu, Malawi, 265 0999236092, gbchirambo@yahoo.co.uk %K community case management %K mobile health %K pediatrics %K childhood infection %K mobile phone %D 2021 %7 20.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ≥2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited—49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission). Conclusions: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345 %M 34668872 %R 10.2196/25777 %U https://www.jmir.org/2021/10/e25777 %U https://doi.org/10.2196/25777 %U http://www.ncbi.nlm.nih.gov/pubmed/34668872 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 4 %P e29739 %T A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study %A Shetty,Vinutha B %A Soon,Wayne H K %A Roberts,Alison G %A Fried,Leanne %A Roby,Heather C %A Smith,Grant J %A Fournier,Paul A %A Jones,Timothy W %A Davis,Elizabeth A %+ Department of Endocrinology and Diabetes, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Perth, 6009, Australia, 61 864562222, vinutha.shetty@health.wa.gov.au %K mobile health app %K exercise %K acT1ve %K type 1 diabetes %K young people %K blood glucose level %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. Objective: Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. Methods: A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. Results: The main themes arising from the interview analysis were “increased knowledge,” “increased confidence to exercise,” and “suitability” for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). Conclusions: The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373 %M 34647896 %R 10.2196/29739 %U https://diabetes.jmir.org/2021/4/e29739 %U https://doi.org/10.2196/29739 %U http://www.ncbi.nlm.nih.gov/pubmed/34647896 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32271 %T Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial %A Suffoletto,Brian %A Goldstein,Tina %A Gotkiewicz,Dawn %A Gotkiewicz,Emily %A George,Brandie %A Brent,David %+ Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 412 901 6892, suffbp@stanford.edu %K college %K mental health %K self-management %K digital intervention %K mHealth %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation. Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college. Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85% female [45/52], 91% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months. Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed. Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed. Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075 %M 34647893 %R 10.2196/32271 %U https://formative.jmir.org/2021/10/e32271 %U https://doi.org/10.2196/32271 %U http://www.ncbi.nlm.nih.gov/pubmed/34647893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23968 %T Need for Cognition Among Users of Self-Monitoring Systems for Physical Activity: Survey Study %A Halttu,Kirsi %A Oinas-Kukkonen,Harri %+ Oulu Advanced Research on Service and Information Systems Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, P.O. Box 3000, Oulu, FI-90014, Finland, 358 458601190, kirsi.halttu@oulu.fi %K self-monitoring %K wearables %K physical activity tracking %K mHealth %K need for cognition %K persuasive design %K tailoring %K user research %K mobile phone %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Need for cognition (NFC) is among the most studied personality traits in psychology. Despite its apparent relevance for engaging with technology and the use of information, it has not been studied in the context of self-monitoring systems and wearables for health. This study is the first to explore the relationship between NFC and commercial self-monitoring systems among healthy users. Objective: This study aims to explore the effect of NFC levels on the selection of self-monitoring systems and evaluation of system features of self-monitoring and feedback, as well as perceived credibility and perceived persuasiveness. We also assessed perceived behavior change in the form of self-reported activity after adopting the system. Methods: Survey data were collected in October 2019 among university students and personnel. The invitation to respond to the questionnaire was addressed to those who had used a digital system to monitor their physical activity for at least two months. The web-based questionnaire comprised the following 3 parts: details of system use, partially randomly ordered theoretical measurement items, and user demographics. The data were analyzed using structural equation modeling. The effect of NFC was assessed both as 3 groups (low, moderate, and high) and as a continuous moderator variable. Results: In all, 238 valid responses to the questionnaire were obtained. Individuals with high NFC reported all tested system features with statistically significantly higher scores. The NFC also had some effect on system selection. Hypothesized relationships with perceived credibility gained support in a different way for individuals with low and high NFC; for those with low NFC, credibility increased the persuasiveness of the system, but this effect was absent among individuals with high NFC. For users with high NFC, credibility was related to feedback and self-monitoring and perhaps continuously evaluated during prolonged use instead of being a static system property. Furthermore, the relationship between perceived persuasiveness and self-reported activity after adopting the system had a large effect size (Cohen f2=0.355) for individuals with high NFC, a small effect size for individuals with moderate NFC (Cohen f2=0.107), and a nonsignificant path (P=.16) for those with low NFC. We also detected a moderating effect of NFC in two paths on perceived persuasiveness but only among women. Our research model explained 59.2%, 63.9%, and 47.3% of the variance in perceived persuasiveness of the system among individuals with low, moderate, and high NFC, respectively. Conclusions: The system choices of individuals seem to reflect their intrinsic motivations to engage with rich data, and commercial systems might themselves be a tailoring strategy. Important characteristics of the system, such as perceived credibility, have different roles depending on the NFC levels. Our data demonstrate that NFC as a trait that differentiates information processing has several implications for the selection, design, and tailoring of self-monitoring systems. %M 34647894 %R 10.2196/23968 %U https://formative.jmir.org/2021/10/e23968 %U https://doi.org/10.2196/23968 %U http://www.ncbi.nlm.nih.gov/pubmed/34647894 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e24865 %T A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study %A Cruz,Flávia Oliveira de Almeida Marques da %A Faria,Edison Tostes %A Ghobad,Pabblo Cardelino %A Alves,Leandro Yukio Mano %A Reis,Paula Elaine Diniz dos %+ Interdisciplinary Laboratory of Research Applied to Clinical Practice in Oncology, School of Health Sciences, University of Brasilia (UnB), Darcy Ribeiro s/n - Asa Norte, Brasilia, 70910-900, Brazil, 55 61998552290, flavinhaoliveira5@hotmail.com %K mobile applications %K health education %K nursing care %K oncology nursing %K educational technology %K breast neoplasms %K radiation therapy %D 2021 %7 13.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. Objective: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. Methods: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80% was considered to ensure the adequacy of the material. Results: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80%. Conclusions: The mobile app titled “AMOR Mama” was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use. %M 34643531 %R 10.2196/24865 %U https://www.jmir.org/2021/10/e24865 %U https://doi.org/10.2196/24865 %U http://www.ncbi.nlm.nih.gov/pubmed/34643531 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e23663 %T A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study %A Singh,Devinder Kaur Ajit %A Goh,Jing Wen %A Shaharudin,Muhammad Iqbal %A Shahar,Suzana %+ Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, 60 392897000, devinder@ukm.edu.my %K fall risk %K self-screening %K mobile app %K older person %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent falls prevention guidelines recommend early routine fall risk assessment among older persons. Objective: The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. Methods: FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. Results: The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802. Conclusions: These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention. %M 34636740 %R 10.2196/23663 %U https://mhealth.jmir.org/2021/10/e23663 %U https://doi.org/10.2196/23663 %U http://www.ncbi.nlm.nih.gov/pubmed/34636740 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28136 %T An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study %A Kruglova,Katya %A O'Connell,Siobhan Bernadette Laura %A Dawadi,Shrinkhala %A Gelgoot,Eden Noah %A Miner,Skye A %A Robins,Stephanie %A Schinazi,Joy %A Zelkowitz,Phyllis %+ Lady Davis Institute for Medical Research, Jewish General Hospital, Ludmer Research & Training Bldg, Montreal, QC, H3A 1A1, Canada, 1 514 340 8222, phyllis.zelkowitz@mcgill.ca %K mHealth app %K mHealth development process %K infertility %K intervention design %K mobile phone %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app’s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app’s content based on participants’ feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. %M 34636741 %R 10.2196/28136 %U https://formative.jmir.org/2021/10/e28136 %U https://doi.org/10.2196/28136 %U http://www.ncbi.nlm.nih.gov/pubmed/34636741 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e22653 %T Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review %A Maliwichi,Priscilla %A Chigona,Wallace %A Sowon,Karen %+ Department of Information Systems, Faculty of Commerce, University of Cape Town, Private Bag X1, Rondebosch, Cape Town, 7701, South Africa, 27 21 650 2261, pmaliwichi@must.ac.mw %K mHealth %K appropriation %K mobile phones %K model of technology appropriation %K maternal health %K community of purpose %K hermeneutic literature review %D 2021 %7 6.10.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Many maternal clients from poorly resourced communities die from preventable pregnancy-related complications. The situation is especially grave in sub-Saharan Africa. Mobile health (mHealth) interventions have the potential to improve maternal health outcomes. mHealth interventions are used to encourage behavioral change for health care–seeking by maternal clients. However, the appropriation of such interventions among maternal health clients is not always guaranteed. Objective: This study aims to understand how maternal clients appropriate mHealth interventions and the factors that affect this appropriation. Methods: This study used a hermeneutic literature review informed by the model of technology appropriation. We used data from three mHealth case studies in sub-Saharan Africa: Mobile Technology for Community Health, MomConnect, and Chipatala Cha Pa Foni. We used the search and acquisition hermeneutic circle to identify and retrieve peer-reviewed and gray literature from the Web of Science, Google Scholar, Google, and PubMed. We selected 17 papers for analysis. We organized the findings using three levels of the appropriation process: adoption, adaptation, and integration. Results: This study found that several factors affected how maternal clients appropriated mHealth interventions. The study noted that it is paramount that mHealth designers and implementers should consider the context of mHealth interventions when designing and implementing interventions. However, the usefulness of an mHealth intervention may enhance how maternal health clients appropriate it. Furthermore, a community of purpose around the maternal client may be vital to the success of the mHealth intervention. Conclusions: The design and implementation of interventions have the potential to exacerbate inequalities within communities. To mitigate against inequalities during appropriation, it is recommended that communities of purpose be included in the design and implementation of maternal mHealth interventions. %M 34612835 %R 10.2196/22653 %U https://mhealth.jmir.org/2021/10/e22653 %U https://doi.org/10.2196/22653 %U http://www.ncbi.nlm.nih.gov/pubmed/34612835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26125 %T Perceptions and Attitudes Toward the Use of a Mobile Health App for Remote Monitoring of Gingivitis and Willingness to Pay for Mobile Health Apps (Part 3): Mixed Methods Study %A Tobias,Guy %A Sgan-Cohen,Harold %A Spanier,Assaf B %A Mann,Jonathan %+ Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University-Hadassah School of Dental Medicine, Ein Kerem, Jerusalem, 91120, Israel, 972 52 705 2333, guy.tobias@mail.huji.ac.il %K mHealth %K public health %K oral health promotion %K gum health %K willingness to pay %K willingness to use %K willingness %K perception %K attitude %K mouth %K oral health %K dentist %K app %K monitoring %K mixed method %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Gum infection, known as gingivitis, is a global issue. Gingivitis does not cause pain; however, if left untreated, it can worsen, leading to bad breath, bleeding gums, and even tooth loss, as the problem spreads to the underlying structures anchoring the teeth in the jaws. The asymptomatic nature of gingivitis leads people to postpone dental appointments until clinical signs are obvious or pain is evident. The COVID-19 pandemic has necessitated social distancing, which has caused many people to postpone dental visits and neglect gingival health. iGAM is a dental mobile health (mHealth) app that remotely monitors gum health, and an observational study demonstrated the ability of iGAM to reduce gingivitis. We found that a weekly dental selfie using the iGAM app reduced the signs of gingivitis and promoted oral health in a home-based setting. Objective: The aim of this mixed methods study is to assess perceptions, attitudes, willingness to pay, and willingness to use an mHealth app. Methods: The first qualitative phase of the study included eight semistructured interviews, and the second quantitative phase included data collected from responses to 121 questionnaires. Results: There was a consensus among all interviewees that apps dealing with health-related issues (mHealth apps) can improve health. Three themes emerged from the interviews: the iGAM app is capable of improving health, the lack of use of medical apps, and a contradiction between the objective state of health and the self-definition of being healthy. Participants were grouped according to how they responded to the question about whether they believed that mHealth apps could improve their health. Participants who believed that mHealth apps can enhance health (mean 1.96, SD 1.01) had a higher willingness to pay for the service (depending on price) than those who did not believe in app efficacy (mean 1.31, SD 0.87; t119=−2417; P=.02). A significant positive correlation was found between the amount a participant was willing to pay and the benefits offered by the app (rs=0.185; P=.04). Conclusions: Potential mHealth users will be willing to pay for app use depending on their perception of the app’s ability to help them personally, provided they define themselves as currently unhealthy. %M 34609320 %R 10.2196/26125 %U https://formative.jmir.org/2021/10/e26125 %U https://doi.org/10.2196/26125 %U http://www.ncbi.nlm.nih.gov/pubmed/34609320 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27358 %T A Novel Mobile App (“CareFit”) to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study %A Egan,Kieren J %A Hodgson,William %A Dunlop,Mark D %A Imperatore,Gennaro %A Kirk,Alison %A Maguire,Roma %+ Department of Computer and Information Science, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 548 3138, kieren.egan@strath.ac.uk %K physical activity %K Android %K COVID-19 %K intervention %K co-design %K exercise %K app %K development %K support %K caregiver %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. %M 34406969 %R 10.2196/27358 %U https://formative.jmir.org/2021/10/e27358 %U https://doi.org/10.2196/27358 %U http://www.ncbi.nlm.nih.gov/pubmed/34406969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27093 %T Exploring the Associations Between Self-reported Tendencies Toward Smartphone Use Disorder and Objective Recordings of Smartphone, Instant Messaging, and Social Networking App Usage: Correlational Study %A Marengo,Davide %A Sariyska,Rayna %A Schmitt,Helena Sophia %A Messner,Eva-Maria %A Baumeister,Harald %A Brand,Matthias %A Kannen,Christopher %A Montag,Christian %+ Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, Ulm, 89081, Germany, 49 07315026550, christian.montag@uni-ulm.de %K smartphone use disorder %K smartphone use %K social media %K objective measures %K mediation model %K smartphone %K web-based communication %K social networking %K mobile phone %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social communication via instant messaging (IM) and social networking (SN) apps makes up a large part of the time that smartphone users spend on their devices. Previous research has indicated that the excessive use of these apps is positively associated with problematic smartphone use behaviors. In particular, image-based SN apps, such as Instagram (Facebook Inc) and Snapchat (Snap Inc), have been shown to exert stronger detrimental effects than those exerted by traditional apps, such as Facebook (Facebook Inc) and Twitter (Twitter Inc). Objective: In this study, we investigated the correlation between individuals’ tendencies toward smartphone use disorder (SmUD) and objective measures of the frequency of smartphone usage. Additionally, we put to test the hypothesis that the pathway linking the frequency of actual smartphone usage to self-reported tendencies toward SmUD was mediated by the increased frequency of IM and SN app usage. Methods: We recruited a sample of 124 adult smartphone users (females: 78/124, 62.9%; age: mean 23.84 years, SD 8.29 years) and collected objective information about the frequency of smartphone and SN app usage over 1 week. Participants also filled in a self-report measure for assessing the multiple components of tendencies toward SmUD. Bivariate associations were investigated by using Spearman correlation analyses. A parallel mediation analysis was conducted via multiple regression analysis. Results: The frequency of smartphone usage, as well as the use of IM apps (Messenger, Telegram, and WhatsApp [Facebook Inc]), Facebook, and image-based apps (Instagram and Snapchat), had significant positive associations with at least 1 component of SmUD, and the cyberspace-oriented relationships factor exhibited the strongest associations overall. We found support for an indirect effect that linked actual smartphone usage to SmUD tendencies via the frequency of the use of image-based SN apps. Conclusions: Our novel results shed light on the factors that promote SmUD tendencies and essentially indicate that image-based SN apps seem to be more strongly associated with problematic smartphone behaviors compared to IM apps and traditional SN apps, such as Facebook. %M 34591025 %R 10.2196/27093 %U https://www.jmir.org/2021/9/e27093 %U https://doi.org/10.2196/27093 %U http://www.ncbi.nlm.nih.gov/pubmed/34591025 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27787 %T Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis %A Thurman,Whitney %A Semwal,Monika %A Moczygemba,Leticia R %A Hilbelink,Mark %+ School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78701, United States, 1 5126573855, wthurman@utexas.edu %K homelessness %K self-management %K smartphone technology %K social needs %K mobile phone %D 2021 %7 29.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. Objective: This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. Methods: A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants’ experiences using smartphone technology. Results: Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. Conclusions: People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources—skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs. %M 34586073 %R 10.2196/27787 %U https://www.jmir.org/2021/9/e27787 %U https://doi.org/10.2196/27787 %U http://www.ncbi.nlm.nih.gov/pubmed/34586073 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25837 %T Development, Feasibility, Acceptability, and Utility of an Expressive Speech-Enabled Digital Health Agent to Deliver Online, Brief Motivational Interviewing for Alcohol Misuse: Descriptive Study %A Boustani,Maya %A Lunn,Stephanie %A Visser,Ubbo %A Lisetti,Christine %+ Department of Psychology, Loma Linda University, 11130 Anderson St, Suite 117, Loma Linda, CA, 92350, United States, 1 909 558 7680, mboustani@llu.edu %K digital health agent %K virtual health assistant %K online intervention %K alcohol abuse %K brief intervention %K motivational interviewing %K intelligent virtual agent %K embodied conversational agent %D 2021 %7 29.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health agents — embodied conversational agents designed specifically for health interventions — provide a promising alternative or supplement to behavioral health services by reducing barriers to access to care. Objective: Our goals were to (1) develop an expressive, speech-enabled digital health agent operating in a 3-dimensional virtual environment to deliver a brief behavioral health intervention over the internet to reduce alcohol use and to (2) understand its acceptability, feasibility, and utility with its end users. Methods: We developed an expressive, speech-enabled digital health agent with facial expressions and body gestures operating in a 3-dimensional virtual office and able to deliver a brief behavioral health intervention over the internet to reduce alcohol use. We then asked 51 alcohol users to report on the digital health agent acceptability, feasibility, and utility. Results: The developed digital health agent uses speech recognition and a model of empathetic verbal and nonverbal behaviors to engage the user, and its performance enabled it to successfully deliver a brief behavioral health intervention over the internet to reduce alcohol use. Descriptive statistics indicated that participants had overwhelmingly positive experiences with the digital health agent, including engagement with the technology, acceptance, perceived utility, and intent to use the technology. Illustrative qualitative quotes provided further insight about the potential reach and impact of digital health agents in behavioral health care. Conclusions: Web-delivered interventions delivered by expressive, speech-enabled digital health agents may provide an exciting complement or alternative to traditional one-on-one treatment. They may be especially helpful for hard-to-reach communities with behavioral workforce shortages. %M 34586074 %R 10.2196/25837 %U https://www.jmir.org/2021/9/e25837 %U https://doi.org/10.2196/25837 %U http://www.ncbi.nlm.nih.gov/pubmed/34586074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e20520 %T Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study %A Chew,Chu Shan Elaine %A Davis,Courtney %A Lim,Jie Kai Ethel %A Lim,Chee Meng Micheal %A Tan,Yi Zhen Henny %A Oh,Jean Yin %A Rajasegaran,Kumudhini %A Chia,Yong Hwa Michael %A Finkelstein,Eric Andrew %+ KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore, 65 62255554, elaine.chew.c.s@singhealth.com.sg %K pediatric obesity %K mobile health %K apps %K health behavior %K mHealth %K obesity %K adolescent %K lifestyle %K well-being %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. %M 34581672 %R 10.2196/20520 %U https://www.jmir.org/2021/9/e20520 %U https://doi.org/10.2196/20520 %U http://www.ncbi.nlm.nih.gov/pubmed/34581672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26545 %T An Ostomy Self-management Telehealth Intervention for Cancer Survivors: Technology-Related Findings From a Randomized Controlled Trial %A Weinstein,Ronald S %A Holcomb,Michael J %A Mo,Julia %A Yonsetto,Peter %A Bojorquez,Octavio %A Grant,Marcia %A Wendel,Christopher S %A Tallman,Nancy J %A Ercolano,Elizabeth %A Cidav,Zuleyha %A Hornbrook,Mark C %A Sun,Virginia %A McCorkle,Ruth %A Krouse,Robert S %+ Arizona Telemedicine Program, The University of Arizona Health Sciences, 1501 N Campbell AHSL 1156, Tucson, AZ, 85724, United States, 1 5203733552, rweinstein@telemedicine.arizona.edu %K telehealth %K telemedicine %K cloud computing %K ostomy %K cancer survivors %K family caregivers %K self-management %K patient education %K videoconferencing %K mobile phone %D 2021 %7 27.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: An Ostomy Self-management Telehealth (OSMT) intervention by nurse educators and peer ostomates can equip new ostomates with critical knowledge regarding ostomy care. A telehealth technology assessment aim was to measure telehealth engineer support requirements for telehealth technology–related (TTR) incidents encountered during OSMT intervention sessions held via a secure cloud-based videoconferencing service, Zoom for Healthcare. Objective: This paper examines technology-related challenges, issues, and opportunities encountered in the use of telehealth in a randomized controlled trial intervention for cancer survivors living with a permanent ostomy. Methods: The Arizona Telemedicine Program provided telehealth engineering support for 105 OSMT sessions, scheduled for 90 to 120 minutes each, over a 2-year period. The OSMT groups included up to 15 participants, comprising 4-6 ostomates, 4-6 peer ostomates, 2 nurse educators, and 1 telehealth engineer. OSMT-session TTR incidents were recorded contemporaneously in detailed notes by the research staff. TTR incidents were categorized and tallied. Results: A total of 97.1% (102/105) OSMT sessions were completed as scheduled. In total, 3 OSMT sessions were not held owing to non–technology-related reasons. Of the 93 ostomates who participated in OSMT sessions, 80 (86%) completed their OSMT curriculum. TTR incidents occurred in 36.3% (37/102) of the completed sessions with varying disruptive impacts. No sessions were canceled or rescheduled because of TTR incidents. Disruptions from TTR incidents were minimized by following the TTR incident prevention and incident response plans. Conclusions: Telehealth videoconferencing technology can enable ostomates to participate in ostomy self-management education by incorporating dedicated telehealth engineering support. Potentially, OSMT greatly expands the availability of ostomy self-management education for new ostomates. Trial Registration: ClinicalTrials.gov NCT02974634; https://clinicaltrials.gov/ct2/show/NCT02974634 %M 34086595 %R 10.2196/26545 %U https://www.jmir.org/2021/9/e26545 %U https://doi.org/10.2196/26545 %U http://www.ncbi.nlm.nih.gov/pubmed/34086595 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24671 %T Attitudes Toward the Environment and Use of Information and Communication Technologies to Address Environmental Health Risks in Marginalized Communities: Prospective Cohort Study %A Perez-Ramos,Jose G %A McIntosh,Scott %A Barrett,Emily S %A Velez Vega,Carmen M %A Dye,Timothy D %+ Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Box 668, Rochester, NY, 14622, United States, 1 5852768755, j.perezramos@rochester.edu %K community engagement %K environmental health risk %K epidemiology %K ICT %K mHealth %K mobile phone %K Puerto Rico %D 2021 %7 23.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Information and communication technologies, including mobile health (mHealth), can help isolated communities address environmental health challenges. The Puerto Rican island of Culebra has faced multiple sociopolitical and economic factors that have distressed the island’s environment and health. Culebrenses are technologically engaged and have demonstrated a use of technology that transcends socioeconomic barriers. As a result, technological interventions could potentially help manage environmental risks on the island. Objective: This study aims to test and evaluate the potential benefits of an mHealth tool, termed ¡mZAP! (Zonas, Acción y Protección), for engaging communities with environmental risks through technology. Methods: Participants using ¡mZAP! (N=111) were surveyed. Bivariate analyses were used to examine associations of mHealth use with sociodemographics, technology use, an adapted environmental attitudes inventory, and the multidimensional health locus of control. Logistic regression was used to examine associations between attitudes toward environmental health risks and mHealth use. Results: Higher positive attitudes toward the environment were significantly associated with the use of ¡mZAP! (odds ratio 5.3, 95% CI 1.6-17.0). Environmental attitudes were also associated with the multidimensional health locus of control powerful others subscale (P=.02), indicating that attitudes toward the environment become more negative as feelings controlled by others increase. Participants felt that the authorities would resolve the challenges (63/111, 56.7%). Conclusions: Perceived lack of control could present barriers to collective actions to address salient environmental health challenges in communities. The ongoing dependency on government-based solutions to community problems is worrisome, especially after the hurricane experiences of 2017 (which may potentially continue to be an issue subsequent to the more recent 2020 earthquakes). %M 34554103 %R 10.2196/24671 %U https://www.jmir.org/2021/9/e24671 %U https://doi.org/10.2196/24671 %U http://www.ncbi.nlm.nih.gov/pubmed/34554103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25472 %T Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies %A Neves,Ana Luísa %A Jácome,Cristina %A Taveira-Gomes,Tiago %A Pereira,Ana Margarida %A Almeida,Rute %A Amaral,Rita %A Alves-Correia,Magna %A Mendes,Sandra %A Chaves-Loureiro,Cláudia %A Valério,Margarida %A Lopes,Cristina %A Carvalho,Joana %A Mendes,Ana %A Ribeiro,Carmelita %A Prates,Sara %A Ferreira,José Alberto %A Teixeira,Maria Fernanda %A Branco,Joana %A Santalha,Marta %A Vasconcelos,Maria João %A Lozoya,Carlos %A Santos,Natacha %A Cardia,Francisca %A Moreira,Ana Sofia %A Taborda-Barata,Luís %A Pinto,Cláudia Sofia %A Ferreira,Rosário %A Morais Silva,Pedro %A Monteiro Ferreira,Tania %A Câmara,Raquel %A Lobo,Rui %A Bordalo,Diana %A Guimarães,Cristina %A Espírito Santo,Maria %A Ferraz de Oliveira,José %A Cálix Augusto,Maria José %A Gomes,Ricardo %A Vieira,Inês %A da Silva,Sofia %A Marques,Maria %A Cardoso,João %A Morete,Ana %A Aroso,Margarida %A Cruz,Ana Margarida %A Nunes,Carlos %A Câmara,Rita %A Rodrigues,Natalina %A Abreu,Carmo %A Albuquerque,Ana Luísa %A Vieira,Claúdia %A Santos,Carlos %A Páscoa,Rosália %A Chaves-Loureiro,Carla %A Alves,Adelaide %A Neves,Ângela %A Varanda Marques,José %A Reis,Bruno %A Ferreira-Magalhães,Manuel %A Almeida Fonseca,João %+ Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Praça de Gomes Teixeira, Porto, 4099-002, Portugal, 351 225513622, cristinajacome.ft@gmail.com %K mobile apps %K smartphone %K patient participation %K self-management %K asthma %D 2021 %7 22.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use. %M 34550077 %R 10.2196/25472 %U https://www.jmir.org/2021/9/e25472 %U https://doi.org/10.2196/25472 %U http://www.ncbi.nlm.nih.gov/pubmed/34550077 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e25878 %T Barriers and Facilitators Associated With App-Based Treatment for Female Urinary Incontinence: Mixed Methods Evaluation %A Wessels,Nienke J %A Loohuis,Anne M M %A van der Worp,Henk %A Abbenhuis,Linde %A Dekker,Janny %A Berger,Marjolein Y %A van Gemert-Pijnen,Julia E W C %A Blanker,Marco H %+ Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, FA21, PO Box 196, Groningen, , Netherlands, 31 05 03616746, n.j.wessels@umcg.nl %K mHealth %K female %K mixed methods %K primary health care %K urinary incontinence %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: App-based treatment for urinary incontinence is a proven effective and cost-effective alternative to care as usual, but successful implementation requires that we identify and address the barriers and facilitators associated with app use. Objective: The goal of the research was to explore the factors influencing app-based treatment for urinary incontinence and identify which barriers or facilitators are associated with treatment success or failure. Methods: We used a sequential explanatory mixed methods design to connect the results of a randomized controlled trial with data from semistructured interviews. This previous RCT had shown the noninferiority of app-based treatment compared with care as usual for urinary incontinence over 4 months. Participants who reported success or failure with app-based treatment, as measured by the change in International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form symptom score, were selected for telephone interview by purposive sampling (n=17). This study reports mainly on the qualitative component of our mixed methods study. Qualitative analyses were conducted in two ways. First, we analyzed the qualitative data of all interviewed participants and discussed the relationships between the main themes. Second, the experiences between the success (n=9) and failure group (n=8) were compared and contrasted to explore factors that were positively or negatively associated with the quantitative effect of app-based treatment. These factors were then interpreted as barriers to and facilitators of successful app-based treatment. Results: Four interrelated themes were identified as affecting the app based treatment effect: adherence, personal factors, app factors, and awareness. Qualitative analyses of the relationships between the themes showed that adherence-related factors directly influenced treatment effect in both a positive and negative matter. In turn, adherence was also positively and negatively influenced by the other 3 themes. Additionally, awareness was positively influenced by the treatment effect. Within these themes, several factors were identified that acted as barriers (eg, unrealistic expectation of time investment and interfering personal circumstances), facilitators (eg, strict integration of exercises and prior pelvic floor muscle therapy), or both (eg, personality traits and increased awareness of symptoms). Conclusions: This study shows that the effect of app-based treatment for urinary incontinence is mainly influenced by adherence, which in turn is affected by personal factors, app-based factors, and awareness. The identified factors could function as both facilitators and barriers depending on the user and interaction with other themes. Insight into these facilitators and barriers could lead to improved implementation and increased treatment effectiveness by targeting women most likely to benefit and through further development of the app. International Registered Report Identifier (IRRID): RR2-10.1002/nau.23507 %M 34533466 %R 10.2196/25878 %U https://mhealth.jmir.org/2021/9/e25878 %U https://doi.org/10.2196/25878 %U http://www.ncbi.nlm.nih.gov/pubmed/34533466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e23877 %T Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study %A Shikako,Keiko %A Mogo,Ebele R I %A Grand-Maison,Valerie %A Simpson,Robert %A Pritchard-Wiart,Lesley %A Majnemer,Annette %A , %+ School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 398 4400, keiko.thomas@mcgill.ca %K implementation research %K mobile health %K children with disabilities %K physical activity promotion %K digital health %K inclusive leisure participation %K mobile phone %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The gap between research and its practical application in community settings limits its impact on public health. Closing this gap has the potential to improve the well-being of underserved groups, such as children with disabilities. Mobile health has the potential to improve access to community resources and support for underserved populations, thereby encouraging improved health behaviors. Objective: In this feasibility pilot study, we describe the development of the mobile app Jooay. Jooay was developed in partnership with stakeholders to facilitate access to leisure and physical activity community programs for children and youth with disabilities. We also reflect on the lessons learned throughout the implementation process that are relevant for improving the health behaviors of children with disabilities. Methods: We used a participatory action research approach to develop the app. We also administered a survey to current Jooay users and analyzed various app usage indicators to explore use patterns, user feedback, and preferences. Finally, we critically appraised the implementation process through a best practices for implementation research framework. Results: We developed a product that responds to users’ identified need to find information and follows accessibility and user-centered design standards. The analysis of usage data revealed that access to the Jooay app is concentrated in urban areas. Perceptions, attitudes, and information needs varied according to the type of user. The use of the mobile app changed over time, and usage decreased after the app was downloaded, indicating a need for the sustained engagement of app users. Users found value in the ability to identify activities that they would not otherwise know about. However, app use alone was not sufficient to improve participation. Although the app was developed based on users’ active input in multiple iterations, we encountered challenges with survey recruitment and attrition, suggesting the need for more seamless and engaging means for collecting data within this population. Conclusions: Interactions between users and the app can sustain user engagement and behavior change. We will improve the app’s next iterations by using the information gained from this study to conduct a larger study to assess the relationship among social and material deprivation, urban design, and access to inclusive and adaptive leisure programs. This study will inform the improvement of app listings to improve the use of Jooay by different user groups and promote health through mobile apps for marginalized groups. %M 34528886 %R 10.2196/23877 %U https://formative.jmir.org/2021/9/e23877 %U https://doi.org/10.2196/23877 %U http://www.ncbi.nlm.nih.gov/pubmed/34528886 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e27803 %T Mobile App for Parental Empowerment for Caregivers of Children With Autism Spectrum Disorders: Prospective Open Trial %A Bonnot,Olivier %A Adrien,Vladimir %A Venelle,Veronique %A Bonneau,Dominique %A Gollier-Briant,Fanny %A Mouchabac,Stephane %+ Child and Adolescent Psychiatry Department, Centre Hospitalier Universitaire de Nantes, 30 Boulevard Jean Monnet, Nantes, 440000, France, 33 637702571, olivier.bonnot@gmail.com %K autism spectrum disorders %K empowerment, smartphone application %K autism %K smartphone %K app %K children %K caregivers %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Conflicting data emerge from literature regarding the actual use of smartphone apps in medicine; some considered the introduction of smartphone apps in medicine to be a breakthrough, while others suggested that, in real-life, the use of smartphone apps in medicine is disappointingly low. Yet, digital tools become more present in medicine daily. To empower parents of a child with autism spectrum disorder, we developed the Smartautism smartphone app, which asks questions and provides feedback, using a screen with simple curves. Objective: The purpose of this study was to evaluate usage of the app by caregivers of individuals with autism spectrum disorders. Methods: We conducted a prospective longitudinal exploratory open study with families that have a child with autism spectrum disorder. Data were recorded over a period of 6 months, and the outcome criteria were (1) overall response rates for a feedback screen and qualitative questionnaires, and (2) response rates by degree of completion and by user interest, based on attrition. Results: Participants (n=65) had a very high intent to use the app during the 6-month period (3698/3900 instances, 94.8%); however, secondary analysis showed that only 46% of participants (30/65) had constant response rates over 50%. Interestingly, these users were characterized by higher use and satisfaction with the feedback screen when compared to low (P<.001) and moderate (P=.007) users. Conclusions: We found that real or perceived utility is an important incentive for parents who use empowerment smartphone apps. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-012135 %M 34524101 %R 10.2196/27803 %U https://mental.jmir.org/2021/9/e27803 %U https://doi.org/10.2196/27803 %U http://www.ncbi.nlm.nih.gov/pubmed/34524101 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e23916 %T An mHealth-Based Intervention for Adolescents With Type 1 Diabetes and Their Parents: Pilot Feasibility and Efficacy Single-Arm Study %A Holtz,Bree %A Mitchell,Katharine M %A Holmstrom,Amanda J %A Cotten,Shelia R %A Dunneback,Julie K %A Jimenez-Vega,Jose %A Ellis,Deborah A %A Wood,Michael A %+ Department of Advertising and Public Relations, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48824, United States, 1 5178844537, bholtz@msu.edu %K mobile health (mHealth) %K adolescents %K type 1 diabetes %K mobile phone %K parent-adolescent %K chronic disease %K feasibility %K diabetes management %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management. Objective: The aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A1c (HbA1c) levels, diabetes care adherence, and quality of life, and (2) the adolescents’ overall satisfaction with this intervention. Methods: This pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses. Results: The final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t21=–2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t24=2.48, P=.01, d=0.32). HbA1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t24=0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t23=0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA1c levels (F1,20=9.74, P<.005; R2=0.33). Overall, the adolescents were satisfied with the app intervention. Conclusions: In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects. Trial Registration: ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 %M 34519670 %R 10.2196/23916 %U https://mhealth.jmir.org/2021/9/e23916 %U https://doi.org/10.2196/23916 %U http://www.ncbi.nlm.nih.gov/pubmed/34519670 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28116 %T Using an Individual-Centered Approach to Gain Insights From Wearable Data in the Quantified Flu Platform: Netnography Study %A Greshake Tzovaras,Bastian %A Senabre Hidalgo,Enric %A Alexiou,Karolina %A Baldy,Lukaz %A Morane,Basile %A Bussod,Ilona %A Fribourg,Melvin %A Wac,Katarzyna %A Wolf,Gary %A Ball,Mad %+ Center for Research & Interdisciplinarity, INSERM U1284, Université de Paris, 8bis Rue Charles V, Paris, 75004, France, 33 766752149, bgreshake@googlemail.com %K symptom tracking %K COVID-19 %K wearable devices %K self-tracking %K citizen science %K netnographic analysis %K cocreation %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Wearables have been used widely for monitoring health in general, and recent research results show that they can be used to predict infections based on physiological symptoms. To date, evidence has been generated in large, population-based settings. In contrast, the Quantified Self and Personal Science communities are composed of people who are interested in learning about themselves individually by using their own data, which are often gathered via wearable devices. Objective: This study aims to explore how a cocreation process involving a heterogeneous community of personal science practitioners can develop a collective self-tracking system for monitoring symptoms of infection alongside wearable sensor data. Methods: We engaged in a cocreation and design process with an existing community of personal science practitioners to jointly develop a working prototype of a web-based tool for symptom tracking. In addition to the iterative creation of the prototype (started on March 16, 2020), we performed a netnographic analysis to investigate the process of how this prototype was created in a decentralized and iterative fashion. Results: The Quantified Flu prototype allowed users to perform daily symptom reporting and was capable of presenting symptom reports on a timeline together with resting heart rates, body temperature data, and respiratory rates measured by wearable devices. We observed a high level of engagement; over half of the users (52/92, 56%) who engaged in symptom tracking became regular users and reported over 3 months of data each. Furthermore, our netnographic analysis highlighted how the current Quantified Flu prototype was a result of an iterative and continuous cocreation process in which new prototype releases sparked further discussions of features and vice versa. Conclusions: As shown by the high level of user engagement and iterative development process, an open cocreation process can be successfully used to develop a tool that is tailored to individual needs, thereby decreasing dropout rates. %M 34505836 %R 10.2196/28116 %U https://www.jmir.org/2021/9/e28116 %U https://doi.org/10.2196/28116 %U http://www.ncbi.nlm.nih.gov/pubmed/34505836 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e27021 %T Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study %A Palos-Sanchez,Pedro R %A Saura,Jose Ramon %A Rios Martin,Miguel Ángel %A Aguayo-Camacho,Mariano %+ Department of Financial Economy and Operations Management, Faculty of Economic and Business Sciences, University of Seville, Av. Ramon y Cajal, 1, Seville, 41017, Spain, 34 954557515, ppalos@us.es %K mHealth apps %K mobile apps %K eHealth %K promotion of health %K TAM %K PLS–SEM %K COVID-19 %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps. Objective: The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications. Methods: The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS–SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant. Results: The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; β=.415, t0.001;4999=3.442, P=.001), attitude toward using (β=.301, t0.01;499=2.299, P=.02), and promotion of health (β=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; β=.179, t0.01;499=2.623, P=.009) and PU (β=.755, t0.001;499=12.888, P<.001) were found to have a statistically significant impact on attitude toward using (R2>=78.2%). Furthermore, PEOU (β=.203, t0.01;499=2.810, P=.005), health benefits (β=.448, t0.001;499=4.010, P<.001), and promotion of health (β=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (β=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (β=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%). Conclusions: mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users’ symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender. %M 34499044 %R 10.2196/27021 %U https://mhealth.jmir.org/2021/9/e27021 %U https://doi.org/10.2196/27021 %U http://www.ncbi.nlm.nih.gov/pubmed/34499044 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27985 %T Technology Acceptance Among Patients With Hemophilia in Hong Kong and Their Expectations of a Mobile Health App to Promote Self-management: Survey Study %A Cheung,Yin Ting %A Lam,Pok Hong %A Lam,Teddy Tai-Ning %A Lam,Henry Hon Wai %A Li,Chi Kong %+ School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Rm 801, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, New Territories, Hong Kong SAR, Hong Kong, 852 39436833, yinting.cheung@cuhk.edu.hk %K mobile health %K mHealth %K patients %K expectations %K hemophilia %K chronic diseases %K rare diseases %K self-management %D 2021 %7 9.9.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The lifelong management of hemophilia is demanding and complex. In July 2019, we published a review in the Journal of Medical Internet Research, summarizing telehealth interventions that facilitate monitoring of bleeding events and promoting the appropriate use of clotting factors among patients with hemophilia. This work has led to the development of a community program that aims to harness technology to promote self-management among patients with hemophilia in Hong Kong. Objective: Before the inception of this program, we conducted a cross-sectional survey to evaluate the patients’ level of technology acceptance and identify their expectations of the use of mobile technology for self-management of hemophilia. Methods: In total, 56 participants (75% adult patients and 25% parents of pediatric patients; 87.5% with moderate to severe disease) were recruited from a local nongovernmental organization that serves patients with hemophilia. They rated their perceived confidence and acceptance in using the new mobile technology (score 1 to 5 for each item, with a higher score indicating better acceptance) using a structured questionnaire (adapted from the Technology Acceptance Model). They also identified the top features that they perceived to be the most important components of a mobile app for the self-management of hemophilia. The Mann–Whitney U test was used to compare technology acceptance scores across subgroups of different clinical and socioeconomic characteristics. Results: In general, the participants considered themselves skilled in using mobile apps (mean 4.3, 95% CI 4.1-4.5). They were willing to learn to use the new mobile app to organize their bleeding records (mean 4.0, 95% CI 3.7-4.3) and to manage their health (mean 4.2, 95% CI 4.1-4.5). Participants who lived in public housing (a surrogate marker for lower socioeconomic status in Hong Kong) reported lower technology acceptance than those who lived in private housing (P=.04). The most important features identified by the participants concerned documenting of infusion logs (n=49, 87.5%), bleeding events (n=48, 85.7%), and the secure delivery of the bleeding information to health care professionals (n=40, 71.4%). Conclusions: It is encouraging to infer that patients with hemophilia in Hong Kong are receptive to the use of mobile health technology. The findings of this survey are applicable in designing the key features of a patient-centered, multimodal program harnessing mobile technology to promote self-management among patients with hemophilia. Future studies should evaluate participants’ acceptability and perceived usability of the mobile app via user metrics and assess clinical and humanistic outcomes of this program. %M 34499034 %R 10.2196/27985 %U https://formative.jmir.org/2021/9/e27985 %U https://doi.org/10.2196/27985 %U http://www.ncbi.nlm.nih.gov/pubmed/34499034 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e26318 %T User Experiences of the NZ COVID Tracer App in New Zealand: Thematic Analysis of Interviews %A Tretiakov,Alexei %A Hunter,Inga %+ School of Management, Massey University, Tennent Drive, Palmerston North, 4474, New Zealand, 64 6 951 7905, A.Tretiakov@massey.ac.nz %K COVID-19 %K contact tracing %K app %K New Zealand %K adoption %K use %K civic responsibility %K privacy %D 2021 %7 8.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For mobile app–based COVID-19 contact tracing to be fully effective, a large majority of the population needs to be using the app on an ongoing basis. However, there is a paucity of studies of users, as opposed to potential adopters, of mobile contact tracing apps and of their experiences. New Zealand, a high-income country with western political culture, was successful in managing the COVID-19 pandemic, and its experience is valuable for informing policy responses in similar contexts. Objective: This study asks the following research questions: (1) How do users experience the app in their everyday contexts? and (2) What drives the use of the app? Methods: Residents of New Zealand’s Auckland region, which encompasses the country’s largest city, were approached via Facebook, and 34 NZ COVID Tracer app users were interviewed. Interview transcripts were analyzed using thematic analysis. Results: Interviews ranged in duration from 15 to 50 minutes. Participants ranged in age from those in their late teens to those in their early sixties. Even though about half of the participants identified as White New Zealanders of European origin, different ethnicities were represented, including New Zealanders of South Pacific, Indian, Middle Eastern, South American, and Southeast Asian descent. Out of 34 participants, 2 (6%) identified as Māori (Indigenous New Zealanders). A broad range of careers were represented, from top-middle management to health support work and charity work. Likewise, educational backgrounds ranged broadly, from high school completion to master’s degrees. Out of 34 participants, 2 (6%) were unemployed, having recently lost their jobs because of the pandemic. The thematic analysis resulted in five major themes: perceived benefits, patterns of use, privacy, social influence, and need for collective action. Benefits of using the app to society in general were more salient to the participants than immediate health benefits to the individual. Use, however, depended on the alert level and tended to decline for many participants at low alert levels. Privacy considerations played a small role in shaping adoption and use, even though the participants were highly aware of privacy discourse around the app. Participants were aware of the need for high levels of adoption and use of the app to control the pandemic. Attempts to encourage others to use the app were common, although not always successful. Conclusions: Appeals to civic responsibility are likely to drive the use of a mobile contact tracing app under the conditions of high threat. Under the likely scenario of COVID-19 remaining endemic and requiring ongoing vigilance over the long term, other mechanisms promoting the use of mobile contact tracing apps may be needed, such as offering incentives. As privacy is not an important concern for many users, flexible privacy settings in mobile contact tracing apps allowing users to set their optimal levels of privacy may be appropriate. %M 34292868 %R 10.2196/26318 %U https://mhealth.jmir.org/2021/9/e26318 %U https://doi.org/10.2196/26318 %U http://www.ncbi.nlm.nih.gov/pubmed/34292868 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28320 %T Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial %A Colomina,Jordi %A Drudis,Reis %A Torra,Montserrat %A Pallisó,Francesc %A Massip,Mireia %A Vargiu,Eloisa %A Nadal,Nuria %A Fuentes,Araceli %A Ortega Bravo,Marta %A Miralles,Felip %A Barbé,Ferran %A Torres,Gerard %A de Batlle,Jordi %A , %+ Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida (IRBLleida), Rovira Roure 80, Lleida, 25198, Spain, 34 645624734, jordidebatlle@gmail.com %K mHealth %K osteoarthritis %K arthroplasty %K health plan implementation %K chronic disease %K mobile phone %D 2021 %7 2.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)–enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery. %M 34473068 %R 10.2196/28320 %U https://www.jmir.org/2021/9/e28320 %U https://doi.org/10.2196/28320 %U http://www.ncbi.nlm.nih.gov/pubmed/34473068 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28784 %T A Smartphone App to Support Adherence to Inhaled Corticosteroids in Young Adults With Asthma: Multi-Methods Feasibility Study %A Murphy,Jane %A McSharry,Jenny %A Hynes,Lisa %A Molloy,Gerard J %+ School of Psychology, National University of Ireland, Galway, University Rd, Galway, H91 TK33, Ireland, 353 91 524411, j.murphy51@nuigalway.ie %K asthma %K young adult %K medication adherence %K self-management %K mobile applications %K mHealth %K intervention %K usability %K acceptability %K feasibility %K multi-methods %K mobile phone %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with asthma often report low adherence to inhaled corticosteroids (ICS), leading to uncontrolled symptoms and poor disease outcomes. Technology-enabled digital supports such as mobile health (mHealth) asthma smartphone apps have the potential to support adherence to ICS and asthma self-management. There is a need for feasibility studies to determine the usability, acceptability, and feasibility of these interventions. In addition, it is essential to determine the feasibility of recruiting and retaining young adults to plan future efficacy and effectiveness trials and therefore, establish evidence-based asthma apps. Objective: This study aimed to determine (1) the feasibility of recruiting and retaining young adults to a trial and (2) the usability, acceptability, and feasibility of using the AsthmaMD app to support adherence to ICS in a population of young adults living with asthma. Methods: A multi-methods feasibility study was conducted. Young adults aged 18-30 years with asthma and current prescription for ICS were eligible and invited to take part through a university circular email, social media, and general practice sites. Participation involved completing a baseline self-report questionnaire, downloading and using the AsthmaMD app for 2 weeks, and completing the follow-up assessment, including self-report and open-ended questions about participants’ experience of using the app. Primary outcomes included participant recruitment and retention and the usability, acceptability, and feasibility of using AsthmaMD. Quantitative self-report data were analyzed using descriptive statistics, and qualitative open-ended data were analyzed using inductive reflexive thematic analysis. Results: A total of 122 young adults (females, n=101, 82.8%) with a mean age of 24.4 (SD 3.8) years were recruited and they completed baseline measures. Of the 122 young adults, 59 (48.4%) completed the study. The AsthmaMD app received a mean score of 63.1/100 (SD 20.1) on the System Usability Scale (ie, a standardized measure of usability for technology-based apps), and an overall user satisfaction score of 5.8/10 (SD 2.2). Of the 59 participants who completed the study, 49 (83%) participants used the app ≥1 day per week. Two main themes were identified in the qualitative analysis of user experiences: (1) learning how to use the app to suit the individual and (2) benefits and relevance of using the app. Conclusions: The findings from this study indicate that it is feasible to recruit and retain young adults to examine efficacy and effectiveness in a future trial and that young adults living with asthma may find AsthmaMD to be usable, acceptable, and feasible to support adherence to ICS. Our findings also identified opportunities to further optimize the usability of AsthmaMD and similar apps. Based on our findings, we recommend providing more accessible information on how to use the app and replacing medical terminology with simplified language within the app to improve usability. Trial Registration: ISRCTN Registry ISRCTN11295269; https://www.isrctn.com/ISRCTN11295269 %M 34468325 %R 10.2196/28784 %U https://formative.jmir.org/2021/9/e28784 %U https://doi.org/10.2196/28784 %U http://www.ncbi.nlm.nih.gov/pubmed/34468325 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e30480 %T Promoting Health via mHealth Applications Using a French Version of the Mobile App Rating Scale: Adaptation and Validation Study %A Saliasi,Ina %A Martinon,Prescilla %A Darlington,Emily %A Smentek,Colette %A Tardivo,Delphine %A Bourgeois,Denis %A Dussart,Claude %A Carrouel,Florence %A Fraticelli,Laurie %+ Health, Systemic, Process, Research Unit 4129, University Claude Bernard Lyon 1, University of Lyon, 11 rue Guillaume Paradin, Lyon, Cedex 08, France, 33 0478785745, ina.saliasi@univ-lyon.fr %K mobile health apps %K eHealth %K Mobile App Rating Scale %K MARS %K quality assessment tool %K rating scale evolution %K validation %K mHealth %K mHealth applications %K health applications %K mobile health %K digital health %K digital health tools %K application validation %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the recent decades, the number of apps promoting health behaviors and health-related strategies and interventions has increased alongside the number of smartphone users. Nevertheless, the validity process for measuring and reporting app quality remains unsatisfactory for health professionals and end users and represents a public health concern. The Mobile Application Rating Scale (MARS) is a tool validated and widely used in the scientific literature to evaluate and compare mHealth app functionalities. However, MARS is not adapted to the French culture nor to the language. Objective: This study aims to translate, adapt, and validate the equivalent French version of MARS (ie, MARS-F). Methods: The original MARS was first translated to French by two independent bilingual scientists, and their common version was blind back-translated twice by two native English speakers, culminating in a final well-established MARS-F. Its comprehensibility was then evaluated by 6 individuals (3 researchers and 3 nonacademics), and the final MARS-F version was created. Two bilingual raters independently completed the evaluation of 63 apps using MARS and MARS-F. Interrater reliability was assessed using intraclass correlation coefficients. In addition, internal consistency and validity of both scales were assessed. Mokken scale analysis was used to investigate the scalability of both MARS and MARS-F. Results: MARS-F had a good alignment with the original MARS, with properties comparable between the two scales. The correlation coefficients (r) between the corresponding dimensions of MARS and MARS-F ranged from 0.97 to 0.99. The internal consistencies of the MARS-F dimensions engagement (ω=0.79), functionality (ω=0.79), esthetics (ω=0.78), and information quality (ω=0.61) were acceptable and that for the overall MARS score (ω=0.86) was good. Mokken scale analysis revealed a strong scalability for MARS (Loevinger H=0.37) and a good scalability for MARS-F (H=0.35). Conclusions: MARS-F is a valid tool, and it would serve as a crucial aid for researchers, health care professionals, public health authorities, and interested third parties, to assess the quality of mHealth apps in French-speaking countries. %M 34463623 %R 10.2196/30480 %U https://mhealth.jmir.org/2021/8/e30480 %U https://doi.org/10.2196/30480 %U http://www.ncbi.nlm.nih.gov/pubmed/34463623 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e27926 %T Factors Associated With Intention to Adopt mHealth Apps Among Dementia Caregivers With a Chronic Condition: Cross-sectional, Correlational Study %A Mendez,Kyra Jennifer Waligora %A Budhathoki,Chakra %A Labrique,Alain Bernard %A Sadak,Tatiana %A Tanner,Elizabeth K %A Han,Hae Ra %+ School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 929 4327, kwaligo1@jhu.edu %K mHealth applications %K mobile health %K intention to adopt mHealth applications %K dementia caregivers %K family caregiving %K chronic disease self-management %K mobile phone %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the United States, nearly 80% of family caregivers of people with dementia have at least one chronic condition. Dementia caregivers experience high stress and burden that adversely affect their health and self-management. mHealth apps can improve health and self-management among dementia caregivers with a chronic condition. However, mHealth app adoption by dementia caregivers is low, and reasons for this are not well understood. Objective: The purpose of this study is to explore factors associated with dementia caregivers’ intention to adopt mHealth apps for chronic disease self-management. Methods: We conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers. We created a survey using validated instruments and collected data through computer-assisted telephone interviews and web-based surveys. Before the COVID-19 pandemic, we recruited dementia caregivers through community-based strategies, such as attending community events. After nationwide closures due to the pandemic, the team focused on web-based recruitment. Multiple logistic regression analyses were used to test the relationships between the independent and dependent variables. Results: Our sample of 117 caregivers had an average age of 53 (SD 17.4) years, 16 (SD 3.3) years of education, and 4 (SD 2.5) chronic conditions. The caregivers were predominantly women (92/117, 78.6%) and minorities (63/117, 53.8%), experienced some to extreme income difficulties (64/117, 54.7%), and were the child or child-in-law (53/117, 45.3%) of the person with dementia. In logistic regression models adjusting for the control variables, caregiver burden (odds ratio [OR] 1.3, 95% CI 0.57-2.8; P=.57), time spent caregiving per week (OR 1.7, 95% CI 0.77-3.9; P=.18), and burden of chronic disease and treatment (OR 2.3, 95% CI 0.91-5.7; P=.08) were not significantly associated with the intention to adopt mHealth apps. In the final multiple logistic regression model, only perceived usefulness (OR 23, 95% CI 5.6-97; P<.001) and the interaction term for caregivers’ education and burden of chronic disease and treatment (OR 31, 95% CI 2.2-430; P=.01) were significantly associated with their intention to adopt mHealth apps. Perceived ease of use (OR 2.4, 95% CI 0.67-8.7; P=.18) and social influence (OR 1.8, 95% CI 0.58-5.7; P=.31) were not significantly associated with the intention to adopt mHealth apps. Conclusions: When designing mHealth app interventions for dementia caregivers with a chronic condition, it is important to consider caregivers’ perceptions about how well mHealth apps can help their self-management and which app features would be most useful for self-management. Caregiving factors may not be relevant to caregivers’ intention to adopt mHealth apps. This is promising because mHealth strategies may overcome barriers to caregivers’ self-management. Future research should investigate reasons why caregivers with a low education level and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management. %M 34463637 %R 10.2196/27926 %U https://mhealth.jmir.org/2021/8/e27926 %U https://doi.org/10.2196/27926 %U http://www.ncbi.nlm.nih.gov/pubmed/34463637 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e27662 %T Exercise Management Using a Mobile App in Patients With Parkinsonism: Prospective, Open-Label, Single-Arm Pilot Study %A Kim,Aram %A Yun,Seo Jung %A Sung,Kwan-Sik %A Kim,Yeonju %A Jo,Ju Young %A Cho,Hanseul %A Park,Kyudong %A Oh,Byung-Mo %A Seo,Han Gil %+ Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 220721659, hgseo80@gmail.com %K Parkinsonian disorders %K exercise %K mobile apps %K mhealth %K Parkinson %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with parkinsonism have higher inactivity levels than the general population, and this results in increased comorbidities. Although exercise has benefits for motor function and quality of life (QOL) in patients with parkinsonism, these patients face many barriers to exercise participation, such as lack of motivation, fatigue, depression, and time constraints. Recently, the use of mobile apps has been highlighted as a remote exercise management strategy for patients with chronic diseases. Objective: This study aimed to evaluate the effects of home-based exercise management with a customized mobile app on the exercise amount, physical activity, and QOL of patients with parkinsonism. Methods: This was a prospective, open-label, single-arm pilot study. The therapist installed the app in the smartphones of the participants and educated them on how to use the app. The therapist developed an individualized multimodal exercise program that consisted of stretching, strengthening, aerobic, balance and coordination, and oral-motor and vocal exercises. Participants were encouraged to engage in an 8-week home-based exercise program delivered through a customized app. The alarm notifications of the app provided reminders to exercise regularly at home. The primary outcome was the exercise amount. The secondary outcomes were assessed using the International Physical Activity Questionnaire (IPAQ), Parkinson’s Disease Questionnaire-39 (PDQ-39), and Geriatric Depression Scale (GDS). The usability of the customized app was assessed using a self-report questionnaire. Results: A total of 21 participants with parkinsonism completed the intervention and assessment between September and December 2020 (mean age: 72 years; women: 17/21, 81%; men: 4/21, 19%). The participants reported a significant increase in the total amount of exercise (baseline: mean 343.33, SD 206.70 min/week; 8-week follow-up: mean 693.10, SD 373.45 min/week; P<.001) and in the amount of each exercise component, including stretching, strengthening, balance and coordination, and oral-motor and vocal exercise after 8 weeks. Analysis of the secondary outcomes revealed significant improvements in the IPAQ (P=.006), PDQ-39 (P=.02), and GDS (P=.04) scores. The usability of the program with the mobile app was verified based on the positive responses such as “intention to use” and “role expectation for rehabilitation.” Conclusions: Exercise management with a customized mobile app may be beneficial for improving exercise adherence, physical activity levels, depression management, and QOL in patients with parkinsonism. This remotely supervised technology-based, reinforcing, and multimodal exercise management strategy is recommended for use in patients with parkinsonism. In addition, this program proved useful as an alternative exercise management strategy during the COVID-19 pandemic when patients with Parkinson disease were less physically active than before and showed aggravation of symptoms. However, additional clinical trials are needed to evaluate the efficacy of this exercise program in a large population and to confirm its disease-modifying effects. %M 34463635 %R 10.2196/27662 %U https://mhealth.jmir.org/2021/8/e27662 %U https://doi.org/10.2196/27662 %U http://www.ncbi.nlm.nih.gov/pubmed/34463635 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28075 %T Scoping the Need for a Tailored mHealth App to Improve Health and Well-being Behavioral Transformation in the Police: Exploring the Views of UK Police Workers via Web-Based Surveys and Client Meetings %A Swanston,Emma %A Pulman,Andy %A Dogan,Huseyin %A Murphy,Jane %A Bitters,Fiona %+ Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus,, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202 961047, apulman@bournemouth.ac.uk %K nutrition %K food %K behavior change %K mobile health %K police %K lifestyle management %K well-being %K mobile phone %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Police officers often work long, unsocial hours in a highly pressurized environment and may experience difficulties in managing their health and well-being. Their jobs can be highly stressful and feature unusual working hours and multiple shift patterns. When considering the policing environment of 2021, many roles that were previously the domain of warranted officers are now being carried out by nonwarranted police staff equivalents. These police staff roles are relatively new to policing but put staff under some of the same stresses as police officers. A UK police force requested help to investigate technologies that could be used to improve health and well-being and research how these technologies could be used to measure and track health behavior change. Objective: Historical research studies need to be appraised in light of this new policing environment, and new research also needs to include this shift in dynamics when considering aspects of policing, including their health and well-being. This study explores police officer and staff attitudes toward and their use of existing health-related technology, highlights existing practices, and gathers views about how technology could be used more effectively. Methods: A web-based survey was completed by police officers and staff (N=213) during the initial period of the UK lockdown in 2020. The survey was designed to find the solutions that participants used outside of those supplied by their employer, identify issues or problems, and find what they would like a hypothetical app to focus on. Additional requirements data were captured through client meetings, including discussions concerning previously attempted solutions and those currently in place. Thematic analysis was undertaken to identify the key themes. Results: Attitudes toward and uses of existing health-related technology were captured, and existing practices were highlighted. Participants identified a need for an app to consider that a user was on shift—an important point, as many issues and problems with elements of their health and well-being involved shift work. Data also highlighted that a multifunctional tool would be more beneficial to participants than focusing on just 1 element. The key features and four domains were identified for app coverage. The prioritized order of importance of the four domains was activity, food and diet, sleep, and fluid intake. Conclusions: For police officers and staff, research data suggest that there is a previously unidentified requirement for a mobile app that could provide an easily accessible platform for them to use, regardless of the current location; one that could provide guidelines on diet, lifestyle habits, and health behavior to help the user make informed decisions to assist in personalized behavior change. Notably, one which is multifunctional and which also aligns effectively with the irregular shift patterns of its users. %M 34463625 %R 10.2196/28075 %U https://formative.jmir.org/2021/8/e28075 %U https://doi.org/10.2196/28075 %U http://www.ncbi.nlm.nih.gov/pubmed/34463625 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e26845 %T Relationship Between Perceived Risks of Using mHealth Applications and the Intention to Use Them Among Older Adults in the Netherlands: Cross-sectional Study %A Klaver,Nicky Sabine %A van de Klundert,Joris %A van den Broek,Roy Johannes Gerardus Maria %A Askari,Marjan %+ Erasmus School of Health Policy & Management, Erasmus University, PO Box 1738, Rotterdam, 3000 DR, Netherlands, 31 104088641, m.askari@askari.nl %K mHealth %K older adults %K perceived risks %K intention to use %K adoption %K covid-19 %K digital health %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Considering the increasing demand for health services by older people and the ongoing COVID-19 pandemic, digital health is commonly viewed to offer a pathway to provide safe and affordable health services for older adults, thus enabling self-management of their health while health care systems are struggling. However, several factors cause older people to be particularly reluctant to adopt digital health technologies such as mobile health (mHealth) tools. In addition to previously studied technology acceptance factors, those related to perceived risks of mHealth use (eg, leakage of sensitive information or receiving incorrect health recommendations) may further diminish mHealth adoption by older adults. Objective: The aim of this study was to explore the relationship between perceived risks of using mHealth applications and the intention to use these applications among older adults. Methods: We designed a cross-sectional study wherein a questionnaire was used to collect data from participants aged 65 years and older in the Netherlands. Perceived risk was divided into four constructs: privacy risk, performance risk, legal concern, and trust. Linear regression analyses were performed to determine the associations between these perceived risk constructs and the intention to use mHealth applications. Results: Linear regression per perceived risk factor showed that each of the four constructs is significantly associated with the intention to use mobile medical applications among older adults (adjusted for age, sex, education, and health status). Performance risk (β=–.266; P=<.001), legal concern (β=–.125; P=.007), and privacy risk (β=–.100; P=.03) were found to be negatively correlated to intention to use mHealth applications, whereas trust (β=.352; P=<.001) was found to be positively correlated to the intention to use mHealth applications. Conclusions: Performance risk, legal concern, and privacy risk as perceived by older adults may substantially and significantly decrease their intention to use mHealth applications. Trust may significantly and positively affect this intention. Health care professionals, designers of mHealth applications, and policy makers can use these findings to diminish performance risks, and tailor campaigns and applications to address legal and privacy concerns and promote mHealth uptake and health care access for older adults, especially during the COVID-19 pandemic. %M 34459745 %R 10.2196/26845 %U https://mhealth.jmir.org/2021/8/e26845 %U https://doi.org/10.2196/26845 %U http://www.ncbi.nlm.nih.gov/pubmed/34459745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28192 %T Using a Smartphone Application for the Accurate and Rapid Diagnosis of Acute Anterior Intracranial Arterial Occlusion: Usability Study %A Komatsu,Teppei %A Sakai,Kenichiro %A Iguchi,Yasuyuki %A Takao,Hiroyuki %A Ishibashi,Toshihiro %A Murayama,Yuichi %+ Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan, 81 334331111, teppeinoieni.coicoi@jikei.ac.jp %K stroke %K infarction %K teleradiology %K smartphone %K telehealth %K reperfusion %K neurology %K mHealth %K application %K mobile health %K mobile applications %K diagnosis %K diagnostics %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telestroke has developed rapidly as an assessment tool for patients eligible for reperfusion therapy. Objective: To investigate whether vascular neurologists can diagnose intracranial large vessel occlusion (LVO) as quickly and accurately using a smartphone application compared to a hospital-based desktop PC monitor. Methods: We retrospectively enrolled 108 consecutive patients with acute ischemic stroke in the middle cerebral artery territory who underwent magnetic resonance imaging (MRI) within 24 hours of their stroke onset. Two vascular neurologists, blinded to all clinical information, independently evaluated magnetic resonance angiography and fluid-attenuated inversion recovery images for the presence or absence of LVO in the internal carotid artery and middle cerebral artery (M1, M2, or M3) on both a smartphone application (Smartphone-LVO) and a hospital-based desktop PC monitor (PC-LVO). To evaluate the accuracy of an arterial occlusion diagnosis, interdevice variability between Smartphone-LVO and PC-LVO was analyzed using κ statistics, and image interpretation time was compared between Smartphone-LVO and PC-LVO. Results: There was broad agreement between Smartphone-LVO and PC-LVO evaluations regarding the presence or absence of arterial occlusion (Reader 1: κ=0.94; P<.001 vs Reader 2: κ=0.89; P<.001), and interpretation times were similar between Smartphone-LVO and PC-LVO. Conclusions: The results indicate the evaluation of neuroimages using a smartphone application can provide an accurate and timely diagnosis of anterior intracranial arterial occlusion that can be shared immediately with members of the stroke team to support the management of patients with hyperacute ischemic stroke. %M 34448716 %R 10.2196/28192 %U https://www.jmir.org/2021/8/e28192 %U https://doi.org/10.2196/28192 %U http://www.ncbi.nlm.nih.gov/pubmed/34448716 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e22909 %T Digital Natives’ Preferences on Mobile Artificial Intelligence Apps for Skin Cancer Diagnostics: Survey Study %A Haggenmüller,Sarah %A Krieghoff-Henning,Eva %A Jutzi,Tanja %A Trapp,Nicole %A Kiehl,Lennard %A Utikal,Jochen Sven %A Fabian,Sascha %A Brinker,Titus Josef %+ Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, 69120, Germany, 49 6221 32 19 304, titus.brinker@dkfz.de %K artificial intelligence %K skin cancer %K skin cancer screening %K diagnostics %K digital natives %K acceptance %K concerns %K preferences %K online survey %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Artificial intelligence (AI) has shown potential to improve diagnostics of various diseases, especially for early detection of skin cancer. Studies have yet to investigate the clear application of AI technology in clinical practice or determine the added value for younger user groups. Translation of AI-based diagnostic tools can only be successful if they are accepted by potential users. Young adults as digital natives may offer the greatest potential for successful implementation of AI into clinical practice, while at the same time, representing the future generation of skin cancer screening participants. Objective: We conducted an anonymous online survey to examine how and to what extent individuals are willing to accept AI-based mobile apps for skin cancer diagnostics. We evaluated preferences and relative influences of concerns, with a focus on younger age groups. Methods: We recruited participants below 35 years of age using three social media channels—Facebook, LinkedIn, and Xing. Descriptive analysis and statistical tests were performed to evaluate participants’ attitudes toward mobile apps for skin examination. We integrated an adaptive choice-based conjoint to assess participants’ preferences. We evaluated potential concerns using maximum difference scaling. Results: We included 728 participants in the analysis. The majority of participants (66.5%, 484/728; 95% CI 0.631-0.699) expressed a positive attitude toward the use of AI-based apps. In particular, participants residing in big cities or small towns (P=.02) and individuals that were familiar with the use of health or fitness apps (P=.02) were significantly more open to mobile diagnostic systems. Hierarchical Bayes estimation of the preferences of participants with a positive attitude (n=484) revealed that the use of mobile apps as an assistance system was preferred. Participants ruled out app versions with an accuracy of ≤65%, apps using data storage without encryption, and systems that did not provide background information about the decision-making process. However, participants did not mind their data being used anonymously for research purposes, nor did they object to the inclusion of clinical patient information in the decision-making process. Maximum difference scaling analysis for the negative-minded participant group (n=244) showed that data security, insufficient trust in the app, and lack of personal interaction represented the dominant concerns with respect to app use. Conclusions: The majority of potential future users below 35 years of age were ready to accept AI-based diagnostic solutions for early detection of skin cancer. However, for translation into clinical practice, the participants’ demands for increased transparency and explainability of AI-based tools seem to be critical. Altogether, digital natives between 18 and 24 years and between 25 and 34 years of age expressed similar preferences and concerns when compared both to each other and to results obtained by previous studies that included other age groups. %M 34448722 %R 10.2196/22909 %U https://mhealth.jmir.org/2021/8/e22909 %U https://doi.org/10.2196/22909 %U http://www.ncbi.nlm.nih.gov/pubmed/34448722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e27454 %T Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care %A Coleone,Joane Diomara %A Bellei,Ericles Andrei %A Roman,Mateus Klein %A Kirsten,Vanessa Ramos %A De Marchi,Ana Carolina Bertoletti %+ Institute of Exact Sciences and Geosciences, University of Passo Fundo, B5 Building, São José, Highway BR285, Km 292, Passo Fundo, RS, 99052-900, Brazil, 55 5433168354, 168729@upf.br %K eating %K mobile applications %K primary health care %K aged %K type 2 diabetes mellitus %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice. Objective: In this study, we aimed to (1) assess the dietary intake and health status of elderly patients with type 2 diabetes mellitus (T2DM) in primary care, (2) use a mobile app as a tool for data collection and analysis in the context of primary care, and (3) verify the perceptions of multidisciplinary health professionals regarding app use. Methods: First, we developed a mobile app comprised of the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with T2DM, and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants’ demographic, anthropometric, biochemical, and lifestyle variables. The associations between dietary intake and other variables were tested using chi-square tests with a 5% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals. Results: Between August 2018 and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1%), fruits (76.6%), milk products (68.2%), fried foods (72.7%), savory biscuits (60.4%), cookies or sweets (72.1%), and sugary drinks (92.9%) Meanwhile, the consumption of beans (59.7%), pulses and cooked vegetables (73.4%), and processed meat products (59.7%) was not in line with the guidelines. There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary disease (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores, and the qualitative questions revealed positive perceptions. Conclusions: We identified that most participants complied with recommended intake guidelines for 7 of 10 categories in the SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool for collecting and analyzing data in primary care settings. %M 34448711 %R 10.2196/27454 %U https://formative.jmir.org/2021/8/e27454 %U https://doi.org/10.2196/27454 %U http://www.ncbi.nlm.nih.gov/pubmed/34448711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e25900 %T Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design %A Ranney,Megan L %A Pittman,Sarah K %A Moseley,Isabelle %A Morgan,Kristen E %A Riese,Alison %A Ybarra,Michele %A Cunningham,Rebecca %A Rosen,Rochelle %+ Center for Digital Health, Brown University, 139 Point St, Providence, RI, 02903, United States, 1 4014445159, megan_ranney@brown.edu %K adolescent %K mobile health %K digital health %K cyberbullying %K user-centered design %K qualitative %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. Methods: Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3. Conclusions: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents. %M 34448702 %R 10.2196/25900 %U https://formative.jmir.org/2021/8/e25900 %U https://doi.org/10.2196/25900 %U http://www.ncbi.nlm.nih.gov/pubmed/34448702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e14004 %T Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study %A Ribanszki,Robert %A Saez Fonseca,Jose Andres %A Barnby,Joseph Matthew %A Jano,Kimberly %A Osmani,Fatima %A Almasi,Soma %A Tsakanikos,Elias %+ Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, UK, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 000 000 000, elias.tsakanikos@kcl.ac.uk %K qualitative %K adolescents %K mental health %K digital smartphone app %K digital mental health %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health digital apps hold promise for providing scalable solutions to individual self-care, education, and illness prevention. However, a problem with these apps is that they lack engaging user interfaces and experiences and thus potentially result in high attrition. Although guidelines for new digital interventions for adults have begun to examine engagement, there is a paucity of evidence on how to best address digital interventions for adolescents. As adolescence is a period of transition, during which the onset of many potentially lifelong mental health conditions frequently occurs, understanding how best to engage this population is crucial. Objective: The study aims to detect potential barriers to engagement and to gather feedback on the current elements of app design regarding user experience, user interface, and content. Methods: This study used a qualitative design. A sample of 14 adolescents was asked to use the app for 1 week and was interviewed using a semistructured interview schedule. The interviews were transcribed and analyzed using thematic analysis. Results: Overall, 13 participants completed the interviews. The authors developed 6 main themes and 20 subthemes based on the data that influenced engagement with and the perceived usefulness of the app. Our main themes were timing, stigma, perception, congruity, usefulness, and user experience. Conclusions: In line with previous research, we suggest how these aspects of app development should be considered for future apps that aim to prevent and manage mental health conditions. %M 34128814 %R 10.2196/14004 %U https://formative.jmir.org/2021/8/e14004 %U https://doi.org/10.2196/14004 %U http://www.ncbi.nlm.nih.gov/pubmed/34128814 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26227 %T Satisfaction and Usability of an Information and Communications Technology–Based System by Clinically Healthy Patients With COVID-19 and Medical Professionals: Cross-sectional Survey and Focus Group Interview Study %A Bae,Ye Seul %A Kim,Kyung Hwan %A Choi,Sae Won %A Ko,Taehoon %A Lim,Jun Seo %A Piao,Meihua %+ Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 220727546, kkh726@snu.ac.kr %K COVID-19 %K mobile app %K telemedicine %K wearable device %K vital sign %K satisfaction %K usability %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health care is an important strategy in the war against COVID-19. South Korea introduced living and treatment support centers (LTSCs) to control regional outbreaks and care for patients with asymptomatic or mild COVID-19. Seoul National University Hospital (SNUH) introduced information and communications technology (ICT)–based solutions to manage clinically healthy patients with COVID-19. Objective: This study aims to investigate satisfaction and usability by patients and health professionals in the optimal use of a mobile app and wearable device that SNUH introduced to the LTSC for clinically healthy patients with COVID-19. Methods: Online surveys and focus group interviews were conducted to collect quantitative and qualitative data. Results: Regarding usability testing of the wearable device, perceived usefulness had the highest mean score of 4.45 (SD 0.57) points out of 5. Regarding usability of the mobile app, perceived usefulness had the highest mean score of 4.62 (SD 0.48) points out of 5. Regarding satisfaction items for the mobile app among medical professionals, the “self-reporting” item had the highest mean score of 4.42 (SD 0.58) points out of 5. In focus group interviews of health care professionals, hospital information system interfacing was the most important functional requirement for ICT-based COVID-19 telemedicine. Conclusions: Improvement of patient safety and reduction of the burden on medical staff were the expected positive outcomes. Stability and reliability of the device, patient education, accountability, and reimbursement issues should be considered as part of the development of remote patient monitoring. In responding to a novel contagious disease, telemedicine and a wearable device were shown to be useful during a global crisis. %M 34254946 %R 10.2196/26227 %U https://formative.jmir.org/2021/8/e26227 %U https://doi.org/10.2196/26227 %U http://www.ncbi.nlm.nih.gov/pubmed/34254946 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e14552 %T Use of Home-Based Connected Devices in Patients With Cystic Fibrosis for the Early Detection and Treatment of Pulmonary Exacerbations: Protocol for a Qualitative Study %A Morsa,Maxime %A Perrin,Amélie %A David,Valérie %A Rault,Gilles %A Le Roux,Enora %A Alberti,Corinne %A Gagnayre,Rémi %A Pougheon Bertrand,Dominique %+ The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, 74 rue Marcel Cachin, Bobigny, 93017, France, 33 177 194 691, maxime.morsa@univ-paris13.fr %K cystic fibrosis %K pulmonary exacerbation %K connected devices %K patient education %K self-management %D 2021 %7 18.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis (CF) is important to quickly trigger treatment and reduce respiratory damage. We hypothesized that using home-based and wearable connected devices (CDs) and educating patients to react in case of abnormal variations in a set of parameters would allow patients to detect and manage their PEx early with their care team. Objective: This qualitative study aimed to assess the feasibility and appropriate conditions of a new PEx management process from the users’ point of view by analyzing the experience of patients and of CF center teams regarding the education program, the use of CDs, and the relationship between the patient and the care team during PEx management. Methods: We have been conducting a multicenter pilot study involving 36 patients with CF aged ≥12 years. The intervention was divided into 3 phases. In phase 1 (3 months), patients were equipped with CDs, and their parameters were collected on 3 nonconsecutive days each week. Phase 2 involved the development of a “React to PEx” educational program aimed at providing patients with a personalized action plan. A training session to the educational program was organized for the physicians. Physicians then determined the patients’ personalized alert thresholds by reviewing the data collected during phase 1 and their patients’ clinical history. In phase 3 (12 months), patients were educated by the physician during a clinic visit, and their action plan for reacting in timely fashion to their PEx signs was defined. Education and action plans were revised during clinic visits. At the end of the project, the patients’ experience was collected during semistructured interviews with a researcher as part of the qualitative study. The experience of CF teams was collected during focus groups using a semistructured guide once all their patients had finished the study. The interviews and focus groups were recorded and transcribed verbatim to be analyzed. Data from educational sessions were collected throughout the educational program to be put into perspective with the learnings reported by patients. Analyses are being led by 2 researchers using NVivo (QSR International). Results: The study received the favorable reception of the Committee for the Protection of Persons (CPP NORTH WEST III) on June 10, 2017 (#2017-A00723-50). Out of the 36 patients included in phase 1, 27 were educated and entered phase 3. We completed collection of all data from the patients and care providers. Qualitative analysis will provide a better understanding of users’ experience on the conditions of data collection, how useful CDs are for detecting PEx, how useful the PEx action plan is for reacting quickly, what patients learned about PEx management, and the conditions for this PEx management to be sustainable in routine care. Conclusions: This study will open new perspectives for further research into the implementation of an optimal PEx care process in the organization of care teams in order to support patient self-management. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 International Registered Report Identifier (IRRID): DERR1-10.2196/14552 %M 34406124 %R 10.2196/14552 %U https://www.researchprotocols.org/2021/8/e14552 %U https://doi.org/10.2196/14552 %U http://www.ncbi.nlm.nih.gov/pubmed/34406124 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e22608 %T Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study %A Oakley-Girvan,Ingrid %A Davis,Sharon Watkins %A Kurian,Allison %A Rosas,Lisa G %A Daniels,Jena %A Palesh,Oxana Gronskaya %A Mesia,Rachel J %A Kamal,Arif H %A Longmire,Michelle %A Divi,Vasu %+ Medable Inc, 525 University Avenue, Suite A 70, Palo Alto, CA, 94301, United States, 1 408 656 2948, ingrid@medable.com %K cancer %K oncology %K mHealth %K caregiver %K cancer survivor %K mobile app %K smartphone %K feasibility %K caregiver burden %K symptom reporting %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors’ care partners to monitor the survivors’ health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient’s health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner’s health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 %M 34398787 %R 10.2196/22608 %U https://formative.jmir.org/2021/8/e22608 %U https://doi.org/10.2196/22608 %U http://www.ncbi.nlm.nih.gov/pubmed/34398787 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e26300 %T Mobile Electronic Devices as Means of Facilitating Patient Activation and Health Professional Empowerment Related to Information Seeking on Chronic Conditions and Medications: Qualitative Study %A Imeri,Hyllore %A Desselle,Shane %A Hetemi,Dardan %A Hoti,Kreshnik %+ Division of Pharmacy, Faculty of Medicine, University of Prishtina, George Bush Street #31, Pristina, 10000, Kosovo, 383 44945173, kreshnik.hoti@uni-pr.edu %K patient activation %K mobile electronic devices %K health professionals %K chronic conditions %K medications %D 2021 %7 11.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patient activation has an impact on the management of patients’ health, clinical outcomes, and treatment costs. Mobile electronic devices (MEDs) have shown the potential to engage patients in wellness behavior. Furthermore, the potentially positive role of MEDs is evident in supporting health professionals in their practice. Objective: This study aims to explore the impact of MEDs on patient activation to search for information on chronic conditions and medications and the impact of MEDs on the empowerment of health professionals or future health professionals. Methods: We conducted 6 focus groups—2 with health sciences students, 2 with health professionals, and 2 with hospitalized patients with chronic conditions. A protocol comprising eight questions was used to guide discussions. Audio-recorded data were transcribed verbatim and analyzed thematically; a ranking system was used to analyze the relevance of identified themes and subthemes, using a coding system depicted by the + symbol, to indicate different relevance levels. Results: Our results suggest that MEDs can positively affect patient activation to search for chronic conditions and medication information by facilitating patients’ information-seeking behavior. Key drivers leading to patients’ activation to seek information related to chronic conditions and medications through MEDs were the accessibility and abundance of available and detailed information, reduced search time, information updates, and convenience in finding information at any time and place. The lack of accurate information in one’s native language, access to incorrect information, and limited access to the internet were key obstacles to seeking information related to chronic conditions and medications via MEDs. In addition, findings of this study suggest that MEDs in general and mobile apps, in particular, may have a positive impact on the work routine of health care professionals as they enable them to make quicker decisions by accessing the required information faster, thus improving practice efficiency. Furthermore, the appropriate usage of MEDs by patients for seeking information about their chronic conditions and medications may positively impact the physician-patient relationship. All focus groups recognized the questionable reliability of health information on the internet and its potential negative effects on patients. Therefore, our findings suggest the need for an additional role of health professionals in assisting patients in using MEDs to search for health and medication information, such as providing reliable websites and mobile apps where patients can safely search for health-related information on the web. Conclusions: The use of MEDs may help activate patients to seek chronic conditions and medication-related information, potentially leading to better management of their chronic conditions and medications. Our findings also highlight the positive impact MEDs may have on empowering health professionals in their practice and the need for health professionals to help patients through specific education that addresses MEDs utilization for chronic conditions and medication information seeking. %M 34383686 %R 10.2196/26300 %U https://mhealth.jmir.org/2021/8/e26300 %U https://doi.org/10.2196/26300 %U http://www.ncbi.nlm.nih.gov/pubmed/34383686 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e29368 %T Understanding People’s Use of and Perspectives on Mood-Tracking Apps: Interview Study %A Schueller,Stephen M %A Neary,Martha %A Lai,Jocelyn %A Epstein,Daniel A %+ Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 9498243850, s.schueller@uci.edu %K mental health %K mobile apps %K mHealth %K emotions %K affect %K self-tracking %D 2021 %7 11.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Supporting mental health and wellness is of increasing interest due to a growing recognition of the prevalence and burden of mental health issues. Mood is a central aspect of mental health, and several technologies, especially mobile apps, have helped people track and understand it. However, despite formative work on and dissemination of mood-tracking apps, it is not well understood how mood-tracking apps used in real-world contexts might benefit people and what people hope to gain from them. Objective: To address this gap, the purpose of this study was to understand motivations for and experiences in using mood-tracking apps from people who used them in real-world contexts. Methods: We interviewed 22 participants who had used mood-tracking apps using a semistructured interview and card sorting task. The interview focused on their experiences using a mood-tracking app. We then conducted a card sorting task using screenshots of various data entry and data review features from mood-tracking apps. We used thematic analysis to identify themes around why people use mood-tracking apps, what they found useful about them, and where people felt these apps fell short. Results: Users of mood-tracking apps were primarily motivated by negative life events or shifts in their own mental health that prompted them to engage in tracking and improve their situation. In general, participants felt that using a mood-tracking app facilitated self-awareness and helped them to look back on a previous emotion or mood experience to understand what was happening. Interestingly, some users reported less inclination to document their negative mood states and preferred to document their positive moods. There was a range of preferences for personalization and simplicity of tracking. Overall, users also liked features in which their previous tracked emotions and moods were visualized in figures or calendar form to understand trends. One gap in available mood-tracking apps was the lack of app-facilitated recommendations or suggestions for how to interpret their own data or improve their mood. Conclusions: Although people find various features of mood-tracking apps helpful, the way people use mood-tracking apps, such as avoiding entering negative moods, tracking infrequently, or wanting support to understand or change their moods, demonstrate opportunities for improvement. Understanding why and how people are using current technologies can provide insights to guide future designs and implementations. %M 34383678 %R 10.2196/29368 %U https://mental.jmir.org/2021/8/e29368 %U https://doi.org/10.2196/29368 %U http://www.ncbi.nlm.nih.gov/pubmed/34383678 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e23896 %T General Practitioners' Perceptions of the Use of Wearable Electronic Health Monitoring Devices: Qualitative Analysis of Risks and Benefits %A Volpato,Lucia %A del Río Carral,María %A Senn,Nicolas %A Santiago Delefosse,Marie %+ Research Centre for Psychology of Health, Aging and Sport Examination, Institute of Psychology, University of Lausanne, Géopolis Quartier UNIL - Mouline, Lausanne, 1015, Switzerland, 41 21 692 32 67, maria.delriocarral@unil.ch %K mHealth %K wearable devices %K health wearables %K activity trackers %K health monitoring %K self-tracking %K general practitioners %K mind maps %K qualitative research %K health psychology %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The rapid diffusion of wearable electronic health monitoring devices (wearable devices or wearables) among lay populations shows that self-tracking and self-monitoring are pervasively expanding, while influencing health-related practices. General practitioners are confronted with this phenomenon, since they often are the expert-voice that patients will seek. Objective: This article aims to explore general practitioners’ perceptions of the role of wearable devices in family medicine and of their benefits, risks, and challenges associated with their use. It also explores their perceptions of the future development of these devices. Methods: Data were collected during a medical conference among 19 Swiss general practitioners through mind maps. Maps were first sketched at the conference and their content was later compared with notes and reports written during the conference, which allowed for further integration of information. This tool represents an innovative methodology in qualitative research that allows for time-efficient data collection and data analysis. Results: Data analysis highlighted that wearable devices were described as user-friendly, adaptable devices that could enable performance monitoring and support medical research. Benefits included support for patients’ empowerment and education, behavior change facilitation, better awareness of personal medical history and body functioning, efficient information transmission, and connection with the patient’s medical network; however, general practitioners were concerned by a lack of scientific validation, lack of clarity over data protection, and the risk of stakeholder-associated financial interests. Other perceived risks included the promotion of an overly medicalized health culture and the risk of supporting patients’ self-diagnosis and self-medication. General practitioners also feared increased pressure on their workload and a compromised doctor–patient relationship. Finally, they raised important questions that can guide wearables’ future design and development, highlighting a need for general practitioners and medical professionals to be involved in the process. Conclusions: Wearables play an increasingly central role in daily health-related practices, and general practitioners expressed a desire to become more involved in the development of such technologies. Described as useful information providers, wearables were generally positively perceived and did not seem to pose a threat to the doctor–patient relationship. However, general practitioners expressed their concern that wearables may fuel a self-monitoring logic, to the detriment of patients’ autonomy and overall well-being. While wearables can contribute to health promotion, it is crucial to clarify the logic underpinning the design of such devices. Through the analysis of group discussions, this study contributes to the existing literature by presenting general practitioners’ perceptions of wearable devices. This paper provides insight on general practitioners’ perception to be considered in the context of product development and marketing. %M 34383684 %R 10.2196/23896 %U https://mhealth.jmir.org/2021/8/e23896 %U https://doi.org/10.2196/23896 %U http://www.ncbi.nlm.nih.gov/pubmed/34383684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24909 %T Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study %A Hoevenaars,Dirk %A Holla,Jasmijn F M %A te Loo,Leonie %A Koedijker,Johan M %A Dankers,Sarah %A Houdijk,Han %A Visser,Bart %A Janssen,Thomas W J %A de Groot,Sonja %A Deutekom,Marije %A , %+ Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Blijdorplaan 15, Haarlem, 2015 CE, Netherlands, 31 621115227, jasmijn.holla@inholland.nl %K mHealth %K mobile app %K lifestyle %K usability %K feasibility %K wheelchair users %K spinal cord injury %K lower limb amputation %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining a healthy lifestyle is important for wheelchair users’ well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale. %M 34379056 %R 10.2196/24909 %U https://formative.jmir.org/2021/8/e24909 %U https://doi.org/10.2196/24909 %U http://www.ncbi.nlm.nih.gov/pubmed/34379056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24112 %T Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study %A Derksen,Marloes E %A Jaspers,Monique WM %A van Strijp,Sander %A Fransen,Mirjam P %+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 5664494, m.e.derksen@amsterdamumc.nl %K think aloud %K heuristic evaluation %K usability %K mHealth %K game elements %K smoking prevention %K user-centered design %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. %M 34346895 %R 10.2196/24112 %U https://formative.jmir.org/2021/8/e24112 %U https://doi.org/10.2196/24112 %U http://www.ncbi.nlm.nih.gov/pubmed/34346895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26852 %T Patients’ Experiences of Using a Self-help App for Posttraumatic Stress Disorder: Qualitative Study %A Riisager,Lisa H G %A Christensen,Anne Bryde %A Scharff,Frederik Bernt %A Arendt,Ida-Marie T P %A Ismail,Israa %A Lau,Marianne Engelbrecht %A Moeller,Stine Bjerrum %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 25300977, lisagr@health.sdu.dk %K app %K PTSD %K mHealth %K qualitative analysis %K patient experience %K posttraumatic stress disorder %K thematic analysis %K smartphone %K intervention %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Posttraumatic stress disorder (PTSD) is a common disorder that requires more treatment options. Mobile health (mHealth) app interventions are promising for patients with PTSD, as they can provide easily accessible support, strategies, and information. However, knowledge about mHealth interventions is sparse and primarily based on quantitative studies. Objective: The aim of this study is to qualitatively explore the experiences of patients with PTSD with regard to using an mHealth app as a stand-alone intervention before commencing psychotherapeutic treatment. Methods: We conducted semistructured interviews with 14 participants 6 weeks after they received the app. The participants were all referred to PTSD treatment and were waiting to commence psychotherapeutic treatment. During this waiting time, the participants had no contact with the health staff. Interviews were transcribed and were analyzed using thematic analysis. Results: A total of 3 themes were identified—the use of app, being a patient, and the overall evaluation of the app. The use of the app was described with the subtheme of habits, and the theme of being a patient included the subthemes of having negative experiences with the app and being a part of a research project. The use of the app encompassed how psychological factors and technical problems could interfere with the use of the app. The theme of being a patient depicted that the waiting time before starting treatment was long, and a subgroup of patients experienced feeling worse during this time, which they partly attributed to using the app. Several suggestions for change have been described in the overall evaluation of the app. Conclusions: The findings in this study revealed that emotional arousal influenced the use of the app and that it was difficult for participants to establish a habit of using the app, thus reflecting the importance of supporting habit formation when implementing an mHealth app in mental health care services. This study makes an important contribution to the field of mHealth research, as it revealed that some participants had negative experiences resulting from using the app, thus reflecting the potential harm of having an mHealth app without the support of a clinician. It is therefore recommended to use a blended care treatment or an approach in which mental health care professionals prescribe an mHealth app for relevant patients to avoid increased suicidal risk. %M 34346896 %R 10.2196/26852 %U https://formative.jmir.org/2021/8/e26852 %U https://doi.org/10.2196/26852 %U http://www.ncbi.nlm.nih.gov/pubmed/34346896 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e29315 %T Development, Acceptance, and Concerns Surrounding App-Based Services to Overcome the COVID-19 Outbreak in South Korea: Web-Based Survey Study %A Park,Jihwan %A Han,Jinhyun %A Kim,Yerin %A Rho,Mi Jung %+ Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea, 82 222585905, romy1018@naver.com %K COVID-19 %K app-based services %K acceptance %K concerns %K epidemiological investigation, self-route management app, privacy %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Since the COVID-19 outbreak, South Korea has been engaged in various efforts to overcome the pandemic. One of them is to provide app-based COVID-19–related services to the public. As the pandemic continues, a need for various apps has emerged, including COVID-19 apps that can support activities aimed at overcoming the COVID-19 pandemic. Objective: We aimed to determine which apps were considered the most necessary according to users and evaluate the current status of the development of COVID-19–related apps in South Korea. We also aimed to determine users’ acceptance and concerns related to using apps to support activities to combat COVID-19. Methods: We collected data from 1148 users from a web-based survey conducted between November 11 and December 6, 2020. Basic statistical analysis, multiple response analysis, and the Wilcoxon rank sum test were performed using R software. We then manually classified the current status of the development of COVID-19–related apps. Results: In total, 68.4% (785/1148) of the respondents showed high willingness to protect themselves from COVID-19 by using related apps. Users considered the epidemiological investigation app to be the most necessary app (709/1148, 61.8%) overall, followed by the self-management app for self-isolation (613/1148, 53.4%), self-route management app (605/1148, 52.7%), COVID-19 symptom management app (483/1148, 42.1%), COVID-19–related information provision app (339/1148, 29.5%), and mental health management app (270/1148, 23.5%). Despite the high intention to use these apps, users were also concerned about privacy issues and media exposure. Those who had an underlying disease and had experience using COVID-19–related apps showed significantly higher intentions to use those apps (P=.05 and P=.01, respectively). Conclusions: Targeting users is very important in order to design and develop the most necessary apps. Furthermore, to gain the public’s trust and make the apps available to as many people as possible, it is vital to develop diverse apps in which privacy protection is maximized. %M 34137726 %R 10.2196/29315 %U https://medinform.jmir.org/2021/7/e29315 %U https://doi.org/10.2196/29315 %U http://www.ncbi.nlm.nih.gov/pubmed/34137726 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e27885 %T Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study %A Vasiloglou,Maria F %A Christodoulidis,Stergios %A Reber,Emilie %A Stathopoulou,Thomai %A Lu,Ya %A Stanga,Zeno %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland, 41 316327592, stavroula.mougiakakou@artorg.unibe.ch %K dietary assessment %K end-users %K mHealth %K mobile apps %K smartphone %K survey %K apps %K nutrition %K diet %K mobile health %K users %K behavior %K behavior change %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. Objective: We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. Methods: A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. Results: A total of 2382 respondents (1891 female, 79.4%; 474 male, 19.9%; and 17 neither, 0.7%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9%), free cost (1413/2382, 59.3%), and ability to produce automatic readings of caloric content (1231/2382, 51.7%) and macronutrient content (1117/2382, 46.9%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5%) or that may omit major foods (977/2382, 41%). Conclusions: This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition. %M 34328425 %R 10.2196/27885 %U https://mhealth.jmir.org/2021/7/e27885 %U https://doi.org/10.2196/27885 %U http://www.ncbi.nlm.nih.gov/pubmed/34328425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e23229 %T A Biofeedback App for Migraine: Development and Usability Study %A Ingvaldsen,Sigrid Hegna %A Tronvik,Erling %A Brenner,Eiliv %A Winnberg,Ingunn %A Olsen,Alexander %A Gravdahl,Gøril Bruvik %A Stubberud,Anker %+ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs Gate 8, Trondheim , Norway, 47 73 59 20 20, sigrid.h.ingvaldsen@ntnu.no %K mHealth %K headache %K wearables %K smartphone %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Biofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine. However, widespread use of biofeedback is hampered by the need for a trained therapist and specialized equipment. Emerging digital health technology, including smartphones and wearables (mHealth), enables new ways of administering biofeedback. Currently, mHealth interventions for migraine appear feasible, but development processes and usability testing remain insufficient. Objective: The objective of this study was to evaluate and improve the feasibility and usability of an mHealth biofeedback treatment app for adults with migraine. Methods: In a prospective development and usability study, 18 adults with migraine completed a 4-week testing period of self-administered therapist-independent biofeedback treatment consisting of a smartphone app connected to wearable sensors (Cerebri, Nordic Brain Tech AS). The app included biofeedback training, instructions for self-delivery, and a headache diary. Two wearable sensors were used to measure surface electromyographic voltage at the trapezius muscle and peripheral skin temperature and heart rate at the right second fingertip. Participants were instructed to complete a daily headache diary entry and biofeedback session of 10 minutes duration. The testing period was preceded by a preusability expectation interview and succeeded by a postusability experience interview. In addition, an evaluation questionnaire was completed at weeks 2 and 4. Adherence was calculated as the proportion of 10-minute sessions completed within the first 28 days of treatment. Usability and feasibility were analyzed and summarized quantitatively and qualitatively. Results: A total of 391 biofeedback sessions were completed with a median of 25 (IQR 17-28) per participant. The mean adherence rate was 0.76 (SD 0.26). The evaluation questionnaire revealed that functionality and design had the highest scores, whereas engagement and biofeedback were lower. Qualitative preexpectation analysis revealed that participants expected to become better familiar with physical signals and gain more understanding of their migraine attacks and noted that the app should be simple and understandable. Postusability analysis indicated that participants had an overall positive user experience with some suggestions for improvement regarding the design of the wearables and app content. The intervention was safe and tolerable. One case of prespecified adverse events was recorded in which a patient developed a skin rash from the sticky surface electromyography electrodes. Conclusions: The app underwent a rigorous development process that indicated an overall positive user experience, good usability, and high adherence rate. This study highlights the value of usability testing in the development of mHealth apps. %M 34319243 %R 10.2196/23229 %U https://formative.jmir.org/2021/7/e23229 %U https://doi.org/10.2196/23229 %U http://www.ncbi.nlm.nih.gov/pubmed/34319243 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e23303 %T Acceptability of Intervention Design Factors in mHealth Intervention Research: Experimental Factorial Study %A Materia,Frank T %A Smyth,Joshua M %+ Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, United States, 1 (816) 731 7123, ftmateria@cmh.edu %K mHealth %K acceptability %K implementation %K health behavior %K smartphone %K mobile phone %K wearable %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the growing interest in mobile health (mHealth), behavioral medicine researchers are increasingly conducting intervention studies that use mobile technology (eg, to support healthy behavior change). Such studies’ scientific premises are often sound, yet there is a dearth of implementational data on which to base mHealth research methodologies. Notably, mHealth approaches must be designed to be acceptable to research participants to support meaningful engagement, but little empirical data about design factors influencing acceptability in such studies exist. Objective: This study aims to evaluate the impact of two common design factors in mHealth intervention research—requiring multiple devices (eg, a study smartphone and wrist sensor) relative to requiring a single device and providing individually tailored feedback as opposed to generic content—on reported participant acceptability. Methods: A diverse US adult convenience sample (female: 104/255, 40.8%; White: 208/255, 81.6%; aged 18-74 years) was recruited to complete a web-based experiment. A 2×2 factorial design (number of devices×nature of feedback) was used. A learning module explaining the necessary concepts (eg, behavior change interventions, acceptability, and tailored content) was presented, followed by four vignettes (representing each factorial cell) that were presented to participants in a random order. The vignettes each described a hypothetical mHealth intervention study featuring different combinations of the two design factors (requiring a single device vs multiple devices and providing tailored vs generic content). Participants rated acceptability dimensions (interest, benefit, enjoyment, utility, confidence, difficulty, and overall likelihood of participating) for each study presented. Results: Reported interest, benefit, enjoyment, confidence in completing study requirements, and perceived utility were each significantly higher for studies featuring tailored (vs generic) content, and the overall estimate of the likelihood of participation was significantly higher. Ratings of interest, benefit, and perceived utility were significantly higher for studies requiring multiple devices (vs a single device); however, multiple device studies also had significantly lower ratings of confidence in completing study requirements, and participation was seen as more difficult and was associated with a lower estimated likelihood of participation. The two factors did not exhibit any evidence of statistical interactions in any of the outcomes tested. Conclusions: The results suggest that potential research participants are sensitive to mHealth design factors. These mHealth intervention design factors may be important for initial perceptions of acceptability (in research or clinical settings). This, in turn, may be associated with participant (eg, self) selection processes, differential compliance with study or treatment processes, or retention over time. %M 34309563 %R 10.2196/23303 %U https://mhealth.jmir.org/2021/7/e23303 %U https://doi.org/10.2196/23303 %U http://www.ncbi.nlm.nih.gov/pubmed/34309563 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28083 %T Examining Challenges to the Incorporation of End Users in the Design of Digital Health Interventions: Protocol for a Systematic Review %A Duffy,Anthony %A Christie,Greg %A Moreno,Sylvain %+ School of Interactive Arts & Technology, Simon Fraser University, 13450 102 Ave #250, Surrey, BC, V3T 0A3, Canada, 1 7787829742, sylvainm@sfu.ca %K digital health %K end user(s) %K user experience %K UX %K health behavior %K intervention %K co-design %K mobile health %K mHealth %D 2021 %7 26.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The process of designing a digital health intervention (DHI)—also referred to as mobile health or eHealth—spans needs assessments, technical functionality and feasibility, user satisfaction, effectiveness, impact, and value. These interventions are causing a rapid evolution in the landscape of health care. Multiple studies have shown their propensity to extend both the quality and reach of interventions. However, failure to improve DHI design is linked to failed uptake and health outcomes. This dilemma is further conflicted by the colliding backdrops of the digital and health industries, both of which approach, understand, and involve end users differently in the framing of a DHI. Objective: The objective of this systematic review is to assess the challenges to incorporating end users in the design stage of digital health interventions, to identify key pain points, and to identify limitations and gaps for areas of future investigation. Methods: The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist will be used to structure this protocol. A systematic search of the PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Scopus, and IEEE Xplore databases will be conducted. Additionally, the PerSPEcTiF guidelines for complex interventions will be consulted. Two reviewers will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardized form and conduct quality appraisal. Results: As of February 2021, we have completed a preliminary literature search examining challenges to the incorporation of end users in the design stage of DHIs. Systematic searches, data extraction and analysis, and writing of the systematic review are expected to be completed by December 2021. Conclusions: This systematic review aims to provide an effective summary of key pain points toward incorporating end users in DHIs. Results from this review will provide an evidence base for a better approach to end user involvement in the interest of improving efficacy and uptake of DHIs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238164 International Registered Report Identifier (IRRID): PRR1-10.2196/28083 %M 34309578 %R 10.2196/28083 %U https://www.researchprotocols.org/2021/7/e28083 %U https://doi.org/10.2196/28083 %U http://www.ncbi.nlm.nih.gov/pubmed/34309578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e26297 %T Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing %A Woolf,Thomas B %A Goheer,Attia %A Holzhauer,Katherine %A Martinez,Jonathan %A Coughlin,Janelle W %A Martin,Lindsay %A Zhao,Di %A Song,Shanshan %A Ahmad,Yanif %A Sokolinskyi,Kostiantyn %A Remayeva,Tetyana %A Clark,Jeanne M %A Bennett,Wendy %A Lehmann,Harold %+ Department of Physiology, Johns Hopkins University School of Medicine, 725 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 416 2643, twoolf@jhu.edu %K mhealth %K circadian %K sleep %K ecological momentary assessment %K timing of eating %K mobile applications %K habits %K body weight %K surveys and questionnaires %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ≥4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. %M 34296999 %R 10.2196/26297 %U https://formative.jmir.org/2021/7/e26297 %U https://doi.org/10.2196/26297 %U http://www.ncbi.nlm.nih.gov/pubmed/34296999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22968 %T Exploring the Constituent Elements of a Successful Mobile Health Intervention for Prediabetic Patients in King Saud University Medical City Hospitals in Saudi Arabia: Cross-sectional Study %A Alshehri,Fayz %A Alshaikh,Fahdah %+ Executive Department of Information Technology, King Saud University Medical City, King Saud University, King Abdulaziz University Hospital, Building 4, Level 3, King Abdulaziz Road, Riyadh, 12629, Saudi Arabia, 966 118067119, afayz@ksu.edu.sa %K prediabetes %K mHealth %K CeHRes roadmap %K Saudi Arabia %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-management of prediabetic patients is crucial since they are at high risk of developing type 2 diabetes. Mobile health (mHealth) apps could contribute to potentially reducing the burden of diabetes by supporting the self-management of prediabetic patients. Objective: This study aimed to explore the constituent elements of a successful mHealth intervention for prediabetic patients in King Saud University Medical City (KSUMC) hospitals in Saudi Arabia using the Centre for eHealth Research (CeHRes) roadmap. Methods: This study used the CeHRes roadmap as a developmental guideline for proposing mHealth app features for self-management of prediabetic patients and was performed in 3 phases with one round in each phase. First, a contextual inquiry was conducted via an online self-administered questionnaire for both health care providers and patients. Second, the value specification phase elaborated on the outcomes from the contextual inquiry phase. Finally, prototype user design was performed in cocreation with end users. The design phase was also conducted via an online self-administered questionnaire to evaluate the proposed features of mHealth apps by prediabetic patients. Results: A total of 20 health care providers participated in the study. The results revealed that the most powerful intervention for prediabetes was a combination of medication, physical activity, and healthy diet plans (12/20, 60%). Furthermore, the most common challenge faced by prediabetes patients was patient adherence to healthy diet and physical activity recommendations (10/20, 50%). Almost all patients believed that mHealth apps would be useful for prediabetic patients. A total of 48 prediabetic patients participated in the study. The results indicated that the most powerful intervention for prediabetic patients is a combination of healthy diet and physical activity plans (21/48, 44%), and the most frequent challenge that may lead the patients to discontinue the current intervention was the commitment to a physical activity plan (35/48, 75%). Furthermore, 15% (17/48) of patients use well-being and health apps to manage their current health status. The most common difficulties faced by the patients were navigating app features (mean 2.02 [SD 1.7]) followed by the app language (mean 1.88 [SD 2.0]); these difficulties occurred at a significantly higher rate among those with secondary or lower educational levels as compared to undergraduate and postgraduate levels (P<.05). Finally, the features proposed in the prototype design scored more than 2.5 points higher and indicate the need for these features to be included in the mHealth app. Conclusions: This study aimed to provide real-world insights into the development of an mHealth app for a diabetes prevention intervention by involving both health care providers and prediabetic patients in KSUMC hospitals. Therefore, the proposed app, which comprises all necessary features, may aid patients with prediabetes in self-management and making changes in their lifestyle. %M 34061762 %R 10.2196/22968 %U https://formative.jmir.org/2021/7/e22968 %U https://doi.org/10.2196/22968 %U http://www.ncbi.nlm.nih.gov/pubmed/34061762 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e27449 %T Contact Tracing Apps: Lessons Learned on Privacy, Autonomy, and the Need for Detailed and Thoughtful Implementation %A Hogan,Katie %A Macedo,Briana %A Macha,Venkata %A Barman,Arko %A Jiang,Xiaoqian %+ School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St #600, Houston, TX, 77030, United States, 1 7135003930, xiaoqian.jiang@uth.tmc.edu %K contact tracing %K COVID-19 %K privacy %K smartphone apps %K mobile phone apps %K health information %K electronic health %K eHealth %K pandemic %K app %K mobile health %K mHealth %D 2021 %7 19.7.2021 %9 Viewpoint %J JMIR Med Inform %G English %X The global and national response to the COVID-19 pandemic has been inadequate due to a collective lack of preparation and a shortage of available tools for responding to a large-scale pandemic. By applying lessons learned to create better preventative methods and speedier interventions, the harm of a future pandemic may be dramatically reduced. One potential measure is the widespread use of contact tracing apps. While such apps were designed to combat the COVID-19 pandemic, the time scale in which these apps were deployed proved a significant barrier to efficacy. Many companies and governments sprinted to deploy contact tracing apps that were not properly vetted for performance, privacy, or security issues. The hasty development of incomplete contact tracing apps undermined public trust and negatively influenced perceptions of app efficacy. As a result, many of these apps had poor voluntary public uptake, which greatly decreased the apps’ efficacy. Now, with lessons learned from this pandemic, groups can better design and test apps in preparation for the future. In this viewpoint, we outline common strategies employed for contact tracing apps, detail the successes and shortcomings of several prominent apps, and describe lessons learned that may be used to shape effective contact tracing apps for the present and future. Future app designers can keep these lessons in mind to create a version that is suitable for their local culture, especially with regard to local attitudes toward privacy-utility tradeoffs during public health crises. %M 34254937 %R 10.2196/27449 %U https://medinform.jmir.org/2021/7/e27449 %U https://doi.org/10.2196/27449 %U http://www.ncbi.nlm.nih.gov/pubmed/34254937 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e29689 %T Popular Evidence-Based Commercial Mental Health Apps: Analysis of Engagement, Functionality, Aesthetics, and Information Quality %A Lau,Nancy %A O'Daffer,Alison %A Yi-Frazier,Joyce P %A Rosenberg,Abby R %+ Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 2068840569, nancy.lau@seattlechildrens.org %K mobile health %K mental health %K behavioral health %K user-centered design %K evidence-based health management %K smartphones %K mobile phones %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a robust market for mobile health (mHealth) apps focused on self-guided interventions to address a high prevalence of mental health disorders and behavioral health needs in the general population. Disseminating mental health interventions via mHealth technologies may help overcome barriers in access to care and has broad consumer appeal. However, development and testing of mental health apps in formal research settings are limited and far outpaced by everyday consumer use. In addition to prioritizing efficacy and effectiveness testing, researchers should examine and test app design elements that impact the user experience, increase engagement, and lead to sustained use over time. Objective: The aim of this study was to evaluate the objective and subjective quality of apps that are successful across both research and consumer sectors, and the relationships between objective app quality, subjective user ratings, and evidence-based behavior change techniques. This will help inform user-centered design considerations for mHealth researchers to maximize design elements and features associated with consumer appeal, engagement, and sustainability. Methods: We conducted a user-centered design analysis of popular consumer apps with scientific backing utilizing the well-validated Mobile Application Rating Scale (MARS). Popular consumer apps with research support were identified via a systematic search of the App Store iOS (Apple Inc) and Google Play (Google LLC) and literature review. We evaluated the quality metrics of 19 mental health apps along 4 MARS subscales, namely, Engagement, Functionality, Aesthetics, and Information Quality. MARS total and subscale scores range from 1 to 5, with higher scores representing better quality. We then extracted user ratings from app download platforms and coded apps for evidence-based treatment components. We calculated Pearson correlation coefficients to identify associations between MARS scores, App Store iOS/Google Play consumer ratings, and number of evidence-based treatment components. Results: The mean MARS score was 3.52 (SD 0.71), consumer rating was 4.22 (SD 0.54), and number of evidence-based treatment components was 2.32 (SD 1.42). Consumer ratings were significantly correlated with the MARS Functionality subscale (r=0.74, P<.001), Aesthetics subscale (r=0.70, P<.01), and total score (r=0.58, P=.01). Number of evidence-based intervention components was not associated with MARS scores (r=0.085, P=.73) or consumer ratings (r=–0.329, P=.16). Conclusions: In our analysis of popular research-supported consumer apps, objective app quality and subjective consumer ratings were generally high. App functionality and aesthetics were highly consistent with consumer appeal, whereas evidence-based components were not. In addition to designing treatments that work, we recommend that researchers prioritize aspects of app design that impact the user experience for engagement and sustainability (eg, ease of use, navigation, visual appeal). This will help translate evidence-based interventions to the competitive consumer app market, thus bridging the gap between research development and real-world implementation. %M 34259639 %R 10.2196/29689 %U https://mhealth.jmir.org/2021/7/e29689 %U https://doi.org/10.2196/29689 %U http://www.ncbi.nlm.nih.gov/pubmed/34259639 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e21837 %T A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial %A Moltrecht,Bettina %A Patalay,Praveetha %A Deighton,Jessica %A Edbrooke-Childs,Julian %+ Evidence-based Practice Unit, University College London & Anna Freud National Centre, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 020 7794 ext 2313, Julian.childs@annafreud.org %K emotion regulation %K digital mental health %K mhealth %K school intervention %K child mental health %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale. Objective: This study investigates the use of a new app-based intervention designed to support children’s emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context. Methods: As part of an interdisciplinary development framework, the app is being evaluated in a 3-month trial across 4 primary schools. In total, 144 children (aged 10-12 years) took part and accessed the intervention app in the classroom or at home. Outcomes regarding usability, acceptability, and implementation opportunities were assessed through digital user data, self-report questionnaires (132/144, 91.6%), and semistructured interviews with children (19/144, 13.2%) and teachers (6/8, 75%). Results: The app usage data showed that 30% (128/426) of the users were returning users. Self-report data indicated that 40.1% (53/132) of the children had not used the app, whereas 57.5% (76/132) had used it once or more. Of the children who had used the app, 67% (51/76) reported that the app was helpful. Interviews with children and teachers suggested positive experiences with the app and that it helped them to calm down and relax. Children reported that they perceived the app as acceptable, usable, and helpful. In terms of the intervention’s usability, most features functioned well; however, certain technical issues were reported, which may have led to reduced engagement levels. Teachers not only reported overall positive experiences but also discussed access difficulties and reported a lack of content as one of the main barriers to implementing the app. Having a web-based app significantly enhanced accessibility across devices and settings and provided teachers with more opportunities to use it. We identified the need for new, activating app features in addition to the existing, primarily relaxing ones. The findings indicated that it is possible to use and evaluate an app intervention in the school context and that the app could help enhance children’s emotion regulation. We discuss areas for improvement regarding the app, study design, and future implementation strategies. Conclusions: We share important insights with regard to the development, implementation, and evaluation of a new app for supporting children’s emotion regulation in schools. Our results demonstrate that mental health apps represent a promising means to facilitate effective mental health service provision in and outside of the school context. Important lessons learned are shared to support other researchers and clinicians on similar journeys. %M 34259642 %R 10.2196/21837 %U https://mhealth.jmir.org/2021/7/e21837 %U https://doi.org/10.2196/21837 %U http://www.ncbi.nlm.nih.gov/pubmed/34259642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22510 %T Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App %A Resnick,Daniel %A Schapira,Marilyn M %A Smith,Jazmine M %A Bautista,Allison %A Xu,Chang %A Jones,Liz %A Aysola,Jaya %+ Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1229 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 573 9475, jaysola@upenn.edu %K mHealth %K cancer prevention %K goal setting %K social networks %K health disparities %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients. Objective: This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change. Methods: In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app’s acceptability by qualitatively analyzing open-ended responses regarding participants’ overall experience with the app. We assessed participants’ engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study. Results: The mean age of the 41 participants was 51 years (SD 12), and 76% (31/41) were women. App use data were captured from all participants, and 83% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app’s ease of use and health behavior–promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study. Conclusions: The implementation of a mobile cancer prevention goal–setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients. %M 34259162 %R 10.2196/22510 %U https://formative.jmir.org/2021/7/e22510 %U https://doi.org/10.2196/22510 %U http://www.ncbi.nlm.nih.gov/pubmed/34259162 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e27156 %T Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study %A Scheibe,Madlen %A Lang,Caroline %A Druschke,Diana %A Arnold,Katrin %A Luntz,Edwin %A Schmitt,Jochen %A Holthoff-Detto,Vjera %+ Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, Dresden, 01307, Germany, 49 351 458 2815, Madlen.Scheibe@ukdd.de %K telemedicine %K aged %K multimorbidity %K dementia %K patient acceptance of health care %K health care quality, access, and evaluation %K qualitative research %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. Objective: We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? Methods: We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. Results: Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. Conclusions: The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps. %M 34255664 %R 10.2196/27156 %U https://humanfactors.jmir.org/2021/3/e27156 %U https://doi.org/10.2196/27156 %U http://www.ncbi.nlm.nih.gov/pubmed/34255664 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e28677 %T User Perspectives on a Resilience-Building App (JoyPop): Qualitative Study %A Mushquash,Aislin R %A Pearson,Erin S %A Waddington,Kayla %A MacIsaac,Angela %A Mohammed,Shakira %A Grassia,Elizabeth %A Smith,Savanah %A Wekerle,Christine %+ Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON, , Canada, 1 807 343 8771, aislin.mushquash@lakeheadu.ca %K resilience %K smartphone %K app %K innovation %K qualitative %K perspective %K mHealth %K emotion %K mental health %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Resilience is the capability, resources, and processes that are available to a person or system to adapt successfully in the face of stress or adversity. Given that resilience can be enhanced, using advances in technology to deliver and evaluate the impact of resilience interventions is warranted. Evidence supports the effectiveness of the resilience-building JoyPop app in improving resilience-related outcomes after use; however, experiential data from users is also needed to provide a more comprehensive account of its utility. Objective: The aim of this study was to explore users’ experiences with the JoyPop app and their perspectives on its utility. Methods: This qualitative description study involved a combination of group and one-on-one semistructured interviews with a subset of first-year undergraduate students who participated in a larger evaluation of the JoyPop app. Participants used the app for a 4-week period and were subsequently asked about their frequency of app use, most and least used features (and associated reasons), most and least helpful features (and associated reasons), barriers to use, facilitators of use and continuation, and recommendations for improvement. Data were coded and categorized through inductive content analysis. Results: The sample of 30 participants included 24 females and 6 males, with a mean age of 18.77 years (SD 2.30). App use ranged from 1 to 5 times daily (mean 2.11, SD 0.74), with the majority indicating that they used the app at least twice daily. The Rate My Mood, Journal, and SquareMoves features were reported to be used most often, while the Rate My Mood, Journal, and Breathing Exercises features were identified as the most helpful. A number of themes and subthemes pertaining to facilitators of app use (prompts, creating routine, self-monitoring opportunities, expressive opportunities), barriers to app use (editing, lack of variety, student lifestyle), outcomes of app use (increased awareness, checking in with oneself, helpful distraction, emotional control), and recommendations for app improvement (adding more features, enhancing existing features, enhancing tracking abilities, providing personalization) were identified. Conclusions: This study provides insight into the aspects of the JoyPop app that motivated and benefitted users, as well as measures that can be taken to improve user experiences and promote longer-term uptake. Users were willing to engage with the app and incorporate it into their routine, and they valued the ability to self-monitor, express emotion, and engage in distraction. %M 34255696 %R 10.2196/28677 %U https://mhealth.jmir.org/2021/7/e28677 %U https://doi.org/10.2196/28677 %U http://www.ncbi.nlm.nih.gov/pubmed/34255696 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e28175 %T Supportive Accountability and Mobile App Use in a Tobacco Control Intervention Targeting Low-Income Minority Mothers Who Smoke: Observational Study %A Lepore,Stephen J %A Collins,Bradley N %A Killam,Howard W %A Barry,Barbara %+ Department of Social and Behavioral Sciences, Temple University, 975 Ritter Annex, 1301 Cecil B Moore Ave, Philadelphia, PA, 19122, United States, 1 215 204 9422, slepore@temple.edu %K tobacco cessation %K smoking %K mHealth %K mobile apps %K smartphone %K mobile phone %K adherence %K engagement %K minority health %D 2021 %7 2.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone mobile apps are frequently used in standalone or multimodal smoking cessation interventions. However, factors that impede or improve app usage are poorly understood. Objective: This study used the supportive accountability model to investigate factors that influence app usage in the context of a trial designed to reduce maternal smoking in low-income and predominantly minority communities. Methods: We conducted a secondary analysis of data (N=181) from a randomized controlled trial that included a smoking cessation app (QuitPal-m). Supportive accountability was measured by the number of times a participant was advised by their cessation counselor to use QuitPal-m. Participants reported app use helpfulness and barriers. Investigators tracked reported phone and technical problems that impeded app use. Results: Most participants rated the app as very helpful (103/155, 66.5%), but daily use declined rapidly over time. App use was positively related to the level of perceived app helpfulness (P=.02) and education (P=.002) and inversely related to perceived barriers (P=.003), phone technical problems (P<.001), and cigarettes smoked per day at the end of treatment (P<.001). Participants used the app a greater proportion of the days following app advice than those preceding app advice (0.45 versus 0.34; P<.001). The positive relation between counselor app advice and app usage 24 hours after receiving advice was stronger among smokers with no plan to quit than in those planning to quit (P=.03), independent of education and phone or app problems. Conclusions: Findings show the utility of supportive accountability for increasing smoking cessation app use in a predominantly low-income, minority population, particularly if quit motivation is low. Results also highlight the importance of addressing personal and phone/technical barriers in addition to adding supportive accountability. Trial Registration: ClinicalTrials.gov NCT02602288; https://clinicaltrials.gov/ct2/show/NCT02602288 %M 34255698 %R 10.2196/28175 %U https://mhealth.jmir.org/2021/7/e28175 %U https://doi.org/10.2196/28175 %U http://www.ncbi.nlm.nih.gov/pubmed/34255698 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25891 %T Usability and Acceptance of the Embodied Conversational Agent Anne by People With Dementia and Their Caregivers: Exploratory Study in Home Environment Settings %A Stara,Vera %A Vera,Benjamin %A Bolliger,Daniel %A Rossi,Lorena %A Felici,Elisa %A Di Rosa,Mirko %A de Jong,Michiel %A Paolini,Susy %+ Model of Care and New Technologies, IRCCS INRCA - National Institute of Health and Science on Ageing, Via Santa Margherita, 5, Ancona, 60124, Italy, 39 071 800 4614, v.stara@inrca.it %K dementia %K older adults with dementia %K embodied conversational agent %K virtual personal assistant %K virtual agent %K virtual companion %K design for older adults with dementia %D 2021 %7 19.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Information and communication technologies are tools that are able to support cognitive functions, monitor health and movements, provide reminders to maintain residual memory abilities, and promote social support, especially among patients with dementia. Among these technologies, embodied conversational agents (ECAs) are seen as screen-based entities designed to stimulate human face-to-face conversation skills, allowing for natural human-machine interaction. Unfortunately, the evidence that such agents deliver care benefits in supporting people affected by dementia and their caregivers has not yet been well studied. Therefore, research in this area is essential for the entire scientific community. Objective: This study aims to evaluate the usability and acceptability of the virtual agent Anne by people living with dementia. The study is also designed to assess the ability of target users to use the system independently and receive valuable information from it. Methods: We conducted a 4-week trial that involved 20 older adults living with dementia and 14 family caregivers in home environment settings in Italy. This study used a mixed methods approach, balancing quantitative and qualitative instruments to gather data from users. Telemetry data were also collected. Results: Older users were particularly engaged in providing significant responses and participating in system improvements. Some of them clearly discussed how technical problems related to speech recognition had a negative impact on the intention to use, adaptiveness, usefulness, and trust. Moreover, the usability of the system achieved an encouraging score, and half of the sample recognized a role of the agent Anne. This study confirms that the quality of automatic speech recognition and synthesis is still a technical issue and has room for improvement, whereas the touch screen modality is almost stable and positively used by patients with dementia. Conclusions: This study demonstrated the ability of target users to use the system independently in their home environment; overall, the involved participants shared good engagement with the system, approaching the virtual agents as a companion able to support memory and enjoyment needs. Therefore, this research provides data that sustain the use of ECAs as future eHealth systems that are able to address the basic and higher-level needs of people living with dementia. This specific field of research is novel and poorly discussed in the scientific community. This could be because of its novelty, yet there is an urgent need to strengthen data, research, and innovation to accelerate the implementation of ECAs as a future method to offer nonpharmacological support to community-dwelling people with dementia. %M 34170256 %R 10.2196/25891 %U https://mhealth.jmir.org/2021/6/e25891/ %U https://doi.org/10.2196/25891 %U http://www.ncbi.nlm.nih.gov/pubmed/34170256 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25522 %T A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis %A Song,Ting %A Liu,Fang %A Deng,Ning %A Qian,Siyu %A Cui,Tingru %A Guan,Yingping %A Arnolda,Leonard %A Zhang,Zhenyu %A Yu,Ping %+ Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 2 4221 5412, ping@uow.edu.au %K patient experience %K mHealth %K mobile phone %K mobile app %K intervention %K self-management %K high blood pressure %K chronic disease management %K qualitative research %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension affects over 15% of the world’s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. Objective: This study aims to explore patients’ perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. Methods: A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. Results: The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. Conclusions: The mHealth service extended the traditional hypertension care model beyond the hospital and clinician’s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions. %M 34152272 %R 10.2196/25522 %U https://www.jmir.org/2021/6/e25522 %U https://doi.org/10.2196/25522 %U http://www.ncbi.nlm.nih.gov/pubmed/34152272 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28094 %T Mobile Tuberculosis Treatment Support Tools to Increase Treatment Success in Patients with Tuberculosis in Argentina: Protocol for a Randomized Controlled Trial %A Iribarren,Sarah %A Milligan,Hannah %A Goodwin,Kyle %A Aguilar Vidrio,Omar Alfonso %A Chirico,Cristina %A Telles,Hugo %A Morelli,Daniela %A Lutz,Barry %A Sprecher,Jennifer %A Rubinstein,Fernando %+ Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, HSB, Box 357266, Seattle, WA, 98195, United States, 1 2065435211, sjiribar@uw.edu %K tuberculosis %K disease management %K infectious disease %K mHealth %K digital health %K direct drug metabolite test %K mobile phone %D 2021 %7 21.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tuberculosis (TB) is an urgent global health threat and the world’s deadliest infectious disease despite being largely curable. A critical challenge is to ensure that patients adhere to the full course of treatment to prevent the continued spread of the disease and development of drug-resistant disease. Mobile health interventions hold promise to provide the required adherence support to improve TB treatment outcomes. Objective: This study aims to evaluate the effectiveness of the TB treatment support tools (TB-TSTs) intervention on treatment outcomes (success and default) and to assess patient and provider perceptions of the facilitators and barriers to TB-TSTs implementation. Methods: The TB-TSTs study is an open-label, randomized controlled trial with 2 parallel groups in which 400 adult patients newly diagnosed with TB will be randomly assigned to receive usual care or usual care plus TB-TSTs. Participants will be recruited on a rolling basis from 4 clinical sites in Argentina. The intervention consists of a smartphone progressive web app, a treatment supporter (eg, TB nurse, physician, or social worker), and a direct adherence test strip engineered for home use. Intervention group participants will report treatment progress and interact with a treatment supporter using the app and metabolite urine test strip. The primary outcome will be treatment success. Secondary outcomes will include treatment default rates, self-reported adherence, technology use, and usability. We will assess patients’ and providers’ perceptions of barriers to implementation and synthesize lessons learned. We hypothesize that the TB-TSTs intervention will be more effective because it allows patients and TB supporters to monitor and address issues in real time and provide tailored support. We will share the results with stakeholders and policy makers. Results: Enrollment began in November 2020, with a delayed start due to the COVID-19 pandemic, and complete enrollment is expected by approximately July 2022. Data collection and follow-up are expected to be completed 6 months after the last patient is enrolled. Results from the analyses based on the primary end points are expected to be submitted for publication within a year of data collection completion. Conclusions: To our knowledge, this randomized controlled trial will be the first study to evaluate a patient-centered remote treatment support strategy using a mobile tool and a home-based direct drug metabolite test. The results will provide robust scientific evidence on the effectiveness, implementation, and adoption of mobile health tools. The findings have broader implications not only for TB adherence but also more generally for chronic disease management and will improve our understanding of how to support patients facing challenging treatment regimens. Trial Registration: ClinicalTrials.gov NCT04221789; https://clinicaltrials.gov/ct2/show/NCT04221789. International Registered Report Identifier (IRRID): DERR1-10.2196/28094 %M 34152281 %R 10.2196/28094 %U https://www.researchprotocols.org/2021/6/e28094 %U https://doi.org/10.2196/28094 %U http://www.ncbi.nlm.nih.gov/pubmed/34152281 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24659 %T Professionals’ and Students’ Perceived Needs for an Online Supportive Application for Reducing School Absence and Stimulating Reintegration: Concept Mapping Study %A Hoogsteder,Mariette H H %A Douma,Linda N %A Eskens,Charlotte G A %A Berendsen,Renske L %A Vanneste,Yvonne T M %A Schaafsma,Frederieke G %+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 20 4445965, m.hoogsteder@amsterdamumc.nl %K medical absenteeism %K secondary education %K eHealth %K mHealth %K mobile health %K students %K schools, health occupations %K youth health physicians %K concept mapping %D 2021 %7 21.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: To limit students’ medical absenteeism and premature school dropout in the Netherlands, the Medical Advice for Sick-reported Students (MASS) intervention was developed to enhance collaboration between students, parents, school, and health care professionals. MASS reduces medical absenteeism. However, it does not yet optimally support professionals in monitoring students nor automatically stimulating students’ autonomy regarding their situation. Objective: This study aimed to identify professionals’ and students’ perceived need for an online supportive application to monitor and reduce absenteeism and stimulate student autonomy and school reintegration. Methods: Concept mapping sessions were held with professionals (n=23) and secondary school students (n=27) in group meetings or online to identify their perspectives and needs. Multidimensional scaling and hierarchical clustering were done with Ariadne 3.0 software. The resulting concept maps were reclustered and interpreted by 4 researchers. Results: Three heterogeneous groups of professionals generated 17 clusters (135 unique statements), with a mean importance rating ranging from 2.9 to 4.6 on a Likert scale with scores ranging from 1 to 5. Three heterogeneous groups of secondary school students generated 18 clusters (95 unique statements), with a mean importance rating ranging from 3.2 to 4.6. Professionals considered as most important the following: easily accessible contact with students; supporting, motivating, and rewarding students; monitoring absent students; providing information to students and their parents; exchanging information between professionals. Students considered as most important the following: better teacher-student communication and respect; communication between school professionals on the one hand and parents, other professionals, and students on the other hand; guidance in missed learning materials and tests. Students perceived an online format for support as the obvious option. Conclusions: Both professionals and students were positive about an online application to support students in dealing with medical absenteeism, especially considering the need for better and easily accessible contact between students and professionals. An eHealth or mobile health (mHealth) application addressing these aspects could stimulate student autonomy and have positive effects on medical absenteeism. %M 34152275 %R 10.2196/24659 %U https://formative.jmir.org/2021/6/e24659 %U https://doi.org/10.2196/24659 %U http://www.ncbi.nlm.nih.gov/pubmed/34152275 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25151 %T Comparing Two Commercially Available Diabetes Apps to Explore Challenges in User Engagement: Randomized Controlled Feasibility Study %A Maharaj,Alita %A Lim,David %A Murphy,Rinki %A Serlachius,Anna %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 3073, a.serlachius@auckland.ac.nz %K type 2 diabetes %K mobile apps %K diabetes %K self-management %K user engagement %K app %K mHealth %K randomized controlled trial %K intervention %K efficacy %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes apps represent a promising addition to face-to-face self-management interventions, which can be time and resource intensive. However, few randomized controlled trials have evaluated the efficacy of diabetes apps, in particular as a stand-alone intervention without additional clinical support. Objective: We used a feasibility randomized trial design to investigate differences in user engagement between 2 commercially available apps (free versions of Glucose Buddy and mySugr) over 2 weeks in adults with type 2 diabetes. Feasibility was assessed based on recruitment uptake, adherence to the diabetes apps, and follow-up rates. We also hypothesized that the diabetes app mySugr would demonstrate higher user engagement at follow-up due to its use of gamification. We also predicted higher user engagement would be associated with improved self-care behaviors and illness beliefs. Methods: Adults with type 2 diabetes attending outpatient diabetes clinics in Auckland were recruited and randomized (1:1 without blinding) to use either the Glucose Buddy or mySugr diabetes apps. User engagement, self-care behaviors, and illness beliefs were measured 2 weeks after baseline. Spearman rank correlations, Mann-Whitney tests, and Wilcoxon signed-rank tests were used to explore associations between the outcome measures and to investigate possible changes between and within groups. Six participants were interviewed to further explore acceptability and usability. Results: In total, 58 participants (29 per group) completed the 2-week follow-up, of whom only 38 reported using the apps (Glucose Buddy: n=20; mySugr: n=18). Both groups reported low engagement (Glucose Buddy: median 4 days; mySugr: median 6.5 days; P=.06; use for both groups: median 10 minutes). No changes were observed in self-care or illness beliefs in either group. Out of the self-care behaviors, only blood glucose testing was significantly associated with minutes of app use (P=.02). The interviews suggested that although both apps were deemed acceptable, they were generally viewed as time-consuming and too complicated to use. Conclusions: Low engagement with both Glucose Buddy and mySugr reflect the challenges associated with engaging users with diabetes apps. Due to low engagement and loss to follow-up, the changes in outcome measures should be interpreted with caution. The results highlight the need for more clinical support as well as involvement from end users and behavior change specialists in order to incorporate evidence-based behavior change techniques to motivate and provide value to users. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618000424202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374671 %M 34132640 %R 10.2196/25151 %U https://formative.jmir.org/2021/6/e25151 %U https://doi.org/10.2196/25151 %U http://www.ncbi.nlm.nih.gov/pubmed/34132640 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27076 %T Co-designing a Lifestyle-Focused Text Message Intervention for Women After Breast Cancer Treatment: Mixed Methods Study %A Singleton,Anna %A Raeside,Rebecca %A Partridge,Stephanie R %A Hayes,Molly %A Maka,Katherine %A Hyun,Karice K %A Thiagalingam,Aravinda %A Chow,Clara K %A Sherman,Kerry A %A Elder,Elisabeth %A Redfern,Julie %+ Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Level 6 Block K Westmead Hospital, Sydney, 2145, Australia, 61 288908181, anna.singleton@sydney.edu.au %K breast neoplasms %K cancer survivors %K text messaging %K telemedicine %K mobile health %K co-design %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Breast cancer is the most common cancer among women globally. Recovery from breast cancer treatment can be mentally and physically challenging. SMS text message programs offer a novel way to provide health information and support, but few programs are co-designed with consumer representatives. Objective: This study aims to report the procedures and outcomes of a co-design process of a lifestyle-focused SMS text message program to support women’s mental and physical health after breast cancer treatment. Methods: We followed an iterative mixed methods two-step process: (1) co-design workshop with consumers and health professionals and researchers to draft text messages and (2) evaluation of message content, which was scored (5-point Likert scale; 1=strongly disagree to 5=strongly agree) for ease of understanding, usefulness, and appropriateness, and readability (Flesch-Kincaid score). Additional free-text responses and semistructured interviews were coded into themes. Messages were edited or deleted based on the evaluations, with consumers’ evaluations prioritized. Results: In step 1, co-designed text messages (N=189) were semipersonalized, and the main content themes were (1) physical activity and healthy eating, (2) medications and side effects, (3) mental health, and (4) general breast cancer information. In step 2, consumers (n=14) and health professionals and researchers (n=14) provided 870 reviews of 189 messages and found that most messages were easy to understand (799/870, 91.8%), useful (746/870, 85.7%), and appropriate (732/870, 84.1%). However, consumers rated 50 messages differently from health professionals and researchers. On the basis of evaluations, 37.6% (71/189) of messages were deleted, 36.5% (69/189) were edited, and 12 new messages related to fatigue, self-care, and cognition were created. The final 130 text messages had a mean 7.12 (SD 2.8) Flesch-Kincaid grade level and 68.9 (SD 15.5) ease-of-reading score, which represents standard reading ease. Conclusions: Co-designing and evaluating a bank of evidence-based mental and physical health-themed text messages with breast cancer survivors, health professionals, and researchers was feasible and resulted in a bank of 130 text messages evaluated highly by participants. Some consumer evaluations differed from health professionals and researchers, supporting the importance of co-design. %M 34125072 %R 10.2196/27076 %U https://www.jmir.org/2021/6/e27076 %U https://doi.org/10.2196/27076 %U http://www.ncbi.nlm.nih.gov/pubmed/34125072 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e17418 %T Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study %A Twimukye,Adelline %A Bwanika Naggirinya,Agnes %A Parkes-Ratanshi,Rosalind %A Kasirye,Ronnie %A Kiragga,Agnes %A Castelnuovo,Barbara %A Wasswa,Jacob %A Nabaggala,Maria Sarah %A Katabira,Elly %A Lamorde,Mohammed %A King,Rachel Lisa %+ Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, University Hall Lane, Kampala, 10218, Uganda, 256 256 312 307000, anaggirinya@idi.co.ug %K HIV %K mHealth %K young adults %K adherence %K qualitative %K Uganda %D 2021 %7 14.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adherence to treatment is critical for successful treatment outcomes. Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment. The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone–based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support. Objective: This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial. Methods: An exploratory qualitative design with a phenomenological approach at 2 study sites was used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach. Results: The CFLU mHealth tool was perceived as an acceptable intervention; young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips. Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues. HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth friendly. Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important. Conclusions: This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 %M 34121665 %R 10.2196/17418 %U https://mhealth.jmir.org/2021/6/e17418 %U https://doi.org/10.2196/17418 %U http://www.ncbi.nlm.nih.gov/pubmed/34121665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25958 %T Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study %A Lauffenburger,Julie C %A Barlev,Renee A %A Sears,Ellen S %A Keller,Punam A %A McDonnell,Marie E %A Yom-Tov,Elad %A Fontanet,Constance P %A Hanken,Kaitlin %A Haff,Nancy %A Choudhry,Niteesh K %+ Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, United States, 1 6175258865, jlauffenburger@bwh.harvard.edu %K diabetes %K technology %K mobile health %K medication adherence %K mobile phone %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated. Objective: This study aims to understand patients’ preferences for mobile health (mHealth) technology and how that technology can be integrated into patients’ routines, especially with regard to medication use. Methods: We conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication–taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations. Results: We conducted interviews with 20 participants, of whom 12 (60%) were female and 9 (45%) were White; in addition, the participants’ mean glycated hemoglobin A1c control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate cues into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized. Conclusions: The participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content. %M 34114964 %R 10.2196/25958 %U https://www.jmir.org/2021/6/e25958 %U https://doi.org/10.2196/25958 %U http://www.ncbi.nlm.nih.gov/pubmed/34114964 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e16304 %T The SleepFit Tablet Application for Home-Based Clinical Data Collection in Parkinson Disease: User-Centric Development and Usability Study %A Mascheroni,Alessandro %A Choe,Eun Kyoung %A Luo,Yuhan %A Marazza,Michele %A Ferlito,Clara %A Caverzasio,Serena %A Mezzanotte,Francesco %A Kaelin-Lang,Alain %A Faraci,Francesca %A Puiatti,Alessandro %A Ratti,Pietro Luca %+ Neurocenter of Southern Switzerland, Regional Hospital of Lugano, EOC, via Tesserete 46, Lugano, CH-6903, Switzerland, 41 353 412 71 91, pietroluca.ratti@gmail.com %K Parkinson disease %K ecological momentary assessment %K finger-tapping test %K subjective scales %K sleep diaries %K tablet application %K home-based system %D 2021 %7 8.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parkinson disease (PD) is a common, multifaceted neurodegenerative disorder profoundly impacting patients' autonomy and quality of life. Assessment in real-life conditions of subjective symptoms and objective metrics of mobility and nonmotor symptoms such as sleep disturbance is strongly advocated. This information would critically guide the adaptation of antiparkinsonian medications and nonpharmacological interventions. Moreover, since the spread of the COVID-19 pandemic, health care practices are being reshaped toward a more home-based care. New technologies could play a pivotal role in this new approach to clinical care. Nevertheless, devices and information technology tools might be unhandy for PD patients, thus dramatically limiting their widespread employment. Objective: The goals of the research were development and usability evaluation of an application, SleepFit, for ecological momentary assessment of objective and subjective clinical metrics at PD patients’ homes, and as a remote tool for researchers to monitor patients and integrate and manage data. Methods: An iterative and user-centric strategy was employed for the development of SleepFit. The core structure of SleepFit consists of (1) an electronic finger-tapping test; (2) motor, sleepiness, and emotional subjective scales; and (3) a sleep diary. Applicable design, ergonomic, and navigation principles have been applied while tailoring the application to the specific patient population. Three progressively enhanced versions of the application (alpha, v1.0, v2.0) were tested by a total of 56 patients with PD who were asked to perform multiple home assessments 4 times per day for 2 weeks. Patient compliance was calculated as the proportion of completed tasks out of the total number of expected tasks. Satisfaction on the latest version (v2.0) was evaluated as potential willingness to use SleepFit again after the end of the study. Results: From alpha to v1.0, SleepFit was improved in graphics, ergonomics, and navigation, with automated flows guiding the patients in performing tasks throughout the 24 hours, and real-time data collection and consultation were made possible thanks to a remote web portal. In v2.0, the kiosk-mode feature restricts the use of the tablet to the SleepFit application only, thus preventing users from accidentally exiting the application. A total of 52 (4 dropouts) patients were included in the analyses. Overall compliance (all versions) was 88.89% (5707/6420). SleepFit was progressively enhanced and compliance increased from 87.86% (2070/2356) to 89.92% (2899/3224; P=.04). Among the patients who used v2.0, 96% (25/26) declared they would use SleepFit again. Conclusions: SleepFit can be considered a state-of-the-art home-based system that increases compliance in PD patients, ensures high-quality data collection, and works as a handy tool for remote monitoring and data management in clinical research. Thanks to its user-friendliness and modular structure, it could be employed in other clinical studies with minimum adaptation efforts. Trial Registration: ClinicalTrials.gov NCT02723396; https://clinicaltrials.gov/ct2/show/NCT02723396 %M 34100767 %R 10.2196/16304 %U https://mhealth.jmir.org/2021/6/e16304 %U https://doi.org/10.2196/16304 %U http://www.ncbi.nlm.nih.gov/pubmed/34100767 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26022 %T Using the Computer-based Health Evaluation System (CHES) to Support Self-management of Symptoms and Functional Health: Evaluation of Hematological Patient Use of a Web-Based Patient Portal %A Lehmann,Jens %A Buhl,Petra %A Giesinger,Johannes M %A Wintner,Lisa M %A Sztankay,Monika %A Neppl,Lucia %A Willenbacher,Wolfgang %A Weger,Roman %A Weyrer,Walpurga %A Rumpold,Gerhard %A Holzner,Bernhard %+ University Hospital of Psychiatry II, Medical University of Innsbruck, Anichstraße 35, Innsbruck, AT-6020, Austria, 43 5050481551, jens.lehmann@i-med.ac.at %K quality of life %K monitoring %K patient portals %K multiple myeloma %K chronic lymphocytic leukemia %K patient-reported outcome measures %K eHealth %K mHealth %D 2021 %7 8.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portals offer the possibility to assess patient-reported outcome measures (PROMs) remotely, and first evidence has demonstrated their potential benefits. Objective: In this study, we evaluated patient use of a web-based patient portal that provides patient information and allows online completion of PROMs. A particular focus was on patient motivation for (not) using the portal. The portal was developed to supplement routine monitoring at the Department of Internal Medicine V in Innsbruck. Methods: We included patients with multiple myeloma and chronic lymphocytic leukemia who were already participating in routine monitoring at the hospital for use of the patient portal. Patients were introduced to the portal and asked to complete questionnaires prior to their next hospital visits. We used system access logs and 3 consecutive semistructured interviews to analyze patient use and evaluation of the portal. Results: Between July 2017 and August 2020, we approached 122 patients for participation in the study, of whom 83.6% (102/122) consented to use the patient portal. Patients were on average 60 (SD 10.4) years old. Of patients providing data at all study time points, 37% (26/71) consistently used the portal prior to their hospital visits. The main reason for not completing PROMs was forgetting to do so in between visits (25/84, 29%). During an average session, patients viewed 5.3 different pages and spent 9.4 minutes logged on to the portal. Feedback from interviews was largely positive with no patients reporting difficulties navigating the survey and 50% of patients valuing the self-management tools provided in the portal. Regarding the portal content, patients were interested in reviewing their own results and reported high satisfaction with the dynamic self-management advice, also reflected in the high number of clicks on those pages. Conclusions: Patient portals can contribute to patient empowerment by offering sought-after information and self-management advice. In our study, the majority of our patients were open to using the portal. The low number of technical complaints and average time spent in the portal demonstrate the feasibility of our patient portal. While initial interest was high, long-term use was considerably lower and identified as the main area for improvement. In a next step, we will improve several aspects of the patient portal (eg, including a reminder to visit the portal before the next appointment and closer PROM symptom monitoring via an onconurse). %M 34100765 %R 10.2196/26022 %U https://www.jmir.org/2021/6/e26022 %U https://doi.org/10.2196/26022 %U http://www.ncbi.nlm.nih.gov/pubmed/34100765 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e23832 %T Older Adults’ Experiences With Using Wearable Devices: Qualitative Systematic Review and Meta-synthesis %A Moore,Kevin %A O'Shea,Emma %A Kenny,Lorna %A Barton,John %A Tedesco,Salvatore %A Sica,Marco %A Crowe,Colum %A Alamäki,Antti %A Condell,Joan %A Nordström,Anna %A Timmons,Suzanne %+ Centre for Gerontology and Rehabilitation, University College Cork, The Bungalow, Block 13, St Finbarrs Hospital, Douglas Road, Cork, T12 Y319, Ireland, 353 857070042, kevin.moore@ucc.ie %K wearable device %K older adult %K digital health %K meta-synthesis %K qualitative review %K acceptance %K adherence %K mobile phone %D 2021 %7 3.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Older adults may use wearable devices for various reasons, ranging from monitoring clinically relevant health metrics or detecting falls to monitoring physical activity. Little is known about how this population engages with wearable devices, and no qualitative synthesis exists to describe their shared experiences with long-term use. Objective: This study aims to synthesize qualitative studies of user experience after a multi-day trial with a wearable device to understand user experience and the factors that contribute to the acceptance and use of wearable devices. Methods: We conducted a systematic search in CINAHL, APA PsycINFO, PubMed, and Embase (2015-2020; English) with fixed search terms relating to older adults and wearable devices. A meta-synthesis methodology was used. We extracted themes from primary studies, identified key concepts, and applied reciprocal and refutational translation techniques; findings were synthesized into third-order interpretations, and finally, a “line-of-argument” was developed. Our overall goal was theory development, higher-level abstraction, and generalizability for making this group of qualitative findings more accessible. Results: In total, we reviewed 20 papers; 2 evaluated fall detection devices, 1 tested an ankle-worn step counter, and the remaining 17 tested activity trackers. The duration of wearing ranged from 3 days to 24 months. The views of 349 participants (age: range 51-94 years) were synthesized. Four key concepts were identified and outlined: motivation for device use, user characteristics (openness to engage and functional ability), integration into daily life, and device features. Motivation for device use is intrinsic and extrinsic, encompassing many aspects of the user experience, and appears to be as, if not more, important than the actual device features. To overcome usability barriers, an older adult must be motivated by the useful purpose of the device. A device that serves its intended purpose adds value to the user’s life. The user’s needs and the support structure around the device—aspects that are often overlooked—seem to play a crucial role in long-term adoption. Our “line-of-argument” model describes how motivation, ease of use, and device purpose determine whether a device is perceived to add value to the user’s life, which subsequently predicts whether the device will be integrated into the user’s life. Conclusions: The added value of a wearable device is the resulting balance of motivators (or lack thereof), device features (and their accuracy), ease of use, device purpose, and user experience. The added value contributes to the successful integration of the device into the daily life of the user. Useful device features alone do not lead to continued use. A support structure should be placed around the user to foster motivation, encourage peer engagement, and adapt to the user’s preferences. %M 34081020 %R 10.2196/23832 %U https://mhealth.jmir.org/2021/6/e23832 %U https://doi.org/10.2196/23832 %U http://www.ncbi.nlm.nih.gov/pubmed/34081020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e18167 %T Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation %A Salari,Raheleh %A R Niakan Kalhori,Sharareh %A GhaziSaeedi,Marjan %A Jeddi,Marjan %A Nazari,Mahin %A Fatehi,Farhad %+ Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, No17, FareDanesh Alley, Oods St., Eghelab Ave, Tehran, 1417653761, Iran, 98 2188982886, sh-rniakank@sina.tums.ac.ir %K type 2 diabetes %K mobile health %K mHealth %K mobile app, self-management %K behavior change %D 2021 %7 2.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis. Objective: This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers. Methods: The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire. Results: The developed mobile app includes modules that support several features. A person’s data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician’s portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app. Conclusions: Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up. %M 34076579 %R 10.2196/18167 %U https://www.jmir.org/2021/6/e18167 %U https://doi.org/10.2196/18167 %U http://www.ncbi.nlm.nih.gov/pubmed/34076579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e22970 %T Using a Mobile App–Based Video Recommender System of Patient Narratives to Prepare Women for Breast Cancer Surgery: Development and Usability Study Informed by Qualitative Data %A Ormel,Ilja %A Onu,Charles C %A Magalhaes,Mona %A Tang,Terence %A Hughes,John B %A Law,Susan %+ Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Rd, Montréal, QC, H2T 1W1, Canada, 1 (514) 345 3511 ext 5060, ilja.ormel@mail.mcgill.ca %K qualitative research %K illness narratives %K experiential information %K breast cancer %K surgery %K tailored information %K recommender system %K patient information and communication %K mobile app %K mobile phone %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Women diagnosed with breast cancer are often bombarded with information. Such information overload can lead to misunderstandings and hamper women’s capacity for making informed decisions about their care. For women with breast cancer, this uncertainty is particularly severe in the period before surgery. Personalized narratives about others’ experiences can help patients better understand the disease course, the quality and type of care to be expected, the clinical decision-making processes, and the strategies for coping. Existing resources and eHealth apps rarely include experiential information, and no tools exist that tailor information for individual preferences and needs—offering the right information at the right time and in the right format. Combining high-quality experiential evidence with novel technical approaches may contribute to patient-centered solutions in this area. Objective: This study aims to design and seek preliminary feedback on a mobile app that will improve information access about surgery for patients with breast cancer, by drawing on a qualitative collection of personal narratives from a diverse sample of Canadian women and using video and audio recordings or audio recordings from the Canadian Health Experiences Research Network. Methods: In a previous study, we conducted in-depth interviews with 35 Canadian women and used video and audio recordings or audio recordings to collect stories about the lived experiences of breast cancer. The participants highlighted the need for more specific information between diagnosis and surgery that was relevant to their personal situations and preferences. They also wanted to learn from other women’s experiences. We worked with patients, clinicians, and informatics experts to develop a mobile app that provides access to tailored experiential information relevant to women’s personal situations and preferences. We completed focus groups and qualitative interviews, conducted a further analysis of the original qualitative data, designed novel software using artificial intelligence, and sought preliminary feedback from users on a new app via focus groups and a survey. Results: The secondary analysis of the breast cancer narratives revealed key themes and their interconnections relevant to the experience of surgery, including preparation, treatment decisions, aftercare, reconstruction, prostheses, lumpectomy and mastectomy, and complications. These themes informed the development of the structure and content of the app. We developed a recommender system within the app by using content matching (user and speaker profiles and user interests and video content) and collaborative filtering to identify clips marked as relevant by the user and by similar users. A 2-minute animated introductory video for users was developed. Pilot testing revealed generally positive responses regarding the content and value of this type of e-tool. Conclusions: Developing reliable, evidence-based tools and apps that are based on diverse collections of people’s experiences of illness offers a novel approach to help manage the plethora of information that women face after a diagnosis of breast cancer. %M 34076582 %R 10.2196/22970 %U https://formative.jmir.org/2021/6/e22970 %U https://doi.org/10.2196/22970 %U http://www.ncbi.nlm.nih.gov/pubmed/34076582 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24156 %T Perceptions and Acceptability of a Smartphone App Intervention (ChildSafe) in Malaysia: Qualitative Exploratory Study %A Yong,Teresa Sui Mien %A Perialathan,Komathi %A Ahmad,Masitah %A Juatan,Nurashma %A Abdul Majid,Liana %A Johari,Mohammad Zabri %+ Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, No 1, Jalan Setia Murni U13/52, Section U13, Shah Alam, 40170, Malaysia, 60 333627600 ext 8612, teresa_yong@yahoo.co.uk %K child safety %K unintentional injuries %K consolidated framework for implementation research (CFIR) %K characteristics of individuals %K Mobile App Rating Scale (MARS) %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Home is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes—they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home. Objective: This study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians. Methods: This study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR. Results: The study revealed users’ perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features. Conclusions: Parents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians. %M 34061039 %R 10.2196/24156 %U https://pediatrics.jmir.org/2021/2/e24156 %U https://doi.org/10.2196/24156 %U http://www.ncbi.nlm.nih.gov/pubmed/34061039 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28961 %T Factors Influencing the Adoption of Contact Tracing Applications: Protocol for a Systematic Review %A Oyibo,Kiemute %A Sahu,Kirti Sundar %A Oetomo,Arlene %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K technology acceptance %K user perception %K adoption %K COVID-19 %K review %K perception %K barrier %K challenge %K effective %K usability %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Following the onset of the COVID-19 pandemic, digital contact tracing apps have become prevalent worldwide in a coordinated effort to curb the spread of COVID-19. However, their uptake has been low and slow due to privacy concerns, the lack of trust and motivational affordances, and their minimalist design. Objective: The objective of this article is to present a protocol for a systematic review of the main factors, including facilitators and barriers, that influence the adoption of contact tracing apps. Methods: We searched seven databases, namely, Scopus, CINAHL, PubMed (MEDLINE), IEEE Xplore Digital Library, Association for Computing Machinery (ACM) Digital Library, Web of Science, and Google Scholar, for relevant publications between October 30, 2020, and January 31, 2021. Three authors were involved in removing duplicates, screening, and selection of relevant articles according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) guidelines. Results: Altogether, we retrieved 777 articles from the seven databases. As of May 14, 2021, we have completed the screening process and arrived at 13 eligible articles to be included in the systematic review. We hope to elicit, summarize, and report the main findings in the systematic review article by the end of August 2021. We expect to uncover facilitators and barriers related to app utility, data security, ease of use, and persuasive design that are deemed important to adoption of contact tracing apps. Conclusions: The findings of the systematic review will help researchers to uncover the gaps in the adoption of contact tracing apps, and decision makers and designers to focus on the principal adoption factors necessary to create better and more effective contact tracing apps. International Registered Report Identifier (IRRID): DERR1-10.2196/28961 %M 33974551 %R 10.2196/28961 %U https://www.researchprotocols.org/2021/6/e28961 %U https://doi.org/10.2196/28961 %U http://www.ncbi.nlm.nih.gov/pubmed/33974551 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26282 %T Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study %A Yoon,Sungwon %A Goh,Hendra %A Nadarajan,Gayathri Devi %A Sung,Sharon %A Teo,Irene %A Lee,Jungup %A Ong,Marcus E H %A Graves,Nicholas %A Teo,Tess Lin %+ Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore, , Singapore, 65 66013198, sungwon.yoon@duke-nus.edu.sg %K COVID-19 %K frontline health care workers %K mHealth %K well-being %K psychosocial %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. Objective: This study aimed to explore frontline workers’ experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. Methods: We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies—those commonly used for mHealth development—to assess participants’ preferences for particular features and their reasoning. Results: A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. Conclusions: Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use. %M 33979296 %R 10.2196/26282 %U https://www.jmir.org/2021/5/e26282 %U https://doi.org/10.2196/26282 %U http://www.ncbi.nlm.nih.gov/pubmed/33979296 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26110 %T Person-Generated Health Data in Women’s Health: Protocol for a Scoping Review %A Karim,Jalisa Lynn %A Talhouk,Aline %+ Department of Obstetrics and Gynecology, University of British Columbia, 593-828 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4111, a.talhouk@ubc.ca %K digital health %K women’s health %K mobile health %K health app %K wearables %K femtech %K self-tracking %K personalized health %K person-generated health data %K patient-generated health data %K scoping review %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The “femtech” market is growing rapidly, and women are some of the largest adopters of digital health technologies. Objective: This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women’s health. The objectives of the scoping review are to identify the various contexts of digital technologies in women’s health and to consolidate women’s views on the usability and acceptability of the devices. Methods: Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Results: Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021. Conclusions: This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women’s health research. International Registered Report Identifier (IRRID): DERR1-10.2196/26110 %M 34047708 %R 10.2196/26110 %U https://www.researchprotocols.org/2021/5/e26110 %U https://doi.org/10.2196/26110 %U http://www.ncbi.nlm.nih.gov/pubmed/34047708 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26442 %T Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study %A Jácome,Cristina %A Almeida,Rute %A Pereira,Ana Margarida %A Amaral,Rita %A Mendes,Sandra %A Alves-Correia,Magna %A Vidal,Carmen %A López Freire,Sara %A Méndez Brea,Paula %A Araújo,Luís %A Couto,Mariana %A Antolín-Amérigo,Darío %A de la Hoz Caballer,Belén %A Barra Castro,Alicia %A Gonzalez-De-Olano,David %A Todo Bom,Ana %A Azevedo,João %A Leiria Pinto,Paula %A Pinto,Nicole %A Castro Neves,Ana %A Palhinha,Ana %A Todo Bom,Filipa %A Costa,Alberto %A Chaves Loureiro,Cláudia %A Maia Santos,Lilia %A Arrobas,Ana %A Valério,Margarida %A Cardoso,João %A Emiliano,Madalena %A Gerardo,Rita %A Cidrais Rodrigues,José Carlos %A Oliveira,Georgeta %A Carvalho,Joana %A Mendes,Ana %A Lozoya,Carlos %A Santos,Natacha %A Menezes,Fernando %A Gomes,Ricardo %A Câmara,Rita %A Rodrigues Alves,Rodrigo %A Moreira,Ana Sofia %A Bordalo,Diana %A Alves,Carlos %A Ferreira,José Alberto %A Lopes,Cristina %A Silva,Diana %A Vasconcelos,Maria João %A Teixeira,Maria Fernanda %A Ferreira-Magalhães,Manuel %A Taborda-Barata,Luís %A Cálix,Maria José %A Alves,Adelaide %A Almeida Fonseca,João %+ Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, Porto, 4200-450, Portugal, 351 225 513 622, cristinajacome.ft@gmail.com %K mHealth %K smartphone %K technology assessment %K medication adherence %K self-management %K gamification %K patient participation %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients’ asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app. %M 34032576 %R 10.2196/26442 %U https://mhealth.jmir.org/2021/5/e26442 %U https://doi.org/10.2196/26442 %U http://www.ncbi.nlm.nih.gov/pubmed/34032576 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26573 %T An App-Based Intervention to Support First Responders and Essential Workers During the COVID-19 Pandemic: Needs Assessment and Mixed Methods Implementation Study %A Vilendrer,Stacie %A Amano,Alexis %A Brown Johnson,Cati G %A Favet,Marissa %A Safaeinili,Nadia %A Villasenor,Jacqueline %A Shaw,Jonathan G %A Hertelendy,Attila J %A Asch,Steven M %A Mahoney,Megan %+ Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, Mail Code 5475, Stanford, CA, 94305, United States, 1 650 736 5211, staciev@stanford.edu %K COVID-19 %K pandemic %K health literacy %K social media %K quality improvement %K police %K emergency responders %K physicians %K disasters %K natural disasters %K health behavior %K literacy %K app %K intervention %K adoption %K accessibility %K usability %K support %K testing %D 2021 %7 20.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has created unprecedented challenges for first responders (eg, police, fire, and emergency medical services) and nonmedical essential workers (eg, workers in food, transportation, and other industries). Health systems may be uniquely suited to support these workers given their medical expertise, and mobile apps can reach local communities despite social distancing requirements. Formal evaluation of real-world mobile app–based interventions is lacking. Objective: We aimed to evaluate the adoption, acceptability, and appropriateness of an academic medical center–sponsored app-based intervention (COVID-19 Guide App) designed to support access of first responders and essential workers to COVID-19 information and testing services. We also sought to better understand the COVID-19–related needs of these workers early in the pandemic. Methods: To understand overall community adoption, views and download data of the COVID-19 Guide App were described. To understand the adoption, appropriateness, and acceptability of the app and the unmet needs of workers, semistructured qualitative interviews were conducted by telephone, by video, and in person with first responders and essential workers in the San Francisco Bay Area who were recruited through purposive, convenience, and snowball sampling. Interview transcripts and field notes were qualitatively analyzed and presented using an implementation outcomes framework. Results: From its launch in April 2020 to September 2020, the app received 8262 views from unique devices and 6640 downloads (80.4% conversion rate, 0.61% adoption rate across the Bay Area). App acceptability was mixed among the 17 first responders interviewed and high among the 10 essential workers interviewed. Select themes included the need for personalized and accurate information, access to testing, and securing personal safety. First responders faced additional challenges related to interprofessional coordination and a “culture of heroism” that could both protect against and exacerbate health vulnerability. Conclusions: First responders and essential workers both reported challenges related to obtaining accurate information, testing services, and other resources. A mobile app intervention has the potential to combat these challenges through the provision of disease-specific information and access to testing services but may be most effective if delivered as part of a larger ecosystem of support. Differentiated interventions that acknowledge and address the divergent needs between first responders and non–first responder essential workers may optimize acceptance and adoption. %M 33878023 %R 10.2196/26573 %U https://www.jmir.org/2021/5/e26573 %U https://doi.org/10.2196/26573 %U http://www.ncbi.nlm.nih.gov/pubmed/33878023 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e27205 %T Usability Testing of a Digital Assessment Routing Tool: Protocol for an Iterative Convergent Mixed Methods Study %A Lowe,Cabella %A Hanuman Sing,Harry %A Browne,Mitchell %A Alwashmi,Meshari F %A Marsh,William %A Morrissey,Dylan %+ Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Bancroft Road, London, E1 4DG, United Kingdom, 44 7976315105, c.lowe@qmul.ac.uk %K mHealth %K mobile health %K eHealth %K digital health %K digital technology %K musculoskeletal injury %K musculoskeletal conditions %K triage %K physiotherapy triage %K usability %K acceptability %D 2021 %7 18.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on millions of patients and an increasing burden on health care utilization. Digital technologies that improve health care outcomes and efficiency are considered a priority; however, innovations are often inadequately developed and poorly adopted. Further, they are rarely tested with sufficient rigor in clinical trials—the gold standard for clinical proof of efficacy. We have developed a new musculoskeletal Digital Assessment Routing Tool (DART) that allows users to self-assess and be directed to the right care. DART requires usability testing in preparation for clinical trials. Objective: This study will use the iterative convergent mixed methods design to assess and mitigate all serious usability issues to optimize user experience and adoption. Using this methodology, we will provide justifiable confidence to progress to full-scale randomized controlled trials when DART is integrated into clinical management pathways. This study protocol will provide a blueprint for future usability studies of mobile health solutions. Methods: We will collect qualitative and quantitative data from 20-30 participants aged 18 years and older for 4 months. The exact number of participants recruited will be dependent on the number of iterative cycles required to reach the study end points. Building on previous internal testing and stakeholder involvement, quantitative data collection is defined by the constructs within the ISO 9241-210-2019 standard and the system usability scale, providing a usability score for DART. Guided by the participant responses to quantitative questioning, the researcher will focus the qualitative data collection on specific usability problems. These will then be graded to provide the rationale for further DART system improvements throughout the iterative cycles. Results: This study received approval from the Queen Mary University of London Ethics of Research Committee (QMREC2018/48/048) on June 4, 2020. At manuscript submission, study recruitment was on-going, with data collection to be completed and results published in 2021. Conclusions: This study will provide evidence concerning mobile health DART system usability and acceptance determining system improvements required to support user adoption and minimize suboptimal system usability as a potential confounder within subsequent noninferiority clinical trials. Success should produce a safe effective system with excellent usability, facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This deliberately rigorous approach to mobile health innovation could be used as a guide for other developers of similar apps. International Registered Report Identifier (IRRID): DERR1-10.2196/27205 %M 34003135 %R 10.2196/27205 %U https://www.researchprotocols.org/2021/5/e27205 %U https://doi.org/10.2196/27205 %U http://www.ncbi.nlm.nih.gov/pubmed/34003135 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e25316 %T User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study %A Lopes,Filipa %A Rodrigues,Mário %A Silva,Anabela G %+ Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234247119 ext 27120, asilva@ua.pt %K pain assessment %K mobile app %K validity %K reliability %K usability %K mHealth %K pain %K user-centered design %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain-related mobile apps targeting pain assessment commonly limit pain assessment to pain behaviors and physiological aspects. However, current guidelines state that pain assessment should follow the biopsychosocial model, clearly addressing biological, psychological, and social aspects of the pain experience. Existing reviews also highlight that pain specialists and end users are not commonly involved in the development process of mobile apps for pain assessment, negatively affecting the quality of the available apps. Objective: This study aimed to develop a mobile app for pain assessment (AvaliaDor) and assess its usability, validity, reliability, and measurement error in a sample of real patients with chronic pain recruited from a physiotherapy clinic. Methods: This study was divided into 2 phases: phase 1—development of the AvaliaDor app; and phase 2—assessment of the apps’ usability, reliability, measurement error, and validity. AvaliaDor was developed (phase 1) based on the literature and the recommendations of physiotherapists and patients with pain in cycles of evaluation, inclusion of recommendations, and reevaluation until no further changes were required. The final version of the app was then tested in patients with musculoskeletal pain attending a private physiotherapy practice (phase 2) who were asked to use the app twice on 2 consecutive days for reliability purposes. In addition, participants had to complete a set of paper-based scales (Brief Pain Inventory, painDETECT, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia), which were used to assess the validity (criterion validity and hypothesis testing) of the app, and the Post-Study System Usability Questionnaire was used to assess its usability. Results: The development process (phase 1) included 5 physiotherapists external to the research team and 5 patients with musculoskeletal pain, and it resulted in the creation of an app named AvaliaDor, which includes an assessment of pain intensity, location, and phenotype; associated disability; and the issues of pain catastrophizing and fear of movement. A total of 52 patients with pain (mean age 50.12 years, SD 11.71 years; 39 females) participated in phase 2 and used the app twice. The Pearson correlation coefficient between the scores on the paper-based scales and the app ranged between 0.81 and 0.93 for criterion validity and between 0.41 and 0.59 for hypothesis testing. Test-retest reliability was moderate to good (intraclass correlation coefficient between 0.67 and 0.90) and the score for usability was 1.16 (SD 0.27), indicating good usability. Conclusions: A mobile app named AvaliaDor was developed to assess the intensity, location, and phenotype of pain; associated disability; and the issues of pain catastrophizing and fear of movement in a user-centered design process. The app was shown to be usable, valid, and reliable for assessing pain from a biopsychosocial perspective in a heterogeneous group of patients with pain. Future work can explore the long-term use of AvaliaDor in clinical contexts and its advantages for the assessment and management of patients with pain. %M 33988515 %R 10.2196/25316 %U https://mhealth.jmir.org/2021/5/e25316 %U https://doi.org/10.2196/25316 %U http://www.ncbi.nlm.nih.gov/pubmed/33988515 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e17189 %T Acceptability of the Pregnancy, Exercise, and Nutrition Research Study With Smartphone App Support (PEARS) and the Use of Mobile Health in a Mixed Lifestyle Intervention by Pregnant Obese and Overweight Women: Secondary Analysis of a Randomized Controlled Trial %A Greene,Ellen M %A O'Brien,Eileen C %A Kennelly,Maria A %A O'Brien,Orna A %A Lindsay,Karen L %A McAuliffe,Fionnuala M %+ UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Dublin 2, Ireland, 353 637 3216, fionnuala.mcauliffe@ucd.ie %K pregnancy %K mHealth %K nutrition %K lifestyle %K acceptability %K app %K mobile phone %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietary interventions can improve pregnancy outcomes among women with increased BMI. Although the interest in mobile health interventions is growing, little is known about the acceptability of smartphone apps to support lifestyle interventions in such a cohort. Objective: We aimed to assess the acceptability of the pregnancy, exercise, and nutrition research study with smartphone app support (PEARS) and the use of mobile health in a mixed lifestyle intervention delivered to overweight and obese pregnant women. Methods: PEARS was a randomized controlled trial of a low glycemic index dietary intervention with exercise prescription and a smartphone app, which was delivered to pregnant women who were overweight or obese. Acceptability questionnaires were completed by the intervention group at 28 weeks of gestation (n=149) and at postintervention (n=123). Maternal characteristics were recorded (ie, age, ethnicity, BMI, socioeconomic status). Associations between maternal characteristics and acceptability of the intervention and app were analyzed using two-tailed t tests, Mann-Whitney U tests, chi-square test, and logistic regression. One-on-one semistructured interviews were conducted with a subcohort of the intervention participants (n=28) at 34 weeks of gestation, in which the participants shared their experiences of the PEARS intervention. Results: The intervention was generally accepted, with respondents agreeing that the diet was easy to follow (98/148, 68.5%), enjoyable (106/148, 74.1%), and affordable (110/148, 76.9%). Qualitative and quantitative results were consistent with each another, both demonstrating that app acceptability was high. The participants agreed that the app was enjoyable (96/120, 80.0%) and easy to use (116/119, 97.5%). Compared to those with tertiary education, those with lower education levels were more likely to enjoy the dietary changes (P=.04). Enjoyment of the app was associated with disadvantaged neighborhood deprivation index (P=.01) and higher BMI (P=.03). Conclusions: The PEARS intervention and use of a supportive smartphone app were accepted by pregnant women, particularly by those from vulnerable subgroups of this population. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 29316280; https://www.isrctn.com/ISRCTN29316280 %M 33978597 %R 10.2196/17189 %U https://mhealth.jmir.org/2021/5/e17189 %U https://doi.org/10.2196/17189 %U http://www.ncbi.nlm.nih.gov/pubmed/33978597 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22599 %T Smartphone Usage Among Doctors in the Clinical Setting in Two Culturally Distinct Countries: Cross-sectional Comparative Study %A Nair,Anjali Ajay %A Afroz,Samreen %A Ahmed,Bushra Urooj %A Ahmed,Uzma Urooj %A Foo,Chi Chung %A Zaidan,Hind %A Corbally,Martin %+ School of Medicine, RCSI Bahrain, Building No. 2441, Road 2835, Busaiteen, Bahrain, 852 6759 5753, 14034735@rcsi.com %K smartphone use %K mobile phone %K mobile technology %K smartphone technology %K medical apps %K mobile applications %K smartphone applications %K mHealth %K mobile health %K digital health %K medical informatics %K internet %K doctors %K patient care %K point of care %K Bahrain %K Hong Kong %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones and mobile applications have seen a surge in popularity in recent years, a pattern that has also been reflected in the health care system. Despite increased reliance among clinicians however, limited research has been conducted on the uptake and impact of smartphone usage in medical practice, especially outside the Western world. Objective: This study aimed to identify the usage of smartphones and medical apps by doctors in the clinical setting in 2 culturally distinct countries: King Hamad University Hospital (KHUH), Bahrain and Queen Mary Hospital (QMH), Hong Kong. Methods: A cross-sectional, comparative study was conducted where doctors in both hospitals were asked to take part in a 15-item online survey. The questions were categorized into the following groups: demographics of the study population, ownership and main use of smartphones, number and names of medical apps currently owned, rating usage of smartphones for medical purposes, time spent on a smartphone related to clinical use, clinical reliance on smartphones, and views on further integration of smartphones. The results were then tabulated and analyzed using SPSS Statistics 25 for Mac (IBM Corp Inc, Armonk, NY). Results: A total of 200 doctors were surveyed, with a total of 99.0% (99/100) of the doctors owning a smartphone in both KHUH and QMH; 58% (57/99) and 55% (54/99) of the doctors from KHUH and QMH, respectively, identified communication as their main use of smartphones in the clinical setting (P=.004). Doctors from KHUH were likely to spend more time on medical apps than doctors from QMH (P=.002). According to the overall results of both hospitals, 48% (32/67) of the junior doctors claimed high reliance on smartphones, whereas only 32.3% (41/127) of the senior doctors said the same (P=.03). Of doctors in KHUH and QMH, 78.0% (78/100) and 69.0% (69/100), respectively, either strongly agreed or agreed that smartphones need to be integrated into the clinical setting. In terms of preferences for future apps, 48% (48/100) and 56% (56/100) of the doctors in KHUH and QMH, respectively, agreed that more medical applications need to be created in order to support smartphone use in the clinical setting. Conclusions: These results suggest a substantial acceptance of smartphones by doctors in the clinical setting. It also elicits the need to establish policies to officially integrate smartphone technology into health care in accordance with ethical guidelines. More emphasis should be placed on creating medical applications that aid health care professionals in attaining their information from accurate sources and also regulate a system to monitor the usage of mobile devices within hospitals to prevent a breach of patient privacy and confidentiality. %M 33970119 %R 10.2196/22599 %U https://mhealth.jmir.org/2021/5/e22599 %U https://doi.org/10.2196/22599 %U http://www.ncbi.nlm.nih.gov/pubmed/33970119 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18096 %T Usability and Acceptance of Wearable Biosensors in Forensic Psychiatry: Cross-sectional Questionnaire Study %A de Looff,Pieter Christiaan %A Nijman,Henk %A Didden,Robert %A Noordzij,Matthijs L %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, Netherlands, 31 030 2256405, peterdelooff@gmail.com %K forensic psychiatry %K wearable biosensors %K intellectual disabilities %K usability %K acceptance %K continuous use %K emotion regulation %K behavior regulation %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of wearable biosensor devices for monitoring and coaching in forensic psychiatric settings yields high expectations for improved self-regulation of emotions and behavior in clients and staff members. More so, if clients have mild intellectual disabilities (IQ 50-85), they might benefit from these biosensors as they are easy to use in everyday life, which ensures that clients can practice with the devices in multiple stress and arousal-inducing situations. However, research on (continuous) use and acceptance of biosensors in forensic psychiatry for clients with mild intellectual disabilities and their caretakers is scarce. Although wearable biosensors show promise for health care, recent research showed that the acceptance and continuous use of wearable devices in consumers is not as was anticipated, probably due to low expectations. Objective: The main goal of this study was to investigate the associations between and determinants of the expectation of usability, the actual experienced usability, and the intention for continuous use of biosensors. Methods: A total of 77 participants (31 forensic clients with mild intellectual disabilities and 46 forensic staff members) participated in a 1-week trial. Preceding the study, we selected 4 devices thought to benefit the participants in domains of self-regulation, physical health, or sleep. Qualitative and quantitative questionnaires were used that explored the determinants of usability, acceptance, and continuous use of biosensors. Questionnaires consisted of the System Usability Scale, the Technology Acceptance Model questionnaire, and the extended expectation confirmation model questionnaire. Results: Only the experienced usability of the devices was associated with intended continuous use. Forensic clients scored higher on acceptance and intention for continuous use than staff members. Moderate associations were found between usability with acceptance and continuous use. Staff members showed stronger associations between usability and acceptance (r=.80, P<.001) and usability and continuous use (r=.79, P<.001) than clients, who showed more moderate correlations between usability and acceptance (r=.46, P=.01) and usability and continuous use (r=.52, P=.003). The qualitative questionnaires in general indicated that the devices were easy to use and gave clear information. Conclusions: Contrary to expectations, it was the actual perceived usability of wearing a biosensor that was associated with continuous use and to a much lesser extent the expectancy of usability. Clients scored higher on acceptance and intention for continuous use, but associations between usability and both acceptance and continuous use were markedly stronger in staff members. This study provides clear directions on how to further investigate these associations. For example, whether this is a true effect or due to a social desirability bias in the client group must be investigated. Clients with mild intellectual disabilities might benefit from the ease of use of these devices and their continuing monitoring and coaching apps. For these clients, it is especially important to develop easy-to-use biosensors with a minimum requirement on cognitive capacity to increase usability, acceptance, and continuous use. %M 33970115 %R 10.2196/18096 %U https://formative.jmir.org/2021/5/e18096 %U https://doi.org/10.2196/18096 %U http://www.ncbi.nlm.nih.gov/pubmed/33970115 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22990 %T Commercially Available Apps to Support Healthy Family Meals: User Testing of App Utility, Acceptability, and Engagement %A Mauch,Chelsea E %A Laws,Rachel A %A Prichard,Ivanka %A Maeder,Anthony J %A Wycherley,Thomas P %A Golley,Rebecca K %+ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 8 83038988, chelsea.mauch@csiro.au %K diet %K nutrition %K family %K mobile applications %K behavior modification %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents juggling caregiving and paid employment encounter a range of barriers in providing healthy food to their families. Mobile apps have the potential to help parents in planning, purchasing, and preparing healthy family food. The utility and acceptability of apps for supporting parents are unknown. User perspectives of existing technology, such as commercially available apps, can guide the development of evidence-based apps in the future. Objective: This study aims to determine the feasibility of existing commercially available apps for supporting the healthy food provision practices of working parents. Methods: Working parents (N=133) were recruited via the web and completed a 10-item Capability, Opportunity, Motivation, and Behavior (COM-B) self-evaluation survey assessing their needs in relation to the provision of healthy family meals. A total of 5 apps were selected for testing, including a meal planning app, recipe app, recipe manager app, family organizer app, and barcode scanning app. Survey items were mapped to app features, with a subsample of parents (67/133, 50.4%) allocated 2 apps each to trial simultaneously over 4 weeks. A semistructured interview exploring app utility and acceptability and a web-based survey, including the System Usability Scale and the user version of the Mobile App Rating Scale, followed app testing. The interview data were analyzed using a theoretical thematic approach. Results: Survey participants (N=133; mean age 34 years, SD 4 years) were mainly mothers (130/133, 97.7%) and partnered (122/133, 91.7%). Participants identified a need for healthy recipes (109/133, 82% agreed or strongly agreed) and time for food provision processes (107/133, 80.5%). Engagement quality was the lowest rated domain of the user version of the Mobile App Rating Scale across all 5 apps (mean score per app ranging from 3.0 to 3.7 out of a maximum of 5). The family organizer, requiring a high level of user input, was rated the lowest for usability (median 48, IQR 34-73). In the interviews, participants weighed the benefits of the apps (ie, time saving) against the effort involved in using them in determining their acceptability. Organization was a subtheme emerging from interviews, associated with the use of meal planners and shopping lists. Meal planners and shopping lists were used in time, while behavior was occurring. Conclusions: Meal planning apps and features promoting organization present feasible, time-saving solutions to support healthy food provision practices. Attention must be paid to enhancing app automation and integration, as well as recipe and nutrition content, to ensure that apps do not add to the time burden of food provision and are supportive of healthy food provision behavior in time. %M 33960951 %R 10.2196/22990 %U https://mhealth.jmir.org/2021/5/e22990 %U https://doi.org/10.2196/22990 %U http://www.ncbi.nlm.nih.gov/pubmed/33960951 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25011 %T The Smartphone App haMSter for Tracking Patient-Reported Outcomes in People With Multiple Sclerosis: Protocol for a Pilot Study %A Altmann,Patrick %A Hinterberger,Werner %A Leutmezer,Fritz %A Ponleitner,Markus %A Monschein,Tobias %A Zrzavy,Tobias %A Zulehner,Gudrun %A Kornek,Barbara %A Lanzenberger,Rupert %A Berek,Klaus %A Rommer,Paulus Stefan %A Berger,Thomas %A Bsteh,Gabriel %+ Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria, 43 14040031450, gabriel.bsteh@meduniwien.ac.at %K mHealth %K mobile health %K remote monitoring %K patient-reported outcomes %K multiple sclerosis %K telemedicine %D 2021 %7 7.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Treatment and monitoring decisions in people with multiple sclerosis (MS) are based commonly on clinician-reported outcomes. These reflect physical and radiological disease activity and are the most relevant endpoints in clinical trials. Over the past few years, the number of studies evaluating so-called patient-reported outcomes (PROs) has been increasing. PROs are reports from patients concerning their own health perception. They are typically obtained by means of questionnaires and aim to quantify symptoms such as fatigue, depression, and sexual dysfunction. The emergence of PROs has made a tremendous contribution to understanding the individual impact of disease in people with MS and their health-related quality of life. However, the assessment of PROs consumes resources, including time and personnel. Thus, useful ways to conveniently introduce PROs into clinical practice are needed. Objective: We aim to provide a rationale and pilot study protocol for a mobile health (mHealth) solution named “haMSter” that allows for remote monitoring of PROs in people with MS. Methods: The core function of haMSter is to provide three scientifically validated PRO questionnaires relevant to MS for patients to fill out at home once a month. Thereby, longitudinal and remote documentation of PROs is enabled. A scoring algorithm graphically plots PRO scores over time and makes them available at the next visit. Results: The pilot study is currently ongoing and will evaluate adherence to this mHealth solution in 50 patients over a period of 6 months. Results from the haMSter pilot study are expected in 2021. Conclusions: haMSter is a novel mHealth-based solution for modern PRO research, which may constitute the first step in achieving the ability to integrate PROs in clinical practice. This allows for a more problem-oriented approach in monitoring visits, which addresses patient needs and ultimately saves time. Trial Registration: ClinicalTrials.gov NCT04555863; https://clinicaltrials.gov/ct2/show/NCT04555863 International Registered Report Identifier (IRRID): DERR1-10.2196/25011 %M 33960949 %R 10.2196/25011 %U https://www.researchprotocols.org/2021/5/e25011 %U https://doi.org/10.2196/25011 %U http://www.ncbi.nlm.nih.gov/pubmed/33960949 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e20966 %T Usability and Accuracy of a Smartwatch for the Assessment of Physical Activity in the Elderly Population: Observational Study %A Martinato,Matteo %A Lorenzoni,Giulia %A Zanchi,Tommaso %A Bergamin,Alessia %A Buratin,Alessia %A Azzolina,Danila %A Gregori,Dario %+ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Via Leonardo Loredan, 18, Padova, , Italy, 39 049 827 5384, dario.gregori@unipd.it %K wearable devices %K elderly %K physical activity %K smartwatches %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular physical activity (PA) contributes to the primary and secondary prevention of several chronic diseases and reduces the risk of premature death. Physical inactivity is a modifiable risk factor for cardiovascular disease and a variety of chronic disorders such as diabetes, obesity, hypertension, bone and joint diseases (eg, osteoporosis and osteoarthritis), depression, and colon and breast cancer. Population aging and the related increase in chronic diseases have a major impact on the health care systems of most Western countries and will produce an even more significant effect in the future. Monitoring PA is a valuable method of determining whether people are performing enough PA so as to prevent chronic diseases or are showing early symptoms of those diseases. Objective: The aim of this study was to estimate the accuracy of wearable devices in quantifying the PA of elderly people in a real-life setting. Methods: Participants aged 70 to 90 years with the ability to walk safely without any walking aid for at least 300 meters, who had no walking disabilities or episodes of falling while walking in the last 12 months, were asked to walk 150 meters at their preferred pace wearing a vívoactive HR device (Garmin Ltd) and actual steps were monitored and tallied by a researcher using a hand-tally counter to assess the performance of the device at a natural speed. A Bland-Altman plot was used to analyze the difference between manually counted steps and wearable device–measured steps. The intraclass correlation coefficient (ICC) was computed (with a 95% confidence interval) between step measurements. The generalized linear mixed-model (GLMM) ICCs were estimated, providing a random effect term (random intercept) for the individual measurements (gold standard and device). Both adjusted and conditional ICCs were computed for the GLMM models considering separately the effect of age, sex, BMI, and obesity. Analyses were performed using R software (R Foundation for Statistical Computing) with the rms package. Results: A total of 23 females and 26 males were enrolled in the study. The median age of the participants was 75 years. The Bland-Altman plot revealed that, excluding one observation, all differences across measurements were in the confidence bounds, demonstrating the substantial agreement between the step count measurements. The results were confirmed by an ICC equal to .98 (.96-.99), demonstrating excellent agreement between the two sets of measurements. Conclusions: The level of accuracy of wearable devices in quantifying the PA of elderly people in a real-life setting that was found in this study supports the idea of considering wrist-wearable nonmedical devices (widely available in nonspecialized stores) as reliable tools. Both health care professionals and informal caregivers could monitor the level of PA of their patients. %M 33949953 %R 10.2196/20966 %U https://mhealth.jmir.org/2021/5/e20966 %U https://doi.org/10.2196/20966 %U http://www.ncbi.nlm.nih.gov/pubmed/33949953 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e27173 %T Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study %A Szinay,Dorothy %A Perski,Olga %A Jones,Andy %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ School of Health Sciences, University of East Anglia, , Norwich , United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K behavior change %K health apps %K mHealth %K smartphone app %K framework analysis %K Capability, Opportunity, Motivation-Behavior model %K Theoretical Domains Framework %K think aloud %K mobile phone %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health and well-being smartphone apps can provide a cost-effective solution to addressing unhealthy behaviors. The selection of these apps tends to occur in commercial app stores, where thousands of health apps are available. Their uptake is often influenced by popularity indicators. However, these indicators are not necessarily associated with app effectiveness or evidence-based content. Alternative routes to app selection are increasingly available, such as via curated app portals, but little is known about people’s experiences of them. Objective: The aim of this study is to explore how people select health apps on the internet and their views on curated app portals. Methods: A total of 18 UK-based adults were recruited through social media and asked during an in-person meeting to verbalize their thoughts while searching for a health or well-being app on the internet on a platform of their choice. The search was then repeated on 2 curated health app portals: the National Health Service Apps Library and the Public Health England One You App portal. This was followed by semistructured interviews. Data were analyzed using framework analysis, informed by the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework. Results: Searching for health and well-being apps on the internet was described as a minefield. App uptake appeared to be influenced by participants’ capabilities such as app literacy skills and health and app awareness, and opportunities including the availability of apps, app esthetics, the price of an app, and social influences. Motivation factors that seemed to affect the uptake were perceived competence, time efficiency, perceived utility and accuracy of an app, transparency about data protection, commitment and social identity, and a wide range of emotions. Social influences and the perceived utility of an app were highlighted as particularly important. Participants were not previously aware of curated portals but found the concept appealing. Curated health app portals appeared to engender trust and alleviate data protection concerns. Although apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. This disappointment seemed to stem from the functionality of the portals, lack of user guidance, and lack of tailored content to an individual’s needs. Conclusions: The uptake of health and well-being apps appears to be primarily affected by social influences and the perceived utility of an app. App uptake via curated health app portals perceived as credible may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs and expectations. %M 33904827 %R 10.2196/27173 %U https://mhealth.jmir.org/2021/4/e27173 %U https://doi.org/10.2196/27173 %U http://www.ncbi.nlm.nih.gov/pubmed/33904827 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e27290 %T Impact of Gamification on the Self-Efficacy and Motivation to Quit of Smokers: Observational Study of Two Gamified Smoking Cessation Mobile Apps %A Rajani,Nikita B %A Mastellos,Nikolaos %A Filippidis,Filippos T %+ Department of Primary Care and Public Health, Imperial College London, School of Public Health, St. Dunstan's Road, London, W6 8RP, United Kingdom, 44 7427615928, nikita.rajani14@imperial.ac.uk %K gamification %K smoking cessation %K mobile applications %K self-efficacy %K motivation to quit %K mHealth %K mobile phone %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The proportion of smokers making quit attempts and the proportion of smokers successfully quitting have been decreasing over the past few years. Previous studies have shown that smokers with high self-efficacy and motivation to quit have an increased likelihood of quitting and staying quit. Consequently, further research on strategies that can improve the self-efficacy and motivation of smokers seeking to quit could lead to substantially higher cessation rates. Some studies have found that gamification can positively impact the cognitive components of behavioral change, including self-efficacy and motivation. However, the impact of gamification in the context of smoking cessation and mobile health has been sparsely investigated. Objective: This study aims to examine the association between perceived usefulness, perceived ease of use, and frequency of use of gamification features embedded in smoking cessation apps on self-efficacy and motivation to quit smoking. Methods: Participants were assigned to use 1 of the 2 mobile apps for a duration of 4 weeks. App-based questionnaires were provided to participants before app use and 2 weeks and 4 weeks after they started using the app. Gamification was quantitatively operationalized based on the Cugelman gamification framework and concepts from the technology acceptance model. The mean values of perceived frequency, ease of use, and usefulness of gamification features were calculated at midstudy and end-study. Two linear regression models were used to investigate the impact of gamification on self-efficacy and motivation to quit. Results: A total of 116 participants completed the study. The mean self-efficacy increased from 37.38 (SD 13.3) to 42.47 (SD 11.5) points and motivation to quit increased from 5.94 (SD 1.4) to 6.32 (SD 1.7) points after app use. Goal setting was perceived to be the most useful gamification feature, whereas sharing was perceived to be the least useful. Participants self-reported that they used the progress dashboards the most often, whereas they used the sharing feature the least often. The average perceived frequency of gamification features was statistically significantly associated with change in self-efficacy (β=3.35; 95% CI 0.31-6.40) and change in motivation to quit (β=.54; 95% CI 0.15-0.94) between baseline and end-study. Conclusions: Gamification embedded in mobile apps can have positive effects on self-efficacy and motivation to quit smoking. The findings of this study can provide important insights for tobacco control policy makers, mobile app developers, and smokers seeking to quit. %M 33904824 %R 10.2196/27290 %U https://games.jmir.org/2021/2/e27290 %U https://doi.org/10.2196/27290 %U http://www.ncbi.nlm.nih.gov/pubmed/33904824 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24180 %T Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey %A Suruliraj,Banuchitra %A Bessenyei,Kitti %A Bagnell,Alexa %A McGrath,Patrick %A Wozney,Lori %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Dalhousie University, 5850/5980 University Avenue, PO Box 970, Halifax, NS, B3K 6R8, Canada, 1 782 414 8054, sandra.m.meier@gmail.com %K app %K awareness %K behavior %K COVID-19 %K helpfulness %K mobile health %K mobile sensing %K self-management %K sensing %K web-based survey %D 2021 %7 26.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, people had to adapt their daily life routines to the currently implemented public health measures, which is likely to have resulted in a lack of in-person social interactions, physical activity, or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people, thus making them aware of maladaptive behavioral adjustments to the pandemic. Objective: This study aimed to explore the views of people on mobile sensing apps that passively record behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic. Methods: We conducted an anonymous web-based survey including people with and those without mental disorders, asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey was conducted in May 2020. Results: The majority of participants, particularly those with a mental disorder (n=106/148, 72%), perceived mobile sensing apps as very or extremely helpful for managing their mental health by becoming aware of maladaptive behaviors. The perceived helpfulness of mobile sensing apps was also higher among people who experienced a stronger health impact of the COVID-19 pandemic (β=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (β=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (β=.1; 95% CI 0.02-0.19; P=.02). Conclusions: Our findings highlight the potential of mobile sensing apps to assist in mental health care during the pandemic. %M 33872181 %R 10.2196/24180 %U https://formative.jmir.org/2021/4/e24180 %U https://doi.org/10.2196/24180 %U http://www.ncbi.nlm.nih.gov/pubmed/33872181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e27383 %T Results of a Culturally Tailored Smartphone-Delivered Physical Activity Intervention Among Midlife African American Women: Feasibility Trial %A Joseph,Rodney P %A Ainsworth,Barbara E %A Hollingshead,Kevin %A Todd,Michael %A Keller,Colleen %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N 3rd St, Phoenix, AZ, 85004, United States, 1 602 496 0772, rodney.joseph@asu.edu %K exercise %K physical activity %K minority health %K women’s health %K mHealth %K mobile phone %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular aerobic physical activity (PA) is an important component of healthy aging. However, only 27%-40% of African American women achieve national PA guidelines. Available data also show a clear decline in PA as African American women transition from young adulthood (ie, 25-44 years) into midlife. This decline in PA during midlife coincides with an increased risk for African American women developing cardiometabolic disease conditions, including obesity, type 2 diabetes, and cardiovascular disease. Thus, effective efforts are needed to promote PA among sedentary African American women during midlife. Objective: This study aims to examine the acceptability and feasibility of a culturally tailored, smartphone-delivered PA intervention, originally developed to increase PA among African American women aged 24-49 years, among a slightly older sample of midlife African American women aged 50-65 years. Methods: A single-arm pretest-posttest study design was implemented. In total, 20 insufficiently active African American (ie, ≤60 min per week of PA) women between the ages of 50-65 years participated in the 4-month feasibility trial. The Smart Walk intervention was delivered through the study Smart Walk smartphone app and text messages. Features available on the Smart Walk app include personal profile pages, multimedia PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported PA and social cognitive theory mediators targeted by the intervention (ie, self-regulation, behavioral capability, outcome expectations, self-efficacy, and social support) were assessed at baseline and at 4 months. Feasibility and acceptability were assessed using a postintervention satisfaction survey that included multiple-choice and open-ended questions evaluating participant perceptions of the intervention and suggestions for intervention improvement. Wilcoxon signed-rank tests were used to examine pre- and postintervention changes in the PA and social cognitive theory variables. The effect size estimates were calculated using the Pearson r test statistic. Results: Participants increased moderate-to-vigorous PA (median 30 minutes per week increase; r=0.503; P=.002) and reported improvements in 2 theoretical mediators (self-regulation: r=0.397; P=.01; behavioral capability: r=0.440; P=.006). Nearly all participants (14/15, 93% completing the satisfaction survey) indicated that they would recommend the intervention to a friend. Participants’ suggestions for improving the intervention included enhancing the intervention’s provisions of social support for PA. Conclusions: The results provide preliminary support for the feasibility of the smartphone-based approach to increase PA among midlife African American women. However, before larger-scale implementation among midlife African American women, enhancements to the social support components of the intervention are warranted. Trial Registration: ClinicalTrials.gov NCT04073355; https://clinicaltrials.gov/ct2/show/NCT04073355 %M 33885368 %R 10.2196/27383 %U https://mhealth.jmir.org/2021/4/e27383 %U https://doi.org/10.2196/27383 %U http://www.ncbi.nlm.nih.gov/pubmed/33885368 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25160 %T User Perspectives of Diet-Tracking Apps: Reviews Content Analysis and Topic Modeling %A Zečević,Mila %A Mijatović,Dejan %A Kos Koklič,Mateja %A Žabkar,Vesna %A Gidaković,Petar %+ School of Economics and Business, University of Ljubljana, Kardeljeva ploscad 17, Ljubljana, 1000, Slovenia, 386 15892429, mila.zecevic@ef.uni-lj.si %K diet-tracking apps %K mobile apps %K user reviews %K topic modeling %K n-grams %K mHealth %K nutrition %K diet %K well-being %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The availability and use of mobile apps in health and nutrition management are increasing. Ease of access and user friendliness make diet-tracking apps an important ally in their users’ efforts to lose and manage weight. To foster motivation for long-term use and to achieve goals, it is necessary to better understand users’ opinions and needs for dietary self-monitoring. Objective: The aim of this study was to identify the key topics and issues that users highlight in their reviews of diet-tracking apps on Google Play Store. Identifying the topics that users frequently mention in their reviews of these apps, along with the user ratings for each of these apps, allowed us to identify areas where further improvement of the apps could facilitate app use, and support users’ weight loss and intake management efforts. Methods: We collected 72,084 user reviews from Google Play Store for 15 diet-tracking apps that allow users to track and count calories. After a series of text processing operations, two text-mining techniques (topic modeling and topical n-grams) were applied to the corpus of user reviews of diet-tracking apps. Results: Using the topic modeling technique, 11 separate topics were extracted from the pool of user reviews. Most of the users providing feedback were generally satisfied with the apps they use (average rating of 4.4 out of 5 for the 15 apps). Most topics referred to the positive evaluation of the apps and their functions. Negatively rated topics mostly referred to app charges and technical difficulties encountered. We identified the positive and negative topic trigrams (3-word combinations) among the most frequently mentioned topics. Usability and functionality (tracking options) of apps were rated positively on average. Negative ratings were associated with trigrams related to adding new foods, technical issues, and app charges. Conclusions: Motivating users to use an app over time could help them better achieve their nutrition goals. Although user reviews generally showed positive opinions and ratings of the apps, developers should pay more attention to users’ technical problems and inform users about expected payments, along with their refund and cancellation policies, to increase user loyalty. %M 33885375 %R 10.2196/25160 %U https://www.jmir.org/2021/4/e25160 %U https://doi.org/10.2196/25160 %U http://www.ncbi.nlm.nih.gov/pubmed/33885375 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e24482 %T Youth and Provider Perspectives on Behavior-Tracking Mobile Apps: Qualitative Analysis %A Armstrong,Courtney C %A Odukoya,Erica J %A Sundaramurthy,Keerthi %A Darrow,Sabrina M %+ Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, University of California, Berkeley, CA, 94720, United States, 1 9178417015, courtney.armstrong@berkeley.edu %K qualitative %K mHealth %K mobile phone %K behavior monitoring %K youth %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile health apps stand as one possible means of improving evidence-based mental health interventions for youth. However, a better understanding of youth and provider perspectives is necessary to support widespread implementation. Objective: The objective of this research was to explore both youth and provider perspectives on using mobile apps to enhance evidence-based clinical care, with an emphasis on gathering perspectives on behavior-tracking apps. Methods: Inductive qualitative analysis was conducted on data obtained from semistructured interviews held with 10 youths who received psychotherapy and 12 mental health care providers who conducted therapy with youths aged 13-26 years. Interviews were independently coded by multiple coders and consensus meetings were held to establish reliability. Results: During the interviews, the youths and providers broadly agreed on the benefits of behavior tracking and believed that tracking via app could be more enjoyable and accessible. Providers and youths also shared similar concerns that negative emotions and user burden could limit app usage. Participants also suggested potential app features that, if implemented, would help meet the clinical needs of providers and support long-term use among youth. Such features included having a pleasant user interface, reminders for clients, and graphical output of data to clients and providers. Conclusions: Youths and providers explained that the integration of mobile health into psychotherapy has the potential to make treatment, particularly behavior tracking, easy and more accessible. However, both groups had concerns about the increased burden that could be placed on the clients and providers. %M 33885364 %R 10.2196/24482 %U https://mental.jmir.org/2021/4/e24482 %U https://doi.org/10.2196/24482 %U http://www.ncbi.nlm.nih.gov/pubmed/33885364 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25717 %T Perception of Purposeful and Recreational Smartphone Use in Physiotherapy: Randomized Controlled Trial %A Bientzle,Martina %A Restle,Anne %A Kimmerle,Joachim %+ Leibniz-Institut für Wissensmedien, Schleichstr. 6, Tuebingen, 72076, Germany, 49 7071 979 120, m.bientzle@iwm-tuebingen.de %K smartphone use %K phubbing %K physiotherapy %K smartphone %K therapy %K patients %K therapists %K therapeutic %K treatment %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many people constantly use their smartphones in all kinds of situations. Often smartphones are used in a meaningful and targeted way, but frequently they are used as a pastime without any purpose. This also applies to patients and therapists in treatment situations. Objective: The aim of this study was to investigate how purposeful smartphone use compared with recreational smartphone use (by a physiotherapist or by a patient) influenced the perception of a physiotherapeutic treatment situation. We examined the impact of smartphone use during a physiotherapy session on the perception of the physiotherapist, evaluation of attentiveness, and evaluation of smartphone use in physiotherapy in general. Methods: Members of various music and sports clubs were invited to participate in an online randomized controlled trial. Participants were randomly assigned to one of four conditions. They watched a video in which a physiotherapeutic treatment was shown and in which a smartphone was used or not used in the following four different ways: (1) therapeutically purposeful use, (2) recreational use by the physiotherapist (looking at the phone from time to time with no therapeutic purpose), (3) recreational use by the patient, and (4) no smartphone use (control condition). After watching the video, the participants indicated their perception of the physiotherapist’s professional competence, social competence, and empathetic behavior. They also rated the physiotherapist’s and patient’s attentiveness and evaluated the usage of smartphones generally in physiotherapy. Results: The analysis included 118 participants (63 women and 55 men). When the physiotherapist used the smartphone in a purposeful way, the physiotherapist was perceived as more professionally competent (P=.007), socially competent (P=.03), and empathetic (P=.04) than if the physiotherapist used it with no therapeutic purpose. These effects occurred because recreational smartphone use by the physiotherapist was evaluated more negatively than the behavior in the control condition (professional competence: P=.001; social competence: P=.03; empathy: P=.04). Moreover, when the physiotherapist used the smartphone in a recreational way, the physiotherapist was perceived as being less attentive (P<.001). Likewise, when the patient used the smartphone in a recreational way, the patient was perceived as being less attentive (P<.001). Finally, smartphone use in physiotherapy was rated as more positive in general when the smartphone was used in a purposeful way compared with the conditions in which the physiotherapist or patient looked at the smartphone with no therapeutic purpose (P<.001). This positive evaluation occurred because purposeful use led to a more positive rating than no smartphone use (P<.001, R=0.42). Conclusions: Smartphones are only appropriate for therapists and patients if they are used directly for a therapeutic purpose. Otherwise, it is better not to use smartphones during treatment. Trial Registration: AsPredicted (aspredicted.org) #24740; https://aspredicted.org/blind.php?x=vv532i %M 33881402 %R 10.2196/25717 %U https://mhealth.jmir.org/2021/4/e25717 %U https://doi.org/10.2196/25717 %U http://www.ncbi.nlm.nih.gov/pubmed/33881402 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23784 %T Acceptance, Barriers, and Future Preferences of Mobile Health Among Patients Receiving Trauma and Orthopedic Surgical Care: Paper-Based Survey in a Prospective Multicenter Study %A Reinecke,Felix %A Dittrich,Florian %A Dudda,Marcel %A Stang,Andreas %A Polan,Christina %A Müller,Roman %A Beck,Paula %A Kauther,Max Daniel %+ Department of Orthopedics and Orthopedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrberger Straße, Building 37-38, Homburg, 66421, Germany, 49 68411624520, florian.dittrich@uks.eu %K smartphone %K mHealth %K app %K orthopedics %K trauma surgery %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones have become an essential part of everyday life and it is undeniable that apps offer enormous opportunities for dealing with future challenges in public health. Nevertheless, the exact patient requirements for medical apps in the field of orthopedic and trauma surgery are currently unknown. Objective: The aim of this study was to define target groups, evaluate patient requirements, and the potential and pitfalls regarding medical apps specific for patients receiving orthopedic and trauma surgical care. Methods: A prospective multicenter study was conducted between August 2018 and December 2019 at a German trauma center and 3 trauma surgery/orthopedic practices. A paper-based survey consisting of 15 questions evaluated information regarding smartphone and medical app usage behavior. In addition, suggested app functions were rated using Likert scales. Descriptive statistics and binary log-binomial regression were performed. Results: A total of 1055 questionnaires were included in our statistical analysis. Approximately 89.57% (945/1055) of the patients in this study owned a smartphone. Smartphone ownership probability decreased with every decade of life and increased with higher levels of education. Medical information was obtained via mobile web access by 62.65% (661/1055) of the patients; this correlated with smartphone ownership in regard to age and educational level. Only 11.18% (118/1055) of the patients reported previous medical app usage, and 3.50% (37/1055) of the patients received an app recommendation from a physician. More than half (594/1055, 56.30%) of the patients were unwilling to pay for a medical app. The highest rated app functions were information about medication, behavioral guidelines, and medical record archival. An improved treatment experience was reported through the suggested app features by 71.18% (751/1055) of the patients. Conclusions: Mobile devices are a widely used source of information for medical content, but only a minority of the population reported previous medical app usage. The main target group for medical apps among patients receiving orthopedic and trauma surgical care tends to be the younger population, which results in a danger of excluding fringe groups, especially the older adults. Education seems to be one of the most important pull factors to use smartphones or a mobile web connection to obtain health information. Medical apps primarily focusing on an optimized patient education and flow of information seem to have the potential to support patients in health issues, at least in their subjective perception. For future target group–oriented app developments, further evidence on the clinical application, feasibility, and acceptance of app usage are necessary in order to avoid patient endangerment and to limit socioeconomic costs. %M 33881401 %R 10.2196/23784 %U https://mhealth.jmir.org/2021/4/e23784 %U https://doi.org/10.2196/23784 %U http://www.ncbi.nlm.nih.gov/pubmed/33881401 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e19564 %T Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study %A Palotai,Miklos %A Wallack,Max %A Kujbus,Gergo %A Dalnoki,Adam %A Guttmann,Charles %+ Center for Neurological Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA, 02215, United States, 1 617 278 0613, palotai@bwh.harvard.edu %K multiple sclerosis %K fatigue %K depression %K mobile application %K mobile phone %K real-time assessment %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited. Objective: This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity. Methods: After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal. Results: Of 64 patients, 56 (88%) used the app, of which 51 (91%) completed all one-time questionnaires and 47 (84%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance. Conclusions: The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity. %M 33861208 %R 10.2196/19564 %U https://mhealth.jmir.org/2021/4/e19564 %U https://doi.org/10.2196/19564 %U http://www.ncbi.nlm.nih.gov/pubmed/33861208 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24184 %T Gender Differences in Satisfaction With a Text Messaging Program (Text4Hope) and Anticipated Receptivity to Technology-Based Health Support During the COVID-19 Pandemic: Cross-sectional Survey Study %A Shalaby,Reham %A Vuong,Wesley %A Hrabok,Marianne %A Gusnowski,April %A Mrklas,Kelly %A Li,Daniel %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russell %A Greenshaw,Andrew James %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K COVID-19 %K Text4Hope %K satisfaction %K mobile phone %K text %K anxiety %K depression %K stress, pandemic %K e-mental health %K gender %D 2021 %7 15.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In March 2020, Text4Hope—a community health service—was provided to Alberta residents. This free service aims to promote psychological resilience and alleviate pandemic-associated stress, anxiety, and depression symptoms during the COVID-19 pandemic. Objective: This study aimed to evaluate the feedback, satisfaction, experience, and perceptions of Text4Hope subscribers and to examine any differences based on gender after subscribers received 6 weeks of daily supportive text messages. Additionally, this study examined subscribers’ anticipated receptivity to technology-based medical services that could be offered during major crises, emergencies, or pandemics. Methods: Individuals self-subscribed to Text4Hope to receive daily supportive text messages for 3 months. Subscribers were invited to complete a web-based survey at 6 weeks postintervention to provide service satisfaction–related information. Overall satisfaction was assessed on a scale of 0-10, and satisfaction scores were analyzed using a related-measures t test. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope program. Gender differences were analyzed using one-way analysis of variance (ANOVA) and Chi-square analyses. Results: A total of 2032 subscribers completed the baseline and 6-week surveys; 1788 (88%) were female, 219 (10.8%) were male, and 25 (1.2%) were other gender. The mean age of study participants was 44.58 years (SD 13.45 years). The mean overall satisfaction score was 8.55 (SD 1.78), suggesting high overall satisfaction with Text4Hope. The ANOVA analysis, which was conducted using the Welch test (n=1716), demonstrated that females had significantly higher mean satisfaction scores than males (8.65 vs 8.11, respectively; mean difference=0.546; 95% CI 0.19 to 0.91; P<.001) and nonsignificantly lower satisfaction scores than other gender respondents (mean difference=−0.938; 95% CI −0.37 to 2.25; P=.15). More than 70% of subscribers agreed that Text4Hope helped them cope with stress (1334/1731, 77.1%) and anxiety (1309/1728, 75.8%), feel connected to a support system (1400/1729, 81%), manage COVID-19–related issues (1279/1728, 74%), and improve mental well-being (1308/1731, 75.6%). Similarly, subscribers agreed that messages were positive, affirmative, and succinct. Messages were always or often read by 97.9% (1681/1716) of respondents, and more than 20% (401/1716, 23.4%) always or often returned to messages. The majority of subscribers (1471/1666, 88.3%) read the messages and either reflected upon them or took a positive action. Subscribers welcomed almost all technology-based services as part of their health care during crisis or emergency situations. Text4Hope was perceived to be effective by many female subscribers, who reported higher satisfaction and improved coping after receiving text messages for 6 weeks. Conclusions: Respondents affirmed the high quality of the text messages with their positive feedback. Technology-based services can provide remotely accessible and population-level interventions that align with the recommended physical distancing practices for pandemics. Text4Hope subscriber feedback revealed high satisfaction and acceptance at 6 weeks postintervention. International Registered Report Identifier (IRRID): RR2-10.2196/19292 %M 33750738 %R 10.2196/24184 %U https://mhealth.jmir.org/2021/4/e24184 %U https://doi.org/10.2196/24184 %U http://www.ncbi.nlm.nih.gov/pubmed/33750738 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24976 %T Feasibility and Acceptability of a Smoking Cessation Smartphone App (My QuitBuddy) in Older Persons: Pilot Randomized Controlled Trial %A Peek,Jenny %A Hay,Karen %A Hughes,Pauline %A Kostellar,Adrienne %A Kumar,Subodh %A Bhikoo,Zaheerodin %A Serginson,John %A Marshall,Henry M %+ The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Level 2, Admin Building, Rode Rd, Chermside, 4032, Australia, 61 (07) 3139 6802, jenny.peek@health.qld.gov.au %K mHealth %K mobile apps %K motivation %K smartphone %K smoking cessation %K tobacco smoking %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although many smoking cessation smartphone apps exist, few have been independently evaluated, particularly in older populations. In 2017, of the 112 commercially available smoking cessation apps in Australia, only 6 were deemed to be of high quality, in that they partially adhered to Australian guidelines. Mobile health (mHealth) apps have the potential to modify smoking behavior at a relatively low cost; however, their acceptability in older smokers remains unknown. Rigorous scientific evaluation of apps is thus urgently needed to assist smokers and clinicians alike. Objective: We conducted a pilot randomized controlled trial to evaluate the feasibility of a large-scale trial to assess the use and acceptability of a high-quality smoking cessation app in older smokers. Methods: Adult inpatient and outpatient smokers with computer and smartphone access were recruited face to face and via telephone interviews from Metropolitan Hospitals in Brisbane, Australia. Participants were randomized 1:1 to the intervention (requested to download the “My QuitBuddy” smoking cessation app on their smartphone) or the control group (provided access to a tailored smoking cessation support webpage [Quit HQ]). The My QuitBuddy app is freely available from app stores and provides personalized evidenced-based smoking cessation support. Quit HQ offers regular email support over 12 weeks. No training or instructions on the use of these e-resources were given to participants. Outcomes at 3 months included recruitment and retention rates, use and acceptability of e-resource (User Version of the Mobile App Rating Scale [uMARS]), changes in quitting motivation (10-point scale), and self-reported smoking abstinence. Results: We randomized 64 of 231 potentially eligible individuals (27.7%). The mean age of participants was 62 (SD 8). Nicotine dependence was moderate (mean Heaviness of Smoking Index [HSI] 2.8 [SD 1.2]). At 3 months the retention rate was (58/64, 91%). A total of 15 of 31 participants in the intervention arm (48%) used the app at least once, compared with 10 of 33 (30%) in the control arm. uMARS scores for e-resource use and acceptability were statistically similar (P=.29). Motivation to quit was significantly higher in the intervention arm compared with the control arm (median 6 [IQR 4-8] versus 4 [IQR 4-5], respectively, P=.02). According to the intention-to-treat analysis, smoking abstinence was nonsignificantly higher in the intervention group (4/31 [13%], 95% CI 4%-30%, versus 2/33 [6%], 95% CI 1%-20%; P=.42). The estimated number needed to treat was 14. Conclusions: Internet and mHealth smoking cessation resources appear acceptable to a minority of older smokers. Smokers who engaged with the allocated e-resources rated them equally, and there were trends toward greater uptake, increased motivation, and higher abstinence rates in the app group; however, only the change in motivation reached statistical significance (median score 6 versus 4, respectively, P=.02). This results of this pilot study suggest that apps may improve quit outcomes in older adults who are willing to use them. Further research into user–app interactions should be undertaken to facilitate improvements in app design and consumer engagement. These favorable trends should be explored in larger trials with sufficient statistical power. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000159156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376849&isReview=true %M 33851923 %R 10.2196/24976 %U https://formative.jmir.org/2021/4/e24976 %U https://doi.org/10.2196/24976 %U http://www.ncbi.nlm.nih.gov/pubmed/33851923 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24271 %T A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study %A Bakogiannis,Constantinos %A Tsarouchas,Anastasios %A Mouselimis,Dimitrios %A Lazaridis,Charalampos %A Theofillogianakos,Efstratios K %A Billis,Antonios %A Tzikas,Stergios %A Fragakis,Nikolaos %A Bamidis,Panagiotis D %A Papadopoulos,Christodoulos E %A Vassilikos,Vassilios P %+ Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki, 54642, Greece, 30 2310892598, bakogianniscon@gmail.com %K mHealth %K heart failure %K smartphone app %K self-care %K COVID-19 %K patients %K caregivers %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease. Objective: The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study. Methods: The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate. Results: A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%. Conclusions: The need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF. %M 33847599 %R 10.2196/24271 %U https://mhealth.jmir.org/2021/4/e24271 %U https://doi.org/10.2196/24271 %U http://www.ncbi.nlm.nih.gov/pubmed/33847599 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e16518 %T Smartphone Users’ Persuasion Knowledge in the Context of Consumer mHealth Apps: Qualitative Study %A Joo,Eunsin %A Kononova,Anastasia %A Kanthawala,Shaheen %A Peng,Wei %A Cotten,Shelia %+ Department of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, 2000 Jintong Road, Tangjiawan, Zhuhai, 519087, China, 82 1086813554, eunsinjoo@uic.edu.hk %K mHealth app %K personal health information sharing %K mobile phone %K mobile promotion strategy %K persuasion knowledge %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Persuasion knowledge, commonly referred to as advertising literacy, is a cognitive dimension that embraces recognition of advertising, its source and audience, and understanding of advertisers’ persuasive and selling intents as well as tactics. There is little understanding of users’ awareness of organizations that develop or sponsor mobile health (mHealth) apps, especially in light of personal data privacy. Persuasion knowledge or recognition of a supporting organization’s presence, characteristics, competencies, intents, and persuasion tactics are crucial to investigate because app users have the right to know about entities that support apps and make informed decisions about app usage. The abundance of free consumer mHealth apps, especially those in the area of fitness, often makes it difficult for users to identify apps’ dual purposes, which may be related to not only helping the public manage health but also promoting the supporting organization itself and collecting users’ information for further consumer targeting by third parties. Objective: This study aims to investigate smartphone users’ awareness of mHealth apps’ affiliations with 3 different types of supporting organizations (commercial, government, and nonprofit); differences in users’ persuasion knowledge and mHealth app quality and credibility evaluations related to each of the 3 organization types; and users’ coping mechanisms for dealing with personal information management within consumer mHealth apps. Methods: In-depth semistructured interviews were conducted with 25 smartphone users from a local community in midwestern United States. Interviews were thematically analyzed using inductive and deductive approaches. Results: Participants indicated that their awareness of and interest in mHealth app–supporting organizations were secondary to the app’s health management functions. After being probed, participants showed a high level of persuasion knowledge regarding the types of app-supporting organizations and their promotional intents. They thought that commercial companies sponsored mHealth apps mostly as entertainment tools, whereas noncommercial entities sponsored mHealth apps for users’ education. They assigned self-promotional motives to commercial organizations; however, they associated commercial mHealth apps with good quality and functioning. Noncommercial entities were perceived as more credible. Participants were concerned about losing control over personal information within mHealth apps supported by different organizations. They used alternative digital identities to protect themselves from privacy invasion and advertising spam. They were willing to trade some personal information for high-quality commercial mHealth apps. There was a sense of fatalism in discussing privacy risks linked to mHealth app usage, and some participants did not perceive the risks to be serious. Conclusions: The discussion of and recommendations for the safe and ethical use of mHealth apps associated with organizations’ promotional strategies and personal data protection are provided to ensure users’ awareness of and enhanced control over digitalized personal information flows. The theoretical implications are discussed in the context of the Persuasion Knowledge Model and dual-processing theories. %M 33847596 %R 10.2196/16518 %U https://mhealth.jmir.org/2021/4/e16518 %U https://doi.org/10.2196/16518 %U http://www.ncbi.nlm.nih.gov/pubmed/33847596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25513 %T A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App %A Thornton,Louise %A Gardner,Lauren Anne %A Osman,Bridie %A Green,Olivia %A Champion,Katrina Elizabeth %A Bryant,Zachary %A Teesson,Maree %A Kay-Lambkin,Frances %A Chapman,Cath %A , %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), 160 City Road, Sydney, 2006, Australia, 61 286279012, lauren.gardner@sydney.edu.au %K mHealth %K mobile phone %K chronic disease %K adolescents %K health promotion %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. %M 33843590 %R 10.2196/25513 %U https://formative.jmir.org/2021/4/e25513 %U https://doi.org/10.2196/25513 %U http://www.ncbi.nlm.nih.gov/pubmed/33843590 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25927 %T Usability and Acceptability of a Mobile App for the Self-Management of Alcohol Misuse Among Veterans (Step Away): Pilot Cohort Study %A Malte,Carol A %A Dulin,Patrick L %A Baer,John S %A Fortney,John C %A Danner,Anissa N %A Lott,Aline M K %A Hawkins,Eric J %+ Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, MS 116 ATC, Seattle, WA, 98108, United States, 1 206 277 3780, carol.malte@va.gov %K mobile apps %K alcohol misuse %K smartphone %K veterans %K access %D 2021 %7 8.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol misuse is common among Operation Enduring Freedom and Operation Iraqi Freedom veterans, yet barriers limit treatment participation. Mobile apps hold promise as means to deliver alcohol interventions to veterans who prefer to remain anonymous, have little time for conventional treatments, or live too far away to attend treatment in person. Objective: This pilot study evaluated the usability and acceptability of Step Away, a mobile app designed to reduce alcohol-related risks, and explored pre-post changes on alcohol use, psychological distress, and quality of life. Methods: This single-arm pilot study recruited Operation Enduring Freedom and Operation Iraqi Freedom veterans aged 18 to 55 years who exceeded National Institute on Alcohol Abuse and Alcoholism drinking guidelines and owned an iPhone. Enrolled veterans (N=55) completed baseline and 1-, 3-, and 6-month assessments. The System Usability Scale (scaled 1-100, ≥70 indicating acceptable usability) assessed the effectiveness, efficiency, and satisfaction dimensions of usability, while a single item (scaled 1-9) measured the attractiveness of 10 screenshots. Learnability was assessed by app use during week 1. App engagement (proportion of participants using Step Away, episodes of use, and minutes per episode per week) over 6 months measured acceptability. Secondary outcomes included pre-post change on heavy drinking days (men: ≥5 drinks per day; women: ≥4 drinks per day) and Short Inventory of Problems–Revised, Kessler-10, and brief World Health Organization Quality of Life Questionnaire scores. Results: Among the 55 veterans enrolled in the study, the mean age was 37.4 (SD 7.6), 16% (9/55) were women, 82% (45/55) were White, and 82% (45/55) had an alcohol use disorder. Step Away was used by 96% (53/55) of participants in week 1, 55% (30/55) in week 4, and 36% (20/55) in week 24. Step Away use averaged 55.1 minutes (SD 57.6) in week 1 and <15 minutes per week in weeks 2 through 24. Mean System Usability Scale scores were 69.3 (SD 19.7) and 71.9 (SD 15.8) at 1 and 3 months, respectively. Median attractiveness scores ranged from 5 to 8, with lower ratings for text-laden screens. Heavy drinking days decreased from 29.4% (95% CI 23.4%-35.4%) at baseline to 16.2% (95% CI 9.9%-22.4%) at 6 months (P<.001). Likewise, over 6 months, Short Inventory of Problems–Revised scores decreased from 6.3 (95% CI 5.1-7.5) to 3.6 (95% CI 2.4-4.9) (P<.001) and Kessler-10 scores decreased from 18.8 (95% CI 17.4-20.1) to 17.3 (95% CI 15.8-18.7) (P=.046). Changes were not detected on quality of life scores. Conclusions: Operation Enduring Freedom and Operation Iraqi Freedom veterans found the usability of Step Away to be acceptable and engaged in the app over the 6-month study. Reductions were seen in heavy drinking days, alcohol-related problems, and Kessler-10 scores. A larger randomized trial is warranted to confirm our findings. %M 33830064 %R 10.2196/25927 %U https://mhealth.jmir.org/2021/4/e25927 %U https://doi.org/10.2196/25927 %U http://www.ncbi.nlm.nih.gov/pubmed/33830064 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24565 %T An Intervention for the Transition From Pediatric or Adolescent to Adult-Oriented HIV Care: Protocol for the Development and Pilot Implementation of iTransition %A Tanner,Amanda E %A Dowshen,Nadia %A Philbin,Morgan M %A Rulison,Kelly L %A Camacho-Gonzalez,Andres %A Lee,Susan %A Moore,Shamia J %A Fortenberry,J Dennis %A Hussen,Sophia A %+ Department of Public Health Education, University of North Carolina Greensboro, 437 Coleman Building, Greensboro, NC, 27402-6169, United States, 1 715 497 2885, aetanner@uncg.edu %K HIV %K mHealth %K transition to adult care %K young adult %K feasibility studies %K retention in care %K control groups %K United States %K telemedicine %K HIV infections %K mobile phone %D 2021 %7 7.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, adolescents and young adults are disproportionately affected by HIV and have poorer HIV-related health outcomes than adults. Health care transition (HCT) from pediatric or adolescent to adult-oriented HIV care is associated with disruptions to youths’ care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HCT outcomes for youth living with HIV. Objective: There are 2 phases of this project. Phase 1 involves the iterative development and usability testing of a Social Cognitive Theory–based mobile health (mHealth) HIV HCT intervention (iTransition). In phase 2, we will conduct a pilot implementation trial to assess iTransition’s feasibility and acceptability and to establish preliminary efficacy among youth and provider participants. Methods: The iterative phase 1 development process will involve in-person and virtual meetings and a design team comprising youth living with HIV and health care providers. The design team will both inform the content and provide feedback on the look, feel, and process of the iTransition intervention. In phase 2, we will recruit 100 transition-eligible youth across two clinical sites in Atlanta, Georgia, and Philadelphia, Pennsylvania, to participate in the historical control group (n=50; data collection only) or the intervention group (n=50) in a pilot implementation trial. We will also recruit 28 provider participants across the pediatric or adolescent and adult clinics at the two sites. Data collection will include electronic medical chart abstraction for clinical outcomes as well as surveys and interviews related to demographic and behavioral characteristics; Social Cognitive Theory constructs; and intervention feasibility, acceptability, and use. Analyses will compare historical control and intervention groups in terms of HCT outcomes, including adult care linkage (primary), care retention, and viral suppression (secondary). Interview data will be analyzed using content analysis to understand the experience with use and acceptability. Results: Phase 1 (development) of iTransition research activities began in November 2019 and is ongoing. The data collection for the phase 2 pilot implementation trial is expected to be completed in January 2023. Final results are anticipated in summer 2023. Conclusions: The development and pilot implementation trial of the iTransition intervention will fill an important gap in understanding the role of mHealth interventions to support HCT outcomes for youth living with HIV. International Registered Report Identifier (IRRID): DERR1-10.2196/24565 %M 33825691 %R 10.2196/24565 %U https://www.researchprotocols.org/2021/4/e24565 %U https://doi.org/10.2196/24565 %U http://www.ncbi.nlm.nih.gov/pubmed/33825691 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23280 %T Staff Perceptions of Preimplementation Barriers and Facilitators to a Mobile Health Antiretroviral Therapy Adherence Counseling Intervention in South Africa: Qualitative Study %A McCreesh-Toselli,Siobhan %A Torline,John %A Gouse,Hetta %A Robbins,Reuben N %A Mellins,Claude A %A Remien,Robert H %A Rowe,Jessica %A Peton,Neshaan %A Rabie,Stephan %A Joska,John A %+ HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, J Block, Groote Schuur Hospital, Observatory, South Africa, 27 21 404 2174, john.joska@uct.ac.za %K HIV/AIDS %K antiretroviral treatment %K low-resource settings %K mHealth %K Masivukeni %K Consolidated Framework for Implementation Research %K implementation research %K lay antiretroviral therapy adherence counselors %K mobile phone %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: South Africa adopted a universal test and treatment program for HIV infection in 2015. The standard of care that people living with HIV receive consists of 3 sessions of readiness counseling delivered by lay counselors (LCs). In the largest antiretroviral therapy (ART) program worldwide, effective and early HIV and ART education and support are key for ensuring ART adoption, adherence, and retention in care. Having LCs to deliver readiness counseling allows for the wide task-sharing of this critical activity but carries the risks of loss of standardization, incomplete content delivery, and inadequate monitoring and supervision. Systems for ensuring that a minimum standard of readiness counseling is delivered to the growing number of people living with HIV are essential in the care cascade. In resource-constrained, high-burden settings, mobile health (mHealth) apps may potentially offer solutions to these treatment gaps by providing content structure and delivery records. Objective: This study aims to explore, at a large Cape Town–based nonprofit HIV care organization, the staff’s perceived preimplementation barriers and facilitators of an mHealth intervention (Masivukeni) developed as a structured app for ART readiness counseling. Methods: Masivukeni is a laptop-based app that incorporates written content, graphics, short video materials, and participant activities. In total, 20 participants were included in this study. To explore how an mHealth intervention might be adopted across different staff levels within the organization, we conducted 7 semistructured interviews (participants: 7/20, 35%) and 3 focus groups (participants in 2 focus groups: 4/20, 20%; participants in 1 focus group: 3/20, 15%) among LCs, supervisors, and their managers. In total, 20 participants were included in this study. Interviews lasted approximately 60 minutes, and focus groups ranged from 90 to 120 minutes. The Consolidated Framework for Implementation Research was used to explore the perceived implementation barriers and facilitators of the Masivukeni mHealth intervention. Results: Several potential facilitators of Masivukeni were identified. Multimedia and visual elements were generally regarded as aids in content delivery. The interactive learning components were notably helpful, whereas facilitated updates to the adherence curriculum were important to facilitators and managers. The potential to capture administrative information regarding LC delivery and client logging was regarded as an attractive feature. Barriers to implementation included security risks and equipment costs, the high volume of clients to be counseled, and variable computer literacy among LCs. There was uncertainty about the app’s appeal to older clients. Conclusions: mHealth apps, such as Masivukeni, were perceived as being well placed to address some of the needs of those who deliver ART adherence counseling in South Africa. However, the successful implementation of mHealth apps appeared to be dependent on overcoming certain barriers in this setting. %M 33821806 %R 10.2196/23280 %U https://mhealth.jmir.org/2021/4/e23280 %U https://doi.org/10.2196/23280 %U http://www.ncbi.nlm.nih.gov/pubmed/33821806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21638 %T Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study %A Acorda,Darlene %A Businelle,Michael %A Santa Maria,Diane %+ Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX, 77030, United States, 1 832 824 1179, darlene.e.acorda@uth.tmc.edu %K youth experiencing homelessness %K ecological momentary assessment %K mobile apps %K behavior change %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective. Objective: This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. Methods: YEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. Results: A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the “freezing” of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time. Conclusions: YEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population. %M 33821805 %R 10.2196/21638 %U https://formative.jmir.org/2021/4/e21638 %U https://doi.org/10.2196/21638 %U http://www.ncbi.nlm.nih.gov/pubmed/33821805 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e26562 %T Technology-Based Psychological Interventions for Young Adults With Early Psychosis and Cannabis Use Disorder: Qualitative Study of Patient and Clinician Perspectives %A Tatar,Ovidiu %A Abdel-Baki,Amal %A Tra,Christophe %A Mongeau-Pérusse,Violaine %A Arruda,Nelson %A Kaur,Navdeep %A Landry,Vivianne %A Coronado-Montoya,Stephanie %A Jutras-Aswad,Didier %+ Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St-Denis Street Viger Tower, 5th floor, room R05.740, Montreal, QC, H2X 1P1, Canada, 1 514 890 8000 ext 35703, didier.jutras-aswad@umontreal.ca %K psychology %K intervention %K cannabis misuse %K cannabis use disorder %K young adult %K clinician %K psychosis %K schizophrenia %K dual diagnosis %K qualitative %K acceptability %K technology-based %K telemedicine %K mHealth %K digital health %K eHealth %K application %K smartphone %K mobile phone %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. Objective: The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. Methods: A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. Results: Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). Conclusions: This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis. %M 33818397 %R 10.2196/26562 %U https://formative.jmir.org/2021/4/e26562 %U https://doi.org/10.2196/26562 %U http://www.ncbi.nlm.nih.gov/pubmed/33818397 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24249 %T Slip Buddy App for Weight Management: Randomized Feasibility Trial of a Dietary Lapse Tracking App %A Pagoto,Sherry %A Tulu,Bengisu %A Waring,Molly E %A Goetz,Jared %A Bibeau,Jessica %A Divito,Joseph %A Groshon,Laurie %A Schroeder,Matthew %+ University of Connecticut, Department of Allied Health Sciences, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT, 06269, United States, 1 5084864900, Sherry.Pagoto@uconn.edu %K mobile app %K mHealth %K weight loss %K obesity %K diet %K mobile phone %D 2021 %7 1.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common. Objective: This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program. Methods: We conducted a randomized pilot trial to evaluate the feasibility and acceptability of using the Slip Buddy app compared with a popular commercial calorie tracking app during a counselor-led, web-based behavioral weight loss intervention. Adults who were overweight or obese were recruited on the web and randomized into a 12-week web-based weight loss intervention that included either the Slip Buddy app or a commercial calorie tracking app. Feasibility outcomes included retention, app use, usability, slips reported, and contextual factors reported at slips. Acceptability outcomes included ratings of how helpful, tedious, taxing, time consuming, and burdensome using the assigned app was. We described weight change from baseline to 12 weeks in both groups as an exploratory outcome. Participants using the Slip Buddy app provided feedback on how to improve it during the postintervention focus groups. Results: A total of 75% (48/64) of the participants were female and, on average, 39.8 (SD 11.0) years old with a mean BMI of 34.2 (SD 4.9) kg/m2. Retention was high in both conditions, with 97% (31/32) retained in the Slip Buddy condition and 94% (30/32) retained in the calorie tracking condition. On average, participants used the Slip Buddy app on 53.8% (SD 31.3%) of days, which was not significantly different from those using the calorie tracking app (mean 57.5%, SD 28.4% of days), and participants who recorded slips (30/32, 94%) logged on average 17.9 (SD 14.4) slips in 12 weeks. The most common slips occurred during snack times (220/538, 40.9%). Slips most often occurred at home (297/538, 55.2%), while working (153/538, 28.4%), while socializing (130/538, 24.2%), or during screen time (123/538, 22.9%). The conditions did not differ in participants’ ratings of how their assigned app was tedious, taxing, or time consuming (all values of P>.05), but the calorie tracking condition gave their app higher helpfulness and usability ratings (all values of P<.05). Technical issues were the most common type of negative feedback, whereas simplicity was the most common type of positive feedback. Weight losses of ≥5% of baseline weight were achieved by 31% (10/32) of Slip Buddy participants and 34% (11/32) of calorie tracking participants. Conclusions: Self-monitoring of dietary lapses and the contextual factors associated with them may be an alternative for people who do not prefer calorie tracking. Future research should examine patient characteristics associated with adherence to different forms of dietary self-monitoring. Trial Registration: ClinicalTrials.gov NCT02615171; https://clinicaltrials.gov/ct2/show/NCT02615171 %M 33792547 %R 10.2196/24249 %U https://mhealth.jmir.org/2021/4/e24249 %U https://doi.org/10.2196/24249 %U http://www.ncbi.nlm.nih.gov/pubmed/33792547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21839 %T A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study %A Kuhns,Lisa M %A Hereth,Jane %A Garofalo,Robert %A Hidalgo,Marco %A Johnson,Amy K %A Schnall,Rebecca %A Reisner,Sari L %A Belzer,Marvin %A Mimiaga,Matthew J %+ Ann & Robert H Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, 225 E Chicago Avenue, Box 161, Chicago, IL, 60611, United States, 1 312 227 7760, lkuhns@luriechildrens.org %K transgender persons %K HIV %K mobile app %K mHealth %K mobile phone %D 2021 %7 31.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Young transgender women (YTW) are a key population for HIV-related risk reduction, yet very few interventions have been developed to meet their needs. Mobile health interventions with the potential for both efficacy and wide reach are a promising strategy to reduce HIV risk among YTW. Objective: This study aims to adapt an efficacious group-based intervention to a mobile app, Project LifeSkills, to reduce HIV risk among YTW, and to test its acceptability and usability. Methods: The group-based intervention was adapted to a mobile app, LifeSkills Mobile, with input from an expert advisory group and feedback from YTW collected during user-centered design sessions. A beta version of the app was then tested in a usability evaluation using a think-aloud protocol with debriefing interviews, recordings of screen activity, and assessments of usability via the Post-Study System Usability Questionnaire (PSSUQ) and the Health Information Technology Usability Evaluation Scale (Health-ITUES). Results: YTW (n=8; age: mean 24 years, SD 3 years; racial or ethnic minority: 7/8, 88%) provided feedback on the app prototype in design sessions and then tested a beta version of the app in a usability trial (n=10; age: mean 24 years, SD 3 years; racial or ethnic minority: 8/10, 80%). Both usability ratings (Health-ITUES: mean 4.59, SD 0.86; scale range: 1-5) and ratings for satisfaction and accessibility (PSSUQ: mean 4.64, SD 0.90; scale range 1-5) were in the good to excellent range. No functional bugs were identified, and all mobile activities were deployed as expected. Participant feedback from the usability interviews indicated very good salience of the intervention content among the focal population. Participants’ suggestions to further increase app engagement included adding animation, adding audio, and reducing the amount text. Conclusions: We conclude that the LifeSkills Mobile app is a highly usable and engaging mobile app for HIV prevention among YTW. %M 33787503 %R 10.2196/21839 %U https://www.jmir.org/2021/3/e21839 %U https://doi.org/10.2196/21839 %U http://www.ncbi.nlm.nih.gov/pubmed/33787503 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e19310 %T Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study %A Teferi,Gizaw Hailiye %A Tilahun,Binyam Cheklu %A Guadie,Habtamu Alganeh %A Amare,Ashenafi Tazebew %+ Department of Health Informatics, College of Medicine and Health Science, Debre-Markos University, PO Box: 269, Debre Markos, Ethiopia, 251 921493560, ghailiye463@gmail.com %K application %K medical %K physician %K smartphone %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Information in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff. Objective: The aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia. Methods: An institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (α=.78) Results: In this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use. Conclusions: Most respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians.  %M 33769303 %R 10.2196/19310 %U https://mhealth.jmir.org/2021/3/e19310 %U https://doi.org/10.2196/19310 %U http://www.ncbi.nlm.nih.gov/pubmed/33769303 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27882 %T The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study %A Bente,Britt Elise %A van 't Klooster,Jan Willem Jaap Roderick %A Schreijer,Maud Annemarie %A Berkemeier,Lea %A van Gend,Joris Elmar %A Slijkhuis,Peter Jan Hendrik %A Kelders,Saskia Marion %A van Gemert-Pijnen,Julia Elisabeth Wilhelmina Cornelia %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 9660, b.e.bente@utwente.nl %K usability testing %K user evaluation %K user experience %K contact tracing apps %K CoronaMelder %K COVID-19 %K pandemic %K mobile apps %K mHealth %K public health %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective: The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods: Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results: Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions: The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app. %M 33724198 %R 10.2196/27882 %U https://formative.jmir.org/2021/3/e27882 %U https://doi.org/10.2196/27882 %U http://www.ncbi.nlm.nih.gov/pubmed/33724198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18460 %T System Architecture for "Support Through Mobile Messaging and Digital Health Technology for Diabetes" (SuMMiT-D): Design and Performance in Pilot and Randomized Controlled Feasibility Studies %A Chi,Yuan %A Velardo,Carmelo %A Allen,Julie %A Robinson,Stephanie %A Riga,Evgenia %A Judge,David %A Tarassenko,Lionel %A Farmer,Andrew J %+ Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, United Kingdom, 44 01865 617675, yuan.chi@eng.ox.ac.uk %K type 2 diabetes %K short message service %K health-related behavior %K mobile health %K mHealth %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is a highly prevalent long-term condition with high morbidity and mortality rates. People with diabetes commonly worry about their diabetes medicines and do not always take them regularly as prescribed. This can lead to poor diabetes control. The Support Through Mobile Messaging and Digital Health Technology for Diabetes (SuMMiT-D) study aims to deliver brief messages as tailored interventions to support people with type 2 diabetes in better use of their diabetes medicines and to improve treatment adherence and health outcomes. Objective: This paper describes the overall architecture of a tailored intervention delivery system used in the pilot and randomized controlled feasibility studies of SuMMiT-D and reports its performance. Methods: The SuMMiT-D system includes several platforms and resources to recruit participants and deliver messages as tailored interventions. Its core component is called the clinical system and is responsible for interacting with the participants by receiving and sending SMS text messages from and to them. The personalization and tailoring of brief messages for each participant is based on a list of built-in commands that they can use. Results: For the pilot study, a total of 48 participants were recruited; they had a median age of 64 years (first quartile, third quartile [Q1, Q3: 54.5, 69]). For the feasibility study, a total of 209 participants were recruited and randomly assigned to either the control or intervention group; they had a median age of 65 years (Q1, Q3: 56, 71), with 41.1% (86/209) being female. The participants used the SuMMiT-D system for up to 6 months (26 weeks) and had a wide range of different interactions with the SuMMiT-D system while tailored interventions were being delivered. For both studies, we had low withdrawal rates: only 4.2% and 5.3% for the pilot and feasibility studies, respectively. Conclusions: A system was developed to successfully deliver brief messages as tailored health interventions to more than 250 people with type 2 diabetes via SMS text messages. On the basis of the low withdrawal rates and positive feedback received, it can be inferred that the SuMMiT-D system is robust, user-friendly, useful, and positive for most participants. From the two studies, we found that online recruitment was more efficient than recruitment via postal mail; a regular SMS text reminder (eg, every 4 weeks) can potentially increase the participants’ interactions with the system. Trial Registration: ISRCTN Registry ISRCTN13404264; http://www.isrctn.com/ISRCTN13404264 %M 33769299 %R 10.2196/18460 %U https://formative.jmir.org/2021/3/e18460 %U https://doi.org/10.2196/18460 %U http://www.ncbi.nlm.nih.gov/pubmed/33769299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24023 %T Development of a Smartphone App to Predict and Improve the Rates of Suicidal Ideation Among Transgender Persons (TransLife): Qualitative Study %A Dubov,Alex %A Fraenkel,Liana %A Goldstein,Zil %A Arroyo,Hansel %A McKellar,Derek %A Shoptaw,Steve %+ School of Behavioral Health, Loma Linda University, 11065 Campus Street, Loma Linda, CA, 92350, United States, 1 9095581900, adubov@llu.edu %K mobile health %K mHealth %K mobile app %K pilot study %K qualitative research %K user-centered design %K acceptability study %K health services for transgender persons %K suicide prevention %K mental health %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Transgender people are at a high risk of suicidal ideation, suicide attempts, and deaths. Among transgender individuals, 77% and 41% engage in suicidal ideation and suicide attempt in their lifetime, respectively, which exceeds the general population rates (9.2% and 2.7%, respectively). Traditionally, suicide risk factors have been studied over a long period between measurements, making it difficult to understand the short-term variability in suicide risk. Mobile phone apps offer an opportunity to understand the immediate precursors of suicidality through the assessment of behaviors and moods in real time. This is the first study to use a mobile phone app (TransLife) to understand the short-term risk factors for suicide among transgender individuals. Objective: This study aims to beta test the usability of an evidence-informed mobile health (mHealth) suicide prevention phone app, TransLife. The primary aims are to obtain preliminary data on user engagement and satisfaction with the app, and to assess the feasibility of completing ecological momentary assessments (mood logs) within the app. Methods: We used qualitative methods and an exploratory research approach that combined naturalistic app use, focus groups, and semistructured phone interviews. The focus group was informed about the development of the prototype. We conducted a 3-week evaluation to determine engagement and obtain detailed user feedback about the app. After participation in the pilot, phone-based, semistructured, and audio-recorded exit interviews were conducted with the research participants. Results: In total, 16 transgender individuals participated in this study. On average, users logged in 4 (SD 2.7) times a week and spent approximately 5 (SD 3.5) minutes on the app per log-in. A total of 6 major themes emerged in this study. These themes focused on the app’s functionality, satisfaction with using the app, perceived ease of use, perceived safety of providing personal data within the app, trusting the app enough to share personal feelings, and features that make this app engaging. These themes suggest that TransLife is an engaging, useful, and acceptable mHealth intervention. Participants reported that the app was easy to use and understand, supported mental self-care, promoted self-awareness, and helped them identify triggers of negative moods. Conclusions: The results of this pilot study indicate that TransLife is an engaging, acceptable, and potentially effective mHealth intervention. Transgender participants reported many advantages of using TransLife, such as being able to track their mood, connecting to the community, and accessing local resources. This study provides initial support for the acceptability and usability of TransLife as an mHealth intervention designed for the transgender community. %M 33596181 %R 10.2196/24023 %U https://www.jmir.org/2021/3/e24023 %U https://doi.org/10.2196/24023 %U http://www.ncbi.nlm.nih.gov/pubmed/33596181 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e26355 %T Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders’ Input %A Zucchelli,Fabio %A Donnelly,Olivia %A Rush,Emma %A Smith,Harriet %A Williamson,Heidi %A , %+ The Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 11732 83882, fabio.zucchelli@uwe.ac.uk %K mobile health %K acceptance and commitment therapy %K appearance %K qualitative %K participatory design %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective: The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods: Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results: Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions: The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords. %M 33759791 %R 10.2196/26355 %U https://formative.jmir.org/2021/3/e26355 %U https://doi.org/10.2196/26355 %U http://www.ncbi.nlm.nih.gov/pubmed/33759791 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e24062 %T A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach %A Morse,Robert S %A Lambden,Kaley %A Quinn,Erin %A Ngoma,Twalib %A Mushi,Beatrice %A Ho,Yun Xian %A Ngoma,Mamsau %A Mahuna,Habiba %A Sagan,Sarah B %A Mmari,Joshua %A Miesfeldt,Susan %+ Maine Medical Center, Suite 111, 100 Campus Drive, Scarborough, ME, 04074, United States, 1 207 396 7787, MIESFS@mmc.org %K mobile health %K mHealth %K user-centered design %K palliative care %K pain %K cancer %K sub-Saharan Africa %K mobile phone %D 2021 %7 23.3.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life–focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app’s effectiveness in symptom control among cancer patients. Results: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users—patients or caregivers, LHWs, and members of the palliative care team—and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas. %M 33755022 %R 10.2196/24062 %U https://cancer.jmir.org/2021/1/e24062 %U https://doi.org/10.2196/24062 %U http://www.ncbi.nlm.nih.gov/pubmed/33755022 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e21312 %T Usability, Usefulness, and Acceptance of a Novel, Portable Rehabilitation System (mRehab) Using Smartphone and 3D Printing Technology: Mixed Methods Study %A Bhattacharjya,Sutanuka %A Cavuoto,Lora Anne %A Reilly,Brandon %A Xu,Wenyao %A Subryan,Heamchand %A Langan,Jeanne %+ Department of Occupational Therapy, Byrdine F Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur St SE, Urban Life Building, STE#1246, Atlanta, GA, 30303, United States, 1 404 413 1449, sutanuka.ot@gmail.com %K stroke %K rehabilitation %K smart technology %K 3-dimensional printing %K usability %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smart technology use in rehabilitation is growing and can be used remotely to assist clients in self-monitoring their performance. With written home exercise programs being the commonly prescribed form of rehabilitation after discharge, mobile health technology coupled with task-oriented programs can enhance self-management of upper extremity training. In the current study, a rehabilitation system, namely mRehab, was designed that included a smartphone app and 3D-printed household items such as mug, bowl, key, and doorknob embedded with a smartphone. The app interface allowed the user to select rehabilitation activities and receive feedback on the number of activity repetitions completed, time to complete each activity, and quality of movement. Objective: This study aimed to assess the usability, perceived usefulness, and acceptance of the mRehab system by individuals with stroke and identify the challenges experienced by them when using the system remotely in a home-based setting. Methods: A mixed-methods approach was used with 11 individuals with chronic stroke. Following training, individuals with stroke used the mRehab system for 6 weeks at home. Each participant completed surveys and engaged in a semistructured interview. Participants’ qualitative reports regarding the usability of mRehab were integrated with their survey reports and quantitative performance data. Results: Of the 11 participants, 10 rated the mRehab system between the 67.5th and 97.5th percentile on the System Usability Scale, indicating their satisfaction with the usability of the system. Participants also provided high ratings of perceived usefulness (mean 5.8, SD 0.9) and perceived ease of use (mean 5.3, SD 1.5) on a 7-point scale based on the Technology Acceptance Model. Common themes reported by participants showed a positive response to mRehab with some suggestions for improvements. Participants reported an interest in activities they perceived to be adequately challenging. Some participants indicated a need for customizing the feedback to be more interpretable. Overall, most participants indicated that they would like to continue using the mRehab system at home. Conclusions: Assessing usability in the lived environment over a prolonged duration of time is essential to identify the match between the system and users’ needs and preferences. While mRehab was well accepted, further customization is desired for a better fit with the end users. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 %M 33749608 %R 10.2196/21312 %U https://humanfactors.jmir.org/2021/1/e21312 %U https://doi.org/10.2196/21312 %U http://www.ncbi.nlm.nih.gov/pubmed/33749608 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e25604 %T Usability of a Fall Risk mHealth App for People With Multiple Sclerosis: Mixed Methods Study %A Hsieh,Katherine %A Fanning,Jason %A Frechette,Mikaela %A Sosnoff,Jacob %+ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 South Goodwin Ave, Urbana, IL, 61820, United States, 1 2172447006, khsieh@wakehealth.edu %K smartphone %K user center design %K falls %K mobile phone %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Multiple sclerosis (MS) is a chronic, neurodegenerative disease that causes a range of motor, sensory, and cognitive symptoms. Due to these symptoms, people with MS are at a high risk for falls, fall-related injuries, and reductions in quality of life. There is no cure for MS, and managing symptoms and disease progression is important to maintain a high quality of life. Mobile health (mHealth) apps are commonly used by people with MS to help manage their health. However, there are limited health apps for people with MS designed to evaluate fall risk. A fall risk app can increase access to fall risk assessments and improve self-management. When designing mHealth apps, a user-centered approach is critical for improving use and adoption. Objective: The purpose of this study is to undergo a user-centered approach to test and refine the usability of the app through an iterative design process. Methods: The fall risk app Steady-MS is an extension of Steady, a fall risk app for older adults. Steady-MS consists of 2 components: a 25-item questionnaire about demographics and MS symptoms and 5 standing balance tasks. Data from the questionnaire and balance tasks were inputted into an algorithm to compute a fall risk score. Two iterations of semistructured interviews (n=5 participants per iteration) were performed to evaluate usability. People with MS used Steady-MS on a smartphone, thinking out loud. Interviews were recorded, transcribed, and developed into codes and themes. People with MS also completed the System Usability Scale. Results: A total of 3 themes were identified: intuitive navigation, efficiency of use, and perceived value. Overall, the participants found Steady-MS efficient to use and useful to learn their fall risk score. There were challenges related to cognitive overload during the balance tasks. Modifications were made, and after the second iteration, people with MS reported that the app was intuitive and efficient. Average System Usability Scale scores were 95.5 in both iterations, representing excellent usability. Conclusions: Steady-MS is the first mHealth app for people with MS to assess their overall risk of falling and is usable by a subset of people with MS. People with MS found Steady-MS to be usable and useful for understanding their risk of falling. When developing future mHealth apps for people with MS, it is important to prevent cognitive overload through simple and clear instructions and present scores that are understood and interpreted correctly through visuals and text. These findings underscore the importance of user-centered design and provide a foundation for the future development of tools to assess and prevent scalable falls for people with MS. Future steps include understanding the validity of the fall risk algorithm and evaluating the clinical utility of the app. %M 33749609 %R 10.2196/25604 %U https://humanfactors.jmir.org/2021/1/e25604 %U https://doi.org/10.2196/25604 %U http://www.ncbi.nlm.nih.gov/pubmed/33749609 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e24846 %T Effects of User Characteristics on the Usability of a Home-Connected Medical Device (Smart Angel) for Ambulatory Monitoring: Usability Study %A Chaniaud,Noémie %A Megalakaki,Olga %A Capo,Sophie %A Loup-Escande,Emilie %+ Centre de Recherche en Psychologie: Cognition, Psychisme et Organisations, Université de Picardie Jules Verne, Chemin du Thil, Amiens, UR UPJV 7273, France, 33 3 22 82 70 59, noemie.chaniaud@u-picardie.fr %K user characteristics %K health literacy %K home medical devices %K usability study %K remote health %K home health %D 2021 %7 17.3.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Smart Angel home medical device allows ambulatory surgery patients to monitor their own health by taking their blood pressure and oxygen levels and answering a health questionnaire from home. Currently, this device is a prototype in the design phase, and no usability evaluation has been performed. This preventive device must be usable by patients with different profiles; however, it is important to select patients carefully to ensure their safety when using the device. As such, it would be interesting to know how to select or exclude patients. However, the links between user characteristics and the usability of this home medical device remain unclear. Objective: This study aims to better understand the links between certain characteristics of potential patients (ie, age, education, technophilia, and health literacy) and the usability (ie, effectiveness, efficiency, and satisfaction) of Smart Angel, as defined by the ISO 9241-11. Methods: We conducted an experimental study involving 36 participants investigating the effects of 4 patient characteristics (ie, age, education, technophilia, and health literacy) on usability, measured in terms of effectiveness, efficiency, and satisfaction. A mixed methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). First, to help participants project themselves into the real use of the Smart Angel device, they watched a scenario in a video. Second, the participants completed a set of questionnaires to show the extent of their health literacy level (Newest Vital Sign [NVS] and the Health Literacy Survey [HLS]) and then operated Smart Angel devices. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (System Usability Scale [SUS]). The qualitative observational data were coded using inductive analysis by 2 independent researchers specialized in cognitive psychology and cognitive ergonomics. Results: The results show a moderate and positive correlation between age and effectiveness (r=0.359; P=.03) and efficiency (r=0.357; P=.03). There is strong correlation between health literacy scored by the NVS and effectiveness (r=0.417; P=.01), efficiency (r=-0.38; P=.02), and satisfaction (r=0.45; P=.006). However, there is a weak correlation between technophilia and usability and no relationship between education level and usability. Conclusions: Our results show that literacy level and age are 2 important factors to consider when selecting future users of the Smart Angel device to ensure patient safety. This study also serves as an example promoting mixed methodologies in assessments of medical device usability that cannot be performed under real-world conditions. %M 33729161 %R 10.2196/24846 %U https://humanfactors.jmir.org/2021/1/e24846 %U https://doi.org/10.2196/24846 %U http://www.ncbi.nlm.nih.gov/pubmed/33729161 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24755 %T Intention to Adopt mHealth Apps Among Informal Caregivers: Cross-Sectional Study %A Ghahramani,Fereshteh %A Wang,Jingguo %+ College of Computing and Digital Media, DePaul University, 243 South Wabash Ave, Chicago, IL, 60604, United States, 1 3123628381, fereshteh.ghahramani@depaul.edu %K mobile health %K cross-sectional study %K informal caregivers %K mobile app %K caregiving app %K mobile phone %D 2021 %7 17.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Caregiving responsibility can change caregivers’ lives; modify their emotions; and make them feel frustrated, fearful, and nervous, thereby imposing physical and mental stress. Caregiving-related mobile apps provide a platform for obtaining valuable and trusted information, connecting more easily with other caregivers, monitoring medications, and managing appointments, and assessing health requirements and conditions of care receivers. Such apps also incorporate valuable resources that address care for the caregivers. Despite the potential benefits of caregiving-related apps, only a limited number of caregivers have adopted and used them. Objective: The aim of this study is to explore the important factors that affect caregivers’ intentions to integrate related mobile apps into their routine caregiving responsibilities. Methods: Using the protection motivation theory, we conducted a cross-sectional study among 249 participants. Purposive sampling was used to target participants who met 4 inclusion criteria: US residents, owning and using a smartphone, informal caregivers (individuals who give care to a friend or family member without payment) who provided at least 8 hours of care per week in the past year, and those currently not using any mobile app for caregiving purposes. We created a survey using Qualtrics and posted it on Amazon’s Mechanical Turk website. Participants received monetary compensation after successful completion of the survey. Results: We found that capabilities and skills of caregivers to use mobile apps, the app’s effectiveness in responding to the needs of caregivers, the degree of control of caregivers over their responsibilities, and the decisions they make for their care receivers can predict their willingness to adopt caregiving-related apps. In addition, the severity of health status and vulnerability of care receivers to unexpected health changes indirectly shape their caregivers’ decisions to adopt and use mobile apps for caregiving purposes. Conclusions: This study explores the important factors that affect informal caregivers’ intentions to adopt related mobile apps into their routine caregiving responsibilities. The results contribute to both mobile health adoption and the caregiving literature, and they offer significant implications for developers, health care practitioners, and policy makers. %M 33729166 %R 10.2196/24755 %U https://mhealth.jmir.org/2021/3/e24755 %U https://doi.org/10.2196/24755 %U http://www.ncbi.nlm.nih.gov/pubmed/33729166 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e20890 %T An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study %A Ratnanather,J Tilak %A Bhattacharya,Rohit %A Heston,Margo B %A Song,Joanne %A Fernandez,Lindsey R %A Lim,Hong Seo %A Lee,Seung-Wook %A Tam,Edric %A Yoo,Sungho %A Bae,Seung-Ho %A Lam,Inez %A Jeon,Hyoung Won %A Chang,Son A %A Koo,Ja-Won %+ Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 7402, speechbanana@jhu.edu %K speech therapy %K mobile phone %K computers, handheld %K cochlear implants %K hearing aids %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the growing adult population using electronic hearing devices such as cochlear implants or hearing aids, there is an increasing worldwide need for auditory training (AT) to promote optimal device use. However, financial resources and scheduling conflicts make clinical AT infeasible. Objective: To address this gap between need and accessibility, we primarily aimed to develop a mobile health (mHealth) app called Speech Banana for AT. The app would be substantially more affordable and portable than clinical AT; would deliver a validated training model that is reflective of modern techniques; and would track users’ progress in speech comprehension, providing greater continuity between periodic in-person visits. To improve international availability, our secondary aim was to implement the English language training model into Korean as a proof of concept for worldwide usability. Methods: A problem- and objective-centered Design Science Research Methodology approach was adopted to develop the Speech Banana app. A review of previous literature and computer-based learning programs outlined current AT gaps, whereas interviews with speech pathologists and users clarified the features that were addressed in the app. Past and present users were invited to evaluate the app via community forums and the System Usability Scale. Results: Speech Banana has been implemented in English and Korean languages for iPad and web use. The app comprises 38 lessons, which include analytic exercises pairing visual and auditory stimuli, and synthetic quizzes presenting auditory stimuli only. During quizzes, users type the sentence heard, and the app provides visual feedback on performance. Users may select a male or female speaker and the volume of background noise, allowing for training with a range of frequencies and signal-to-noise ratios. There were more than 3200 downloads of the English iPad app and almost 100 downloads of the Korean app; more than 100 users registered for the web apps. The English app received a System Usability Scale rating of “good” from 6 users, and the Korean app received a rating of “OK” from 16 users. Conclusions: Speech Banana offers AT accessibility with a validated curriculum, allowing users to develop speech comprehension skills with the aid of a mobile device. This mHealth app holds potential as a supplement to clinical AT, particularly in this era of global telemedicine. %M 33720025 %R 10.2196/20890 %U https://mhealth.jmir.org/2021/3/e20890 %U https://doi.org/10.2196/20890 %U http://www.ncbi.nlm.nih.gov/pubmed/33720025 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e22771 %T Mobile App-Based Intervention for Pregnant Women With Stress Urinary Incontinence: Protocol for a Hybrid Effectiveness-Implementation Trial %A Li,Tiantian %A Chen,Xiaomin %A Wang,Jia %A Chen,Ling %A Cai,Wenzhi %+ Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoán District Shenzhen, Guangdong, Shenzhen, 518101, China, 86 13078484316, caiwzh@smu.edu.cn %K mHealth %K stress urinary incontinence %K pregnancy %K randomized controlled trial %K process evaluation %K mixed methods %K study protocol %D 2021 %7 10.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress urinary incontinence (SUI) is a common source of distress among women during and after pregnancy. It has a negative effect on quality of life but with poor care-seeking. Mobile health (mHealth) may be a promising solution with potential advantages. However, there is uncertainty whether a mobile app is effective for SUI symptom improvement during and after pregnancy. The implementation is also unclear. We developed an app named UIW (Urinary Incontinence for Women) aimed at improving perinatal incontinence. Objective: The objective of this study is to evaluate the effectiveness of the UIW app-based intervention in improving SUI symptoms among pregnant women and explore the facilitators and barriers to using the UIW app to help refine and optimize the intervention. Methods: This study is a hybrid effectiveness-implementation trial with a randomized controlled trial alongside a mixed-methods process evaluation according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Pregnant women with SUI (n=336) will be recruited from a university-affiliated hospital in China. They will be randomly allocated (1:1) to either the intervention group that receive usual care plus UIW app or control group that receive usual care alone. The intervention period will last 2 months. The 5 dimensions of the RE-AIM framework will be evaluated at recruitment (-T1), baseline (T0), immediately after intervention (T1), 42 days after delivery (T2), 3 months after delivery (T3), and 6 months after delivery (T4) through project documents, online questionnaires and a pelvic floor muscle training diary, surface electromyography, log data in the background management system, and qualitative interviews. Data analysis will follow the intention-to-treat principle. Descriptive statistics, t tests, chi-square tests, and a linear mixed model will be used to analyze the quantitative data. Deductive and inductive content analysis will be used to analyze the qualitative data. Results: The effectiveness-implementation trial started in June 2020, trial recruitment was completed in October 2020, and the intervention will last for a 2-month period. Completion of the 6-month follow-up will be in July 2021, and we anticipate that the results of this study will be published in December 2021. Conclusions: This study will evaluate both effectiveness and implementation of the UIW app-based intervention among pregnant women. The hybrid effectiveness-implementation trial design according to the RE-AIM framework with a mixed-methods approach will give valuable insights into the effects as well as facilitators and barriers to the implementation that will influence the effects of the UIW app-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): PRR1-10.2196/22771 %M 33688842 %R 10.2196/22771 %U https://www.researchprotocols.org/2021/3/e22771 %U https://doi.org/10.2196/22771 %U http://www.ncbi.nlm.nih.gov/pubmed/33688842 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26159 %T Participants’ Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial %A Sandborg,Johanna %A Henriksson,Pontus %A Larsen,Erica %A Lindqvist,Anna-Karin %A Rutberg,Stina %A Söderström,Emmie %A Maddison,Ralph %A Löf,Marie %+ Department of Biosciences and Nutrition, Karolinska Institutet, Group/MLÖ, Huddinge, SE-141 83, Sweden, 46 733285912, johanna.sandborg@ki.se %K pregnancy %K gestational weight gain %K mHealth %K telemedicine %K digital health %K mobile health %K eHealth %K smartphone intervention %K mobile application %K smartphone application %K engagement %K physical activity %K exercise %K nutrition %K diet %K qualitative %K thematic analysis %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health–delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users’ experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective: This qualitative study explored participants’ engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods: A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68%; primiparous: 11/19, 58%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results: Thematic analysis revealed a main theme and 2 subthemes. The main theme, “One could suit many: a multifunctional tool to strengthen women’s health during pregnancy,” and the 2 subthemes, “Factors within and beyond the app influence app engagement” and “Trust, knowledge, and awareness: aspects that can motivate healthy habits,” illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions: The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 %M 33666554 %R 10.2196/26159 %U https://mhealth.jmir.org/2021/3/e26159 %U https://doi.org/10.2196/26159 %U http://www.ncbi.nlm.nih.gov/pubmed/33666554 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26702 %T Going Remote—Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study %A Hill,Jordan R %A Harrington,Addison B %A Adeoye,Philip %A Campbell,Noll L %A Holden,Richard J %+ Department of Medicine, Indiana University School of Medicine, 1101 W 10th St, Indianapolis, IN, 46202, United States, 1 7655438559, jrh6@iu.edu %K COVID-19 %K mobile usability testing %K usability inspection %K methods %K aging %K agile %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic necessitated “going remote” with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations, and none for older adults specifically. Older adults comprise a diverse population, including in terms of their experience with and access to technology, making this a challenging endeavor. Objective: Our objective was to remotely deliver and conduct usability testing for a mobile health (mHealth) technology intervention for older adult participants enrolled in a clinical trial of the technology. This paper describes the methodology used, its successes, and its limitations. Methods: We developed a conceptual model for remote operations, called the Framework for Agile and Remote Operations (FAR Ops), that combined the general requirements for spaceflight operations with Agile project management processes to quickly respond to this challenge. Using this framework, we iteratively created care packages that differed in their contents based on participant needs and were sent to study participants to deliver the study intervention—a medication management app—and assess its usability. Usability data were collected using the System Usability Scale (SUS) and a novel usability questionnaire developed to collect more in-depth data. Results: In the first 6 months of the project, we successfully delivered 21 care packages. We successfully designed and deployed a minimum viable product in less than 6 weeks, generally maintained a 2-week sprint cycle, and achieved a 40% to 50% return rate for both usability assessment instruments. We hypothesize that lack of engagement due to the pandemic and our use of asynchronous communication channels contributed to the return rate of usability assessments being lower than desired. We also provide general recommendations for performing remote usability testing with diverse populations based on the results of our work, including implementing screen sharing capabilities when possible, and determining participant preference for phone or email communications. Conclusions: The FAR Ops model allowed our team to adopt remote operations for our mHealth trial in response to interruptions from the COVID-19 pandemic. This approach can be useful for other research or practice-based projects under similar circumstances or to improve efficiency, cost, effectiveness, and participant diversity in general. In addition to offering a replicable approach, this paper tells the often-untold story of practical challenges faced by mHealth projects and practical strategies used to address them. Trial Registration: ClinicalTrials.gov NCT04121858; https://clinicaltrials.gov/ct2/show/NCT04121858 %M 33606655 %R 10.2196/26702 %U https://mhealth.jmir.org/2021/3/e26702 %U https://doi.org/10.2196/26702 %U http://www.ncbi.nlm.nih.gov/pubmed/33606655 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24202 %T Mobile Apps for Foot Measurement in Pedorthic Practice: Scoping Review %A Kabir,Muhammad Ashad %A Rahman,Sheikh Sowmen %A Islam,Mohammad Mainul %A Ahmed,Sayed %A Laird,Craig %+ School of Computing and Mathematics, Charles Sturt University, Panorama Ave, Bathurst, NSW, 2795, Australia, 61 263386259, akabir@csu.edu.au %K foot measurement %K foot scanning %K mobile app %K custom shoes making %K apps review %K diabetic foot %K pedorthics %K footcare %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the use of smartphones increases globally across various fields of research and technology, significant contributions to the sectors related to health, specifically foot health, can be observed. Numerous smartphone apps are now being used for providing accurate information about various foot-related properties. Corresponding to this abundance of foot scanning and measuring apps available in app stores, there is a need for evaluating these apps, as limited information regarding their evidence-based quality is available. Objective: The aim of this review was to assess the measurement techniques and essential software quality characteristics of mobile foot measurement apps, and to determine their potential as commercial tools used by foot care health professionals, to assist in measuring feet for custom shoes, and for individuals to enhance their awareness of foot health and hygiene to ultimately prevent foot-related problems. Methods: An electronic search across Android and iOS app stores was performed between July and August 2020 to identify apps related to foot measurement and general foot health. The selected apps were rated by three independent raters, and all discrepancies were resolved by discussion among raters and other investigators. Based on previous work on app rating tools, a modified rating scale tool was devised to rate the selected apps. The internal consistency of the rating tool was tested with a group of three people who rated the selected apps over 2-3 weeks. This scale was then used to produce evaluation scores for the selected foot measurement apps and to assess the interrater reliability. Results: Evaluation inferences showed that all apps failed to meet even half of the measurement-specific criteria required for the proper manufacturing of custom-made footwear. Only 23% (6/26) of the apps reportedly used external scanners or advanced algorithms to reconstruct 3D models of a user’s foot that could possibly be used for ordering custom-made footwear (shoes, insoles/orthoses), and medical casts to fit irregular foot sizes and shapes. The apps had varying levels of performance and usability, although the overall measurement functionality was subpar with a mean of 1.93 out of 5. Apps linked to online shops and stores (shoe recommendation) were assessed to be more usable than other apps but lacked some features (eg, custom shoe sizes and shapes). Overall, the current apps available for foot measurement do not follow any specific guidelines for measurement purposes. Conclusions: Most commercial apps currently available in app stores are not viable for use as tools in assisting foot care health professionals or individuals to measure their feet for custom-made footwear. Current apps lack software quality characteristics and need significant improvements to facilitate proper measurement, enhance awareness of foot health, and induce motivation to prevent and cure foot-related problems. Guidelines similar to the essential criteria items introduced in this study need to be developed for future apps aimed at foot measurement for custom-made or individually fitted footwear and to create awareness of foot health. %M 33661124 %R 10.2196/24202 %U https://mhealth.jmir.org/2021/3/e24202 %U https://doi.org/10.2196/24202 %U http://www.ncbi.nlm.nih.gov/pubmed/33661124 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e21795 %T Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study %A Sarradon-Eck,Aline %A Bouchez,Tiphanie %A Auroy,Lola %A Schuers,Matthieu %A Darmon,David %+ Aix Marseille University, INSERM, IRD, SESSTIM, UMR1252-CanBios-SESSTIM, 232 Bb Ste Marguerite, Marseille, 13009, France, 33 4 91 22 33 09, aline.sarradon@inserm.fr %K mobile applications %K qualitative research %K general practitioners %K France %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients’ care needs. Previous studies have shown that general practitioners (GPs) have both expectations and concerns regarding patients’ use of mHealth apps that could impact their willingness to recommend the apps to patients. Objective: The aim of this qualitative study is to investigate French GPs’ attitudes toward the prescription of mHealth apps or devices aimed toward patients by analyzing GPs’ perceptions and expectations of mHealth technologies. Methods: A total of 36 GPs were interviewed individually (n=20) or in a discussion group (n=16). All participants were in private practice. A qualitative analysis of each interview and focus group was conducted using grounded theory analysis. Results: Considering the value assigned to mHealth apps by participants and their willingness or resistance to prescribe them, 3 groups were defined based on the attitudes or positions adopted by GPs: digital engagement (favorable attitude; mHealth apps are perceived as additional resources and complementary tools that facilitate the medical work, the follow-up care, and the monitoring of patients; and apps increase patients’ compliance and empowerment); patient protection (related to the management of patient care and fear of risks for patients, concerns about patient data privacy and security, doubt about the usefulness for empowering patients, standardization of the medical decision process, overmedicalization, risks for individual freedom, and increasing social inequalities in health); doctor protection (fear of additional tasks and burden, doubt about the actionability of patient-gathered health data, risk for medical liability, dehumanization of the patient-doctor relationship, fear of increased drug prescription, and commodification of patient data). Conclusions: A deep understanding of both the expectations and fears of GPs is essential to motivate them to recommend mHealth apps to their patients. The results of this study show the need to provide appropriate education and training to enhance GPs’ digital skills. Certification of the apps by an independent authority should be encouraged to reassure physicians about ethical and data security issues. Our results highlight the need to overcome technical issues such as interoperability between data collection and medical records to limit the disruption of medical work because of data flow. %M 33661123 %R 10.2196/21795 %U https://mhealth.jmir.org/2021/3/e21795 %U https://doi.org/10.2196/21795 %U http://www.ncbi.nlm.nih.gov/pubmed/33661123 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e19034 %T Early Detection of Dengue Fever Outbreaks Using a Surveillance App (Mozzify): Cross-sectional Mixed Methods Usability Study %A Herbuela,Von Ralph Dane Marquez %A Karita,Tomonori %A Carvajal,Thaddeus Marzo %A Ho,Howell Tsai %A Lorena,John Michael Olea %A Regalado,Rachele Arce %A Sobrepeña,Girly Dirilo %A Watanabe,Kozo %+ Center for Marine Environmental Studies, Ehime University, 3 Bunkyo-cho, Matsuyama, Japan, 81 89 927 9847, watanabe.kozo.mj@ehime-u.ac.jp %K dengue fever %K mHealth %K public health surveillance %K health communication %K behavior modification %K dengue outbreak %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While early detection and effective control of epidemics depend on appropriate surveillance methods, the Philippines bases its dengue fever surveillance system on a passive surveillance method (notifications from barangay/village health centers, municipal or city health offices, hospitals, and clinics). There is no available mHealth (mobile health) app for dengue fever that includes all the appropriate surveillance methods in early detection of disease outbreaks in the country. Objective: This study aimed to evaluate the usability of the Mozzify app in terms of objective quality (engagement, functionality, aesthetics, information) and app subjective and app-specific qualities and compare total app mean score ratings by sociodemographic profile and self and family dengue fever history to see what factors are associated with high app mean score rating among school-based young adult samples and health care professionals. Individual interviews and focus group discussions were also conducted among participants to develop themes from their comments and suggestions to help structure further improvement and future development of the app. Methods: User experience sessions were conducted among participants, and the Mobile Application Rating Scale (MARS) professional and user versions (uMARS) were administered followed by individual interviews and focus group discussions. Descriptive statistical analysis of the MARS and uMARS score ratings was performed. The total app mean score ratings by sociodemographic and dengue fever history using nonparametric mean difference analyses were also conducted. Thematic synthesis was used to develop themes from the comments and suggestions raised in individual interviews and focus group discussions. Results: Mozzify obtained an overall >4 (out of 5) mean score ratings in the MARS and uMARS app objective quality (4.45), subjective (4.17), and specific (4.55) scales among 948 participants (79 health care professionals and 869 school-based samples). Mean difference analyses revealed that total app mean score ratings were not significantly different across ages and gender among health care professionals and across age, income categories, and self and family dengue fever history but not gender (P<.001) among the school-based samples. Thematic syntheses revealed 7 major themes: multilanguage options and including other diseases; Android version availability; improvements on the app’s content, design, and engagement; inclusion of users from low-income and rural areas; Wi-Fi connection and app size concerns; data credibility and issues regarding user security and privacy. Conclusions: With its acceptable performance as perceived by health care professionals and school-based young adults, Mozzify has the potential to be used as a strategic health intervention system for early detection of disease outbreaks in the Philippines. It can be used by health care professionals of any age and gender and by school-based samples of any age, socioeconomic status, and dengue fever history. The study also highlights the feasibility of school-based young adults to use health-related apps for disease prevention. %M 33646128 %R 10.2196/19034 %U https://publichealth.jmir.org/2021/3/e19034 %U https://doi.org/10.2196/19034 %U http://www.ncbi.nlm.nih.gov/pubmed/33646128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18224 %T Perspectives From Underserved African Americans and Their Health Care Providers on the Development of a Diabetes Self-Management Smartphone App: Qualitative Exploratory Study %A Barber-Gumbs,Tai %A Trolle Lagerros,Ylva %A Sena,Laura M %A Gittelsohn,Joel %A Chang,Larry W %A Zachary,Wayne W %A Surkan,Pamela J %+ Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Room E5523, Baltimore, MD, 21205-2179, United States, 1 410 502 7396, psurkan@jhu.edu %K diabetes %K mHealth %K type 2 diabetes mellitus %K diabetes self-management %K mobile app %K mobile phone %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes mellitus (T2DM) affects approximately 10% of the US population, disproportionately afflicting African Americans. Smartphone apps have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. Objective: The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African American community. Methods: Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features, and app mock-ups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes and T2DM, their friends and family members, and health care providers; data were collected from six interactive forums, one focus group, and 15 in-depth interviews. We carried out thematic data analysis using an inductive approach. Results: All three types of participants reported that difficulty with accessing health care was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care–related behaviors and receive feedback on their progress in a way that would increase engagement in self-management among persons with T2DM. Conclusions: We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in users’ logs. %M 33635279 %R 10.2196/18224 %U https://formative.jmir.org/2021/2/e18224 %U https://doi.org/10.2196/18224 %U http://www.ncbi.nlm.nih.gov/pubmed/33635279 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e14179 %T Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study %A Maatoug,Redwan %A Peiffer-Smadja,Nathan %A Delval,Guillaume %A Brochu,Térence %A Pitrat,Benjamin %A Millet,Bruno %+ Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, 47-83 Boulevard de l'hôpital, Paris, 75013, France, 33 682476484, redwanmaatoug@gmail.com %K ecological momentary assessment %K depression %K smartphone %K feasibility study %K user experience %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) is a promising tool in the management of psychiatric disorders and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. The generalization of the smartphone in the modern world offers a new, large-scale support for EMA. Objective: The main objective of this study was twofold: (1) to assess patients’ compliance with an EMA smartphone app defined by the number of EMAs completed, and (2) to estimate the external validity of the EMA using a correlation between self-esteem/guilt/mood variables and Hamilton Depression Rating Scale (HDRS) score. Methods: Eleven patients at the Pitié-Salpêtrière Hospital, Paris, France, were monitored for 28 days by means of a smartphone app. Every patient enrolled in the study had two types of assessment: (1) three outpatient consultations with a psychiatrist at three different time points (days 1, 15, and 28), and (2) real-time data collection using an EMA smartphone app with a single, fixed notification per day at 3 pm for 28 days. The results of the real-time data collected were reviewed during the three outpatient consultations by a psychiatrist using a dashboard that aggregated all of the patients’ data into a user-friendly format. Results: Of the 11 patients in the study, 6 patients attended the 3 outpatient consultations with the psychiatrist and completed the HDRS at each consultation. We found a positive correlation between the HDRS score and the variables of self-esteem, guilt, and mood (Spearman correlation coefficient 0.57). Seven patients completed the daily EMAs for 28 days or longer, with an average response rate to the EMAs of 62.5% (175/280). Furthermore, we observed a positive correlation between the number of responses to EMAs and the duration of follow-up (Spearman correlation coefficient 0.63). Conclusions: This preliminary study with a prolonged follow-up demonstrates significant patient compliance with the smartphone app. In addition, the self-assessments performed by patients seemed faithful to the standardized measurements performed by the psychiatrist. The results also suggest that for some patients it is more convenient to use the smartphone app than to attend outpatient consultations. %M 33625367 %R 10.2196/14179 %U https://formative.jmir.org/2021/2/e14179 %U https://doi.org/10.2196/14179 %U http://www.ncbi.nlm.nih.gov/pubmed/33625367 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e21986 %T Usability, Perceived Usefulness, and Shared Decision-Making Features of the AFib 2gether Mobile App: Protocol for a Single-Arm Intervention Study %A Kapoor,Alok %A Andrade,Andreza %A Hayes,Anna %A Mazor,Kathleen %A Possidente,Carl %A Nolen,Kim %A Hegeman-Dingle,Rozelle %A McManus,David %+ Department of Medicine, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, United States, 1 9178564538, Alok.Kapoor@umassmemorial.org %K shared decision making %K mobile health %K stroke risk %K anticoagulation risk %K anticoagulation education %K atrial fibrillation %K anticoagulation therapy %K anticoagulation %K atrial flutter %K mobile phone %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Centers for Disease Control and Prevention has estimated that atrial fibrillation (AF) affects between 2.7 million and 6.1 million people in the United States. Those who have AF tend to have a much higher stroke risk than others. Although most individuals with AF benefit from anticoagulation (AC) therapy, a significant majority are hesitant to start it. To add, providers often struggle in helping patients negotiate the decision to start AC therapy. To assist in the communication between patients and providers regarding preferences and knowledge about AC therapy, different strategies are being used to try and solve this problem. In this research study, we will have patients and providers utilize the AFib 2gether app with hopes that it will create a platform for shared decision making regarding the prevention of stroke in patients with AF receiving AC therapy. Objective: The aim of our study is to measure several outcomes related to encounters between patients and their cardiology providers where AFib 2gether is used. These outcomes include usability and perceived usefulness of the app from the perspective of patients and providers. In addition, we will assess the extent and nature of shared decision making. Methods: Eligible patients and providers will evaluate the AFib 2gether mobile app for usability and perceived usefulness in facilitating shared decision making regarding understanding the patient’s risk of stroke and whether or not to start AC therapy. Both patients and providers will review the app and complete multiple questionnaires about the usability and perceived usefulness of the mobile app in a clinical setting. We will also audio-record a subset of encounters to assess for evidence of shared decision making. Results: Enrollment in the AFib 2gether shared decision-making study is still ongoing for both patients and providers. The first participant enrolled on November 22, 2019. Analysis and publishing of results are expected to be completed in spring 2021. Conclusions: The AFib 2gether app emerged from a desire to increase the ability of patients and providers to engage in shared decision making around understanding the risk of stroke and AC therapy. We anticipate that the AFib 2gether mobile app will facilitate patient discussion with their cardiologist and other providers. Additionally, we hope the study will help us identify barriers that providers face when placing patients on AC therapy. We aim to demonstrate the usability and perceived usefulness of the app with a future goal of testing the value of our approach in a larger sample of patients and providers at multiple medical centers across the country. Trial Registration: ClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270 International Registered Report Identifier (IRRID): DERR1-10.2196/21986 %M 33625361 %R 10.2196/21986 %U https://www.researchprotocols.org/2021/2/e21986 %U https://doi.org/10.2196/21986 %U http://www.ncbi.nlm.nih.gov/pubmed/33625361 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22877 %T Smoking Cessation Using Wearable Sensors: Protocol for a Microrandomized Trial %A Hernandez,Laura M %A Wetter,David W %A Kumar,Santosh %A Sutton,Steven K %A Vinci,Christine %+ Moffitt Cancer Center, 4115 E. Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 5421, Christine.Vinci@moffitt.org %K mHealth %K microrandomized trial %K smoking cessation %K mindfulness %K tobacco %K mobile phone %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cigarette smoking has numerous health consequences and is the leading cause of morbidity and mortality in the United States. Mindfulness has the ability to enhance resilience to stressors and can strengthen an individual’s ability to deal with discomfort, which may be particularly useful when managing withdrawal and craving to smoke. Objective: This study aims to evaluate feasibility results from an intervention that provides real-time, real-world mindfulness strategies to a sample of racially and ethnically diverse smokers making a quit attempt. Methods: This study uses a microrandomized trial design to deliver mindfulness-based strategies in real time to individuals attempting to quit smoking. Data will be collected via wearable sensors, a study smartphone, and questionnaires filled out during the in-person study visits. Results: Recruitment is complete, and data management is ongoing. Conclusions: The data collected during this feasibility trial will provide preliminary findings about whether mindfulness strategies delivered in real time are a useful quit smoking aid that warrants additional investigation. Trial Registration: Clinicaltrials.gov NCT03404596; https://clinicaltrials.gov/ct2/show/NCT03404596 International Registered Report Identifier (IRRID): DERR1-10.2196/22877 %M 33625366 %R 10.2196/22877 %U https://www.researchprotocols.org/2021/2/e22877 %U https://doi.org/10.2196/22877 %U http://www.ncbi.nlm.nih.gov/pubmed/33625366 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22572 %T A Theory-Based mHealth Intervention (Getting Off) for Methamphetamine-Using Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial %A Reback,Cathy J %A Fletcher,Jesse B %A Mata,Raymond P %+ Friends Research Institution, Inc, 6910 Santa Monica Blvd, Los Angeles, CA, 90038, United States, 1 323 463 1601, rmata@friendsresearch.org %K HIV %K AIDS %K methamphetamine %K mHealth %K mobile app %K ART %K mobile phone %D 2021 %7 22.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Methamphetamine (meth) use among men who have sex with men (MSM) is associated with increased HIV prevalence and transmission and substandard advancement along the HIV prevention and care continuum. Given the growth of mobile health (mHealth) technologies, it is no longer necessary to limit meth treatment options to physical, brick-and-mortar sites, and administration using generic, nontailored content. Objective: In a 2-arm randomized controlled trial (RCT; N=300), we aim to evaluate the use of an mHealth intervention (Getting Off) to assess the impact and noninferiority of a cross-platform app (developed from a manualized meth treatment intervention) to help MSM reduce meth use and HIV sexual risk behaviors and improve their advancement along the HIV prevention and care continuum (HIV testing, pre-exposure prophylaxis uptake and persistence, and antiretroviral therapy uptake and adherence). Methods: Participants will be randomized into 2 arms: arm A, with immediate access to the app (immediate delivery: n=150), or arm B, with delayed access to the app after a 30-day period (delayed delivery: n=150). Participants in both arms will use the same Getting Off app and will have 30 days to complete the 24 sessions. Participants will be assessed at the 1-, 2- (delayed delivery arm only), 3-, 6-, and 9-month timepoints to determine observed treatment effects and will be compared with a historical matched sample of participants (n=~600) who received the brick-and-mortar group-based Getting Off intervention. Results: Recruitment began in January 2019 for phase 1, the formative phase. In January and February 2019, 4 focus groups (N=36) were formed to provide input on the adaptation of the group-based manual intervention to a mobile app. Data collection for phase 2, the RCT, is expected to be completed in January 2023. The final results are anticipated in April 2023. Conclusions: By creating a culturally responsive mobile app, Getting Off aims to reduce meth use and improve sexual health outcomes among meth-using MSM. The Getting Off app could have significant public health impact by greatly expanding access to effective, affordable, private, culturally competent, and highly scalable meth treatment for MSM. Trial Registration: Clinicaltrials.gov NCT03884946; https://clinicaltrials.gov/ct2/show/NCT03884946 International Registered Report Identifier (IRRID): DERR1-10.2196/22572 %M 33616547 %R 10.2196/22572 %U https://www.researchprotocols.org/2021/2/e22572 %U https://doi.org/10.2196/22572 %U http://www.ncbi.nlm.nih.gov/pubmed/33616547 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e23313 %T Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores %A Portenhauser,Alexandra A %A Terhorst,Yannik %A Schultchen,Dana %A Sander,Lasse B %A Denkinger,Michael D %A Stach,Michael %A Waldherr,Natalie %A Dallmeier,Dhayana %A Baumeister,Harald %A Messner,Eva-Maria %+ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Lise-Meitner-Str. 16, Ulm, Germany, 49 73150 32802, eva-maria.messner@uni-ulm.de %K mHealth %K MARS %K MARS-G %K older adults %K mobile apps %K apps %K aging %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Through the increasingly aging population, the health care system is confronted with various challenges such as expanding health care costs. To manage these challenges, mobile apps may represent a cost-effective and low-threshold approach to support older adults. Objective: This systematic review aimed to evaluate the quality, characteristics, as well as privacy and security measures of mobile apps for older adults in the European commercial app stores. Methods: In the European Google Play and App Store, a web crawler systematically searched for mobile apps for older adults. The identified mobile apps were evaluated by two independent reviewers using the German version of the Mobile Application Rating Scale. A correlation between the user star rating and overall rating was calculated. An exploratory regression analysis was conducted to determine whether the obligation to pay fees predicted overall quality. Results: In total, 83 of 1217 identified mobile apps were included in the analysis. Generally, the mobile apps for older adults were of moderate quality (mean 3.22 [SD 0.68]). Four mobile apps (5%) were evidence-based; 49% (41/83) had no security measures. The user star rating correlated significantly positively with the overall rating (r=.30, P=.01). Obligation to pay fees could not predict overall quality. Conclusions: There is an extensive quality range within mobile apps for older adults, indicating deficits in terms of information quality, data protection, and security precautions, as well as a lack of evidence-based approaches. Central databases are needed to identify high-quality mobile apps. %M 33605884 %R 10.2196/23313 %U https://aging.jmir.org/2021/1/e23313 %U https://doi.org/10.2196/23313 %U http://www.ncbi.nlm.nih.gov/pubmed/33605884 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21432 %T Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial %A Egilsson,Erlendur %A Bjarnason,Ragnar %A Njardvik,Urdur %+ Department of Psychology, University of Iceland, Sturlugata 1, Reykjavik, 101, Iceland, 354 6184805, erlendu@hi.is %K mHealth %K intervention %K adolescent %K attrition %K self-efficacy %K mental health %K physical activity %K young adult %K behavior %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of adolescents own smartphones, although only 8% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed. Objective: The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention’s usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health. Methods: A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted α levels through Bonferroni corrections were used to assess main outcome effects. Results: The attrition from initiation of the intervention to 6-week follow up was 35%. Attrition started in the third week of the intervention and was related to daily time of app usage (Rt=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61% in the intervention group but dropped by 26.21% among controls. Self-efficacy levels increased by 8.23% in the invention arm compared to a 3.03% decrease in the control group. Conclusions: This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants’ self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates. %M 33481750 %R 10.2196/21432 %U http://formative.jmir.org/2021/2/e21432/ %U https://doi.org/10.2196/21432 %U http://www.ncbi.nlm.nih.gov/pubmed/33481750 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e14760 %T A Novel Food Record App for Dietary Assessments Among Older Adults With Type 2 Diabetes: Development and Usability Study %A Jung,Hyunggu %A Demiris,George %A Tarczy-Hornoch,Peter %A Zachry,Mark %+ Department of Computer Science and Engineering, University of Seoul, Information and Technology Building, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 02504, Republic of Korea, 82 2 6490 2455, hjung@uos.ac.kr %K mobile health %K older adults %K diabetes %K dietary assessment %K smartphone app %K usability test %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: More than 1 in 4 people in the United States aged 65 years and older have type 2 diabetes. For diabetes care, medical nutrition therapy is recommended as a clinically effective intervention. Previous researchers have developed and validated dietary assessment methods using images of food items to improve the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability of image-assisted dietary assessment methods for older adults with diabetes. Objective: The aims of this study were (1) to create a food record app for dietary assessments (FRADA) that would support image-assisted dietary assessments, and (2) to evaluate the usability of FRADA for older adults with diabetes. Methods: For the development of FRADA, we identified design principles that address the needs of older adults and implemented three fundamental tasks required for image-assisted dietary assessments: capturing, viewing, and transmitting images of food based on the design principles. For the usability assessment of FRADA, older adults aged 65 to 80 years (11 females and 3 males) were assigned to interact with FRADA in a lab-based setting. Participants’ opinions of FRADA and its usability were determined by a follow-up survey and interview. As an evaluation indicator of usability, the responses to the survey, including an after-scenario questionnaire, were analyzed. Qualitative data from the interviews confirmed the responses to the survey. Results: We developed a smartphone app that enables older adults with diabetes to capture, view, and transmit images of food items they consumed. The findings of this study showed that FRADA and its instructions for capturing, viewing, and transmitting images of food items were usable for older adults with diabetes. The survey showed that participants found FRADA easy to use and would consider using FRADA daily. The analysis of the qualitative data from interviews revealed multiple categories, such as the usability of FRADA, potential benefits of using FRADA, potential features to be added to FRADA, and concerns of older adults with diabetes regarding interactions with FRADA. Conclusions: This study demonstrates in a lab-based setting not only the usability of FRADA by older adults with diabetes but also potential opportunities using FRADA in real-world settings. The findings suggest implications for creating a smartphone app for an image-assisted dietary assessment. Future work still remains to evaluate the feasibility and validity of FRADA with multiple stakeholders, including older adults with diabetes and dietitians. %M 33493129 %R 10.2196/14760 %U http://formative.jmir.org/2021/2/e14760/ %U https://doi.org/10.2196/14760 %U http://www.ncbi.nlm.nih.gov/pubmed/33493129 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e23921 %T Tablet-Based Apps for Phonics and Phonological Awareness: Protocol for Evidence-Based Appraisal of Content, Quality, and Usability %A Furlong,Lisa %A Serry,Tanya %A Erickson,Shane %A Morris,Meg E %+ School of Education, College of Arts, Social Sciences and Commerce, La Trobe University, Plenty Road and Kingsbury Drive, Bundoora, Melbourne, 3086, Australia, 61 457645539, l.furlong@latrobe.edu.au %K app %K appraisal %K characteristics %K COVID-19 %K health management %K mHealth %K mobile apps %K phonics %K phonological awareness %K quality %K reading %K usability %D 2021 %7 11.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of mobile apps to manage and promote health is becoming increasingly popular. Mobile apps are gaining popularity particularly in educational and interventional settings owing to their perceived advantages including support for and engagement of individuals with reading difficulties. In the context of COVID-19, the need for technology-based tools has increased. For practitioners and educators who wish to use apps in their practice or recommend apps to individuals with reading difficulties, it is challenging to identify high-quality apps in app stores. Objective: This protocol describes a systematic search, selection, and appraisal process for tablet apps targeting phonics knowledge and phonological awareness skills. This protocol aimed to (1) provide a systematic method for identifying tablet apps targeting phonics knowledge and phonological awareness skills in the Google Play Store and Apple’s App Store and (2) describe an evidence-based approach for quality appraisal of these apps by using structured tools. Methods: This protocol describes an evidence-based method guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework to systematically search, select, and appraise apps targeting phonics knowledge and phonological awareness skills, present in Google Play and the App Store. We intend to perform a systematic and comprehensive search and a 2-step process for screening: (1) broad screening (app titles) and (2) narrow screening (marketing descriptions). Quality appraisal of the included apps will involve two structured appraisal tools: (1) the Mobile Application Rating Scale and (2) the Appraising Apps for Reading Checklist. Results: This method will help determine the number of apps targeting phonics knowledge and phonological awareness, present on the Android and iOS platforms. The content, quality, and usability of these apps will be determined using structured appraisal tools. We have planned to conduct searches on Google Play and the App Store in January-March 2021; broad and focused screening, from April 2021; and data extraction and quality appraisal in October 2021. Conclusions: This protocol provides a basis for locating and evaluating apps targeting phonics knowledge and phonological awareness skills. This protocol will support practitioners, educators, and families to make informed decisions when purchasing apps for instructional use. International Registered Report Identifier (IRRID): PRR1-10.2196/23921 %M 33523827 %R 10.2196/23921 %U http://www.researchprotocols.org/2021/2/e23921/ %U https://doi.org/10.2196/23921 %U http://www.ncbi.nlm.nih.gov/pubmed/33523827 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24472 %T Acceptability, Validity, and Engagement With a Mobile App for Frequent, Continuous Multiyear Assessment of Youth Health Behaviors (mNCANDA): Mixed Methods Study %A Cummins,Kevin M %A Brumback,Ty %A Chung,Tammy %A Moore,Raeanne C %A Henthorn,Trevor %A Eberson,Sonja %A Lopez,Alyssa %A Sarkissyan,Tatev %A Nooner,Kate B %A Brown,Sandra A %A Tapert,Susan F %+ Department of Psychology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 8582952763, kcummins@ucsd.edu %K mobile applications %K young adults %K smartphone %K health behavior %K underage drinking %K alcohol drinking %K self-report %K illicit drugs %K mobile phone %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Longitudinal studies of many health behaviors often rely on infrequent self-report assessments. The measurement of psychoactive substance use among youth is expected to improve with more frequent mobile assessments, which can reduce recall bias. Researchers have used mobile devices for longitudinal research, but studies that last years and assess youth continuously at a fine-grained, temporal level (eg, weekly) are rare. A tailored mobile app (mNCANDA [mobile National Consortium on Alcohol and Neurodevelopment in Adolescence]) and a brief assessment protocol were designed specifically to provide a feasible platform to elicit responses to health behavior assessments in longitudinal studies, including NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence). Objective: This study aimed to determine whether an acceptable mobile app system could provide repeatable and valid assessment of youth’s health behaviors in different developmental stages over extended follow-up. Methods: Participants were recruited (n=534; aged 17-28 years) from a larger longitudinal study of neurodevelopment. Participants used mNCANDA to register reports of their behaviors for up to 18 months. Response rates as a function of time measured using mNCANDA and participant age were modeled using generalized estimating equations to evaluate response rate stability and age effects. Substance use reports captured using mNCANDA were compared with responses from standardized interviews to assess concurrent validity. Reactivity was assessed by evaluating patterns of change in substance use after participants initiated weekly reports via mNCANDA. Quantitative feedback about the app was obtained from the participants. Qualitative interviews were conducted with a subset of participants who used the app for at least one month to obtain feedback on user experience, user-derived explanations of some quantitative results, and suggestions for system improvements. Results: The mNCANDA protocol adherence was high (mean response rate 82%, SD 27%) and stable over time across all age groups. The median time to complete each assessment was 51 s (mean response time 1.14, SD 1.03 min). Comparisons between mNCANDA and interview self-reports on recent (previous 30 days) alcohol and cannabis use days demonstrate close agreement (eg, within 1 day of reported use) for most observations. Models used to identify reactivity failed to detect changes in substance use patterns subsequent to enrolling in mNCANDA app assessments (P>.39). Most participants (64/76, 84%) across the age range reported finding the mNCANDA system acceptable. Participants provided recommendations for improving the system (eg, tailoring signaling times). Conclusions: mNCANDA provides a feasible, multi-year, continuous, fine-grained (eg, weekly) assessment of health behaviors designed to minimize respondent burden and provides acceptable regimes for long-term self-reporting of health behaviors. Fine-grained characterization of variability in behaviors over relatively long periods (eg, up to 18 months) may, through the use of mNCANDA, improve our understanding of the relationship between substance use exposure and neurocognitive development. %M 33565988 %R 10.2196/24472 %U http://mhealth.jmir.org/2021/2/e24472/ %U https://doi.org/10.2196/24472 %U http://www.ncbi.nlm.nih.gov/pubmed/33565988 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24177 %T Using a Commercially Available App for the Self-Management of Hypertension: Acceptance and Usability Study in Saudi Arabia %A Alessa,Tourkiah %A S Hawley,Mark %A Alsulamy,Nouf %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 966 559346711, talessa1@sheffield.ac.uk %K mHealth %K mobile phone %K hypertension %K usability %K acceptance %K user satisfaction %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of smartphone apps to assist in the self-management of hypertension is becoming increasingly common, but few commercially available apps have the potential to be effective along with adequate security and privacy measures in place. In a previous study, we identified 5 apps that are potentially effective and safe, and based on the preferences of doctors and patients, one (Cora Health) was selected as the most suitable app for use in a Saudi context. However, there is currently no evidence of its usability and acceptance among potential users. Indeed, there has been little research into the usability and acceptance of hypertension apps in general, and less research considers this in the Gulf Region. Objective: This study aims to evaluate the acceptance and usability of the selected app in the Saudi context. Methods: This study used a mixed methods approach with 2 studies: a usability test involving patients in a controlled setting performing predefined tasks and a real-world usability study where patients used the app for 4 weeks. In the usability test, participants were asked to think aloud while performing the tasks, and an observer recorded the number of tasks they completed. At the end of the real-world pilot study, participants were interviewed, and the mHealth App Usability Questionnaire was completed. Descriptive statistics were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data. Results: In total, 10 patients completed study 1. The study found that app usability was moderate and that participants needed some familiarization time before they could use the app proficiently. Some usability issues were revealed, related to app accessibility and navigation, and a few tasks remained uncompleted by most people. A total of 20 patients completed study 2, with a mean age of 51.6 (SD 11.7) years. Study 2 found that the app was generally acceptable and easy to use, with some similar usability issues identified. Participants stressed the importance of practice and training to use it more easily and proficiently. Participants had a good engagement level with 48% retention at the end of study 2, with most participants’ engagement being classed as meaningful. The most recorded data were blood pressure, followed by stress and medication, and the most accessed feature was viewing graphs of data trends. Conclusions: This study shows that a commercially available app can be usable and acceptable in the self-management of hypertension but also found a considerable number of possibilities for improvement, which needs to be considered in future app development. The results show that there is potential for a commercially available app to be used in large-scale studies of hypertension self-management if suggestions for improvements are addressed. %M 33560237 %R 10.2196/24177 %U http://mhealth.jmir.org/2021/2/e24177/ %U https://doi.org/10.2196/24177 %U http://www.ncbi.nlm.nih.gov/pubmed/33560237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21737 %T Development and Feasibility of a Digital Acceptance and Commitment Therapy–Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study %A Hemmings,Nicola R %A Kawadler,Jamie M %A Whatmough,Rachel %A Ponzo,Sonia %A Rossi,Alessio %A Morelli,Davide %A Bird,Geoffrey %A Plans,David %+ Department of Organizational Psychology, Birkbeck University of London, Malet St, London, WC1E 7HX, United Kingdom, 44 7716362200, nhemmi01@mail.bbk.ac.uk %K anxiety %K depression %K acceptance and commitment therapy %K person-based approach %K mHealth %K mental health %K digital %K remote %K smartphone %K mobile phone %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. Objective: This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. Methods: Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. Results: The app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for AAQ-II and WEMWBS, respectively). Conclusions: This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD. %M 33560232 %R 10.2196/21737 %U https://formative.jmir.org/2021/2/e21737 %U https://doi.org/10.2196/21737 %U http://www.ncbi.nlm.nih.gov/pubmed/33560232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e19243 %T Attitudes Toward a Proposed GPS-Based Location Tracking Smartphone App for Improving Engagement in HIV Care Among Pregnant and Postpartum Women in South Africa: Focus Group and Interview Study %A Clouse,Kate %A Phillips,Tamsin K %A Mogoba,Phepo %A Ndlovu,Linda %A Bassett,Jean %A Myer,Landon %+ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 (615) 343 5351, kate.clouse@vanderbilt.edu %K HIV/AIDS %K South Africa %K smartphone %K mobile health %K pregnancy %K GPS tracking %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Peripartum women living with HIV in South Africa are at high risk of dropping out of care and are also a particularly mobile population, which may impact their engagement in HIV care. With the rise in mobile phone use worldwide, there is an opportunity to use smartphones and GPS location software to characterize mobility in real time. Objective: The aim of this study was to propose a smartphone app that could collect individual GPS locations to improve engagement in HIV care and to assess potential users’ attitudes toward the proposed app. Methods: We conducted 50 in-depth interviews (IDIs) with pregnant women living with HIV in Cape Town and Johannesburg, South Africa, and 6 focus group discussions (FGDs) with 27 postpartum women living with HIV in Cape Town. Through an open-ended question in the IDIs, we categorized “positive,” “neutral,” or “negative” reactions to the proposed app and identified key quotations. For the FGD data, we grouped the text into themes, then analyzed it for patterns, concepts, and associations and selected illustrative quotations. Results: In the IDIs, the majority of participants (76%, 38/50) responded favorably to the proposed app. Favorable comments were related to the convenience of facilitated continued care, a sense of helpfulness on the part of the researchers and facilities, and the difficulties of trying to maintain care while traveling. Among the 4/50 participants (8%) who responded negatively, their comments were primarily related to the individual’s responsibility for their own health care. The FGDs revealed four themes: facilitating connection to care, informed choice, disclosure (intentional or unintentional), and trust in researchers. Conclusions: Women living with HIV were overwhelmingly positive about the idea of a GPS-based smartphone app to improve engagement in HIV care. Participants reported that they would welcome a tool to facilitate connection to care when traveling and expressed trust in researchers and health care facilities. Within the context of the rapid increase of smartphone use in South Africa, these early results warrant further exploration and critical evaluation following real-world experience with the app. %M 33555261 %R 10.2196/19243 %U https://formative.jmir.org/2021/2/e19243 %U https://doi.org/10.2196/19243 %U http://www.ncbi.nlm.nih.gov/pubmed/33555261 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24457 %T Malay Version of the mHealth App Usability Questionnaire (M-MAUQ): Translation, Adaptation, and Validation Study %A Mustafa,Norashikin %A Safii,Nik Shanita %A Jaffar,Aida %A Sani,Nor Samsiah %A Mohamad,Mohd Izham %A Abd Rahman,Abdul Hadi %A Mohd Sidik,Sherina %+ Dietetics Program and Center for Community Health Study, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Ab Aziz, Kuala Lumpur, 50300, Malaysia, 60 039289 7662, nikshanita@ukm.edu.my %K mHealth app %K questionnaire validation %K questionnaire translation %K Malay MAUQ %K usability %K mHealth %K education %K usability %K Malay language %K Malay %K questionnaire %K mobile phone %D 2021 %7 4.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps play an important role in delivering education, providing advice on treatment, and monitoring patients’ health. Good usability of mHealth apps is essential to achieve the objectives of mHealth apps efficiently. To date, there are questionnaires available to assess the general system usability but not explicitly tailored to precisely assess the usability of mHealth apps. Hence, the mHealth App Usability Questionnaire (MAUQ) was developed with 4 versions according to the type of app (interactive or standalone) and according to the target user (patient or provider). Standalone MAUQ for patients comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. Objective: This study aimed to translate and validate the English version of MAUQ (standalone for patients) into a Malay version of MAUQ (M-MAUQ) for mHealth app research and usage in future in Malaysia. Methods: Forward and backward translation and harmonization of M-MAUQ were conducted by Malay native speakers who also spoke English as their second language. The process began with a forward translation by 2 independent translators followed by harmonization to produce an initial translated version of M-MAUQ. Next, the forward translation was continued by another 2 translators who had never seen the original MAUQ. Lastly, harmonization was conducted among the committee members to resolve any ambiguity and inconsistency in the words and sentences of the items derived with the prefinal adapted questionnaire. Subsequently, content and face validations were performed with 10 experts and 10 target users, respectively. Modified kappa statistic was used to determine the interrater agreement among the raters. The reliability of the M-MAUQ was assessed by 51 healthy young adult mobile phone users. Participants needed to install the MyFitnessPal app and use it for 2 days for familiarization before completing the designated task and answer the M-MAUQ. The MyFitnessPal app was selected because it is one among the most popular installed mHealth apps globally available for iPhone and Android users and represents a standalone mHealth app. Results: The content validity index for the relevancy and clarity of M-MAUQ were determined to be 0.983 and 0.944, respectively, which indicated good relevancy and clarity. The face validity index for understandability was 0.961, which indicated that users understood the M-MAUQ. The kappa statistic for every item in M-MAUQ indicated excellent agreement between the raters (κ ranging from 0.76 to 1.09). The Cronbach α for 18 items was .946, which also indicated good reliability in assessing the usability of the mHealth app. Conclusions: The M-MAUQ fulfilled the validation criteria as it revealed good reliability and validity similar to the original version. M-MAUQ can be used to assess the usability of mHealth apps in Malay in the future. %M 33538704 %R 10.2196/24457 %U http://mhealth.jmir.org/2021/2/e24457/ %U https://doi.org/10.2196/24457 %U http://www.ncbi.nlm.nih.gov/pubmed/33538704 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e19413 %T A Mobile Health Platform for Self-Management of Pediatric Cystic Fibrosis: Qualitative Study of Adaptation to Stakeholder Needs and Integration in Clinical Settings %A Rutland,Sarah B %A Bergquist,Rikard Palmer %A Hager,Andreas %A Geurs,Robin %A Mims,Cathy %A Gutierrez,Hector H %A Oates,Gabriela R %+ Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Lowder 620, 1600 7th Ave S, Birmingham, AL, 35233, United States, 1 2056389583, goates@uab.edu %K cystic fibrosis %K mHealth %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cystic fibrosis (CF) is an inherited chronic condition that requires extensive daily care and quarterly clinic visits with a multidisciplinary care team. The limited exchange of information outside of the quarterly clinic visits impedes optimal disease self-management, patient engagement, and shared decision making. Objective: The aim of this study is to adapt a mobile health (mHealth) app originally developed in Sweden to the needs of patients, families, and health care providers in a CF center in the United States and to test it as a platform for sharing patient-generated health data with the CF health care team. Methods: Focus groups with health care providers of patients with CF, adolescents with CF, and caregivers of children with CF were conducted to determine what modifications were necessary. Focus group data were analyzed using a thematic analysis, and emergent themes were ranked according to desirability and technical feasibility. The mHealth platform was then modified to meet the identified needs and preferences, and the flow of patient-generated health data to a secure Research Electronic Data Capture database was tested. Protocols for data management and clinical follow-up were also developed. Results: A total of 5 focus groups with 21 participants were conducted. Recommended modifications pertained to all functionalities of the mHealth platform, including tracking of symptoms, treatments, and activities of daily care; creating and organizing medication lists and setting up reminders; generating reports for the health care team; language and presentation; sharing and privacy; and settings and accounts. Overall, health care providers recommended changes to align the mHealth platform with US standards of care, people with CF and their caregivers requested more tracking functionalities, and both groups suggested the inclusion of a mental health tracker as well as more detailed response options and precise language. Beta testers of the modified platform reported issues related to translatability to US environment and various bugs. Conclusions: This study demonstrated the importance of identifying the needs and preferences of target users and stakeholders before adopting existing mHealth solutions. All relevant perspectives, including those of clinicians, patients, and caregivers, should be thoroughly considered to meet both end users’ needs and evidence-based practice recommendations. %M 33496667 %R 10.2196/19413 %U http://formative.jmir.org/2021/1/e19413/ %U https://doi.org/10.2196/19413 %U http://www.ncbi.nlm.nih.gov/pubmed/33496667 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24424 %T Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study %A Coughlin,Lara N %A Nahum-Shani,Inbal %A Philyaw-Kotov,Meredith L %A Bonar,Erin E %A Rabbi,Mashfiqui %A Klasnja,Predrag %A Murphy,Susan %A Walton,Maureen A %+ Department of Psychiatry, Addiction Center, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 615 4774, laraco@med.umich.edu %K mHealth %K adolescents %K young adults %K just-in-time adaptive intervention %K alcohol misuse %K cannabis %K mobile phone %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use–related consequences. Objective: This pilot study aims to describe the iterative development and initial feasibility and acceptability testing of an mHealth smartphone app, called MiSARA, designed to reduce escalation in substance use. Methods: We used social media advertisements to recruit youth (n=39; aged 16-24 years, who screened positive for past-month binge drinking or recreational cannabis use) with a waiver of parental consent. Participants used the MiSARA app for 30 days, with feasibility and acceptability data reported at a 1-month follow-up. We present descriptive data regarding behavior changes over time. Results: The results show that most participants (31/39, 79%) somewhat liked the app at least, with most (29/39, 74%) rating MiSARA as 3 or more stars (out of 5). Almost all participants were comfortable with self-reporting sensitive information within the app (36/39, 92%); however, most participants also desired more interactivity (27/39, 69%). In addition, participants’ substance use declined over time, and those reporting using the app more often reported less substance use at the 1-month follow-up than those who reported using the app less often. Conclusions: The findings suggest that the MiSARA app is a promising platform for JITAI delivery, with future trials needed to optimize the timing and dose of messages and determine efficacy. %M 33448931 %R 10.2196/24424 %U http://mhealth.jmir.org/2021/1/e24424/ %U https://doi.org/10.2196/24424 %U http://www.ncbi.nlm.nih.gov/pubmed/33448931 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24467 %T The Human Factor in Automated Image-Based Nutrition Apps: Analysis of Common Mistakes Using the goFOOD Lite App %A Vasiloglou,Maria F %A van der Horst,Klazine %A Stathopoulou,Thomai %A Jaeggi,Michael P %A Tedde,Giulia S %A Lu,Ya %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, Bern, 3008, Switzerland, 41 6327592, stavroula.mougiakakou@artorg.unibe.ch %K mHealth %K dietary assessment %K smartphone %K apps %K human mistakes %K mobile phone %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological advancements have enabled nutrient estimation by smartphone apps such as goFOOD. This is an artificial intelligence–based smartphone system, which uses food images or video captured by the user as input and then translates these into estimates of nutrient content. The quality of the data is highly dependent on the images the user records. This can lead to a major loss of data and impaired quality. Instead of removing these data from the study, in-depth analysis is needed to explore common mistakes and to use them for further improvement of automated apps for nutrition assessment. Objective: The aim of this study is to analyze common mistakes made by participants using the goFOOD Lite app, a version of goFOOD, which was designed for food-logging, but without providing results to the users, to improve both the instructions provided and the automated functionalities of the app. Methods: The 48 study participants were given face-to-face instructions for goFOOD Lite and were asked to record 2 pictures (1 recording) before and 2 pictures (1 recording) after the daily consumption of each food or beverage, using a reference card as a fiducial marker. All pictures that were discarded for processing due to mistakes were analyzed to record the main mistakes made by users. Results: Of the 468 recordings of nonpackaged food items captured by the app, 60 (12.8%) had to be discarded due to errors in the capturing procedure. The principal problems were as follows: wrong fiducial marker or improper marker use (19 recordings), plate issues such as a noncompatible or nonvisible plate (8 recordings), a combination of various issues (17 recordings), and other reasons such as obstacles (hand) in front of the camera or matching recording pairs (16 recordings). Conclusions: No other study has focused on the principal problems in the use of automatic apps for assessing nutritional intake. This study shows that it is important to provide study participants with detailed instructions if high-quality data are to be obtained. Future developments could focus on making it easier to recognize food on various plates from its color or shape and on exploring alternatives to using fiducial markers. It is also essential for future studies to understand the training needed by the participants as well as to enhance the app’s user-friendliness and to develop automatic image checks based on participant feedback. %M 33439139 %R 10.2196/24467 %U http://mhealth.jmir.org/2021/1/e24467/ %U https://doi.org/10.2196/24467 %U http://www.ncbi.nlm.nih.gov/pubmed/33439139 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21094 %T Feasibility, Usability, and Enjoyment of a Home-Based Exercise Program Delivered via an Exercise App for Musculoskeletal Health in Community-Dwelling Older Adults: Short-term Prospective Pilot Study %A Daly,Robin M %A Gianoudis,Jenny %A Hall,Travis %A Mundell,Niamh L %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, 3125, Australia, 61 392446040, rmdaly@deakin.edu.au %K home exercise %K multicomponent exercise %K mobile health %K musculoskeletal %K adherence %K usability %K older adults %K physical activity enjoyment %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many older adults choose and prefer to exercise at home, but to attain the greatest benefits, the correct type and dose of exercise should be prescribed and adherence maintained. Advances in digital health technologies now provide the opportunity for exercise professionals to deliver and monitor personalized, evidence-based exercise programs to anyone at any time. Objective: The aim of this study was to evaluate the feasibility, usability, and enjoyment of a web-based exercise prescription app as a platform for exercise professionals to remotely deliver and monitor an individually tailored, home-based multicomponent exercise program (delivered through tablet computers) to older adults living independently in the community. Methods: This was an 8-week, prospective single-arm pilot study in 20 adults aged ≥65 years living independently in the community: 10 owned a tablet computer (tablet owners) and 10 did not own tablets (tablet nonowners). All participants were prescribed a home-based, muscle strengthening, weight-bearing impact and challenging balance/mobility program (3 days/week) using a commercial exercise prescription app on a tablet computer. Study endpoints were feasibility (retention, adherence, adverse events), usability (System Usability Scale), physical activity enjoyment (Physical Activity Enjoyment Scale), changes in lower extremity function (Short Physical Performance Battery [SPPB]), and level of physical activity (questionnaire). Process measures related to the participants' experiences and perceptions of the exercise program and web-based app were also included. Results: A total of 19 participants (mean age, 70 years) completed the study (19/20, 95%), and mean adherence to the exercise program was 84% (95% CI 70%-97%). There were 2 minor adverse events in 2 participants from 401 completed sessions. Mean weekly walking time increased by 78 minutes (95% CI 0-156, P=.049) and moderate-to-vigorous physical activity time by 41 minutes (95% CI –8 to 90, P=.09). For SPPB scores, there was a 0.3 point (95% CI –0.1 to 0.7, P=.17) modest sized (effect size, d=0.42) improvement after 8 weeks. Mean (SD) system usability was high (86 [10] with 100 best imaginable). There was no change in the overall physical activity enjoyment scores after 8 weeks, but participants reported that they enjoyed using the web-based exercise app and the exercise program (median score 4 on a 5-point Likert scale). For all measures, there were no differences between previous tablet owners and nonowners. Conclusions: This pilot feasibility study indicates that it is safe and feasible for community-dwelling older adults to participate in a home-based, multicomponent exercise program targeting musculoskeletal health and function that was delivered and monitored remotely by exercise professionals using a tablet-based exercise prescription app. %M 33439147 %R 10.2196/21094 %U http://mhealth.jmir.org/2021/1/e21094/ %U https://doi.org/10.2196/21094 %U http://www.ncbi.nlm.nih.gov/pubmed/33439147 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e20427 %T Exploring How Older Adults Use a Smart Speaker–Based Voice Assistant in Their First Interactions: Qualitative Study %A Kim,Sunyoung %+ School of Communication and Information, Rutgers University, 4 Huntington St, New Brunswick, NJ, 08901-1071, United States, 1 848 932 7585, sunyoung.kim@rutgers.edu %K older adults %K voice assistant %K smart speaker %K technology acceptance %K quality of life %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart speaker–based voice assistants promise support for the aging population, with the advantages of hands-free and eyes-free interaction modalities to handle requests. However, little is known about how older adults perceive the benefits of this type of device. Objective: This study investigates how older adults experience and respond to a voice assistant when they first interact with it. Because first impressions act as strong predictors of the overall attitude and acceptability of new technologies, it is important to understand the user experiences of first exposure. Methods: We conducted semistructured interviews with 18 people 74 years and older who had never used a smart speaker before, investigating the patterns of use, usability issues, and perspectives that older adults have when using a voice assistant for the first time. Results: The overall first response to a voice assistant was positive, thanks to the simplicity of a speech-based interaction. In particular, a positive and polite response to complete the interaction with a voice assistant was prevalent, such as expressing gratitude or giving feedback about the quality of answers. Two predominant topics of commands made in the first interaction include asking health care–related questions and streaming music. However, most of the follow-up reactions were unfavorable because of the difficulty in constructing a structured sentence for a command; misperceptions about how a voice assistant operates; and concerns about privacy, security, and financial burdens. Overall, a speech-based interaction was perceived to be beneficial owing to its efficiency and convenience, but no other benefits were perceived. Conclusions: On the basis of the findings, we discuss design implications that can positively influence older adults' first experiences with a voice assistant, including helping better understand how a voice assistant works, incorporating mistakes and common interaction patterns into its design, and providing features tailored to the needs of older adults. %M 33439130 %R 10.2196/20427 %U http://mhealth.jmir.org/2021/1/e20427/ %U https://doi.org/10.2196/20427 %U http://www.ncbi.nlm.nih.gov/pubmed/33439130 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e18021 %T Assessing the Effectiveness and Acceptability of a Personalized Mobile Phone App in Improving Adherence to Oral Hygiene Advice in Orthodontic Patients: Protocol for a Feasibility Study and a Randomized Controlled Trial %A Sharif,Mohammad Owaise %A Newton,Jonathon Timothy %A Cunningham,Susan J %+ Eastman Dental Institute, University College London, Rockefeller Building, 21 University Street, London, WC1E 6DE, United Kingdom, 44 02034561067, mohammad.sharif.16@ucl.ac.uk %K orthodontics %K adherence %K smartphone apps %K mobile phone apps %K personalized health care %K information provision %D 2021 %7 13.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Orthodontic treatment is a common health care intervention; treatment duration can be lengthy (2-3 years on average), and adherence to treatment advice is therefore essential for successful outcomes. It has been reported that up to 43% of patients fail to complete treatment, and there are currently no useful predictors of noncompletion. Given that the National Health Service England annual expenditure on primary-care orthodontic treatment is in excess of £200 million (US $267 million), noncompletion of treatment represents a significant inefficient use of public resources. Improving adherence to treatment is therefore essential. This necessitates behavior change, and interventions that improve adherence and are designed to elicit behavioral change must address an individual’s capability, opportunity, and motivation. Mobile phones are potentially an invaluable tool in this regard, as they are readily available and can be used in a number of ways to address an individual’s capability, opportunity, and motivation. Objective: This study will assess the effectiveness and acceptability of a personalized mobile phone app in improving adherence to orthodontic treatment advice by way of a randomized controlled trial. Methods: This study will be conducted in 2 phases at the Eastman Dental Hospital, University College London Hospitals Foundation Trust. Phase 1 is feasibility testing of the My Braces app. Participants will be asked to complete the user version of the Mobile Application Rating Scale. The app will be amended following analysis of the responses, if appropriate. Phase 2 is a randomized controlled trial to test the effectiveness and acceptability of the My Braces app. Results: This study was approved by the London – Bloomsbury Research Ethics Committee on November 5, 2019 (reference 19/LO/1555). No patients have been recruited to date. The anticipated start date for recruitment to phase 1 is October 2020. Conclusions: Given the availability, affordability, and versatility of mobile phones, it is proposed that they will aid in improving adherence to treatment advice and hence improve treatment completion rates. If effective, the applicability of this methodology to developing behavior change/modification interventions and improving adherence to treatment across health care provides an exciting opportunity. Trial Registration: ClinicalTrials.gov NCT04184739; https://clinicaltrials.gov/ct2/show/NCT04184739 International Registered Report Identifier (IRRID): PRR1-10.2196/18021 %M 33439142 %R 10.2196/18021 %U http://www.researchprotocols.org/2021/1/e18021/ %U https://doi.org/10.2196/18021 %U http://www.ncbi.nlm.nih.gov/pubmed/33439142 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e23402 %T Usability and Preliminary Effectiveness of a Preoperative mHealth App for People Undergoing Major Surgery: Pilot Randomized Controlled Trial %A van der Velde,Miriam %A Valkenet,Karin %A Geleijn,Edwin %A Kruisselbrink,Marjoke %A Marsman,Marije %A Janssen,Liedewij MJ %A Ruurda,Jelle P %A van der Peet,Donald L %A Aarden,Jesse J %A Veenhof,Cindy %A van der Leeden,Marike %+ Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Heidelberglaan 7, Utrecht, , Netherlands, 31 064 221 4251, miriam.vandervelde@hu.nl %K preoperative care %K smartphone %K mhealth %K risk behavior %K prehabilitation %K usability %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Major surgery is associated with negative postoperative outcomes such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mobile health (mHealth) could be an effective new approach. Objective: The objectives of this pilot study were to (1) evaluate the usability of the Be Prepared mHealth app prototype for people undergoing major surgery, (2) explore whether the app was capable of bringing about a change in risk behaviors, and (3) estimate a preliminary effect of the app on functional recovery after major surgery. Methods: A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total, 86 people undergoing major surgery participated. Participants in the intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires. Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about the usability of the app were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data. Results: Seventy-nine people—40 in the intervention group and 39 in the control group—were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that patients considered the Be Prepared app to have acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app. Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values (β=–2.4 [95% CI –5.9 to 1.1]). Conclusions: The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified with which the app and future research can be optimized. Trial Registration: Netherlands Trial Registry NL8623; https://www.trialregister.nl/trial/8623 %M 33410758 %R 10.2196/23402 %U http://mhealth.jmir.org/2021/1/e23402/ %U https://doi.org/10.2196/23402 %U http://www.ncbi.nlm.nih.gov/pubmed/33410758 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e25701 %T Drivers of Acceptance of COVID-19 Proximity Tracing Apps in Switzerland: Panel Survey Analysis %A von Wyl,Viktor %A Höglinger,Marc %A Sieber,Chloé %A Kaufmann,Marco %A Moser,André %A Serra-Burriel,Miquel %A Ballouz,Tala %A Menges,Dominik %A Frei,Anja %A Puhan,Milo Alan %+ Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, Zürich, 8001, Switzerland, 41 446346380, viktor.vonwyl@uzh.ch %K COVID-19 %K SARS-CoV-2 %K digital proximity tracing %K digital contact tracing %K mHealth %K tracing %K compliance %K acceptance %K uptake %K usability %K communication %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital proximity tracing apps have been released to mitigate the transmission of SARS-CoV-2, the virus known to cause COVID-19. However, it remains unclear how the acceptance and uptake of these apps can be improved. Objective: This study aimed to investigate the coverage of the SwissCovid app and the reasons for its nonuse in Switzerland during a period of increasing incidence of COVID-19 cases. Methods: We collected data between September 28 and October 8, 2020, via a nationwide online panel survey (COVID-19 Social Monitor, N=1511). We examined sociodemographic and behavioral factors associated with app use by using multivariable logistic regression, whereas reasons for app nonuse were analyzed descriptively. Results: Overall, 46.5% (703/1511) of the survey participants reported they used the SwissCovid app, which was an increase from 43.9% (662/1508) reported in the previous study wave conducted in July 2020. A higher monthly household income (ie, income >CHF 10,000 or >US $11,000 vs income ≤CHF 6000 or 85% of their doses observed, while only 16.4% (26/158) of the DOT patients had >85% of their doses observed. All patients were cured without recurrences. The VOT management required significantly (P<.001) less median patient time (300 minutes vs 1240 minutes, respectively) and transportation costs (¥53 [US $7.57] vs ¥276 [US $39.43], respectively; P<.001) than DOT. Significantly more patients (191/235, 81.3%) in the VOT group preferred their treatment method compared to those on DOT (37/131, 28.2%) (P<.001), and 92% (61/66) of the health care workers thought that the VOT method was more convenient than DOT for managing patients with TB. Conclusions: Implementation of the VOT-based system into the routine program of TB management was simple and it significantly increased patient adherence to their drug regimens. Our study shows that a comprehensive VOT-based TB management represents a viable and improved evolution of DOT. %M 32735222 %R 10.2196/17658 %U https://mhealth.jmir.org/2020/7/e17658 %U https://doi.org/10.2196/17658 %U http://www.ncbi.nlm.nih.gov/pubmed/32735222 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e12655 %T Patient and Provider Cocreation of Mobile Texting Apps to Support Behavioral Health: Usability Study %A Arevian,Armen C %A O'Hora,Jennifer %A Rosser,James %A Mango,Joseph D %A Miklowitz,David J %A Wells,Kenneth B %+ Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA, , United States, 1 310 794 3732, AArevian@mednet.ucla.edu %K mobile health %K community-based participatory research %K app development %K technology platforms %K personalized medicine %K behavioral health %K mobile phone %D 2020 %7 29.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technologies hold potential for improving the quality of care and engagement of patients. However, there are considerable challenges in ensuring that technologies are relevant, useful, and engaging. While end users such as patients and providers are increasingly involved in the design of health technologies, there are limited examples of their involvement in directly creating technologies for their personal use. Objective: We aim to evaluate the feasibility and acceptability of patients and providers creating mobile texting apps to support treatment goals. Methods: In an 11-month usability study, we enrolled 4 providers and 28 patients in an intensive outpatient program for obsessive-compulsive disorder. Patients and providers created their own mobile texting apps using a visual app development platform. A subsample of 10 patients and 4 providers completed a usability measure. Results: Participants created a total of 360 unique mobile text messages (1787 total messages sent). There were 4 types of messages identified, including personalized reminders, clinical exposures, interactive prompts, and encouraging/informational messages. A total of 9 out of 10 (90%) patients agreed that the messages were relevant to their recovery, and 8 out of 10 (80%) agreed that the messages were effective at helping complete treatment plans. Conclusions: Enabling patients and providers to cocreate apps for their own use by using a visual application platform is feasible and holds potential for increasing the relevance, sustainability, and effectiveness of digital health technologies. %M 32723714 %R 10.2196/12655 %U http://mhealth.jmir.org/2020/7/e12655/ %U https://doi.org/10.2196/12655 %U http://www.ncbi.nlm.nih.gov/pubmed/32723714 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16783 %T The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study %A Jongbloed,Kate %A Pearce,Margo E %A Thomas,Vicky %A Sharma,Richa %A Pooyak,Sherri %A Demerais,Lou %A Lester,Richard T %A Schechter,Martin T %A Spittal,Patricia M %A , %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 875 2345 ext 5944, spittal@sm.hivnet.ubc.ca %K Indigenous %K mobile health %K mHealth %K text messaging %K substance use %K HIV/AIDS %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective: This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods: The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results: Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions: We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population. %M 32716311 %R 10.2196/16783 %U https://mhealth.jmir.org/2020/7/e16783 %U https://doi.org/10.2196/16783 %U http://www.ncbi.nlm.nih.gov/pubmed/32716311 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16856 %T Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy %A Rabinovich,Lila %A Molton,James Steven %A Ooi,Wei Tsang %A Paton,Nicholas Iain %A Batra,Shelly %A Yoong,Joanne %+ Center for Economic and Social Research, University of Southern California, 1090 Vermont Avenue, NW, Washington, DC, 20005, United States, 1 2138210537, lilarabi@usc.edu %K directly observed therapy %K video recording %K telemedicine %K mobile health %K mHealth %K tuberculosis %K low-income settings %K developing countries %K patient acceptance of health care %K patient acceptability %K Cambodia %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the development of effective drugs for treatment, tuberculosis remains one of the leading causes of death from an infectious disease worldwide. One of the greatest challenges to tuberculosis control is patient adherence to treatment. Recent research has shown that video-based directly observed therapy is a feasible and effective approach to supporting treatment adherence in high-income settings. However, few studies have explored the potential for such a solution in a low- or middle-income country setting. Globally, these countries’ rapidly rising rate of mobile penetration suggests that the potential for translation of these results may be high. Objective: We sought to examine patient perceptions related to the use of mobile health, and specifically video-based directly observed therapy, in a previously unstudied patient demographic: patients with tuberculosis in a low-income country setting (Cambodia). Methods: We conducted a cross-sectional qualitative study in urban and periurban areas in Cambodia, consisting of 6 focus groups with tuberculosis patients who were receiving treatment (standard directly observed therapy) through a nongovernmental organization. Results: Familiarity with mobile technology and apps was widespread in this population, and overall willingness to consider a mobile app for video-based directly observed therapy was high. However, we identified potential challenges. First, patients very much valued their frequent in-person interactions with their health care provider, which may be reduced with the video-based directly observed therapy intervention. Second, there may be technical issues to address, including how to make the app suitable for illiterate participants. Conclusions: While video-based directly observed therapy is a promising technology, even in country settings where mobile penetration is reportedly almost universal, it should be introduced with caution. However, the results were generally promising and yielded important insights that not only will be translated into the further adaptation of key features of video-based directly observed therapy for tuberculosis patients in Cambodia, but also can inform the future design and successful implementation of video-based directly observed therapy interventions in low- and middle-income settings more generally. %M 32716309 %R 10.2196/16856 %U https://www.jmir.org/2020/7/e16856 %U https://doi.org/10.2196/16856 %U http://www.ncbi.nlm.nih.gov/pubmed/32716309 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19585 %T User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study %A Kim,HyangHee %A Lee,Sang-Ho %A Cho,Nam-Bin %A You,Heecheon %A Choi,Teukgyu %A Kim,Jinwon %+ Graduate Program in Speech-Language Pathology, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 11-12 Yondaedongmun-gil, Seodaemun-gu, Seoul, 03721, Republic of Korea, 82 2 2228 3900, h.kim@yonsei.ac.kr %K older adults %K dysphagia %K swallowing %K mHealth %K thematic analysis %K usability %K apps %K education %K experience %K sociodemographic %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective: The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods: A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results: The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=–2.023, P=.04). Additionally, the usability scores in the low-potential group were within the “marginal acceptability” range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions: To the best of the authors’ knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program. %M 32663161 %R 10.2196/19585 %U http://mhealth.jmir.org/2020/7/e19585/ %U https://doi.org/10.2196/19585 %U http://www.ncbi.nlm.nih.gov/pubmed/32663161 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17373 %T A Companion App to Support Rheumatology Patients Treated with Certolizumab Pegol: Results From a Usability Study %A Domańska,Barbara %A Vansant,Stijn %A Mountian,Irina %+ UCB Pharma, 208 Bath Road, Slough, United Kingdom, 44 1615 197676, barbara.domanska@UCB.com %K rheumatology %K internet %K digital health %K mobile health %K mHealth %K smartphone %K mobile phone %K validation human factors study %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Certolizumab pegol (CZP) is an anti-tumor necrosis factor drug approved for the treatment of multiple moderate to severe chronic inflammatory diseases. In the European Union, CZP is approved for administration by subcutaneous self-injection using a prefilled syringe, prefilled pen, or reusable electromechanical auto-injector (electronic device). CimplyMe is a companion app for use alongside CZP self-injection devices, designed to support CZP-treated patients self-managing their treatment and disease. Objective: This study aimed to validate the usability of the companion app by demonstrating that tasks required for use can be performed successfully by intended end users. Methods: We recruited 15 patients with moderate to severe rheumatoid arthritis, currently prescribed biologic treatment, and using apps on a smart phone. Patients were assessed on their ability to use the companion app in a setting designed to simulate a location where patients regularly administer biologic treatment. To assess the usability of the key features of the app, 8 critical and 3 noncritical tasks were designed. Patients’ success on each task was recorded through observations or knowledge-based questions. Successes with difficulty and use errors were also recorded. If a patient made a use error at the first attempt, a second attempt was allowed. Second-attempt use errors were recorded as a task failure. Results: A total of 207 first attempts at the 14 components of the 8 critical tasks were evaluated (3 patients failed to complete one component); 178 (86.0%) critical tasks were successfully completed at the first attempt. The remaining first attempts comprised 16 (7.7%) successes with difficulty and 13 (6.3%) use errors, which had to be repeated. One critical task was not re-attempted by one patient due to time constraints; however, there were no use errors in the 12 completed second attempts. A total of 107 first attempts at the 3 noncritical tasks were made, all of which (107/107, 100.0%) were completed without use errors. Conclusions: In simulated testing, patients were able to successfully use the companion app without formal training. This study suggests the companion app is easy to use and could help patients prescribed CZP better manage their treatment and disease. %M 32716310 %R 10.2196/17373 %U http://formative.jmir.org/2020/7/e17373/ %U https://doi.org/10.2196/17373 %U http://www.ncbi.nlm.nih.gov/pubmed/32716310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16380 %T Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study %A Mehra,Sumit %A van den Helder,Jantine %A Visser,Bart %A Engelbert,Raoul H H %A Weijs,Peter J M %A Kröse,Ben J A %+ Applied Psychology, Faculty of Applied Social Sciences and Law, Amsterdam University of Applied Sciences, Wibautstraat 3b, Amsterdam, 1091 GH, Netherlands, 31 0621156956, s.mehra@hva.nl %K frail elderly %K aged %K activities of daily living %K exercise %K health behavior %K telemedicine %K mobile devices %K tablet computers %K usability testing %K evaluation %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results: At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising. %M 32459652 %R 10.2196/16380 %U http://www.jmir.org/2020/7/e16380/ %U https://doi.org/10.2196/16380 %U http://www.ncbi.nlm.nih.gov/pubmed/32459652 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17409 %T Perceptions of Patients Regarding Mobile Health Interventions for the Management of Chronic Obstructive Pulmonary Disease: Mixed Methods Study %A Alwashmi,Meshari F %A Fitzpatrick,Beverly %A Farrell,Jamie %A Gamble,John-Michael %A Davis,Erin %A Nguyen,Hai Van %A Farrell,Gerard %A Hawboldt,John %+ Memorial University of Newfoundland and Labrador, 230 Elizabeth Avenue, St. John’s, NL, A1C 5S7, Canada, 1 7096910728, mfa720@mun.ca %K mhealth %K COPD %K health technology %K smartphone %K mobile phone %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Using a mobile health (mHealth) intervention consisting of a smartphone and compatible medical device has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective: This study aims to describe the demographics, use, and access to smartphones of patients with COPD. It also aims to explore and develop an understanding of potential facilitators and barriers that might influence patients using mHealth interventions for COPD management. Methods: This was an explanatory, sequential mixed methods study. Patients who attended respirology clinics completed a questionnaire on technology access and use. We conducted semistructured individual interviews with the patients. Interview topics included the following: demographics, mHealth use, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of mHealth interventions for COPD management. Results: A total of 100 adults completed the survey but 22 participants were excluded because they were not diagnosed with COPD. Of these, 10 patients with COPD participated in the interview. The quantitative component revealed that many patients with COPD owned a mobile phone, but only about one-fourth of the participants (18/77, 23%) owned a smartphone. The likelihood of owning a smartphone was not associated with age, sex, marital status, or geographical location, but patients with high educational status were more likely to own a smartphone. The qualitative component found that patients with COPD, in general, had a positive attitude toward mHealth adoption for COPD management, but several facilitators and barriers were identified. The main facilitators of mHealth adoption are possible health benefits for patients, ease of use, educating patients, and credibility. Alternatively, the barriers to adoption are technical issues, lack of awareness, potential limited uptake from older adults, privacy and confidentiality issues, finances, and lack of interest in mHealth Conclusions: It is important to understand the perceptions of patients with COPD regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management. %M 32706697 %R 10.2196/17409 %U http://mhealth.jmir.org/2020/7/e17409/ %U https://doi.org/10.2196/17409 %U http://www.ncbi.nlm.nih.gov/pubmed/32706697 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16979 %T Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study %A Garvelink,Mirjam Marjolein %A Agbadjé,Titilayo Tatiana %A Freitas,Adriana %A Bergeron,Lysa %A Petitjean,Thomas %A Dugas,Michèle %A Blair,Louisa %A Archambault,Patrick %A Roy,Noémie %A Jones,Allyson %A Légaré,France %+ Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, 2525, chemin de la Canardière, Québec, QC, G1J 0A4, Canada, 1 (418) 663 5919, france.legare@fmed.ulaval.ca %K internet-based intervention %K frail elderly %K caregivers %K decision making %K personal autonomy %K housing for the elderly %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. Objective: This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. Methods: To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ≥65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. Results: We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors’ accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. Conclusions: Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website—Support for Older Adults to Stay Independent at Home (SUSTAIN)—will be implemented and made available to better assist older adults and caregivers in staying independent at home. %M 32412908 %R 10.2196/16979 %U https://mhealth.jmir.org/2020/7/e16979 %U https://doi.org/10.2196/16979 %U http://www.ncbi.nlm.nih.gov/pubmed/32412908 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15331 %T Usability of Wearable Devices With a Novel Cardiac Force Index for Estimating the Dynamic Cardiac Function: Observational Study %A Hsiao,Po-Jen %A Chiu,Chih-Chien %A Lin,Ke-Hsin %A Hu,Fu-Kang %A Tsai,Pei-Jan %A Wu,Chun-Ting %A Pang,Yuan-Kai %A Lin,Yu %A Kuo,Ming-Hao %A Chen,Kang-Hua %A Wu,Yi-Syuan %A Wu,Hao-Yi %A Chang,Ya-Ting %A Chang,Yu-Tien %A Cheng,Chia-Shiang %A Chuu,Chih-Pin %A Lin,Fu-Huang %A Chang,Chi-Wen %A Li,Yuan-Kuei %A Chan,Jenq-Shyong %A Chu,Chi-Ming %+ Division of Biostatistics and Medical Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Neihu 114, Taipei, Taiwan, 1 886 2 87923100, chuchiming@web.de %K cardiac force %K running %K acceleration %K physical activity %K heart rate %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Long-distance running can be a form of stress to the heart. Technological improvements combined with the public’s gradual turn toward mobile health (mHealth), self-health, and exercise effectiveness have resulted in the widespread use of wearable exercise products. The monitoring of dynamic cardiac function changes during running and running performance should be further studied. Objective: We investigated the relationship between dynamic cardiac function changes and finish time for 3000-meter runs. Using a wearable device based on a novel cardiac force index (CFI), we explored potential correlations among 3000-meter runners with stronger and weaker cardiac functions during running. Methods: This study used the American product BioHarness 3.0 (Zephyr Technology Corporation), which can measure basic physiological parameters including heart rate, respiratory rate, temperature, maximum oxygen consumption, and activity. We investigated the correlations among new physiological parameters, including CFI = weight * activity / heart rate, cardiac force ratio (CFR) = CFI of running / CFI of walking, and finish times for 3000-meter runs. Results: The results showed that waist circumference, smoking, and CFI were the significant factors for qualifying in the 3000-meter run. The prediction model was as follows: ln (3000 meters running performance pass probability / fail results probability) = –2.702 – 0.096 × [waist circumference] – 1.827 × [smoke] + 0.020 × [ACi7]. If smoking and the ACi7 were controlled, contestants with a larger waist circumference tended to fail the qualification based on the formula above. If waist circumference and ACi7 were controlled, smokers tended to fail more often than nonsmokers. Finally, we investigated a new calculation method for monitoring cardiac status during exercise that uses the CFI of walking for the runner as a reference to obtain the ratio between the cardiac force of exercise and that of walking (CFR) to provide a standard for determining if the heart is capable of exercise. A relationship is documented between the CFR and the performance of 3000-meter runs in a healthy 22-year-old person. During the running period, data are obtained while participant slowly runs 3000 meters, and the relationship between the CFR and time is plotted. The runner’s CFR varies with changes in activity. Since the runner’s acceleration increases, the CFR quickly increases to an explosive peak, indicating the runner’s explosive power. At this period, the CFI revealed a 3-fold increase (CFR=3) in a strong heart. After a time lapse, the CFR is approximately 2.5 during an endurance period until finishing the 3000-meter run. Similar correlation is found in a runner with a weak heart, with the CFR at the beginning period being 4 and approximately 2.5 thereafter. Conclusions: In conclusion, the study results suggested that measuring the real-time CFR changes could be used in a prediction model for 3000-meter running performance. %M 32706725 %R 10.2196/15331 %U https://mhealth.jmir.org/2020/7/e15331 %U https://doi.org/10.2196/15331 %U http://www.ncbi.nlm.nih.gov/pubmed/32706725 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16844 %T The Mobile Health App Trustworthiness Checklist: Usability Assessment %A van Haasteren,Afua %A Vayena,Effy %A Powell,John %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom, 44 (0)1865 617768, john.powell@phc.ox.ac.uk %K checklist %K trustworthiness %K trust %K mobile health apps %K validation %K survey %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The mobile health (mHealth) app trustworthiness (mHAT) checklist was created to identify end users’ opinions on the characteristics of trustworthy mHealth apps and to communicate this information to app developers. To ensure that the checklist is suited for all relevant stakeholders, it is necessary to validate its contents. Objective: The purpose of this study was to assess the feasibility of the mHAT checklist by modifying its contents according to ratings and suggestions from stakeholders familiar with the process of developing, managing, or curating mHealth apps. Methods: A 44-item online survey was administered to relevant stakeholders. The survey was largely comprised of the mHAT checklist items, which respondents rated on a 5-point Likert scale, ranging from completely disagree (1) to completely agree (5). Results: In total, seven professional backgrounds were represented in the survey: administrators (n=6), health professionals (n=7), information technology personnel (n=6), managers (n=2), marketing personnel (n=3), researchers (n=5), and user experience researchers (n=8). Aside from one checklist item—“the app can inform end users about errors in measurements”—the combined positive ratings (ie, completely agree and agree) of the checklist items overwhelmingly exceeded the combined negative ratings (ie, completely disagree and disagree). Meanwhile, two additional items were included in the checklist: (1) business or funding model of the app and (2) details on app uninstallation statistics. Conclusions: Our results indicate that the mHAT checklist is a valuable resource for a broad range of stakeholders to develop trustworthy mHealth apps. Future studies should examine if the checklist works best for certain mHealth apps or in specific settings. %M 32706733 %R 10.2196/16844 %U http://mhealth.jmir.org/2020/7/e16844/ %U https://doi.org/10.2196/16844 %U http://www.ncbi.nlm.nih.gov/pubmed/32706733 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18012 %T Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study %A Mena,Luis J %A Félix,Vanessa G %A Ostos,Rodolfo %A González,Armando J %A Martínez-Peláez,Rafael %A Melgarejo,Jesus D %A Maestre,Gladys E %+ Academic Unit of Computing, Master Program in Applied Sciences, Universidad Politecnica de Sinaloa, Carretera Municipal Libre Mazatlan-Higueras Km. 3, Mazatlan, 82199, Mexico, 52 6691800695 ext 140, lmena@upsin.edu.mx %K mHealth %K photoplethysmography %K blood pressure monitoring %K hypertension %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. Objective: This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. Methods: The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor. Results: The employed artificial neural network model had good average accuracy (>90%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. Conclusions: With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations. %M 32459642 %R 10.2196/18012 %U https://mhealth.jmir.org/2020/7/e18012 %U https://doi.org/10.2196/18012 %U http://www.ncbi.nlm.nih.gov/pubmed/32459642 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 3 %P e16692 %T User Experiences With a Type 2 Diabetes Coaching App: Qualitative Study %A Baptista,Shaira %A Wadley,Greg %A Bird,Dominique %A Oldenburg,Brian %A Speight,Jane %A , %+ Melbourne School of Population and Global Health, 207 Bouverie Street Carlton, Melbourne, 3051, Australia, 61 3 8344 4037, shaira.baptista@unimelb.edu.au %K type 2 diabetes %K mobile phone %K mobile apps %K mHealth %K smartphone %K self-management %D 2020 %7 17.7.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: Diabetes self-management apps have the potential to improve self-management in people with type 2 diabetes (T2D). Although efficacy trials provide evidence of health benefits, premature disengagement from apps is common. Therefore, it is important to understand the factors that influence engagement in real-world settings. Objective: This study aims to explore users’ real-world experiences with the My Diabetes Coach (MDC) self-management app. Methods: We conducted telephone-based interviews with participants who had accessed the MDC self-management app via their smartphone for up to 12 months. Interviews focused on user characteristics; the context within which the app was used; barriers and facilitators of app use; and the design, content, and delivery of support within the app. Results: A total of 19 adults with T2D (8/19, 42% women; mean age 60, SD 14 years) were interviewed. Of the 19 interviewees, 8 (42%) had T2D for <5 years, 42% (n=8) had T2D for 5-10 years, and 16% (n=3) had T2D for >10 years. In total, 2 themes were constructed from interview data: (1) the moderating effect of diabetes self-management styles on needs, preferences, and expectations and (2) factors influencing users’ engagement with the app: one size does not fit all. Conclusions: User characteristics, the context of use, and features of the app interact and influence engagement. Promoting engagement is vital if diabetes self-management apps are to become a useful complement to clinical care in supporting optimal self-management. Trial Registration: Australia New Zealand Clinical Trials Registry CTRN126140012296; URL https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366925&isReview=true %M 32706649 %R 10.2196/16692 %U http://diabetes.jmir.org/2020/3/e16692/ %U https://doi.org/10.2196/16692 %U http://www.ncbi.nlm.nih.gov/pubmed/32706649 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e19713 %T Patients’ Utilization and Perception of an Artificial Intelligence–Based Symptom Assessment and Advice Technology in a British Primary Care Waiting Room: Exploratory Pilot Study %A Miller,Stephen %A Gilbert,Stephen %A Virani,Vishaal %A Wicks,Paul %+ Ada Health GmbH, Adalbertstraße 20, Berlin, , Germany, 49 3060031987, science@ada.com %K human-centered design %K innovative %K health care apps %K eHealth %K symptom checker %K primary care %K general practice %K app %K usability %K acceptability %K utility %D 2020 %7 10.7.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: When someone needs to know whether and when to seek medical attention, there are a range of options to consider. Each will have consequences for the individual (primarily considering trust, convenience, usefulness, and opportunity costs) and for the wider health system (affecting clinical throughput, cost, and system efficiency). Digital symptom assessment technologies that leverage artificial intelligence may help patients navigate to the right type of care with the correct degree of urgency. However, a recent review highlighted a gap in the literature on the real-world usability of these technologies. Objective: We sought to explore the usability, acceptability, and utility of one such symptom assessment technology, Ada, in a primary care setting. Methods: Patients with a new complaint attending a primary care clinic in South London were invited to use a custom version of the Ada symptom assessment mobile app. This exploratory pilot study was conducted between November 2017 and January 2018 in a practice with 20,000 registered patients. Participants were asked to complete an Ada self-assessment about their presenting complaint on a study smartphone, with assistance provided if required. Perceptions on the app and its utility were collected through a self-completed study questionnaire following completion of the Ada self-assessment. Results: Over a 3-month period, 523 patients participated. Most were female (n=325, 62.1%), mean age 39.79 years (SD 17.7 years), with a larger proportion (413/506, 81.6%) of working-age individuals (aged 15-64) than the general population (66.0%). Participants rated Ada’s ease of use highly, with most (511/522, 97.8%) reporting it was very or quite easy. Most would use Ada again (443/503, 88.1%) and agreed they would recommend it to a friend or relative (444/520, 85.3%). We identified a number of age-related trends among respondents, with a directional trend for more young respondents to report Ada had provided helpful advice (50/54, 93%, 18-24-year olds reported helpful) than older respondents (19/32, 59%, adults aged 70+ reported helpful). We found no sex differences on any of the usability questions fielded. While most respondents reported that using the symptom checker would not have made a difference in their care-seeking behavior (425/494, 86.0%), a sizable minority (63/494, 12.8%) reported they would have used lower-intensity care such as self-care, pharmacy, or delaying their appointment. The proportion was higher for patients aged 18-24 (11/50, 22%) than aged 70+ (0/28, 0%). Conclusions: In this exploratory pilot study, the digital symptom checker was rated as highly usable and acceptable by patients in a primary care setting. Further research is needed to confirm whether the app might appropriately direct patients to timely care, and understand how this might save resources for the health system. More work is also needed to ensure the benefits accrue equally to older age groups. %M 32540836 %R 10.2196/19713 %U https://humanfactors.jmir.org/2020/3/e19713 %U https://doi.org/10.2196/19713 %U http://www.ncbi.nlm.nih.gov/pubmed/32540836 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17588 %T Drivers of Mobile Health Acceptance and Use From the Patient Perspective: Survey Study and Quantitative Model Development %A Salgado,Tânia %A Tavares,Jorge %A Oliveira,Tiago %+ NOVA Information Management School, Universidade Nova de Lisboa, Campus de Campolide, Lisbon, 1070-312 Lisboa, Portugal, 351 213828610, d2012072@novaims.unl.pt %K digital health %K mHealth %K UTAUT2 %K health management %K patient empowerment %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) has potential to play a significant role in realizing a reversal of the current paradigm in health care toward a more patient-centric and more collaborative system to improve the outcomes obtained along with the quality and sustainability of health care systems. Objective: The aim of this study was to explore and understand individual mHealth acceptance drivers between two groups of users: those with chronic health conditions and those without. Methods: The extended unified theory of acceptance and usage of technology (UTAUT2) was enhanced with a new health-related framework: behavior intention to recommend and new mediation effects. We applied partial least squares (PLS) causal modeling to test the research model. Results: We obtained 322 valid responses through an online questionnaire. The drivers of behavior intention with statistical significance were performance expectancy (β=.29, P<.001), habit (β=.39, P<.001), and personal empowerment (β=.18, P=.01). The precursors of use behavior were habit (β= .47, P<.001) and personal empowerment (β=.17, P=.01). Behavior intention to recommend was significantly influenced by behavior intention (β=.58, P<.001) and personal empowerment (β=.26, P<.001). The model explained 66% of the total variance in behavior intention, 54% of the variance in use behavior, and 70% of the variance in behavior intention to recommend. Conclusions: Our study demonstrates a significant role of personal empowerment, as a second-order construct, in the mHealth acceptance context. The presence of a chronic health condition predicates an impact on acceptance of this technology. %M 32673249 %R 10.2196/17588 %U https://mhealth.jmir.org/2020/7/e17588 %U https://doi.org/10.2196/17588 %U http://www.ncbi.nlm.nih.gov/pubmed/32673249 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15896 %T Users’ Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study %A Floch,Jacqueline %A Vilarinho,Thomas %A Zettl,Annabel %A Ibanez-Sanchez,Gema %A Calvo-Lerma,Joaquim %A Stav,Erlend %A Haro,Peter Halland %A Aalberg,Asbjørn Lein %A Fides-Valero,Alvaro %A Bayo Montón,José Luis %+ SINTEF, Strindveien 4, Trondheim, 7465, Norway, 47 93008536, jacqueline.floch@sintef.no %K mobile health %K mHealth %K self-management %K user experience %K user acceptance %K mixed methods study %K cystic fibrosis %K pediatrics %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users’ experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users’ experiences can inform the design of approaches toward increased motivation for digital self-management. Objective: This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. Methods: A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. Results: Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. Conclusions: Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case—the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF. %M 32673237 %R 10.2196/15896 %U https://mhealth.jmir.org/2020/7/e15896 %U https://doi.org/10.2196/15896 %U http://www.ncbi.nlm.nih.gov/pubmed/32673237 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e16341 %T Engagement and Clinical Improvement Among Older Adult Primary Care Patients Using a Mobile Intervention for Depression and Anxiety: Case Studies %A Orr,L Casey %A Graham,Andrea K %A Mohr,David C %A Greene,Carolyn J %+ Center for Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W Markham #554, Little Rock, AR, 72205, United States, 1 5015512880, lcorr@ualr.edu %K mobile health %K older adults %K depression %K anxiety %K primary care %K smartphone %K mobile phone %K text messaging %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Technology-based mental health interventions are an increasingly attractive option for expanding access to mental health services within the primary care system. Older adults are among the groups that could potentially benefit from the growing ubiquity of technology-based mental health interventions; however, older adults are perceived to be averse to using technology and have reported barriers to use. Objective: The aim of this paper is to present a case study of 3 participants from a clinical trial evaluating IntelliCare, an evidence-based mobile intervention for depression and anxiety, among adults recruited from primary care clinics. Our report of these 3 participants, who were aged 60 years or older, focuses on their engagement with the IntelliCare service (ie, app use, coach communication) and clinical changes in depression or anxiety symptoms over the intervention period. Methods: The 3 case study participants were offered IntelliCare with coaching for 8 weeks. The intervention consisted of 5 treatment intervention apps that support a variety of psychological skills, a Hub app that contained psychoeducational content and administered weekly assessments, and coaching for encouragement, accountability, and technical assistance as needed. The 3 case study participants were selected to reflect the overall demographics of participants within the trial and because their interactions with IntelliCare provided a good illustration of varied experiences regarding engagement with the intervention. Results: The 3 participants’ unique experiences with the intervention are described. Despite potential barriers and experiencing some technical glitches, the participants showed proficient ability to use the apps, high levels of participation through frequent app use and coach interaction, and decreased depression and anxiety scores. At the end of the 8-week intervention, each of these 3 participants expressed great enthusiasm for the benefit of this program through feedback to their coach, and they each identified a number of ways they had seen improvements in themselves. Conclusions: These 3 cases provide examples of older individuals who engaged with and benefitted from the IntelliCare service. Although the results from these 3 cases may not generalize to others, they provide an important, informed perspective of the experiences that can contribute to our understanding of how older adults use and overcome barriers to mental health technologies. The findings also contribute toward the ultimate goal of ensuring that the IntelliCare intervention is appropriate for individuals of all ages. %M 32673236 %R 10.2196/16341 %U https://mental.jmir.org/2020/7/e16341 %U https://doi.org/10.2196/16341 %U http://www.ncbi.nlm.nih.gov/pubmed/32673236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e14161 %T Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study %A Langer,Shelby L %A Ghosh,Neeta %A Todd,Michael %A Randall,Ashley K %A Romano,Joan M %A Bricker,Jonathan B %A Bolger,Niall %A Burns,John W %A Hagan,Rachel C %A Porter,Laura S %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 North Third Street, Phoenix, AZ, 85004, United States, 1 6024960823, shelby.langer@asu.edu %K ecological momentary assessment %K smartphone %K mobile phone %K communication %K disclosure %K affect %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpersonal communication is critical for a healthy romantic relationship. Emotional disclosure, coupled with perceived partner responsiveness, fosters closeness and adjustment (better mood and relationship satisfaction). On the contrary, holding back from disclosure is associated with increased distress and decreased relationship satisfaction. Prior studies assessing these constructs have been cross-sectional and have utilized global retrospective reports of communication. In addition, studies assessing holding back or perceived partner responsiveness have not taken advantage of smartphone ownership for data collection and have instead required website access or use of a study-provided device. Objective: This study aimed to examine the (1) usability and acceptability of a smartphone app designed to assess partner communication, closeness, mood, and relationship satisfaction over 14 days and (2) between-person versus within-person variability of key constructs to inform the utility of their capture via ecological momentary assessment using the participants’ own handheld devices. Methods: Adult community volunteers in a married or cohabiting partnered relationship received 2 smartphone prompts per day, one in the afternoon and one in the evening, for 14 days. In each prompt, participants were asked whether they had conversed with their partner either since awakening (afternoon prompt) or since the last assessment (evening prompt). If yes, a series of items assessed enacted communication, perceived partner communication, closeness, mood, and relationship satisfaction (evening only). Participants were interviewed by phone, 1 week after the end of the 14-day phase, to assess perceptions of the app. Content analysis was employed to identify key themes. Results: Participants (N=27; mean age 36, SD 12 years; 24/27, 89% female; 25/27, 93% white and 2/27, 7% Hispanic) responded to 79.2% (555/701) of the total prompts sent and completed 553 (78.9%) of those assessments. Of the responded prompts, 79.3% (440/555) were characterized by a report of having conversed with one’s partner. The app was seen as highly convenient (mean 4.15, SD 0.78, scale: 1-5) and easy to use (mean 4.39, SD 0.70, scale: 1-5). Qualitative analyses indicated that participants found the app generally easy to navigate, but the response window too short (45 min) and the random nature of receiving notifications vexing. With regard to the variability of the app-delivered items, intraclass correlation coefficients were generally <0.40, indicating that the majority of the variability in each measure was at the within-person level. Notable exceptions were enacted disclosure and relationship satisfaction. Conclusions: The findings of this study support the usability and acceptability of the app, with valuable user input to modify timing windows in future work. The findings also underscore the utility of an intensive repeated-measures approach, given the meaningful day-to-day variation (greater within-person vs between-person variability) in communication and mood. %M 32628614 %R 10.2196/14161 %U https://formative.jmir.org/2020/7/e14161 %U https://doi.org/10.2196/14161 %U http://www.ncbi.nlm.nih.gov/pubmed/32628614 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e15777 %T Smartphone Self-Monitoring by Young Adolescents and Parents to Assess and Improve Family Functioning: Qualitative Feasibility Study %A Swendeman,Dallas %A Sumstine,Stephanie %A Brink,Amber %A Mindry,Deborah %A Medich,Melissa %A Russell,Michael %+ Global Center for Children and Families, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948158, dswendeman@mednet.ucla.edu %K adolescents %K parenting %K conflict %K self-monitoring %K smartphones %K mHealth %K ecological momentary assessment %K mobile phone %D 2020 %7 23.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The natural integration of mobile phones into the daily routines of families provides novel opportunities to study and support family functioning and the quality of interactions between family members in real time. Objective: This study aimed to examine user experiences of feasibility, acceptability, and reactivity (ie, changes in awareness and behaviors) of using a smartphone app for self-monitoring of family functioning with 36 participants across 15 family dyads and triads of young adolescents aged 10 to 14 years and their parents. Methods: Participants were recruited from 2 family wellness centers in a middle-to-upper income shopping area and a low-income school site. Participants were instructed and prompted by alarms to complete ecological momentary assessments (EMAs) by using a smartphone app over 2 weeks 4 times daily (upon waking in the morning, afternoon, early evening, and end of day at bedtime). The domains assessed included parental monitoring and positive parenting, parent involvement and discipline, parent-child conflict and resolution, positive interactions and support, positive and negative affect, sleep, stress, family meals, and general child and family functioning. Qualitative interviews assessed user experiences generally and with prompts for positive and negative feedback. Results: The participants were primarily white and Latino of mixed-income- and education levels. Children were aged 10 to 14 years, and parents had a mean age of 45 years (range 37-50). EMA response rates were high (95% to over 100%), likely because of cash incentives for EMA completion, engaging content per user feedback, and motivated sample from recruitment sites focused on social-emotional programs for family wellness. Some participants responded for up to 19 days, consistent with some user experience interview feedback of desires to continue participation for up to 3 or 4 weeks. Over 80% (25/31) of participants reported increased awareness of their families’ daily routines and functioning of their families. Most also reported positive behavior changes in the following domains: decision making, parental monitoring, quantity and quality of time together, communication, self-regulation of stress and conflict, discipline, and sleep. Conclusions: The results of this study support the feasibility and acceptability of using smartphone EMA by young adolescents and parents for assessing and self-monitoring family daily routines and interactions. The findings also suggest that smartphone self-monitoring may be a useful tool to support improvement in family functioning through functions of reflection on antecedents and consequences of situations, prompting positive and negative alternatives, seeding goals, and reinforcement by self-tracking for self-correction and self-rewards. Future studies should include larger samples with more diverse and higher-risk populations, longer study durations, the inclusion of passive phone sensors and peripheral biometric devices, and integration with counseling and parenting interventions and programs. %M 32574148 %R 10.2196/15777 %U http://formative.jmir.org/2020/6/e15777/ %U https://doi.org/10.2196/15777 %U http://www.ncbi.nlm.nih.gov/pubmed/32574148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17708 %T Usability of a Consumer Health Informatics Tool Following Completion of a Clinical Trial: Focus Group Study %A Cho,Hwayoung %A Porras,Tiffany %A Flynn,Gabriella %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K consumer health informatics tool %K mobile Health %K mobile apps %K clinical trial %K symptom care %K self-management %K HIV-associated nonAIDS (HANA) %K HANA conditions %K HIV/AIDS %D 2020 %7 15.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps have the potential to be effective tools for encouraging patients with chronic diseases to self-manage their health. The success of mHealth apps is related to technology acceptance and its subsequent use by intended consumers. Therefore, it is essential to gain insights from consumers’ perspectives about their use of mHealth apps in daily life. Objective: The purpose of this work was to understand consumers’ perspectives on use of a self-management app following completion of a clinical trial that tested the efficacy of the app for improving health outcomes. Methods: We conducted five focus groups with paricipants of a clinical trial (NCT03182738) who were randomized to use the video information provider (VIP) for HIV-associated nonAIDS (HANA) conditions app (VIP-HANA) or an attention control app. Thematic analysis was conducted, and the themes were organized according to the two key constructs of the technology acceptance model framework: perceived usefulness and perceived ease of use. Results: Thirty-nine people living with HIV (20 from the intervention group and 19 from the control group) participated in the focus group sessions. Of the eight themes identified from focus group data, the five themes related to perceived usefulness were: (1) self-monitoring HIV-related symptoms of HANA conditions, (2) enhanced relationship with clinical providers, (3) improvement in physical and emotional health, (4) long-term impact of self-care strategies on improvement in symptoms of HANA conditions, and (5) inspired lifestyle changes to manage symptoms. The three themes related to perceived ease of use were: (1) easy to navigate, (2) avatar personalization, and (3) privacy/confidentiality maintained even when changing the location of app use. Conclusions: Perceived ease of use was similar in both study groups but perceived usefulness differed between study groups. Participants in both study groups found the VIP-HANA app to be useful in monitoring their symptoms and enhancing communication with their clinical care providers. However, only intervention group participants perceived the app to be useful in improving overall health and long-term symptom management. Findings from this study highlight factors that are essential to ensure the usefulness of self-management apps and facilitate sustained use of mHealth apps for people living with chronic illnesses. %M 32538796 %R 10.2196/17708 %U http://www.jmir.org/2020/6/e17708/ %U https://doi.org/10.2196/17708 %U http://www.ncbi.nlm.nih.gov/pubmed/32538796 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17114 %T User Experiences and Preferences Regarding an App for the Treatment of Urinary Incontinence in Adult Women: Qualitative Study %A Wessels,Nienke J %A Hulshof,Lisa %A Loohuis,Anne M M %A van Gemert-Pijnen,Lisette %A Jellema,Petra %A van der Worp,Henk %A Blanker,Marco H %+ Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Postbus 196, Huispostcode FA21, Groningen, 9700 AD, Netherlands, 31 503616746, n.j.wessels@umcg.nl %K ehealth %K mobile applications %K self-management %K qualitative research %D 2020 %7 12.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although several apps are available to support the treatment of urinary incontinence (UI), little has been reported about the experiences and preferences of their users. Objective: The objective of this study was to explore the experiences and preferences of women using a mobile app for the treatment of UI and to identify potential improvements to the app. We developed this app for three types of UI: stress UI, urgency UI, and mixed UI. Methods: The participants in this qualitative study were women with self-reported stress UI, urgency UI, or mixed UI who used an app-based treatment to manage their condition for at least six weeks. Following the intervention, semistructured interviews were conducted to explore the participants’ experiences and preferences regarding the app. All interviews were audio-recorded, transcribed verbatim, and analyzed separately by two researchers. Results: Data saturation was reached after interviewing 9 women (aged 32-68 years) with stress UI (n=1, 11%), urgency UI (n=3, 33%), or mixed UI (n=5, 56%). Accessibility, awareness, usability, and adherence emerged as the main themes. On the one hand, participants appreciated that the app increased their accessibility to care, preserved their privacy, increased their awareness of therapeutic options, was easy to use and useful, and supported treatment adherence. On the other hand, some participants reported that they wanted more contact with a care provider, and others reported that using the app increased their awareness of symptoms. Conclusions: This qualitative study indicates that women appreciate app-based treatment for UI because it can lower barriers to treatment and increase both awareness and adherence to treatment. However, the app does not offer the ability of face-to-face contact and can lead to a greater focus on symptoms. %M 32530431 %R 10.2196/17114 %U http://mhealth.jmir.org/2020/6/e17114/ %U https://doi.org/10.2196/17114 %U http://www.ncbi.nlm.nih.gov/pubmed/32530431 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15086 %T Patients’ Measurement Priorities for Remote Measurement Technologies to Aid Chronic Health Conditions: Qualitative Analysis %A Simblett,Sara %A Matcham,Faith %A Curtis,Hannah %A Greer,Ben %A Polhemus,Ashley %A Novák,Jan %A Ferrao,Jose %A Gamble,Peter %A Hotopf,Matthew %A Narayan,Vaibhav %A Wykes,Til %A , %+ Institute of Psychiatry, Psychology and Neuroscience, King's College London, Henry Wellcome Building, Psychology Department, 2nd Floor, London, United Kingdom, 44 2078480762, sara.simblett@kcl.ac.uk %K qualitative analysis %K patient involvement %K remote measurement technology %K mHealth %D 2020 %7 10.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Remote measurement technology (RMT), including the use of mobile phone apps and wearable devices, may provide the opportunity for real-world assessment and intervention that will streamline clinical input for years to come. In order to establish the benefits of this approach, we need to operationalize what is expected in terms of a successful measurement. We focused on three clinical long-term conditions where a novel case has been made for the benefits of RMT: major depressive disorder (MDD), multiple sclerosis (MS), and epilepsy. Objective: The aim of this study was to conduct a consultation exercise on the clinical end point or outcome measurement priorities for RMT studies, drawing on the experiences of people with chronic health conditions. Methods: A total of 24 participants (16/24 women, 67%), ranging from 28 to 65 years of age, with a diagnosis of one of three chronic health conditions―MDD, MS, or epilepsy―took part in six focus groups. A systematic thematic analysis was used to extract themes and subthemes of clinical end point or measurement priorities. Results: The views of people with MDD, epilepsy, and MS differed. Each group highlighted unique measurements of importance, relevant to their specific needs. Although there was agreement that remote measurement could be useful for tracking symptoms of illness, some symptoms were specific to the individual groups. Measuring signs of wellness was discussed more by people with MDD than by people with MS and epilepsy. However, overlap did emerge when considering contextual factors, such as life events and availability of support (MDD and epilepsy) as well as ways of coping (epilepsy and MS). Conclusions: This is a unique study that puts patients’ views at the forefront of the design of a clinical study employing novel digital resources. In all cases, measuring symptom severity is key; people want to know when their health is getting worse. Second, symptom severity needs to be placed into context. A holistic approach that, in some cases, considers signs of wellness as well as illness, should be the aim of studies employing RMT to understand the health of people with chronic conditions. %M 32519975 %R 10.2196/15086 %U https://mhealth.jmir.org/2020/6/e15086 %U https://doi.org/10.2196/15086 %U http://www.ncbi.nlm.nih.gov/pubmed/32519975 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16059 %T Experiences of African American Breast Cancer Survivors Using Digital Scales and Activity Trackers in a Weight Gain Prevention Intervention: Qualitative Study %A Power,Julianne M %A Tate,Deborah F %A Valle,Carmina G %+ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB #7440, 135 Dauer Drive, Chapel Hill, NC, 27514, United States, 1 9199665852 ext 2, julma@live.unc.edu %K African American %K cancer survivors %K digital tools %K weight gain prevention %K qualitative %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of digital tools to promote daily self-weighing and daily activity tracking may be a promising strategy for weight control among African American breast cancer survivors (AABCS). There have been no studies exploring the acceptability and feasibility of using digital tools for weight control or qualitative studies characterizing perceptions of daily self-weighing and daily activity tracking among AABCS. Objective: This study aimed to explore the subjective experiences of daily self-weighing and daily activity tracking using digital tools, including wireless scales and activity trackers, in a sample of AABCS participating in two technology-based weight gain prevention interventions over 6 months. Methods: Semistructured interviews (N=21) were conducted in person or over the phone, were audio recorded, and then transcribed verbatim. Each transcript was read to identify key themes and develop a codebook. Each transcript was coded using Atlas.ti software, and code outputs were used to identify overarching themes and patterns in the data. Results: On average, participants were 52.6 (SD 8.3) years of age, with obesity at baseline (BMI 33.1 kg/m2, SD 5.9), and weighed on 123.4 (SD 48.0) days out of the 168 days (73.5%) in the study period. Women tended to attribute their weight gain to cancer treatment and framed program benefits in terms of improved quality of life and perceptions of prolonging their survival following treatment. Using the smart scale for daily self-weighing was viewed as the tool by which participants could control their weight and improve their health and well-being posttreatment. The activity tracker increased awareness of physical activity and motivated participants to be more active. Conclusions: Participants reported positive experiences and benefits from daily self-weighing and daily activity tracking. Findings suggest that daily self-weighing and daily activity tracking using digital tools are well-received, acceptable, and feasible intervention strategies for AABCS in the context of posttreatment weight management. %M 32510461 %R 10.2196/16059 %U https://mhealth.jmir.org/2020/6/e16059 %U https://doi.org/10.2196/16059 %U http://www.ncbi.nlm.nih.gov/pubmed/32510461 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16723 %T Factors Influencing Acceptance of Personal Health Record Apps for Workplace Health Promotion: Cross-Sectional Questionnaire Study %A Park,Hyun Sang %A Kim,Kwang Il %A Soh,Jae Young %A Hyun,Young Ho %A Jang,Sae Kyun %A Lee,Sol %A Hwang,Ga Young %A Kim,Hwa Sun %+ Digital Healthcare Department, BIT Computer Co Ltd, BIT Building 33, Seocho-daero 74-gil, Seocho-gu, Seoul, Republic of Korea, 82 2 3486 1234 ext 507, hspark@bit.kr %K personal health record app %K workplace health promotion %K unified theory of acceptance and use of technology %K perceived risk %D 2020 %7 4.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care technologies can help improve workers’ health and productivity by supporting workplace health promotion. A personal health record app is used to manage medical data such as results from medical checkups, which facilitates decision making for medical personnel. However, an analysis of users’ technology acceptance is required to provide appropriate services based on personal health record apps. Objective: The purpose of this study was to analyze the factors influencing the behavioral intention of health experts and workers to use an app in workers’ health centers and to examine differences in their perception of the main variables. Methods: The study involved health experts and workers who visited 21 workers’ health centers in Korea to verify a research model in which perceived risk was added to the unified theory of acceptance and use of technology, a representative theory of information technology acceptance. After receiving ethical approval from the Korea National Institute for Bioethics Policy, 1050 questionnaires were distributed over 7 weeks with cooperation of the Korea Occupational Safety and Health Agency. A multiple linear regression analysis and multigroup path analysis were performed to verify the hypotheses, and independent samples t tests were performed to analyze differences between workers’ and health experts’ perception of the main variables. Results: The analysis included data from 866 respondents (687 workers and 179 health experts). Effort expectancy (beta=.08, P=.03), social influence (beta=.43, P<.001), performance expectancy (beta=.07, P=.008), and facilitating conditions (beta=.13, P<.001) exerted significant positive effects on behavioral intention, whereas perceived risk (beta=–.29, P<.001) exerted a significant negative effect on behavioral intention. Performance expectancy had a significant effect on path differences depending on gender (critical ratio=–3.38) and age (critical ratio=1.97). Workers’ mean scores for the main variables were higher relative to those of health experts for all remaining variables except perceived risk, and significant differences were observed for all remaining variables except facilitating condition. Conclusions: Social influence exerted the strongest effect on behavioral intention to use the personal health record app. Consequently, it is necessary to coordinate health promotion activities in the workplace as well as the operational direction of community institutions such as in workers’ health centers to allow workers to manage their own health via continuous use of the app. In addition, the app should be developed based on a requirement analysis of the balance between both interest groups in consideration of differences in perspective between consumers and service providers. %M 32496202 %R 10.2196/16723 %U https://mhealth.jmir.org/2020/6/e16723 %U https://doi.org/10.2196/16723 %U http://www.ncbi.nlm.nih.gov/pubmed/32496202 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16648 %T Evaluating Online Consumer Medication Information Systems: Comparative Online Usability Study %A Sigle,Stefan %A Barriga,Pilar %A Correa Fernández,Francisco Javier %A Juhra,Christian %A Härtel,Steffen %A Fegeler,Christian %+ MOLIT Institute, Im Zukunftspark 10, Heilbronn, 74076, Germany, 49 7131 1334500, siglestefan@gmail.com %K online consumer medication information %K online usability study %K sociotechnical system %K information management %K interoperability %K implementation science %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medication is the most common intervention in health care, and the number of online consumer information systems within the pharmaceutical sector is increasing. However, online consumer information systems can be a barrier for users, imposing information asymmetries between stakeholders. Objective: The objective of this study was to quantify and compare the usability of an online consumer medication information system (OCMIS) against a reference implementation based on an interoperable information model for patients, physicians, and pharmacists. Methods: Quantitative and qualitative data were acquired from patients, physicians, and pharmacists in this online usability study. We administered 3 use cases and a post hoc questionnaire per user. Quantitative usability data including effectiveness (task success), efficiency (task time), and user satisfaction (system usability scale [SUS]) was complemented by qualitative and demographic data. Users evaluated 6 existing systems and 1 reference implementation of an OCMIS. Results: A total of 137 patients, 81 physicians, and 68 pharmacists participated in this study. Task success varied from 84% to 92% in patients, 66% to 100% in physicians, and 50% to 91% in pharmacists. Task completion time decreased over the course of the study for all but 2 OCMIS within the patient group. Due to an assumed nonnormal distribution of SUS scores, within-group comparison was done using the Kruskal-Wallis test. Patients showed differences in SUS scores (P=.02) and task time (P=.03), while physicians did not have significant differences in SUS scores (P=.83) and task time (P=.72). For pharmacists, a significant difference in SUS scores (P<.001) and task time (P=.007) was detected. Conclusions: The vendor-neutral reference implementation based on an interoperable information model was proven to be a promising approach that was not inferior to existing solutions for patients and physicians. For pharmacists, it exceeded user satisfaction scores compared to other OCMIS. This data-driven approach based on an interoperable information model enables the development of more user-tailored features to increase usability. This fosters data democratization and empowers stakeholders within the pharmaceutical sector. %M 32490848 %R 10.2196/16648 %U https://mhealth.jmir.org/2020/6/e16648 %U https://doi.org/10.2196/16648 %U http://www.ncbi.nlm.nih.gov/pubmed/32490848 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16343 %T Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study %A Lundell,Sara %A Modig,Mari %A Holmner,Åsa %A Wadell,Karin %+ Division of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden, 46 907868042, sara.lundell@umu.se %K COPD %K qualitative content analysis %K eHealth %K chronic disease %K home-based care %K empowerment %K information and communication technology %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a major health problem and an economic burden globally. There is growing interest in how electronic health (eHealth) can be used to provide efficient health care. Telemonitoring, where the patient’s health-related data is transmitted to a health care provider, can be used to detect early signs of exacerbations. A successful implementation of telemonitoring systems into clinical practice requires in-depth knowledge of the users’ preferences. Objective: The aim of this study was to explore perceptions of the use of a home telemonitoring system among patients with COPD. Methods: Semistructured individual interviews were carried out with 8 women and 5 men who were participants in a project aimed at developing and evaluating a telemonitoring system. The web-based telemonitoring system measured pulmonary function, subjective symptoms, and oxygen saturation. Participants were interviewed after having used the system for 2-4 months. Interview transcripts were analyzed with qualitative content analysis. Results: The analysis resulted in the theme A transition toward increased control and security and four categories: using with (in)security, affecting technical concern or confidence, providing easy access to health care, and increasing control over the disease. The participants reported various perceptions of using the telemonitoring system. They expressed initial feelings of insecurity, both in terms of operating the system and in terms of their disease. However, the practical management of the telemonitoring system became easier with time; the participants gradually gained confidence and improved their self-management. New technology was perceived as an important complement to existing health care, but the importance of maintaining a human contact in real life or through the telemonitoring system was emphasized. Conclusions: This study captured a transition among the participants from being insecure and experiencing technical concerns to acquiring technical confidence and improving disease management. Telemonitoring can be a valuable complement to health care, leading to increased self-knowledge, a sense of security, and improved self-management. Suggestions to improve the further development and implementation of telemonitoring systems include better patient education and the involvement of end users in the technical development process. Additional research is needed, particularly in the design of user-friendly systems, as well as in developing tools to predict which patients are most likely to find the equipment useful, as this may result in increased empowerment, improved quality of life, reduced costs, and a contribution to equity in health. %M 32490844 %R 10.2196/16343 %U https://mhealth.jmir.org/2020/6/e16343 %U https://doi.org/10.2196/16343 %U http://www.ncbi.nlm.nih.gov/pubmed/32490844 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e14024 %T Comparing a Social and Communication App, Telephone Intervention, and Usual Care for Diabetes Self-Management: 3-Arm Quasiexperimental Evaluation Study %A Chiu,Ching-Ju %A Yu,Yung-Chen %A Du,Ye-Fong %A Yang,Yi-Ching %A Chen,Jou-Yin %A Wong,Li-Ping %A Tanasugarn,Chanuantong %+ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Shengli Road, North District, Tainan, 70403, Taiwan, 886 6 2353535 ext 4577, n043328@mail.hosp.ncku.edu.tw %K diabetes %K self-management %K depression symptoms %K distress %K middle-aged and older adults %D 2020 %7 2.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many technology-assisted innovations have been used to manage disease. However, most of these innovations are not broadly used by older adults due to their cost. Additionally, disease management through technology-assisted innovations has not been compared with other interventions. Objective: In this study, we tested the employment of a free and widely used social and communication app to help older adults with diabetes manage their distress and glycemic control. We also compared the effectiveness of the app with 2 other methods, namely telephone and conventional health education, and determined which subgroup experiences the most effects within each intervention. Methods: Adults aged ≥50 years with type 2 diabetes were recruited from Southern Taiwan (N=231) and were allocated to different 3-month interventions. Informed consent was obtained at the Ministry of Science and Technology and approved by the National Cheng Kung University Hospital Institutional Review Board (No. A-ER-102-425). Results: Participants in the mobile-based group had significant reductions in hemoglobin A1c compared with the telephone-based and usual care groups (mean changes of –0.4%, 0.1%, and 0.03%, respectively; P=.02). Diabetes-specific distress decreased to a greater extent in the mobile-based group compared to the other 2 groups (mean changes of –5.16, –3.49, and –2.44, respectively, P=.02). Subgroup analyses further revealed that the effects on reducing blood glucose levels in the social and communication app groups were especially evident in patients with lower distress scores, and diabetes-related distress was especially evident in participants who were younger than 60 years or had higher educational levels. Conclusions: The findings of this study inform more flexible use of social and communication apps with in-person diabetes education and counselling. %M 32484448 %R 10.2196/14024 %U https://mhealth.jmir.org/2020/6/e14024 %U https://doi.org/10.2196/14024 %U http://www.ncbi.nlm.nih.gov/pubmed/32484448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17506 %T The Ubiquitous Cognitive Assessment Tool for Smartwatches: Design, Implementation, and Evaluation Study %A Hafiz,Pegah %A Bardram,Jakob Eyvind %+ Digital Health Section, Department of Health Technology, Technical University of Denmark, Richard Petersens Plads, Building 324, 2nd Floor, Room 270, Kongens Lyngby, 2800, Denmark, 45 91858371, pegh@dtu.dk %K cognition %K memory %K response time %K attention %K Stroop task %K wearable devices %K mobile phone %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cognitive functioning plays a significant role in individuals’ mental health, since fluctuations in memory, attention, and executive functions influence their daily task performance. Existing digital cognitive assessment tools cannot be administered in the wild and their test sets are not brief enough to capture frequent fluctuations throughout the day. The ubiquitous availability of mobile and wearable devices may allow their incorporation into a suitable platform for real-world cognitive assessment. Objective: The aims of this study were threefold: (1) to evaluate a smartwatch-based tool for the assessment of cognitive performance, (2) to investigate the usability of this tool, and (3) to understand participants’ perceptions regarding the application of a smartwatch in cognitive assessment. Methods: We built the Ubiquitous Cognitive Assessment Tool (UbiCAT) on a smartwatch-based platform. UbiCAT implements three cognitive tests—an Arrow test, a Letter test, and a Color test—adapted from the two-choice reaction-time, N-back, and Stroop tests, respectively. These tests were designed together with domain experts. We evaluated the UbiCAT test measures against standard computer-based tests with 21 healthy adults by applying statistical analyses significant at the 95% level. Usability testing for each UbiCAT app was performed using the Mobile App Rating Scale (MARS) questionnaire. The NASA-TLX (Task Load Index) questionnaire was used to measure cognitive workload during the N-back test. Participants rated perceived discomfort of wearing a smartwatch during the tests using a 7-point Likert scale. Upon finishing the experiment, an interview was conducted with each participant. The interviews were transcribed and semantic analysis was performed to group the findings. Results: Pearson correlation analysis between the total correct responses obtained from the UbiCAT and the computer-based tests revealed a significant strong correlation (r=.78, P<.001). One-way analysis of variance (ANOVA) showed a significant effect of the N-back difficulty level on the participants' performance measures. The study also demonstrated usability ratings above 4 out of 5 in terms of aesthetics, functionality, and information. Low discomfort (<3 out of 7) was reported by our participants after using the UbiCAT. Seven themes were extracted from the transcripts of the interviews conducted with our participants. Conclusions: UbiCAT is a smartwatch-based tool that assesses three key cognitive domains. Usability ratings showed that participants were engaged with the UbiCAT tests and did not feel any discomfort. The majority of the participants were interested in using the UbiCAT, although some preferred computer-based tests, which might be due to the widespread use of personal computers. The UbiCAT can be administered in the wild with mentally ill patients to assess their attention, working memory, and executive function. %M 32478664 %R 10.2196/17506 %U https://mhealth.jmir.org/2020/6/e17506 %U https://doi.org/10.2196/17506 %U http://www.ncbi.nlm.nih.gov/pubmed/32478664 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15909 %T A Questionnaire for Assessing User Satisfaction With Mobile Health Apps: Development Using Rasch Measurement Theory %A Melin,Jeanette %A Bonn,Stephanie Erika %A Pendrill,Leslie %A Trolle Lagerros,Ylva %+ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2, Stockholm, 171 76, Sweden, 46 46 851779183, ylva.trolle@ki.se %K cell phone %K healthy lifestyle %K methods %K mobile applications %K psychometrics %K smartphone %K telemedicine %K mobile phone %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps offer great opportunities to deliver large-scale, cost-efficient digital solutions for implementing lifestyle changes. Furthermore, many mHealth apps act as medical devices. Yet, there is little research on how to assess user satisfaction with an mHealth solution. Objective: This study presents the development of the mHealth Satisfaction Questionnaire and evaluates its measurement properties. Methods: Respondents who took part in the Health Integrator Study and were randomized to use the Health Integrator smartphone app for lifestyle changes (n=112), with and without additional telephone coaching, rated their satisfaction with the app using the new 14-item mHealth Satisfaction Questionnaire. The ratings were given on a 5-point Likert scale and measurement properties were evaluated using Rasch measurement theory (RMT). Results: Optimal scoring was reached when response options 2, 3, and 4 were collapsed, giving three response categories. After omitting two items that did not fit into the scale, fit residuals were within, or close to, the recommended range of ±2.5. There was no differential item functioning between intervention group, age group, or sex. The Person Separation Index was 0.79, indicating that the scale’s ability to discriminate correctly between person leniency was acceptable for group comparisons but not for individual evaluations. The scale did not meet the criterion of unidimensionality; 16.1% (18/112) of the respondents were outside the desired range of −1.96 to 1.96. In addition, several items showed local dependency and three underlying dimensions emerged: negative experiences, positive experiences, and lifestyle consequences of using the mHealth solution. Conclusions: In times where mHealth apps and digital solutions are given more attention, the mHealth Satisfaction Questionnaire provides a new possibility to measure user satisfaction to ensure usability and improve development of new apps. Our study is one of only a few cases where RMT has been used to evaluate the usability of such an instrument. There is, though, a need for further development of the mHealth Satisfaction Questionnaire, including the addition of more items and consideration of further response options. The mHealth Satisfaction Questionnaire should also be evaluated in a larger sample and with other mHealth apps and in other contexts. Trial Registration: ClinicalTrials.gov NCT03579342; http://clinicaltrials.gov/ct2/show/NCT03579342. %M 32452817 %R 10.2196/15909 %U http://mhealth.jmir.org/2020/5/e15909/ %U https://doi.org/10.2196/15909 %U http://www.ncbi.nlm.nih.gov/pubmed/32452817 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16527 %T The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial %A Ngo,Victoria %A Matsumoto,Cynthia G %A Joseph,Jill G %A Bell,Janice F %A Bold,Richard J %A Davis,Andra %A Reed,Sarah C %A Kim,Katherine K %+ Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th Street, Suite 2600, Sacramento, CA, United States, 1 5107615461, kathykim@ucdavis.edu %K care coordination, continuity of patient care %K oncology %K chemotherapy %K patient-centered care %K mobile health %K technology adoption %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)—a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. Objective: This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. Methods: A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant’s life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. Results: A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. Conclusions: The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness. %M 32452814 %R 10.2196/16527 %U http://mhealth.jmir.org/2020/5/e16527/ %U https://doi.org/10.2196/16527 %U http://www.ncbi.nlm.nih.gov/pubmed/32452814 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e14453 %T A Mobile Phone–Based Gait Assessment App for the Elderly: Development and Evaluation %A Zhong,Runting %A Rau,Pei-Luen Patrick %+ Department of Industrial Engineering, Tsinghua University, Shunde Building, 5th Floor, Beijing, 100084, China, 86 62776664, rpl@mail.tsinghua.edu.cn %K aged %K gait %K mHealth %K telemedicine %K falls prevention %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gait disorders are common among older adults. With an increase in the use of technology among older adults, a mobile phone app provides a solution for older adults to self-monitor their gait quality in daily life. Objective: This study aimed to develop a gait-monitoring mobile phone app (Pocket Gait) and evaluate its acceptability and usability among potential older users. Methods: The app was developed to allow older adults to track their gait quality, including step frequency, acceleration root mean square (RMS), step regularity, step symmetry, and step variability. We recruited a total of 148 community-dwelling older adults aged 60 years and older from two cities in China: Beijing and Chongqing. They walked in three ways (single task, dual task, and fast walking) using a smartphone with the gait-monitoring app installed and completed an acceptability and usability survey after the walk test. User acceptability was measured by a questionnaire including four quantitative measures: perceived ease of use, perceived usefulness, ease of learning, and intention to use. Usability was measured using the System Usability Scale (SUS). Interviews were conducted with participants to collect open-ended feedback questions. Results: Task type had a significant effect on all gait parameters, namely, step frequency, RMS, step variability, step regularity, and step symmetry (all P values <.001). Age had a significant effect on step frequency (P=.01), and region had a significant effect on step regularity (P=.04). The acceptability of the gait-monitoring app was positive among older adults. Participants identified the usability of the system with an overall score of 59.7 (SD 10.7) out of 100. Older adults from Beijing scored significantly higher SUS compared with older adults from Chongqing (P<.001). The age of older adults was significantly associated with their SUS score (P=.048). Older adults identified improvements such as a larger font size, inclusion of reference values for gait parameters, and inclusion of heart rate and blood pressure monitoring. Conclusions: This mobile phone app is a health management tool for older adults to self-manage their gait quality and prevent adverse outcomes. In the future, it will be important to take factors such as age and region into consideration while designing a mobile phone–based gait assessment app. The feedback of the participants would help to design more elderly-friendly products. %M 32473005 %R 10.2196/14453 %U https://mhealth.jmir.org/2020/5/e14453 %U https://doi.org/10.2196/14453 %U http://www.ncbi.nlm.nih.gov/pubmed/32473005 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e14375 %T Understanding and Preventing Health Concerns About Emerging Mobile Health Technologies %A Materia,Frank T %A Faasse,Kate %A Smyth,Joshua M %+ The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 863 8402, Smyth@psu.edu %K mHealth %K technology %K nocebo effect %K implementation science %K medically unexplained symptoms %D 2020 %7 25.5.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X New technologies and innovations have often improved population well-being and societal function; however, these are also often initially accompanied by worry and fear. In some cases, such worries can impede, or even prevent entirely, the adoption of the technology. Mobile health (mHealth), a discipline broadly focused on employing ambulatory technologies to improve the affordability, reach, and effectiveness of health promotion and clinical intervention approaches, offers new innovations and opportunities. Despite emerging evidence supporting mHealth efficacy (eg, for improving health outcomes), some individuals have concerns about mHealth technology that may impede scalability, efficacy, and, ultimately, the public health benefits of mHealth. We present a review and conceptual framework to examine these issues, focusing on three overarching themes: biophysiological, psychological, and societal concerns. There are features of mHealth that lead to worries about the potential negative effects on an individual’s health (eg, due to exposure to electromagnetic or radio waves), despite evidence supporting the safety of these technologies. When present, such beliefs can lead to worry that gives rise to the experience of unpleasant and concerning physical symptoms—the nocebo effect. This may represent an important implementational barrier because of apprehension toward beneficial mHealth products (or features thereof, such as wireless charging, wearable or implantable sensors, etc) and may also have broader ramifications (eg, leading to economic, governmental, and legislative actions). In addition to reviewing evidence on these points, we provide a broad three-step model of implementation research in mHealth that focuses on understanding and preventing health concerns to facilitate the safe and effective scalability of mHealth (and that may be generalizable and applied to similar technologies): (1) evaluating and better discerning public perceptions and misperceptions (and how these may differ between populations), (2) developing theory-based public health communication strategies regarding the safety of mHealth, and (3) disseminating this messaging using evidence-based methods. Collectively, these steps converge on reviewing evidence regarding the potential role of worry and nocebo in mHealth and providing a model for understanding and changing attitudes and preventing unfounded negative perceptions related to mHealth technology. %M 32449688 %R 10.2196/14375 %U http://mhealth.jmir.org/2020/5/e14375/ %U https://doi.org/10.2196/14375 %U http://www.ncbi.nlm.nih.gov/pubmed/32449688 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16828 %T Midwives’ Attitudes Toward and Experience With a Tablet Intervention to Promote Safety Behaviors for Pregnant Women Reporting Intimate Partner Violence: Qualitative Study %A Garnweidner-Holme,Lisa %A Henriksen,Lena %A Flaathen,Eva Marie %A Klette Bøhler,Tone %A Lukasse,Mirjam %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PB 4 St. Olavs plass, Oslo, 0130, Norway, 47 48091956, lgarnwei@oslomet.no %K intimate partner violence %K mHealth %K attitudes %K midwives %K prenatal care %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Violence against women is considered a global health problem, and intimate partner violence (IPV) around the time of childbirth can have severe consequences for mother and child. Prenatal care is considered a window of opportunity to address IPV and ask women about exposure to violence since women are in regular contact with health care providers. Mobile health (mHealth) interventions might overcome the barriers to talking about IPV face-to-face. Objective: Our objective was to explore midwives’ attitudes toward a tablet intervention consisting of information about IPV and safety behaviors as well as their experiences with recruiting pregnant women of different ethnic backgrounds in a randomized controlled trial (RCT). Methods: Individual interviews were conducted with 9 midwives who recruited participants for an RCT to test a video to promote safety behaviors delivered on a tablet during prenatal care. Analysis was guided by thematic analysis. Results: Midwives perceived the tablet intervention as an appropriate supplement during prenatal care to provide information about IPV and promote safety behaviors. They participated in the RCT primarily to obtain more knowledge regarding how to communicate about IPV. The intervention was perceived as an anonymous door-opener to talk about IPV and a good solution to ensure that every woman gets the same information. However, the content of the intervention had to be trustworthy and align with the information the midwives provide to women. Given the sensitivity of IPV, midwives outlined the importance of following the intervention with face-to-face communication. Midwives reported technical problems and a high demand on their time as the main challenges to recruiting women. They experienced challenges recruiting women of different ethnic backgrounds due to linguistic barriers and the women’s skepticism about scientific research. Conclusions: The tablet intervention might help midwives communicate about IPV. Although the video was considered as an anonymous door-opener to talk about IPV, midwives outlined the importance of following the intervention with face-to-face communication. The scarcity of midwives’ time during consultations has to be considered when implementing the intervention. Further research is needed to overcome barriers that limit inclusion of women from different ethnic backgrounds. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 %M 32432553 %R 10.2196/16828 %U http://mhealth.jmir.org/2020/5/e16828/ %U https://doi.org/10.2196/16828 %U http://www.ncbi.nlm.nih.gov/pubmed/32432553 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16289 %T Recommendations for Developing Support Tools With People Suffering From Chronic Obstructive Pulmonary Disease: Co-Design and Pilot Testing of a Mobile Health Prototype %A Davies,Alan %A Mueller,Julia %A Hennings,Jean %A Caress,Ann-Louise %A Jay,Caroline %+ School of Health Sciences, University of Manchester, Room 1002, Vaughan House, Portsmouth St, Manchester, M13 9GB, United Kingdom, 44 7843112378, alan.davies-2@manchester.ac.uk %K chronic obstructive pulmonary disease %K app design %K mHealth %K ecological momentary assessment %K mobile phone %D 2020 %7 15.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gaps exist between developers, commissioners, and end users in terms of the perceived desirability of different features and functionalities of mobile apps. Objective: The objective of this study was to co-design a prototype mobile app for people with chronic obstructive pulmonary disease (COPD). We present lessons learned and recommendations from working on a large project with various stakeholders to develop a mobile app for patients with COPD. Methods: We adopted a user-centered, participatory approach to app development. Following a series of focus groups and interviews to capture requirements, we developed a prototype app designed to enable daily symptom recording (experience sampling). The prototype was tested in a usability study applying the think aloud protocol with people with COPD. It was then released via the Android app store, and experience sampling data and event data were captured to gather further usability data. Results: A total of 5 people with COPD participated in the pilot study. Identified themes include familiarity with technology, appropriate levels for feeding back information, and usability issues such as manual dexterity. Moreover, 37 participants used the app over a 4-month period (median age 47 years). The symptoms most correlated to perceived well-being were tiredness (r=0.61; P<.001) and breathlessness (r=0.59; P<.001). Conclusions: Design implications for COPD apps include the need for clearly labeled features (rather than relying on colors or symbols that require experience using smartphones), providing weather information, and using the same terminology as health care professionals (rather than simply lay terms). Target users, researchers, and developers should be involved at every stage of app development, using an iterative approach to build a prototype app, which should then be tested in controlled settings as well as in the wild (ie, when deployed and used in real-world settings) over longer periods. %M 32410730 %R 10.2196/16289 %U http://humanfactors.jmir.org/2020/2/e16289/ %U https://doi.org/10.2196/16289 %U http://www.ncbi.nlm.nih.gov/pubmed/32410730 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16043 %T Human-Centered Design Strategies for Device Selection in mHealth Programs: Development of a Novel Framework and Case Study %A Polhemus,Ashley Marie %A Novák,Jan %A Ferrao,Jose %A Simblett,Sara %A Radaelli,Marta %A Locatelli,Patrick %A Matcham,Faith %A Kerz,Maximilian %A Weyer,Janice %A Burke,Patrick %A Huang,Vincy %A Dockendorf,Marissa Fallon %A Temesi,Gergely %A Wykes,Til %A Comi,Giancarlo %A Myin-Germeys,Inez %A Folarin,Amos %A Dobson,Richard %A Manyakov,Nikolay V %A Narayan,Vaibhav A %A Hotopf,Matthew %+ Merck Research Labs Information Technology, Merck Sharpe & Dohme, Svornosti 3321/2, Prague, 150 00, Czech Republic, 420 44 634 48 15, ashley.polhemus@merck.com %K human-centric design %K design thinking %K patient centricity %K device selection %K technology selection %K remote patient monitoring %K remote measurement technologies %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing use of remote measurement technologies (RMT) such as wearables or biosensors in health care programs, challenges associated with selecting and implementing these technologies persist. Many health care programs that use RMT rely on commercially available, “off-the-shelf” devices to collect patient data. However, validation of these devices is sparse, the technology landscape is constantly changing, relative benefits between device options are often unclear, and research on patient and health care provider preferences is often lacking. Objective: To address these common challenges, we propose a novel device selection framework extrapolated from human-centered design principles, which are commonly used in de novo digital health product design. We then present a case study in which we used the framework to identify, test, select, and implement off-the-shelf devices for the Remote Assessment of Disease and Relapse-Central Nervous System (RADAR-CNS) consortium, a research program using RMT to study central nervous system disease progression. Methods: The RADAR-CNS device selection framework describes a human-centered approach to device selection for mobile health programs. The framework guides study designers through stakeholder engagement, technology landscaping, rapid proof of concept testing, and creative problem solving to develop device selection criteria and a robust implementation strategy. It also describes a method for considering compromises when tensions between stakeholder needs occur. Results: The framework successfully guided device selection for the RADAR-CNS study on relapse in multiple sclerosis. In the initial stage, we engaged a multidisciplinary team of patients, health care professionals, researchers, and technologists to identify our primary device-related goals. We desired regular home-based measurements of gait, balance, fatigue, heart rate, and sleep over the course of the study. However, devices and measurement methods had to be user friendly, secure, and able to produce high quality data. In the second stage, we iteratively refined our strategy and selected devices based on technological and regulatory constraints, user feedback, and research goals. At several points, we used this method to devise compromises that addressed conflicting stakeholder needs. We then implemented a feedback mechanism into the study to gather lessons about devices to improve future versions of the RADAR-CNS program. Conclusions: The RADAR device selection framework provides a structured yet flexible approach to device selection for health care programs and can be used to systematically approach complex decisions that require teams to consider patient experiences alongside scientific priorities and logistical, technical, or regulatory constraints. %M 32379055 %R 10.2196/16043 %U https://mhealth.jmir.org/2020/5/e16043 %U https://doi.org/10.2196/16043 %U http://www.ncbi.nlm.nih.gov/pubmed/32379055 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14543 %T Usability of Food Size Aids in Mobile Dietary Reporting Apps for Young Adults: Randomized Controlled Trial %A Liu,Ying-Chieh %A Wu,Sheng-Tang %A Lin,Shan-Ju %A Chen,Chien-Hung %A Lin,Yu-Sheng %A Chen,Hsin-Yun %+ Department of Industrial Design, College of Management, Chang Gung University, No 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, 333, Taiwan, 886 3 2118800 ext 5250, ycl30@mail.cgu.edu.tw %K portion size measurement %K prototype %K user-centered design %K dietary reporting %K mobile health %K randomized controlled trial %D 2020 %7 29.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young adults are more likely to use self-managed dietary reporting apps. However, there is scant research examining the user experience of different measurement approaches for mobile dietary reporting apps when dealing with a wide variety of food shapes and container sizes. Objective: Field user experience testing was conducted under actual meal conditions to assess the accuracy, efficiency, and subjective reaction of three food portion measurement methods embedded in a developed mobile app. Key-in–based aid (KBA), commonly used in many current apps, relies on the user’s ability to key in volumes or weights. Photo-based aid (PBA) extends traditional assessment methods, allowing users to scroll, observe, and select a reduced-size image from a set of options. Gesture-based aid (GBA) is a new experimental approach in which the user makes finger movements on the screen to roughly describe food portion boundaries accompanied by a background reference. Methods: A group of 124 young adults aged 19 to 26 years was recruited for a head-to-head randomized comparison and divided into 3 groups: a KBA (n=42) control group and PBA (n=41) and GBA (n=41) experimental groups. In total, 3 meals (ie, breakfast, lunch, and dinner) were served in a university cafeteria. Participants were provided with 25 dishes and beverages for selection, with a variety of food shapes and containers that reflect everyday life conditions. The accuracy of and time spent on realistic interaction during food portion estimation and the subjective reaction of each aid were recorded and analyzed. Results: Participants in the KBA group provided the highest accuracy in terms of hash brown weight (P=.004) and outperformed PBA or GBA for many soft drinks in cups. PBA had the best results for a cylindrical hot dog (P<.001), irregularly shaped pork chop (P<.001), and green tea beverage (660 mL; P<.001). GBA outperformed PBA for most drinks, and GBA outperformed KBA for some vegetables. The GBA group spent significantly more time assessing food items than the KBA and PBA groups. For each aid, the overall subjective reaction based on the score of the System Usability Scale was not significantly different. Conclusions: Experimental results show that each aid had some distinguishing advantages. In terms of user acceptance, participants considered all 3 aids to be usable. Furthermore, users’ subjective opinions regarding measurement accuracy contradicted the empirical findings. Future work will consider the use of each aid based on food or container shape and integrate the various advantages of the 3 different aids for better results. Our findings on the use of portion size aids are based on realistic and diverse food items, providing a useful reference for future app improvement of an effective, evidence-based, and acceptable feature. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN36710750; http://www.controlled-trials.com/ISRCTN36710750. %M 32347805 %R 10.2196/14543 %U http://mhealth.jmir.org/2020/4/e14543/ %U https://doi.org/10.2196/14543 %U http://www.ncbi.nlm.nih.gov/pubmed/32347805 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e16507 %T App-based Self-administrable Clinical Tests of Physical Function: Development and Usability Study %A Bergquist,Ronny %A Vereijken,Beatrix %A Mellone,Sabato %A Corzani,Mattia %A Helbostad,Jorunn L %A Taraldsen,Kristin %+ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate 8, Trondheim, 7030, Norway, 47 47634462, ronny.bergquist@ntnu.no %K physical function %K mHealth app %K usability %K older people %K seniors %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Objective measures of physical function in older adults are widely used to predict health outcomes such as disability, institutionalization, and mortality. App-based clinical tests allow users to assess their own physical function and have objective tracking of changes over time by use of their smartphones. Such tests can potentially guide interventions remotely and provide more detailed prognostic information about the participant’s physical performance for the users, therapists, and other health care personnel. We developed 3 smartphone apps with instrumented versions of the Timed Up and Go (Self-TUG), tandem stance (Self-Tandem), and Five Times Sit-to-Stand (Self-STS) tests. Objective: This study aimed to test the usability of 3 smartphone app–based self-tests of physical function using an iterative design. Methods: The apps were tested in 3 iterations: the first (n=189) and second (n=134) in a lab setting and the third (n=20) in a separate home-based study. Participants were healthy adults between 60 and 80 years of age. Assessors observed while participants self-administered the tests without any guidance. Errors were recorded, and usability problems were defined. Problems were addressed in each subsequent iteration. Perceived usability in the home-based setting was assessed by use of the System Usability Scale, the User Experience Questionnaire, and semi-structured interviews. Results: In the first iteration, 7 usability problems were identified; 42 (42/189, 22.0%) and 127 (127/189, 67.2%) participants were able to correctly perform the Self-TUG and Self-Tandem, respectively. In the second iteration, errors caused by the problems identified in the first iteration were drastically reduced, and 108 (108/134, 83.1%) and 106 (106/134, 79.1%) of the participants correctly performed the Self-TUG and Self-Tandem, respectively. The first version of the Self-STS was also tested in this iteration, and 40 (40/134, 30.1%) of the participants performed it correctly. For the third usability test, the 7 usability problems initially identified were further improved. Testing the apps in a home setting gave rise to some new usability problems, and for Self-TUG and Self-STS, the rates of correctly performed trials were slightly reduced from the second version, while for Self-Tandem, the rate increased. The mean System Usability Scale score was 77.63 points (SD 16.1 points), and 80-95% of the participants reported the highest or second highest positive rating on all items in the User Experience Questionnaire. Conclusions: The study results suggest that the apps have the potential to be used to self-test physical function in seniors in a nonsupervised home-based setting. The participants reported a high degree of ease of use. Evaluating the usability in a home setting allowed us to identify new usability problems that could affect the validity of the tests. These usability problems are not easily found in the lab setting, indicating that, if possible, app usability should be evaluated in both settings. Before being made available to end users, the apps require further improvements and validation. %M 32338616 %R 10.2196/16507 %U http://mhealth.jmir.org/2020/4/e16507/ %U https://doi.org/10.2196/16507 %U http://www.ncbi.nlm.nih.gov/pubmed/32338616 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17544 %T Consumer Perceptions of Wearable Technology Devices: Retrospective Review and Analysis %A Chong,Kimberly P L %A Guo,Julia Z %A Deng,Xiaomeng %A Woo,Benjamin K P %+ University of California, Los Angeles, 14445 Olive View Drive, Sylmar, CA, 91342, United States, 1 747 210 3830, juliaguo@mednet.ucla.edu %K wearable technology devices %K Fitbit %K Amazon %K sleep %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Individuals of all ages are becoming more health conscious, and wearable technology devices (eg, Fitbit and Apple Watch) are becoming increasingly popular in encouraging healthy lifestyles. Objective: The aim of this paper was to explore how consumers use wearable devices. Methods: A retrospective review was done on the top-rated verified purchase reviews of the Fitbit One posted on Amazon.com between January 2014 and August 2018. Relevant themes were identified by qualitatively analyzing open-ended reviews. Results: On retrieval, there were 9369 reviews with 7706 positive reviews and 1663 critical reviews. The top 100 positive and top 100 critical comments were subsequently analyzed. Four major themes were identified: sleep hygiene (“charts when you actually fall asleep, when you wake up during the night, when you're restless--and gives you a cumulative time of “actual sleep” as well as weekly averages.”), motivation (“25 lbs lost after 8 months – best motivator ever!”), accountability (“platform to connect with people you know and set little competitions or group…fun accountability if you set a goal with a friend/family.”), and discretion (“able to be clipped to my bra without being seen.”). Alternatively, negative reviewers felt that the wearable device’s various tracking functions, specifically steps and sleep, were inaccurate. Conclusions: Wearable technology devices are an affordable, user-friendly application that can support all individuals throughout their everyday lives and potentially be implemented into medical surveillance, noninvasive medical care, and mobile health and wellness monitoring. This study is the first to explore wearable technology device use among consumers, and further studies are needed to examine the limitless possibilities of wearable devices in health care. %M 32310148 %R 10.2196/17544 %U http://mhealth.jmir.org/2020/4/e17544/ %U https://doi.org/10.2196/17544 %U http://www.ncbi.nlm.nih.gov/pubmed/32310148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e17901 %T A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation %A Gannon,Brittany %A Davis,Rindcy %A Kuhns,Lisa M %A Rodriguez,Rafael Garibay %A Garofalo,Robert %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K young adults %K usability %K HIV %K mHealth %K young men %K mobile phone %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV incidence among young adult men who have sex with men (MSM), particularly among black and Latino men, continues to rise. As such, continued HIV prevention interventions for young MSM of color are of utmost importance. Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) Mobile is a comprehensive HIV prevention and sexual health education smartphone app initially created to promote sexual health and HIV prevention among adolescent sexual minority young men aged 13 to 18 years. Objective: The objective of this study was to critically appraise the acceptability and usability of MyPEEPS Mobile for young adult MSM aged 19 to 25 years. Methods: Study participants used the mobile app, completed usability questionnaires and in-depth interviews, and reported their experience using the app. Analysis of interview data was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) to better understand the usability and acceptability of this intervention for young adults. Interview data were coded using the following constructs from the UTAUT model: performance expectancy, effort expectancy, and social influence. Results: A total of 20 young adult MSM (n=10 in Chicago, Illinois, and n=10 in New York, New York) were enrolled in the study. Participants reported that MyPEEPS Mobile was free of functional problems (Health Information Technology Usability Evaluation Scale scores and Post-Study System Usability Questionnaire scores consistent with high usability), easy to use, and useful, with an engaging approach that increased acceptability, including the use of avatars and animation, and inclusive representation of the diverse identities by race and ethnicity, gender identity, and sexual orientation. Recommended areas for improving MyPEEPS Mobile for the target demographic included more adult-oriented graphics, advanced educational content, scenarios for youth with more sexual experience, and search function to increase accessibility of key content. Conclusions: Overall, young adult MSM aged 19 to 25 years described the MyPEEPS Mobile as educational, informative, and usable for their sexual health education and HIV prevention needs, and they provided actionable recommendations to optimize its use and applicability for this age group. %M 32254043 %R 10.2196/17901 %U https://formative.jmir.org/2020/4/e17901 %U https://doi.org/10.2196/17901 %U http://www.ncbi.nlm.nih.gov/pubmed/32254043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e14508 %T Usability of Wearable Devices to Remotely Monitor Sleep Patterns Among Patients With Ischemic Heart Disease: Observational Study %A Fortunato,Michael %A Adusumalli,Srinath %A Chokshi,Neel %A Harrison,Joseph %A Rareshide,Charles %A Patel,Mitesh %+ Crescenz Veterans Affairs Medical Center, 3800 Woodland Ave, South Pavilion 14-176, Philadelphia, PA, , United States, 1 215 823 5800, mpatel@pennmedicine.upenn.edu %K sleep %K wearable devices %K ischemic heart disease %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing interest in using wearable devices to remotely monitor patient behaviors. However, there has been little evaluation of how often these technologies are used to monitor sleep patterns over longer term periods, particularly among more high-risk patients. Objective: The goal of the research was to evaluate the proportion of time that patients with ischemic heart disease used wearable devices to monitor their sleep and identify differences in characteristics of patients with higher versus lower use. Methods: We evaluated wearable device data from a previously conducted clinical trial testing the use of wearable devices with personalized goal-setting and financial incentives. Patients with ischemic heart disease established a sleep baseline and were then followed for 24 weeks. The proportion of days that sleep data was collected was compared over the 24 weeks and by study arm. Characteristics of patients were compared to groups with high, low, or no sleep data. Results: The sample comprised 99 patients with ischemic heart disease, among which 79% (78/99) used the wearable device to track their sleep. During the 6-month trial, sleep data were collected on 60% (10,024/16,632) of patient-days. These rates declined over time from 77% (4292/5544) in months 1 and 2 to 58% (3188/5544) in months 3 and 4 to 46% (2544/5544) in months 5 and 6. Sleep data were collected at higher rates among the intervention group compared with control (67% vs 55%, P<.001). In the main intervention period (months 3 and 4), patients with higher rates of sleep data were on average older (P=.03), had a history of smoking (P=.007), and had higher rates of commercial health insurance (P=.03). Conclusions: Among patients with ischemic heart disease in a physical activity trial, a high proportion used wearable devices to track their sleep; however, rates declined over time. Future research should consider larger evaluations coupled with behavioral interventions. Trial Registration: ClinicalTrials.gov NCT02531022; https://clinicaltrials.gov/ct2/show/NCT02531022 %M 32254044 %R 10.2196/14508 %U https://formative.jmir.org/2020/4/e14508 %U https://doi.org/10.2196/14508 %U http://www.ncbi.nlm.nih.gov/pubmed/32254044 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e17142 %T A Smartphone App for Self-Management of Heart Failure in Older African Americans: Feasibility and Usability Study %A Heiney,Sue P %A Donevant,Sara B %A Arp Adams,Swann %A Parker,Pearman D %A Chen,Hongtu %A Levkoff,Sue %+ College of Nursing, University of South Carolina, 1601 Greene St, Columbia, SC, 29208, United States, 1 803 777 8214, heineys@mailbox.sc.edu %K heart failure %K mobile health app %K self-management %D 2020 %7 3.4.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring. African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients. Objective: The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure. Methods: Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients. In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans. These formative data were then used for creating a prototype of the app, named Healthy Heart. Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight. The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards. Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures. Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales. Results: A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed. Conclusions: An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population. %M 32242822 %R 10.2196/17142 %U http://aging.jmir.org/2020/1/e17142/ %U https://doi.org/10.2196/17142 %U http://www.ncbi.nlm.nih.gov/pubmed/32242822 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e16142 %T Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk %A Lancaster,Claire %A Koychev,Ivan %A Blane,Jasmine %A Chinner,Amy %A Wolters,Leona %A Hinds,Chris %+ Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, United Kingdom, 44 1865 743893, claire.lancaster@bdi.ox.ac.uk %K technology assessment %K cognition %K smartphone %K mhealth %K mobile phone %K Alzheimer disease %K early diagnosis %K feasibility study %K ecological momentary assessment %D 2020 %7 2.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: By enabling frequent, sensitive, and economic remote assessment, smartphones will facilitate the detection of early cognitive decline at scale. Previous studies have sustained participant engagement with remote cognitive assessment over a week; extending this to a period of 1 month clearly provides a greater opportunity for measurement. However, as study durations are increased, the need to understand how participant burden and scientific value might be optimally balanced also increases. Objective: This study explored the little but often approach to assessment employed by the Mezurio app when prompting participants to interact every day for over a month. Specifically, this study aimed to understand whether this extended duration of remote study is feasible, and which factors promote sustained participant engagement over such periods. Methods: A total of 35 adults (aged 40-59 years) with no diagnosis of cognitive impairment were prompted to interact with the Mezurio smartphone app platform for up to 36 days, completing short, daily episodic memory tasks in addition to optional executive function and language tests. A subset (n=20) of participants completed semistructured interviews focused on their experience of using the app. Results: Participants complied with 80% of the daily learning tasks scheduled for subsequent tests of episodic memory, with 88% of participants still actively engaged by the final task. A thematic analysis of the participants’ experiences highlighted schedule flexibility, a clear user interface, and performance feedback as important considerations for engagement with remote digital assessment. Conclusions: Despite the extended study duration, participants demonstrated high compliance with the schedule of daily learning tasks and were extremely positive about their experiences. Long durations of remote digital interaction are therefore definitely feasible but only when careful attention is paid to the design of the users’ experience. %M 32238339 %R 10.2196/16142 %U https://mhealth.jmir.org/2020/4/e16142 %U https://doi.org/10.2196/16142 %U http://www.ncbi.nlm.nih.gov/pubmed/32238339 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 1 %P e14465 %T A Mobile App Directory of Occupational Therapists Who Provide Home Modifications: Development and Preliminary Usability Evaluation %A Nguyen,An Thi %A Somerville,Emily Kling %A Espín-Tello,Sandra Martina %A Keglovits,Marian %A Stark,Susan Lynn %+ Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, CB 8505, St. Louis, MO, 63110, United States, 1 2062443126, an.nguyen@wustl.edu %K mHealth %K mobile app %K occupational therapist %K occupational therapy %K older adult %K user-computer interface %D 2020 %7 30.3.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Home modifications provided by occupational therapists (OTs) are effective in improving daily activity performance and reducing fall risk among community-dwelling older adults. However, the prevalence of home modification is low. One reason is the lack of a centralized database of OTs who provide home modifications. Objective: This study aimed to develop and test the usability of a mobile app directory of OTs who provide home modifications in the United States. Methods: In phase 1, a prototype was developed by identifying OTs who provide home modifications through keyword Web searches. Referral information was confirmed by phone or email. In phase 2, community-dwelling older adults aged older than 65 years and OTs currently working in the United States were purposefully recruited to participate in a single usability test of the mobile app, Home Modifications for Aging and Disability Directory of Referrals (Home Maddirs). Participants completed the System Usability Scale (SUS) and semistructured interview questions. Interview data were coded, and themes were derived using a grounded theory approach. Results: In phase 1, referral information for 101 OTs across 49 states was confirmed. In phase 2, 6 OTs (mean clinical experience 4.3 years, SD 1.6 years) and 6 older adults (mean age 72.8 years, SD 5.0 years) participated. The mean SUS score for OTs was 91.7 (SD 8.0; out of 100), indicating good usability. The mean SUS score for older adults was 71.7 (SD 27.1), indicating considerable variability in usability. In addition, the SUS scores indicated that the app is acceptable to OTs and may be acceptable to some older adults. For OTs, self-reported barriers to acceptability and usability included the need for more information on the scope of referral services. For older adults, barriers included high cognitive load, lack of operational skills, and the need to accommodate sensory changes. For both groups, facilitators of acceptability and usability included perceived usefulness, social support, and multiple options to access information. Conclusions: Home Maddirs demonstrates good preliminary acceptability and usability to OTs. Older adults’ perceptions regarding acceptability and usability varied considerably, partly based on prior experience using mobile apps. Results will be used to make improvements to this promising new tool for increasing older adults’ access to home modifications. %M 32224486 %R 10.2196/14465 %U http://rehab.jmir.org/2020/1/e14465/ %U https://doi.org/10.2196/14465 %U http://www.ncbi.nlm.nih.gov/pubmed/32224486 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e16831 %T Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing %A Kristjansdottir,Olöf Birna %A Børøsund,Elin %A Westeng,Marianne %A Ruland,Cornelia %A Stenberg,Una %A Zangi,Heidi A %A Stange,Kurt %A Mirkovic,Jelena %+ Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4959 Nydalen, Oslo, 0424, Norway, 47 92433964, olof@mestring.no %K mobile app %K self-management %K strengths %K chronic illness %K rheumatology %K usability %K formative evaluation %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Supporting patient engagement and empowerment is increasingly seen as essential in providing person-centered health care to people with chronic illness. Mobile apps helping patients reflect on their concerns as preparation for consultations with their health care providers can have beneficial effects on the consultation quality. However, apps focusing on empowerment and personal strengths are still scarce. Objective: This study aimed to (1) develop a mobile app to support patients with rheumatic diseases in reflecting on their strengths in preparation for consultations with health care providers and (2) explore patients’ perceived usability of the app in a nonclinical test setting. Methods: A prototype app was developed based on input from patients and health care providers, as reported in previous studies. The app was designed for use in self-management support settings aiming to promote awareness of strengths and to focus attention on strengths in the patient-health care provider dialogue. The features included in the prototype were as follows: (1) introduction to the topic of strengths, (2) list of examples of strengths to promote reflection and registration of own strengths, (3) summary of registered strengths, (4) value-based goal setting, (5) linking of strengths to goals, (6) summary of all registrations, and (7) options to share summary digitally or as a print version. In this study, the app was refined through a formative evaluation with patients and health care providers recruited from a specialized rheumatology hospital unit. Patients’ perceptions of the app’s usability were explored in a test setting with self-report measurements and semistructured interviews. The interviews were audiotaped, transcribed, and analyzed with directed content analysis. Data from questionnaires were analyzed with descriptive statistics. Results: Developmental and formative evaluation included 18 patients and 7 health care providers. The evaluation resulted in minor adjustments to the prototype but no major changes in features. The usability testing included 12 patients. All participants found the usability acceptable; the median score on the System Usability Scale was 86.3 (range 70-100). All reported that it was meaningful and relevant to use the app. Out of 12 participants, 9 (75%) reported becoming more aware of their own strengths by using the app; 1 (8%) disagreed and 2 (17%) provided a neutral response. The results on the goal-related feature were mixed, with half of the patients finding it useful to link strengths to concrete goals. A statistically significant positive change from pre- to postintervention was identified on measures of self-efficacy and negative emotions. Conclusions: In this formative evaluation of a mobile app to promote patients’ reflections on their strengths, patients perceived the app as meaningful and supporting awareness. The results suggest the usefulness of building in functionality to support use of strengths and goal attainment. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed. %M 32130126 %R 10.2196/16831 %U https://formative.jmir.org/2020/3/e16831 %U https://doi.org/10.2196/16831 %U http://www.ncbi.nlm.nih.gov/pubmed/32130126 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15346 %T A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk %A Joseph,Rodney P %A Keller,Colleen %A Vega-López,Sonia %A Adams,Marc A %A English,Rebekah %A Hollingshead,Kevin %A Hooker,Steven P %A Todd,Michael %A Gaesser,Glenn A %A Ainsworth,Barbara E %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 6024960772, rodney.joseph@asu.edu %K eHealth %K mHealth %K exercise %K minority health %K primary prevention %K heart diseases %K African-American %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart Walk is a culturally relevant, social cognitive theory–based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women. Objective: This study aimed to describe the development and initial usability testing results of Smart Walk. Methods: Smart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results. Results: The 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week. Conclusions: The development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention. %M 32130198 %R 10.2196/15346 %U https://mhealth.jmir.org/2020/3/e15346 %U https://doi.org/10.2196/15346 %U http://www.ncbi.nlm.nih.gov/pubmed/32130198 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e15935 %T Social, Organizational, and Technological Factors Impacting Clinicians’ Adoption of Mobile Health Tools: Systematic Literature Review %A Jacob,Christine %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge, CB1 1PT, United Kingdom, 44 798769376, christine.k.jacob@gmail.com %K telemedicine %K smartphone %K cell or mobile phone %K electronic health record %K workflow %K workload %K workplace %K public health practice %K technology %K perception %K health education %K mHealth %K mobile health %K telehealth %K eHealth %D 2020 %7 20.2.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. Objective: The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. Methods: A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. Results: The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions: The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits. %M 32130167 %R 10.2196/15935 %U http://mhealth.jmir.org/2020/2/e15935/ %U https://doi.org/10.2196/15935 %U http://www.ncbi.nlm.nih.gov/pubmed/32130167 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e14146 %T Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized Heuristic Trial %A Purkayastha,Saptarshi %A Addepally,Siva Abhishek %A Bucher,Sherri %+ Indiana University - Purdue University Indianapolis, 719 Indiana Avenue, WK 119, Indianapolis, IN, , United States, 1 3172740439, saptpurk@iupui.edu %K cognitive behavioral therapy %K mHealth %K mental health %K heuristics %K usability %D 2020 %7 3.2.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Recent evidence in mobile health has demonstrated that, in some cases, apps are an effective way to improve health care delivery. Health care interventions delivered via mobile technology have demonstrated both practicality and affordability. Lately, cognitive behavioral therapy (CBT) interventions delivered over the internet have also shown a meaningful impact on patients with anxiety and depression. Objective: Given the growing proliferation of smartphones and the trust in apps to support improved health behaviors and outcomes, we were interested in comparing a mobile app with Web-based methods for the delivery of CBT. This study aimed to compare the usability of a CBT mobile app called MoodTrainer with an evidence-based website called MoodGYM. Methods: We used convenience sampling to recruit 30 students from a large Midwestern university and randomly assigned them to either the MoodGYM or MoodTrainer user group. The trial period ran for 2 weeks, after which the students completed a self-assessment survey based on Nielsen heuristics. Statistical analysis was performed to compare the survey results from the 2 groups. We also compared the number of modules attempted or completed and the time spent on CBT strategies. Results: The results indicate that the MoodTrainer app received a higher usability score when compared with MoodGYM. Overall, 87% (13/15) of the participants felt that it was easy to navigate through the MoodTrainer app compared with 80% (12/15) of the MoodGYM participants. All MoodTrainer participants agreed that the app was easy to use and did not require any external assistance, whereas only 67% (10/15) had the same opinion for MoodGYM. Furthermore, 67% (10/15) of the MoodTrainer participants found that the navigation controls were easy to locate compared with 80% (12/15) of the MoodGYM participants. MoodTrainer users, on average, completed 2.5 modules compared with 1 module completed by MoodGYM users. Conclusions: As among the first studies to directly compare the usability of a mobile app–based CBT with smartphone-specific features against a Web-based CBT, there is an opportunity for app-based CBT as, at least in our limited trial, it was more usable and engaging. The study was limited to evaluate usability only and not the clinical effectiveness of the app. %M 32012043 %R 10.2196/14146 %U http://humanfactors.jmir.org/2020/1/e14146/ %U https://doi.org/10.2196/14146 %U http://www.ncbi.nlm.nih.gov/pubmed/32012043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15146 %T Usability and Utility of a Mobile App to Improve Medication Adherence Among Ambulatory Care Patients in Malaysia: Qualitative Study %A Chew,Sara %A Lai,Pauline Siew Mei %A Ng,Chirk Jenn %+ Department of Primary Care Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, 50603, Malaysia, 60 379493920, plai@ummc.edu.my %K medication adherence app %K usability testing %K utility testing %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To date, several medication adherence apps have been developed. However, the existing apps have been developed without involving relevant stakeholders and were not subjected to mobile health app guidelines. In addition, the usability and utility of these apps have not been tested with end users. Objective: This study aimed to describe the usability and utility testing of a newly developed medication adherence app—Med Assist—among ambulatory care patients in Malaysia. Methods: The Med Assist app was developed based on the Theory of Planned Behavior and the Nielson usability model. Beta testing was conducted from March to May 2016 at a primary care clinic in Kuala Lumpur. Ambulatory care patients who scored ≥40% on the electronic health literacy scale, were aged ≥21 years, and were taking two or more long-term medications were recruited. Two rounds of in-depth interviews were conducted with each participant. The first interview, which was conducted upon participant recruitment, was to assess the usability of Med Assist. Participants were asked to download Med Assist on their phone and perform two tasks (register themselves on Med Assist and enter at least one medication). Participants were encouraged to “concurrently think aloud” when using Med Assist, while nonverbal cues were observed and recorded. The participants were then invited for a second interview (conducted ≥7 days after the first interview) to assess the utility of Med Assist after using the app for 1 week. This was done using “retrospective probing” based on a topic guide developed for utilities that could improve medication adherence. Results: Usability and utility testing was performed for the Med Assist app (version P4). A total of 13 participants were recruited (6 men, 7 women) for beta testing. Three themes emerged from the usability testing, while three themes emerged from the utility testing. From the usability testing, participants found Med Assist easy to use and user friendly, as they were able to complete the tasks given to them. However, the details required when adding a new medication were found to be confusing despite displaying information in a hierarchical order. Participants who were caregivers as well as patients found the multiple-user support and pill buddy utility useful. This suggests that Med Assist may improve the medication adherence of patients on multiple long-term medications. Conclusions: The usability and utility testing of Med Assist with end users made the app more patient centered in ambulatory care. From the usability testing, the overall design and layout of Med Assist were simple and user friendly enough for participants to navigate through the app and add a new medication. From the participants’ perspectives, Med Assist was a useful and reliable tool with the potential to improve medication adherence. In addition, utilities such as multiple user support and a medication refill reminder encouraged improved medication management. %M 32003748 %R 10.2196/15146 %U http://mhealth.jmir.org/2020/1/e15146/ %U https://doi.org/10.2196/15146 %U http://www.ncbi.nlm.nih.gov/pubmed/32003748 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15503 %T Mobile Clinical Decision Tools Among Emergency Department Clinicians: Web-Based Survey and Analytic Data for Evaluation of The Ottawa Rules App %A Quan,Amanda My Linh %A Stiell,Ian %A Perry,Jeffrey J %A Paradis,Michelle %A Brown,Erica %A Gignac,Jordan %A Wilson,Lindsay %A Wilson,Kumanan %+ The Ottawa Hospital Research Institute, Clinical Epidemiology, 1053 Carling Avenue, Box 684, Administrative Services Building, Ottawa, ON, K1Y 4E9, Canada, 1 (613) 7985555, kwilson@ohri.ca %K emergency departments %K mHealth %K clinical prediction rule %K decision aids %D 2020 %7 29.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Canadian CT Head Rule (CCHR), the Canadian Transient Ischemic Attack (TIA) Score, and the Subarachnoid Hemorrhage (SAH) Rule have all previously demonstrated the potential to significantly standardize care and improve the management of patients in emergency departments (EDs). On the basis of user feedback, we believe that the addition of these rules to the Ottawa Rules App has the potential to increase the app’s usability and user acceptability. Objective: This study aimed to evaluate the perceived usefulness, acceptability, and uptake of the enhanced Ottawa Rules App (which now includes CCHR, TIA, and SAH Rules) among ED clinicians (medical students, residents, nurses, and physicians). Methods: The enhanced Ottawa Rules App was publicly released for free on iOS and Android operating systems in November 2018. This study was conducted across 2 tertiary EDs in Ottawa, Canada. Posters, direct enrollment, snowball sampling, and emails were used for study recruitment. A 24-question Web-based survey was administered to participants via email, and this was used to determine user acceptability of the app and Technology Readiness Index (TRI) scores. In-app user analytics were collected to track user behavior, such as the number of app sessions, length of app sessions, frequency of rule use, and the date app was first opened. Results: A total of 77 ED clinicians completed the study, including 34 nurses, 12 residents, 14 physicians, and 17 medical students completing ED rotations. The median TRI score for this group was 3.38, indicating a higher than average propensity to embrace and adopt new technologies to accomplish goals in their work or daily lives. The majority of respondents agreed or strongly agreed that the app helped participants accurately carry out the clinical rules (56/77, 73%) and that they would recommend this app to their colleagues (64/77, 83%). Feedback from study participants suggested further expansion of the app—more clinical decision rules (CDRs) and different versions of the app tailored to the clinician role. Analysis and comparison of Google Analytics data and in-app data revealed similar usage behavior among study-enrolled users and all app users globally. Conclusions: This study provides evidence that using the Ottawa Rules App (version 3.0.2) to improve and guide patient care would be feasible and widely accepted. The ability to verify self-reported user data (via a Web-based survey) against server analytics data is a notable strength of this study. Participants’ continued app use and request for the addition of more CDRs warrant the further development of this app and call for additional studies to evaluate its feasibility and usability in different settings as well as assessment of clinical impact. %M 32012095 %R 10.2196/15503 %U https://mhealth.jmir.org/2020/1/e15503 %U https://doi.org/10.2196/15503 %U http://www.ncbi.nlm.nih.gov/pubmed/32012095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15663 %T Factors Related to User Ratings and User Downloads of Mobile Apps for Maternal and Infant Health: Cross-Sectional Study %A Biviji,Rizwana %A Vest,Joshua R %A Dixon,Brian E %A Cullen,Theresa %A Harle,Christopher A %+ Science of Healthcare Delivery, College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ, 85004, United States, 1 6024963300, Rizwana.Biviji@asu.edu %K mHealth %K mobile apps %K pregnancy %K parturition %K infant care %K smartphones %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps related to maternal and infant health (MIH) are prevalent and frequently used. Some of these apps are extremely popular and have been downloaded over 5 million times. However, the understanding of user behavior and user adoption of these apps based on consumer preferences for different app features and categories is limited. Objective: This study aimed to examine the relationship between MIH app characteristics and users’ perceived satisfaction and intent to use. Methods: The associations between app characteristics, ratings, and downloads were assessed in a sample of MIH apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. Multivariable linear regression was used to assess the relationship between app characteristics and user ratings, and ordinal logistic regression was used to assess the relationship between app characteristics and user downloads. Results: The analyses of user ratings and downloads included 421 and 213 apps, respectively. The average user rating was 3.79 out of 5. Compared with the Apple App Store, the Google Play Store was associated with high user ratings (beta=.33; P=.005). Apps with higher standardized user ratings (beta=.80; P<.001), in-app purchases (beta=1.12; P=.002), and in-app advertisements (beta=.64; P=.02) were more frequently downloaded. Having a health care organization developer as part of the development team was neither associated with user ratings (beta=−.20; P=.06) nor downloads (beta=−.14; P=.63). Conclusions: A majority of MIH apps are developed by non–health care organizations, which could raise concern about the accuracy and trustworthiness of in-app information. These findings could benefit app developers in designing better apps and could help inform marketing and development strategies. Further work is needed to evaluate the clinical accuracy of information provided within the apps. %M 32012107 %R 10.2196/15663 %U http://mhealth.jmir.org/2020/1/e15663/ %U https://doi.org/10.2196/15663 %U http://www.ncbi.nlm.nih.gov/pubmed/32012107 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15060 %T Making Self-Management Mobile Health Apps Accessible to People With Disabilities: Qualitative Single-Subject Study %A Zhou,Leming %A Saptono,Andi %A Setiawan,I Made Agus %A Parmanto,Bambang %+ Department of Health Information Management, University of Pittsburgh, 6021 Forbes Tower, 3600 Forbes Ave at Meyran Ave, Pittsburgh, PA, 15260, United States, 1 412 383 6653, Leming.Zhou@pitt.edu %K mobile app %K self-management %K accessibility %K personalization %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over the past decade, a large number of mobile health (mHealth) apps have been created to help individuals to better manage their own health. However, very few of these mHealth apps were specifically designed for people with disabilities, and only a few of them have been assessed for accessibility for people with disabilities. As a result, people with disabilities have difficulties using many of these mHealth apps. Objective: The objective of this study was to identify an approach that can be generally applied to improve the accessibility of mHealth apps. Methods: We recruited 5 study participants with a primary diagnosis of cerebral palsy or spinal cord injury. All the participants had fine motor impairment or lack of dexterity, and hence, they had difficulties using some mHealth apps. These 5 study participants were first asked to use multiple modules in the client app of a novel mHealth system (iMHere 2.0), during which their performance was observed. Interviews were conducted post use to collect study participants’ desired accessibility features. These accessibility features were then implemented into the iMHere 2.0 client app as customizable options. The 5 participants were asked to use the same modules in the app again, and their performance was compared with that in the first round. A brief interview and a questionnaire were then performed at the end of the study to collect the 5 participants’ comments and impression of the iMHere 2.0 app in general and of the customizable accessibility features. Results: Study results indicate that the study participants on their first use of the iMHere 2.0 client app experienced various levels of difficulty consistent with the severity of their lack of dexterity. Their performance was improved after their desired accessibility features were added into the app, and they liked the customizable accessibility features. These participants also expressed an interest in using this mHealth system for their health self-management tasks. Conclusions: The accessibility features identified in this study improved the accessibility of the mHealth app for people with dexterity issues. Our approach for improving mHealth app accessibility may also be applied to other mHealth apps to make those apps accessible to people with disabilities. %M 31899453 %R 10.2196/15060 %U https://mhealth.jmir.org/2020/1/e15060 %U https://doi.org/10.2196/15060 %U http://www.ncbi.nlm.nih.gov/pubmed/31899453 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e15828 %T The mPOWERED Electronic Learning System for Intimate Partner Violence Education: Mixed Methods Usability Study %A Hughes,Charmayne %A Musselman,Elaine A %A Walsh,Lilia %A Mariscal,Tatiana %A Warner,Sam %A Hintze,Amy %A Rashidi,Neela %A Gordon-Murer,Chloe %A Tanha,Tiana %A Licudo,Fahrial %A Ng,Rachel %A Tran,Jenna %+ Health Equity Institute, San Francisco State University, 1600 Holloway Ave, Department of Kinesiology, San Francisco, CA, 94132, United States, 1 4157708121, cmhughes@sfsu.edu %K intimate partner violence %K domestic violence %K nursing education %K learning %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Nurse practitioners are a common resource for victims of intimate partner violence (IPV) presenting to health care settings. However, they often have inadequate knowledge about IPV and lack self-efficacy and confidence to be able to screen for IPV and communicate effectively with patients. Objective: The aim of this study was to develop and test the usability of a blended learning system aimed at educating nurse practitioner students on topics related to IPV (ie, the mPOWERED system [Health Equity Institute]). Methods: Development of the mPOWERED system involved usability testing with 7 nurse educators (NEs) and 18 nurse practitioner students. Users were asked to complete usability testing using a speak-aloud procedure and then complete a satisfaction and usability questionnaire. Results: Overall, the mPOWERED system was deemed to have high usability and was positively evaluated by both NEs and nurse practitioner students. Respondents provided critical feedback that will be used to improve the system. Conclusions: By including target end users in the design and evaluation of the mPOWERED system, we have developed a blended IPV learning system that can easily be integrated into health care education. Larger-scale evaluation of the pedagogical impact of this system is underway. %M 34345778 %R 10.2196/15828 %U https://nursing.jmir.org/2020/1/e15828 %U https://doi.org/10.2196/15828 %U http://www.ncbi.nlm.nih.gov/pubmed/34345778 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e15008 %T Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study %A Hanghøj,Signe %A Boisen,Kirsten A %A Hjerming,Maiken %A Elsbernd,Abbey %A Pappot,Helle %+ Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, The Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 27318806, signe.hanghoej@gmail.com %K AYA %K adolescent and young adult %K app %K cancer %K co-creation %K mHealth %K mobile phone %K think-aloud test %K usability %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Adolescent and young adult (AYA) cancer patients are seldom involved in the process of testing cancer-related apps. As such, knowledge about youth-specific content, functionalities, and design is sparse. As a part of a co-creation process of developing the mobile phone app Kræftværket, AYAs in treatment for cancer and in follow-up participated in a usability think-aloud test of a prototype of the app. Thus, the app was initiated, created, and evaluated by AYAs with cancer experience. Objective: The aim of this study was to explore the results of a think-aloud test administered to see how the prototype of the app Kræftværket was used by AYAs in treatment for cancer and in follow-up, and to investigate the strengths and weaknesses of the app. Methods: A total of 20 AYA cancer patients aged 16 to 29 years (n=10 on treatment, n=10 in follow-up) were provided with the first version of the co-created mobile phone app Kræftværket during a 6-week test period (April-May 2018). After the test period, 15 participated in individual usability think-aloud tests. The tests were video-recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results: The thematic analysis led to the following themes and subthemes: navigation (subthemes: intuition, features, buttons, home page, profile), visual and graphic design (subthemes: overview, text and colors, photos, videos, YouTube), and usefulness (subthemes: notifications, posts, adding). The analysis identified gender differences in app utilization—female participants seemed to be more familiar with parts of the app. The app seemed to be more relevant to AYAs receiving treatment due to app functions such as tracking symptoms and searching for relevant information. Lack of notifications and incorrect counting of posts were perceived as barriers to using the app. Conclusions: Usability testing is crucial to meet the needs of the AYA target audience. AYA cancer apps should preferably be relevant, targeted, and unique, and include a tracking function and AYA-produced videos. Notifications and correct marking and ordering of posts are critical to make apps engaging and dynamic. Further research is recommended to evaluate the Kræftværket app with the input of more AYAs. %M 31895046 %R 10.2196/15008 %U https://cancer.jmir.org/2020/1/e15008 %U https://doi.org/10.2196/15008 %U http://www.ncbi.nlm.nih.gov/pubmed/31895046 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 12 %P e15707 %T Adults’ Preferences for Behavior Change Techniques and Engagement Features in a Mobile App to Promote 24-Hour Movement Behaviors: Cross-Sectional Survey Study %A DeSmet,Ann %A De Bourdeaudhuij,Ilse %A Chastin,Sebastien %A Crombez,Geert %A Maddison,Ralph %A Cardon,Greet %+ Clinical and Health Psychology, Université Libre de Bruxelles, Franklin Rooseveltlaan 50, Brussels, 1050, Belgium, 32 2 650 32 82, Ann.DeSmet@ulb.be %K physical activity %K sleep %K sedentary behavior %K 24-hour movement %K mobile health %K mobile apps %K behavior change technique %K engagement %K adult %D 2019 %7 20.12.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a limited understanding of components that should be included in digital interventions for 24-hour movement behaviors (physical activity [PA], sleep, and sedentary behavior [SB]). For intervention effectiveness, user engagement is important. This can be enhanced by a user-centered design to, for example, explore and integrate user preferences for intervention techniques and features. Objective: This study aimed to examine adult users’ preferences for techniques and features in mobile apps for 24-hour movement behaviors. Methods: A total of 86 participants (mean age 37.4 years [SD 9.2]; 49/86, 57% female) completed a Web-based survey. Behavior change techniques (BCTs) were based on a validated taxonomy v2 by Abraham and Michie, and engagement features were based on a list extracted from the literature. Behavioral data were collected using Fitbit trackers. Correlations, (repeated measures) analysis of variance, and independent sample t tests were used to examine associations and differences between and within users by the type of health domain and users’ behavioral intention and adoption. Results: Preferences were generally the highest for information on the health consequences of movement behavior self-monitoring, behavioral feedback, insight into healthy lifestyles, and tips and instructions. Although the same ranking was found for techniques across behaviors, preferences were stronger for all but one BCT for PA in comparison to the other two health behaviors. Although techniques fit user preferences for addressing PA well, supplemental techniques may be able to address preferences for sleep and SB in a better manner. In addition to what is commonly included in apps, sleep apps should consider providing tips for sleep. SB apps may wish to include more self-regulation and goal-setting techniques. Few differences were found by users’ intentions or adoption to change a particular behavior. Apps should provide more self-monitoring (P=.03), information on behavior health outcome (P=.048), and feedback (P=.04) and incorporate social support (P=.048) to help those who are further removed from healthy sleep. A virtual coach (P<.001) and video modeling (P=.004) may provide appreciated support to those who are physically less active. PA self-monitoring appealed more to those with an intention to change PA (P=.03). Social comparison and support features are not high on users’ agenda and may not be needed from an engagement point of view. Engagement features may not be very relevant for user engagement but should be examined in future research with a less reflective method. Conclusions: The findings of this study provide guidance for the design of digital 24-hour movement behavior interventions. As 24-hour movement guidelines are increasingly being adopted in several countries, our study findings are timely to support the design of interventions to meet these guidelines. %M 31859680 %R 10.2196/15707 %U http://mhealth.jmir.org/2019/12/e15707/ %U https://doi.org/10.2196/15707 %U http://www.ncbi.nlm.nih.gov/pubmed/31859680 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 4 %P e13472 %T Empirical Research on Acceptance of Digital Technologies in Medicine Among Patients and Healthy Users: Questionnaire Study %A Safi,Sabur %A Danzer,Gerhard %A Schmailzl,Kurt JG %+ Center for Connected Health Care UG, Medical School Brandenburg, digiLog, Fehrbelliner Straße 38, Neuruppin, 16816, Germany, 49 3391391009, sabur.safi@gmx.de %K innovative health care applications %K e-Health %K Technology Acceptance Model %K health care innovation %K electronic medical records %K ePatient Survey %K sex differences %K medical technology %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In recent years, interest in digital technologies such as electronic health, mobile health, telemedicine, big data, and health apps has been increasing in the health care sector. Acceptance and sustainability of these technologies play a considerable role for innovative health care apps. Objective: This study aimed to identify the spread of and experience with new digital technologies in the medical sector in Germany. Methods: We analyzed the acceptance of new health care technologies by applying the Technology Acceptance Model to data obtained in the German ePatient Survey 2018. This survey used standardized questionnaires to gain insight into the prevalence, impact, and development of digital health applications in a study sample of 9621 patients with acute and chronic conditions and healthy users. We extracted sociodemographic data and details on the different health app types used in Germany and conducted an evaluation based on the Technology Acceptance Model. Results: The average age of the respondents was 59.7 years, with a standard deviation of 16 years. Digital health care apps were generally accepted, but differences were observed among age groups and genders of the respondents. Men were more likely to accept digital technologies, while women preferred coaching and consultation apps. Analysis of the user typology revealed that most users were patients (n=4041, 42%), followed by patients with acute conditions (n=3175, 33%), and healthy users (n=2405, 25%). The majority (n=6542, 68%) discovered coaching or medication apps themselves on the internet, while more than half of the users faced initial difficulties operating such apps. The time of use of the same app or program ranged from a few days (n=1607, 37%) and several months (n=1694, 39%) to ≥1 year (n=1042, 24%). Most respondents (n=6927, 72%) stated that they would like to receive customized health care apps from their physician. Conclusions: The acceptance of digital technologies in the German health care sector varies depending on age and gender. The broad acceptance of medical digital apps could potentially improve individualized health care solutions and warrants governance. %M 31782741 %R 10.2196/13472 %U http://humanfactors.jmir.org/2019/4/e13472/ %U https://doi.org/10.2196/13472 %U http://www.ncbi.nlm.nih.gov/pubmed/31782741 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13786 %T A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study %A Therkildsen,Signe Bülow %A Hansen,Linda Houlind %A Jensen,Laura Emilie Dinesen %A Finderup,Jeanette %+ Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark, 45 78452525, jeajee@rm.dk %K mobile phone %K app %K patient decision aid %K dialysis %K decisional conflict %K usability %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. Objective: The aim of this study was to uncover the applicability of the DG as a PDA. Methods: The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. Results: A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90%) had attended a patient school for kidney disease, and 13 out of 22 (59%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. Conclusions: The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents’ average age. Thus, the applicability of the DG cannot be definitively determined. %M 31750836 %R 10.2196/13786 %U http://formative.jmir.org/2019/4/e13786/ %U https://doi.org/10.2196/13786 %U http://www.ncbi.nlm.nih.gov/pubmed/31750836 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13604 %T Iterative Adaptation of a Mobile Nutrition Video-Based Intervention Across Countries Using Human-Centered Design: Qualitative Study %A Isler,Jasmin %A Sawadogo,N Hélène %A Harling,Guy %A Bärnighausen,Till %A Adam,Maya %A Kagoné,Moubassira %A Sié,Ali %A Greuel,Merlin %A McMahon,Shannon A %+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 06221 565344, mcmahon@uni-heidelberg.de %K mHealth %K Burkina Faso %K mothers %K Community Health Workers %K pregnancy %K diet %K dgital health %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective: The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods: Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results: We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions: Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions. %M 31710302 %R 10.2196/13604 %U http://mhealth.jmir.org/2019/11/e13604/ %U https://doi.org/10.2196/13604 %U http://www.ncbi.nlm.nih.gov/pubmed/31710302 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 3 %N 2 %P e14332 %T Assessment of Heart Failure Patients’ Interest in Mobile Health Apps for Self-Care: Survey Study %A Sohn,Albert %A Speier,William %A Lan,Esther %A Aoki,Kymberly %A Fonarow,Gregg %A Ong,Michael %A Arnold,Corey %+ Department of Radiological Sciences, University of California, Los Angeles, 924 Westwood Blvd Ste 420, Los Angeles, CA, 90024, United States, 1 3107943538, cwarnold@ucla.edu %K mHealth %K patient-reported outcome %K heart failure %K self-care %K patient monitoring %D 2019 %7 29.10.2019 %9 Original Paper %J JMIR Cardio %G English %X Background: Heart failure is a serious public health concern that afflicts millions of individuals in the United States. Development of behaviors that promote heart failure self-care may be imperative to reduce complications and avoid hospital re-admissions. Mobile health solutions, such as activity trackers and smartphone apps, could potentially help to promote self-care through remote tracking and issuing reminders. Objective: The objective of this study was to ascertain heart failure patients’ interest in a smartphone app to assist them in managing their treatment and symptoms and to determine factors that influence their interest in such an app. Methods: In the clinic waiting room on the day of their outpatient clinic appointments, 50 heart failure patients participated in a self-administered survey. The survey comprised 139 questions from previously published, institutional review board–approved questionnaires. The survey measured patients’ interest in and experience using technology as well as their function, heart failure symptoms, and heart failure self-care behaviors. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was among the 11 questionnaires and was used to measure the heart failure patients’ health-related quality of life through patient-reported outcomes. Results: Participants were aged 64.5 years on average, 32% (16/50) of the participants were women, and 91% (41/45) of the participants were determined to be New York Heart Association Class II or higher. More than 60% (30/50) of the survey participants expressed interest in several potential features of a smartphone app designed for heart failure patients. Participant age correlated negatively with interest in tracking, tips, and reminders in multivariate regression analysis (P<.05). In contrast, MLHFQ scores (worse health status) produced positive correlations with these interests (P<.05). Conclusions: The majority of heart failure patients showed interest in activity tracking, heart failure symptom management tips, and reminder features of a smartphone app. Desirable features and an understanding of factors that influence patient interest in a smartphone app for heart failure self-care may allow researchers to address common concerns and to develop apps that demonstrate the potential benefits of mobile technology. %M 31758788 %R 10.2196/14332 %U https://cardio.jmir.org/2019/2/e14332 %U https://doi.org/10.2196/14332 %U http://www.ncbi.nlm.nih.gov/pubmed/31758788 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14769 %T Usability and Feasibility of a Smartphone App to Assess Human Behavioral Factors Associated with Tick Exposure (The Tick App): Quantitative and Qualitative Study %A Fernandez,Maria P %A Bron,Gebbiena M. %A Kache,Pallavi A %A Larson,Scott R %A Maus,Adam %A Gustafson Jr,David %A Tsao,Jean I %A Bartholomay,Lyric C %A Paskewitz,Susan M %A Diuk-Wasser,Maria A %+ Department of Ecology, Evolution and Environmental Biology, Columbia University, Schemerhorn Ext Building, 11th Floor, Room 1013, New York, NY, United States, 1 212 854 3355, mad2256@columbia.edu %K Lyme disease %K ticks %K ecological momentary assessment %K citizen science %D 2019 %7 24.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technology takes advantage of smartphone features to turn them into research tools, with the potential to reach a larger section of the population in a cost-effective manner, compared with traditional epidemiological methods. Although mHealth apps have been widely implemented in chronic diseases and psychology, their potential use in the research of vector-borne diseases has not yet been fully exploited. Objective: This study aimed to assess the usability and feasibility of The Tick App, the first tick research–focused app in the United States. Methods: The Tick App was designed as a survey tool to collect data on human behaviors and movements associated with tick exposure while engaging users in tick identification and reporting. It consists of an enrollment survey to identify general risk factors, daily surveys to collect data on human activities and tick encounters (Tick Diaries), a survey to enter the details of tick encounters coupled with tick identification services provided by the research team (Report a Tick), and educational material. Using quantitative and qualitative methods, we evaluated the enrollment strategy (passive vs active), the user profile, location, longitudinal use of its features, and users’ feedback. Results: Between May and September 2018, 1468 adult users enrolled in the app. The Tick App users were equally represented across genders and evenly distributed across age groups. Most users owned a pet (65.94%, 962/1459; P<.001), did frequent outdoor activities (recreational or peridomestic; 75.24%, 1094/1454; P<.001 and 64.58%, 941/1457; P<.001, respectively), and lived in the Midwest (56.55%, 824/1457) and Northeast (33.0%, 481/1457) regions in the United States, more specifically in Wisconsin, southern New York, and New Jersey. Users lived more frequently in high-incidence counties for Lyme disease (incidence rate ratio [IRR] 3.5, 95% CI 1.8-7.2; P<.001) and in counties with cases recently increasing (IRR 1.8, 95% CI 1.1-3.2; P=.03). Recurring users (49.25%, 723/1468) had a similar demographic profile to all users but participated in outdoor activities more frequently (80.5%, 575/714; P<.01). The number of Tick Diaries submitted per user (median 2, interquartile range [IQR] 1-11) was higher for older age groups (aged >55 years; IRR 3.4, 95% CI 1.5-7.6; P<.001) and lower in the Northeast (IRR[NE] 0.4, 95% CI 0.3-0.7; P<.001), whereas the number of tick reports (median 1, IQR 1-2) increased with the frequency of outdoor activities (IRR 1.5, 95% CI 1.3-1.8; P<.001). Conclusions: This assessment allowed us to identify what fraction of the population used The Tick App and how it was used during a pilot phase. This information will be used to improve future iterations of The Tick App and tailor potential tick prevention interventions to the users’ characteristics. %M 31651409 %R 10.2196/14769 %U http://mhealth.jmir.org/2019/10/e14769/ %U https://doi.org/10.2196/14769 %U http://www.ncbi.nlm.nih.gov/pubmed/31651409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14276 %T The Fever Coach Mobile App for Participatory Influenza Surveillance in Children: Usability Study %A Kim,Myeongchan %A Yune,Sehyo %A Chang,Seyun %A Jung,Yuseob %A Sa,Soon Ok %A Han,Hyun Wook %+ Department of Biomedical Informatics, Graduate School of Medicine, CHA University, Pangyo-ro 335, Bundang-gu, Seongnam-si, Gyeonggi-do, 13488, Republic of Korea, 82 31 881 7109, stepano7@gmail.com %K data collection %K detecting epidemics %K mobile app %K health care app %K influenza epidemics %K influenza in children %D 2019 %7 17.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective surveillance of influenza requires a broad network of health care providers actively reporting cases of influenza-like illnesses and positive laboratory results. Not only is this traditional surveillance system costly to establish and maintain but there is also a time lag between a change in influenza activity and its detection. A new surveillance system that is both reliable and timely will help public health officials to effectively control an epidemic and mitigate the burden of the disease. Objective: This study aimed to evaluate the use of parent-reported data of febrile illnesses in children submitted through the Fever Coach app in real-time surveillance of influenza activities. Methods: Fever Coach is a mobile app designed to help parents and caregivers manage fever in young children, currently mainly serviced in South Korea. The app analyzes data entered by a caregiver and provides tailored information for care of the child based on the child’s age, sex, body weight, body temperature, and accompanying symptoms. Using the data submitted to the app during the 2016-2017 influenza season, we built a regression model that monitors influenza incidence for the 2017-2018 season and validated the model by comparing the predictions with the public influenza surveillance data from the Korea Centers for Disease Control and Prevention (KCDC). Results: During the 2-year study period, 70,203 diagnosis data, including 7702 influenza reports, were submitted. There was a significant correlation between the influenza activity predicted by Fever Coach and that reported by KCDC (Spearman ρ=0.878; P<.001). Using this model, the influenza epidemic in the 2017-2018 season was detected 10 days before the epidemic alert announced by KCDC. Conclusions: The Fever Coach app successfully collected data from 7.73% (207,699/2,686,580) of the target population by providing care instruction for febrile children. These data were used to develop a model that accurately estimated influenza activity measured by the central government agency using reports from sentinel facilities in the national surveillance network. %M 31625946 %R 10.2196/14276 %U https://mhealth.jmir.org/2019/10/e14276 %U https://doi.org/10.2196/14276 %U http://www.ncbi.nlm.nih.gov/pubmed/31625946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e13479 %T Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study %A Derks,Youri PMJ %A Klaassen,Randy %A Westerhof,Gerben J %A Bohlmeijer,Ernst T %A Noordzij,Matthijs L %+ Department of Psychology, Health, and Technology, University of Twente, Cubicus Bldg, 1st Fl, 5, Drienerlolaan, 7522 NB Enschede, Enschede, 7500 AE, Netherlands, 31 889335253, y.p.m.j.derks@utwente.nl %K mental health %K borderline personality disorder %K mobile health %K emotional awareness %K ambulatory biofeedback %K design science %K user centered design %K iterative prototype testing %D 2019 %7 15.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients’ emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care. Objective: The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness. Methods: Using several methods in a tailored User Centred Design (UCD) framework, we tested the app’s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle). Results: The process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as “Good” (average score of 78.8), whereas the therapists rated the app as “OK” (average score of 59.4). The UCD experts judged the app’s overall usability as between “OK” and “acceptable” (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX. Conclusions: mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed. %M 31617851 %R 10.2196/13479 %U https://mhealth.jmir.org/2019/10/e13479 %U https://doi.org/10.2196/13479 %U http://www.ncbi.nlm.nih.gov/pubmed/31617851 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e15153 %T Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study %A Stiles-Shields,Colleen %A Garcia,Brittney %A Villota,Kimberly %A Wartman,Elicia %A Winning,Adrien M %A Holmbeck,Grayson N %+ Population Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Chicago, IL, 60612, United States, 1 3125631579, elizabeth_stiles-shields@rush.edu %K spina bifida occulta %K mHealth %K mobile apps %K usability testing %K adolescent %K young adult %K weight reduction programs %K body weight maintenance %D 2019 %7 10.10.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs. Objective: This study aimed to evaluate the usability of a high-quality, publicly available, weight management–focused mobile BIT (smartphone app) for AYA-SBs. Methods: Overall, 28 AYA-SBs attending a Young Men’s Christian Association–based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app. Results: The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use. Conclusions: AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs. %M 31603432 %R 10.2196/15153 %U https://pediatrics.jmir.org/2019/2/e15153 %U https://doi.org/10.2196/15153 %U http://www.ncbi.nlm.nih.gov/pubmed/31603432 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e13127 %T Using the Unified Theory of Acceptance and Use of Technology (UTAUT) to Investigate the Intention to Use Physical Activity Apps: Cross-Sectional Survey %A Liu,Di %A Maimaitijiang,Remina %A Gu,Jing %A Zhong,Shuyi %A Zhou,Mengping %A Wu,Ziyue %A Luo,Ao %A Lu,Cong %A Hao,Yuantao %+ School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road II, Guangzhou, , China, 86 020 87335413, gujing5@mail.sysu.edu.cn %K intention %K physical activity apps %K university students %K UTAUT %D 2019 %7 10.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many university students are lacking adequate physical exercise and are failing to develop physical activity (PA) behaviors in China. PA app use could improve this situation. Objective: The aim of this study was to use the unified theory of acceptance and use of technology (UTAUT) to investigate the intention to use PA apps among university students in Guangzhou, China, and how body mass index (BMI) moderates the effects of UTAUT in explaining PA app use intention. Methods: A cross-sectional study was conducted among 1704 university students from different universities in Guangzhou, China. The UTAUT model was used to measure the determinants of intention to use PA apps. Results: Of the participants, 41.8% (611/1461) intended to use PA apps. All three UTAUT-related scales (performance expectancy, effort expectancy, and social influence) were positively associated with the intention to use PA apps after adjusting for background variables (adjusted odds ratio 1.10-1.31, P<.001). The performance expectancy scale had stronger associations with the intention to use PA apps among those whose BMI were beyond normal range compared with those whose BMI were within normal range (P<.001). Conclusions: UTAUT is useful for understanding university students’ intention to use PA apps. Potential moderating effects should be kept in mind when designing UTAUT-based interventions to improve PA via app use. %M 31507269 %R 10.2196/13127 %U https://mhealth.jmir.org/2019/9/e13127 %U https://doi.org/10.2196/13127 %U http://www.ncbi.nlm.nih.gov/pubmed/31507269 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e14863 %T Adherence and Satisfaction of Smartphone- and Smartwatch-Based Remote Active Testing and Passive Monitoring in People With Multiple Sclerosis: Nonrandomized Interventional Feasibility Study %A Midaglia,Luciana %A Mulero,Patricia %A Montalban,Xavier %A Graves,Jennifer %A Hauser,Stephen L %A Julian,Laura %A Baker,Michael %A Schadrack,Jan %A Gossens,Christian %A Scotland,Alf %A Lipsmeier,Florian %A van Beek,Johan %A Bernasconi,Corrado %A Belachew,Shibeshih %A Lindemann,Michael %+ F Hoffmann–La Roche Ltd, 124 Grenzacherstrasse, Basel,, Switzerland, 41 61 687 5113, christian.gossens@roche.com %K multiple sclerosis %K patient adherence %K patient satisfaction %K smartphone %K wearable electronic devices %K mobile phone %D 2019 %7 30.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Current clinical assessments of people with multiple sclerosis are episodic and may miss critical features of functional fluctuations between visits. Objective: The goal of the research was to assess the feasibility of remote active testing and passive monitoring using smartphones and smartwatch technology in people with multiple sclerosis with respect to adherence and satisfaction with the FLOODLIGHT test battery. Methods: People with multiple sclerosis (aged 20 to 57 years; Expanded Disability Status Scale 0-5.5; n=76) and healthy controls (n=25) performed the FLOODLIGHT test battery, comprising active tests (daily, weekly, every two weeks, or on demand) and passive monitoring (sensor-based gait and mobility) for 24 weeks using a smartphone and smartwatch. The primary analysis assessed adherence (proportion of weeks with at least 3 days of completed testing and 4 hours per day passive monitoring) and questionnaire-based satisfaction. In-clinic assessments (clinical and magnetic resonance imaging) were performed. Results: People with multiple sclerosis showed 70% (16.68/24 weeks) adherence to active tests and 79% (18.89/24 weeks) to passive monitoring; satisfaction score was on average 73.7 out of 100. Neither adherence nor satisfaction was associated with specific population characteristics. Test-battery assessments had an at least acceptable impact on daily activities in over 80% (61/72) of people with multiple sclerosis. Conclusions: People with multiple sclerosis were engaged and satisfied with the FLOODLIGHT test battery. FLOODLIGHT sensor-based measures may enable continuous assessment of multiple sclerosis disease in clinical trials and real-world settings. Trial Registration: ClinicalTrials.gov: NCT02952911; https://clinicaltrials.gov/ct2/show/NCT02952911 %M 31471961 %R 10.2196/14863 %U http://www.jmir.org/2019/8/e14863/ %U https://doi.org/10.2196/14863 %U http://www.ncbi.nlm.nih.gov/pubmed/31471961 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14250 %T Assessing Mobile Phone Digital Literacy and Engagement in User-Centered Design in a Diverse, Safety-Net Population: Mixed Methods Study %A Nouri,Sarah S %A Avila-Garcia,Patricia %A Cemballi,Anupama Gunshekar %A Sarkar,Urmimala %A Aguilera,Adrian %A Lyles,Courtney Rees %+ Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1545 Divisadero Street, Box 0320, San Francisco, CA, 94143, United States, 1 2149126555, sarah.nouri@ucsf.edu %K health information technology %K mHealth %K user-centered design %K health literacy %K digital literacy %K limited English proficiency %D 2019 %7 29.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care systems are rapidly deploying digital tools for disease management; however, few studies have evaluated their usability by vulnerable populations. To understand the barriers to app usage among vulnerable populations, we employed user-centered design (UCD) methods in the development of a new text messaging app. Objective: The study aimed to describe variations in patients’ engagement in the app design process, focusing on limited health literacy (LHL), limited English proficiency (LEP), and limited digital literacy (LDL). Methods: We conducted 20 in-depth semistructured interviews with primary care patients at a public health care system, used open-ended discussions and card sorting tasks to seek input about mobile phones and text messaging, and used open coding to categorize the patterns of mobile phone usage and to evaluate engagement in the card sorting process. We examined qualitative differences in engagement by examining the extensiveness of participant feedback on existing and novel text messaging content and calculated the proportion of patients providing extensive feedback on existing and novel content, overall and by health literacy, English proficiency, and digital literacy. Results: The average age of the 20 participants was 59 (SD 8) years; 13 (65%) were female, 18 (90%) were nonwhite, 16 (80%) had LHL, and 13 (65%) had LEP. All had depression, and 14 (70%) had diabetes. Most participants had smartphones (18/20, 90%) and regularly used text messaging (15/20, 75%), but 14 (70%) of them reported having difficulty texting because of inability to type, physical disability, and low literacy. We identified 10 participants as specifically having LDL; 7 of these participants had LEP, and all 10 had LHL. Half of the participants required a modification of the card sorting activity owing to not understanding it or not being able to read the cards in the allotted time. The proportion of participants who gave extensive feedback on existing content was lower in participants with limited versus adequate English proficiency (4/13, 30% vs 5/7, 71%), limited versus adequate health literacy (7/16, 44% vs 3/4, 75%), and limited versus adequate digital literacy (4/10, 40% vs 6/10, 60%); none of these differences were statistically significant. When examining the proportion of patients who gave extensive feedback for novel messaging content, those with LHL were less engaged than those with adequate health literacy (8/16, 50% vs 4/4, 100%); there were no statistical differences by any subgroup. Conclusions: Despite widespread mobile phone use, digital literacy barriers are common among vulnerable populations. Engagement in the card sorting activity varied among participants and appeared to be lower among those with LHL, LEP, and LDL. Researchers employing traditional UCD methods should routinely measure these communication domains among their end-user samples. Future work is needed to replicate our findings in larger samples, but augmentation of card sorting with direct observation and audiovisual cues may be more productive in eliciting feedback for those with communication barriers. %M 31469083 %R 10.2196/14250 %U http://mhealth.jmir.org/2019/8/e14250/ %U https://doi.org/10.2196/14250 %U http://www.ncbi.nlm.nih.gov/pubmed/31469083 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13414 %T Proximity-Based Emergency Response Communities for Patients With Allergies Who Are at Risk of Anaphylaxis: Clustering Analysis and Scenario-Based Survey Study %A Gaziel Yablowitz,Michal %A Dölle,Sabine %A Schwartz,David G %A Worm,Margitta %+ Allergy-Centre-Charite, Department of Dermatology and Allergy, Charite-Universitatsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Berlin,, Germany, 49 30 450 518092, margitta.worm@charite.de %K consumer health informatics %K anaphylaxis %K emergency responders %K social networking %K telemedicine %D 2019 %7 22.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Anaphylaxis is a potentially fatal allergic reaction. However, many patients at risk of anaphylaxis who should permanently carry a life-saving epinephrine auto injector (EAI) do not carry one at the moment of allergen exposure. The proximity-based emergency response communities (ERC) strategy suggests speeding EAI delivery by alerting patient-peers carrying EAI to respond and give their EAI to a nearby patient in need. Objectives: This study had two objectives: (1) to analyze 10,000 anaphylactic events from the European Anaphylaxis Registry (EAR) by elicitor and location in order to determine typical anaphylactic scenarios and (2) to identify patients’ behavioral and spatial factors influencing their response to ERC emergency requests through a scenario-based survey. Methods: Data were collected and analyzed in two phases: (1) clustering 10,000 EAR records by elicitor and incident location and (2) conducting a two-center scenario-based survey of adults and parents of minors with severe allergy who were prescribed EAI, in Israel and Germany. Each group received a four-part survey that examined the effect of two behavioral constructs—shared identity and diffusion of responsibility—and two spatial factors—emergency time and emergency location—in addition to sociodemographic data. We performed descriptive, linear correlation, analysis of variance, and t tests to identify patients’ decision factors in responding to ERC alerts. Results: A total of 53.1% of EAR cases were triggered by food at patients’ home, and 46.9% of them were triggered by venom at parks. Further, 126 Israeli and 121 German participants completed the survey and met the inclusion criteria. Of the Israeli participants, 80% were parents of minor patients with a risk of anaphylaxis due to food allergy; their mean age was 32 years, and 67% were women. In addition, 20% were adult patients with a mean age of 21 years, and 48% were female. Among the German patients, 121 were adults, with an average age of 47 years, and 63% were women. In addition, 21% were allergic to food, 75% were allergic to venom, and 2% had drug allergies. The overall willingness to respond to ERC events was high. Shared identity and the willingness to respond were positively correlated (r=0.51, P<.001) in the parent group. Parents had a stronger sense of shared identity than adult patients (t243= –9.077, P<.001). The bystander effect decreased the willingness of all patients, except the parent group, to respond (F1,269=28.27, P<.001). An interaction between location and time of emergency (F1,473=77.304, P<.001) revealed lower levels of willingness to respond in strange locations during nighttime. Conclusions: An ERC allergy app has the potential to improve outcomes in case of anaphylactic events, but this is dependent on patient-peers’ willingness to respond. Through a two-stage process, our study identified the behavioral and spatial factors that could influence the willingness to respond, providing a basis for future research of proximity-based mental health communities. %M 31441432 %R 10.2196/13414 %U http://mhealth.jmir.org/2019/8/e13414/ %U https://doi.org/10.2196/13414 %U http://www.ncbi.nlm.nih.gov/pubmed/31441432 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 2 %N 1 %P e14279 %T Nurses as Stakeholders in the Adoption of Mobile Technology in Australian Health Care Environments: Interview Study %A Mather,Carey %A Cummings,Elizabeth %A Gale,Fred %+ College of Health and Medicine, School of Nursing, University of Tasmania, Building J, Newnham Drive, Launceston, 7248, Australia, 61 363243149, Carey.Mather@utas.edu.au %K digital %K health policy %K digital professionalism %K nursing education %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Nursing %G English %X Background: The 2017 Australian Digital Health Agency (ADHA) Strategy is based on the underlying assumption that digital technology in health care environments is ubiquitous. The ADHA Strategy views health professionals, especially nurses, as grappling with the complexity of installing and using digital technologies to facilitate personalized and sustainable person-centered care. Yet, ironically, the 2018 debate over how to enroll Australians into the national electronic health record system and its alteration from an opt-in to an opt-out model heightened public and professional concern over what constituted a “safe, seamless and secure” health information system. What can be termed a digital technology paradox has emerged where, although it is widely acknowledged that there are benefits from deploying and using digital technology in the workplace, the perception of risk renders it unavailable or inaccessible at point of care. The inability of nurses to legitimately access and use mobile technology is impeding the diffusion of digital technology in Australian health care environments and undermining the 2017 ADHA Strategy. Objective: This study explored the nature and scope of usability of mobile technology at point of care, in order to understand how current governance structures impacted on access and use of digital technology from an organizational perspective. Methods: Individual semistructured interviews were conducted with 6 representatives from professional nursing organizations. A total of 10 interview questions focused on factors that impacted the use of mobile technology for learning at point of care. Seven national organizations and 52 members from the Coalition of National Nursing and Midwifery Organisations were invited to participate. Interviews were recorded and transcribed verbatim. Data analysis was systematic and organized, consisting of trial coding; member checking was undertaken to ensure rigor. A codebook was developed to provide a framework for analysis to identify the themes latent in the transcribed data. Nurses as stakeholders emerged as a key theme. Results: Out of 6 participants, 4 female (67%) and 2 male (33%) senior members of the nursing profession were interviewed. Each interview lasted between 17 and 54 minutes, which reflected the knowledge of participants regarding the topic of interest and their availability. Two subthemes, coded as ways of thinking and ways of acting, emerged from the open codes. Participants provided examples of the factors that impacted the capacity of nurses to adopt digital technology from an emic perspective. There were contributing factors that related to actions, including work-arounds, attentiveness, and experiences. Nurses also indicated that there were attitudes and influences that impacted thinking regarding access and use of mobile technology at point of care. Conclusions: Nurses are inadequately prepared for the digital future that has now arrived in health care environments. Nurses do not perceive that they are leaders in decision making regarding digital technology adoption, nor are they able to facilitate digital literacy or model digital professionalism. %M 34345771 %R 10.2196/14279 %U https://nursing.jmir.org/2019/1/e14279/ %U https://doi.org/10.2196/14279 %U http://www.ncbi.nlm.nih.gov/pubmed/34345771 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e14785 %T Development and Pilot Testing of Text Messages to Help Reduce Sugar-Sweetened Beverage Intake Among Rural Caregivers and Adolescents: Mixed Methods Study %A Yuhas,Maryam %A Porter,Kathleen J %A Brock,Donna-Jean P %A Loyd,Annie %A McCormick,Brittany A %A Zoellner,Jamie M %+ Department of Public Health Sciences, University of Virginia, 16 E Main St, Christiansburg, VA,, United States, 1 7735317585, maryam24@vt.edu %K sugar-sweetened beverages %K rural health %K text message %K mixed-methods %K caregivers %K adolescents %D 2019 %7 30.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A high consumption of sugar-sweetened beverages (SSBs) poses significant health concerns, particularly for rural adults and adolescents. A manner in which the health of both caregivers and adolescents can be improved is by developing innovative strategies that target caregivers as the agents of change. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. Objective: By targeting rural caregivers, this 2-phase study aimed to (1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery and (2) evaluate the acceptability of text messages for SSB intake behavior change and examine short-term effects on SSB intake behavior. Methods: A convergent mixed methods design was used to systematically develop and pilot-test text messages with caregivers in Southwest Virginia. In phase 1, 5 focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (ie, tone of voice, audience, and phrase preferences), and perceived use of text messages. In phase 2, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB intake assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregivers’ SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. Results: In phase 1, caregivers (N=33) reported that text messages were convenient, accessible, and easy to read. In addition, they preferred messages with empathetic and authoritative tones that provided useful strategies and stayed away from using absolute words (eg, always and never). In the phase 2 pilot trial (N=30), 87% of caregivers completed baseline and 77% completed follow-up assessment, suggesting a high utilization rate. Other ways in which caregivers reported benefiting from the text messages included sharing messages with family members and friends (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (P=.003, P=.02, and P=.04, respectively). In addition, the frequency of SSB intake among caregivers and adolescents significantly decreased (P=.003 and P=.005, respectively). Conclusions: Spending time in the formative phases of text message development helped understand the unique perspectives and language preferences of the target population. Furthermore, delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake among rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which would be used in a future study, testing the effectiveness of a text message intervention targeting SSB intake–related caregiver behaviors. %M 31364600 %R 10.2196/14785 %U http://mhealth.jmir.org/2019/7/e14785/ %U https://doi.org/10.2196/14785 %U http://www.ncbi.nlm.nih.gov/pubmed/31364600 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13817 %T Patients’ Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies %A Vo,VanAnh %A Auroy,Lola %A Sarradon-Eck,Aline %+ Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Développement, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 27 Bd Jean Moulin, Marseille, 13385, France, 33 491 324 600, aline.sarradon@inserm.fr %K mHealth %K apps %K mobile apps %K qualitative studies %K systematic review %K mobile phone %D 2019 %7 10.07.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. Objective: The aim of this paper is to reach a better understanding of people’s perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools. Methods: A systematic review was carried out on qualitative studies published in English, on patients’ perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method. Results: A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients’ point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools. Conclusions: Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information. %M 31293246 %R 10.2196/13817 %U http://mhealth.jmir.org/2019/7/e13817/ %U https://doi.org/10.2196/13817 %U http://www.ncbi.nlm.nih.gov/pubmed/31293246 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12900 %T Attitudes, Beliefs, and Willingness Toward the Use of mHealth Tools for Medication Adherence in the Florida mHealth Adherence Project for People Living With HIV (FL-mAPP): Pilot Questionnaire Study %A Morano,Jamie P %A Clauson,Kevin %A Zhou,Zhi %A Escobar-Viera,César G %A Lieb,Spencer %A Chen,Irene K %A Kirk,David %A Carter,Willie M %A Ruppal,Michael %A Cook,Robert L %+ Department of Infectious Diseases and International Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, MDC 19, Tampa, FL, 33612-4799, United States, 1 813 844 8297, jamie.morano@post.harvard.edu %K mHealth %K mobile phone app %K app %K HIV %K antiretroviral therapy adherence %K persons living with HIV %K HIV care continuum %K digital health %K medication adherence %K mobile health %D 2019 %7 03.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Antiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH. Objectives: The Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps. Methods: A predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform. Results: Among 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a “flip-phone” model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical “daily” interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002). Conclusions: This commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale. %M 31271150 %R 10.2196/12900 %U http://mhealth.jmir.org/2019/7/e12900/ %U https://doi.org/10.2196/12900 %U http://www.ncbi.nlm.nih.gov/pubmed/31271150 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 7 %P e13152 %T Exploring Young People’s Perceptions of the Effectiveness of Text-Based Online Counseling: Mixed Methods Pilot Study %A Navarro,Pablo %A Bambling,Matthew %A Sheffield,Jeanie %A Edirippulige,Sisira %+ Kids Helpline, Yourtown, 5 Cordova St, Milton, Brisbane, 4064, Australia, 61 800 555 079, pablo.fernandez@uqconnect.edu.au %K mental health %K child health %K adolescent health %K distance counseling %K mhealth %K applied psychology %K psychological processes %D 2019 %7 03.07.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people aged 10-24 years are at the highest risk for mental health problems and are the least likely to seek professional treatment. Owing to this population’s high consumption of internet content, electronic mental (e-mental) health services have increased globally, with an aim to address barriers to treatment. Many of these services use text-based online counseling (TBOC), which shows promising results in supporting young people but also greater variance in outcomes compared with adult comparators. Objective: This pilot study qualitatively explored the characteristics of users aged 15-25 years accessing TBOC services, their motivations for access, and their perceptions about factors believed to influence the effectiveness of these modalities. Methods: E-surveys were administered naturalistically to 100 young service users aged 15-25 years who accessed webchat and email counseling services via an Australian e-mental health service. Thematic analysis of qualitative themes and quantitative descriptive and proportional data presented in electronic surveys were examined across the areas of user characteristics, motivations for selecting TBOC modalities, and their perceptions of TBOC effectiveness. Results: Participants were predominately female high school students of Caucasian or European descent from middle socioeconomic status, living with their parents in major cities. Four domains and various themes and subthemes were related to participants’ reasons for accessing TBOC and perceptions of its effectiveness: user characteristics (ie, physical and mental health syndrome and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), factors perceived to increase effectiveness (ie, general therapeutic benefits, positive modality and service factors, and persisting with counseling to increase benefit), and factors perceived to decrease effectiveness (ie, negative modality and service factors, and persisting with counseling despite benefit). Conclusions: Participants were motivated to use TBOC to increase their sense of safety in response to negative perceptions of their social skills and the response of the online counsellor to their presenting problem. By using TBOC services, they also sought to improve their access to mental health services that better met their expectations. Factors that increased effectiveness of TBOC were the counsellor’s interpersonal skills, use of text-based communication, and persisting with beneficial counseling sessions. Factors that reduced TBOC effectiveness were poor timeliness in response to service requests, experiencing no change in their presenting problem, not knowing what postcounseling action to take, and persisting with ineffective counseling sessions. %M 31271149 %R 10.2196/13152 %U https://mental.jmir.org/2019/7/e13152/ %U https://doi.org/10.2196/13152 %U http://www.ncbi.nlm.nih.gov/pubmed/31271149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12242 %T What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App %A Sewitch,Maida J %A Fallone,Carlo A %A Ghali,Peter %A Lee,Ga Eun %+ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve West, Montreal, QC, H4A 3S5, Canada, 1 514 934 1934 ext 44736, maida.sewitch@mcgill.ca %K colonoscopy %K early detection of cancer %K mobile health technology %K qualitative research %K smartphone %K user-centered %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy. Objective: The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments. Methods: We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy. Results: A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use. Conclusions: Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app. %M 31125310 %R 10.2196/12242 %U https://mhealth.jmir.org/2019/7/e12242/ %U https://doi.org/10.2196/12242 %U http://www.ncbi.nlm.nih.gov/pubmed/31125310 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e12920 %T Mobile Health Adoption in Mental Health: User Experience of a Mobile Health App for Patients With an Eating Disorder %A Anastasiadou,Dimitra %A Folkvord,Frans %A Serrano-Troncoso,Eduardo %A Lupiañez-Villanueva,Francisco %+ Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 93 450 52 74, danastasiadou@uoc.edu %K eating disorders %K mental health %K mHealth %K mobile applications %K focus groups %D 2019 %7 31.5.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. Objective: This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. Methods: To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. Results: The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. Conclusions: In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice. %M 31199329 %R 10.2196/12920 %U https://mhealth.jmir.org/2019/6/e12920/ %U https://doi.org/10.2196/12920 %U http://www.ncbi.nlm.nih.gov/pubmed/31199329 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13950 %T Perceptions of Health Care Providers Regarding a Mobile Health Intervention to Manage Chronic Obstructive Pulmonary Disease: Qualitative Study %A Alwashmi,Meshari F %A Fitzpatrick,Beverly %A Davis,Erin %A Gamble,John-Michael %A Farrell,Jamie %A Hawboldt,John %+ Memorial University of Newfoundland, Health Sciences Centre, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada, 1 7096910728, mfa720@mun.ca %K mHealth %K COPD %K qualitative %K smartphone %K eHealth %K technology %D 2019 %7 10.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Using a mobile health (mHealth) intervention, consisting of a smartphone and compatible medical device, has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective: The aim of this study was to explore the potential facilitators and barriers among health care providers (HCPs) regarding the use of mHealth interventions for COPD management. Methods: This was a qualitative study. Semistructured individual interviews were conducted with HCPs, including nurses, pharmacists, and physicians who work directly with patients with COPD. A flexible prompts guide was used to facilitate discussions. Interview topics included the following: demographics, mHealth usage, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of the mHealth intervention for COPD management. Interviews were conversational in nature, and items were not asked verbatim or in the order presented. The interviews were transcribed verbatim and compared against the digital recordings to ensure the accuracy of the content. After creating a codebook for analysis, 2 researchers independently coded the remaining interview data using pattern coding. They discussed commonalities and differences in coding until a consensus was reached. Results: A total of 30 nurses, physicians, and pharmacists participated. The main facilitators to mHealth adoption are possible health benefits for patients, ease of use, educating patients and their HCPs, credibility, and reducing cost to the health care system. Alternatively, the barriers to adoption are technical issues, privacy and confidentiality issues, lack of awareness, potential limited uptake from the elderly, potential limited connection between patients and HCPs, and finances. Conclusions: It is important to understand the perceptions of HCPs regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management. %M 31199330 %R 10.2196/13950 %U http://mhealth.jmir.org/2019/6/e13950/ %U https://doi.org/10.2196/13950 %U http://www.ncbi.nlm.nih.gov/pubmed/31199330 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e12940 %T iCanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway %A Grasaas,Erik %A Fegran,Liv %A Helseth,Sølvi %A Stinson,Jennifer %A Martinez,Santiago %A Lalloo,Chitra %A Haraldstad,Kristin %+ Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Universitetsveien 25, Kristiansand, 4630, Norway, 47 97524422, erik.grasaas@uia.no %K health %K self-management %K adolescent %K chronic pain %K translating %K mobile app %D 2019 %7 03.06.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Persistent or chronic pain is a common health problem among adolescents. Thus, it is important that they receive evidence-based strategies for symptom management. iCanCope with Pain is a mobile phone app designed to help adolescents cope with chronic pain. The app comprises 5 evidence- and theory-based features: (I) symptom trackers for pain, sleep, mood, physical function, and energy; (II) goal setting to improve pain and function; (III) a coping toolbox of pain self-management strategies; (IV) social support; and (V) age-appropriate pain education. The iCanCope with Pain app is based on theory, identified health care needs, and current best practices for pain self-management. Objective: The objectives of this study were to describe the translation and cultural adaptation of the app into the Norwegian context and evaluate the app’s usability using a phased approach. Methods: Phase 1 included translation and cultural adaptation of the app into the Norwegian context. This process used an expert panel of researchers and target group representatives who were responsible for the linguistic quality assurance and assessment. In phases 2 and 3 the app’s usability was tested. For phase 2, the assessments of usability and user experiences included observation, the think aloud method, audiovisual recordings, questionnaires, and individual interviews in a laboratory setting. For phase 3, the assessment of usability and user experience over a 2-week home-based test included questionnaires and individual end-user interviews. Overall, app usability was determined based on ease of use, efficiency, and user satisfaction. Qualitative data were analyzed using deductive content analysis. Descriptive statistics were calculated for quantitative data. Results: End users did not report any misunderstandings or discrepancies with the words or phrasing of the translated and culturally adapted app. Participants in both the laboratory- and home-based usability tests found the app self-explanatory and reported that all 5 of its features were easy to use. All tasks were completed within the allocated time frame (ie, efficiency), with few errors. Overall System Usability Scale scores were high, with average scores of 82 and 89 out of 100 from laboratory- and field-based tests, respectively. Participants liked the idea of a social support function (feature IV), although qualitative and internet server data revealed that this feature was rarely used. Conclusions: This study described the cultural and linguistic adaptation and usability testing of the Norwegian version of the iCanCope with Pain app. High user satisfaction, ease of use, efficiency, and only minor errors cumulatively indicated that no changes to the app were needed, with the exception of facilitating user interaction within the social support feature. The app will be used in an upcoming randomized controlled trial with a larger sample. %M 31162132 %R 10.2196/12940 %U https://www.researchprotocols.org/2019/6/e12940/ %U https://doi.org/10.2196/12940 %U http://www.ncbi.nlm.nih.gov/pubmed/31162132 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12135 %T A Mobile Phone App for the Self-Management of Pediatric Concussion: Development and Usability Testing %A Sandhu,Harminder %A Wilson,Katherine %A Reed,Nick %A Mihailidis,Alex %+ Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3861, nreed@hollandbloorview.ca %K brain concussion %K safety %K pediatrics %K youth %K children %K self-management %K mild traumatic brain injury %K mobile apps %K mobile health %D 2019 %7 31.05.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Concussion is a common injury among Canadian children and adolescents that leads to a range of neurobehavioral deficits. However, noticeable gaps continue to exist in the management of pediatric concussion, with poor health outcomes associated with the inadequate application of best practice guidelines. Objective: The aim of this study was to describe the development and assess the usability of a mobile phone app to aid youth in the self-management of concussion. A secondary objective was to assess the usefulness of the app. Methods: An agile user-centered design approach was used to develop the technology, followed by a formative lab-based usability study for assessment and improvement proposals. Youths aged 10 to 18 years with a history of concussion and health care professionals involved in concussion management were recruited. This study included participants performing 12 tasks with the mobile phone app while using the think aloud protocol and the administration of the System Usability Scale (SUS), posttest questionnaire, and a semistructured interview. Results: A mobile phone app prototype called NeuroCare, an easily accessible pediatric concussion management intervention that provides easy access to expert-informed concussion management strategies and helps guide youth in self-managing and tracking their concussion recovery, was developed. A total of 7 youths aged between 10 and 18 years with a history of concussion and 7 health care professionals were recruited. The mean SUS score was 81.9, mean task success rates were greater than 90% for 92% (11/12) of the tasks, 92% (11/12) of tasks had a total error frequency of less than 11 errors, and mean task completion times were less than 2 min for 100% of the tasks. Conclusions: Results suggest that participants rated this app as highly usable, acceptable to users, and that it may be useful in helping youth self-manage concussion. %M 31152527 %R 10.2196/12135 %U http://humanfactors.jmir.org/2019/2/e12135/ %U https://doi.org/10.2196/12135 %U http://www.ncbi.nlm.nih.gov/pubmed/31152527 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13153 %T The Use of Wireless, Smartphone App–Assisted Home Blood Pressure Monitoring Among Hypertensive Patients in Singapore: Pilot Randomized Controlled Trial %A Moon,Eui Whan %A Tan,Ngiap Chuan %A Allen,John Carson %A Jafar,Tazeen Hasan %+ Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 6601 2582, tazeen.jafar@duke-nus.edu.sg %K mHealth %K smartphone %K hypertension %K home blood pressure monitoring %K self blood pressure monitoring %K health informatics %K data collection methods %K personal health records %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reliable home blood pressure monitoring (HBPM) is essential to effective hypertension management; however, manual recording is subject to underreporting and inaccuracies. Mobile health technologies hold great potential as HBPM tools, but the fidelity of a smartphone app in HBPM has not been adequately assessed. Objective: The primary aim of the trial was to compare the fidelity of a smartphone app to that of a handwritten logbook in making HBPM data available to clinicians at follow-up visits. Fidelity was defined as the percentage of scheduled blood pressure (BP) recordings over a 3-week period that were properly recorded and reported to the clinic. The secondary aims were to investigate patient factors associated with HBPM fidelity and to explore the effect of time on the fidelity. Methods: A 2-arm, parallel, unblinded, randomized controlled pilot trial was conducted in a government polyclinic in Singapore. Hypertensive adults, aged 40 to 70 years, who were on antihypertensive medication and owned a smartphone were recruited and randomized by a computer-generated randomization schedule to 3 weeks of either semiautomated HBPM utilizing a Bluetooth-enabled BP monitor and a smartphone app or a fully manual process utilizing a conventional handwritten logbook. The primary outcome was home BP recording fidelity. Results: Of the 80 patients randomized, 79 (smartphone app: 38 and logbook: 41) were included in the final analysis. Although fidelity was higher among the app users, it did not differ significantly between study arms (smartphone app: 66.7% and logbook: 52.4%; P=.21). Chinese and Indian ethnicities were associated with higher fidelity (absolute percent and 95% CI) by 35.6% (4.27 to 66.9) and 45.0% (8.69 to 81.3), respectively, in comparison with other ethnicities (P=.03); longer smartphone ownership increased fidelity on an average of 10.5% (0.83 to 20.2) per year (P=.03); the number of apps on the smartphone decreased fidelity at a rate of −0.32% (−0.58 to −0.05) per app (P=.02); years of hypertension morbidity increased fidelity at a rate of 1.56% (0.03 to 3.09) per year (P=.046); and the number of people working in the household decreased fidelity at a rate of −8.18% (−16.3 to −0.08) per additional working person (P=.048). The fidelity of the app was significantly higher in the first week (64.4%) than the second (55.1%, P=.001) and third (58.2%, P=.03) weeks of monitoring. Conclusions: Amid the increasing integration of health technologies into clinical practice, our study demonstrates the feasibility of smartphone app–assisted HBPM in hypertensive adults of Singapore. Our pilot study found no statistically significant difference in mean BP recording fidelity between a smartphone app and conventional handwritten logbook. However, the small sample size precludes definitive conclusions and highlights the need for a larger, adequately powered trial. Trial Registration: ClinicalTrials.gov NCT03209024; https://clinicaltrials.gov/ct2/show/NCT03209024 (Archived by WebCite at http://www.webcitation.org/78EVWBg0T) %M 30905872 %R 10.2196/13153 %U http://mhealth.jmir.org/2019/5/e13153/ %U https://doi.org/10.2196/13153 %U http://www.ncbi.nlm.nih.gov/pubmed/30905872 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e9232 %T A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates %A Ferrara,Giannina %A Kim,Jenna %A Lin,Shuhao %A Hua,Jenna %A Seto,Edmund %+ Department of Environmental & Occupational Health Sciences, University of Washington, 1959 NE Pacific Street, Campus Box 357234, Seattle, WA, 98195, United States, 1 206 543 1475, eseto@uw.edu %K diet %K nutrition assessment %K behavior and behavior mechanisms %D 2019 %7 17.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns; however, the usabilities and functionalities of these apps have not been well studied. Objective: The aim of this study was to review the usability of current iPhone operating system (iOS) and Android diet-tracking apps, the degree to which app features align with behavior change constructs, and to assess variations between apps in nutrient coding. Methods: The top 7 diet-tracking apps were identified from the iOS iTunes and Android Play online stores, downloaded and used over a 2-week period. Each app was independently scored by researchers using the System Usability Scale (SUS), and features were compared with the domains in an integrated behavior change theory framework: the Theoretical Domains Framework. An estimated 3-day food diary was completed using each app, and food items were entered into the United States Department of Agriculture (USDA) Food Composition Databases to evaluate their differences in nutrient data against the USDA reference. Results: Of the apps that were reviewed, LifeSum had the highest average SUS score of 89.2, whereas MyDietCoach had the lowest SUS score of 46.7. Some variations in features were noted between Android and iOS versions of the same apps, mainly for MyDietCoach, which affected the SUS score. App features varied considerably, yet all of the apps had features consistent with Beliefs about Capabilities and thus have the potential to promote self-efficacy by helping individuals track their diet and progress toward goals. None of the apps allowed for tracking of emotional factors that may be associated with diet patterns. The presence of behavior change domain features tended to be weakly correlated with greater usability, with R2 ranging from 0 to .396. The exception to this was features related to the Reinforcement domain, which were correlated with less usability. Comparing the apps with the USDA reference for a 3-day diet, the average differences were 1.4% for calories, 1.0% for carbohydrates, 10.4% for protein, and −6.5% for fat. Conclusions: Almost all reviewed diet-tracking apps scored well with respect to usability, used a variety of behavior change constructs, and accurately coded calories and carbohydrates, allowing them to play a potential role in dietary intervention studies. %M 31102369 %R 10.2196/mhealth.9232 %U http://mhealth.jmir.org/2019/5/e9232/ %U https://doi.org/10.2196/mhealth.9232 %U http://www.ncbi.nlm.nih.gov/pubmed/31102369 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13882 %T Feasibility and Acceptability of Using a Mobile Phone App for Characterizing Auditory Verbal Hallucinations in Adolescents With Early-Onset Psychosis: Exploratory Study %A Smelror,Runar Elle %A Bless,Josef Johann %A Hugdahl,Kenneth %A Agartz,Ingrid %+ Department of Psychiatric Research, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo, 0319, Norway, 47 95744029, runar.smelror@medisin.uio.no %K experience sampling method %K ecological momentary assessment %K schizophrenia %K mHealth %K health care technology %D 2019 %7 14.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Auditory verbal hallucinations (AVH) are the most frequent symptom in early-onset psychosis (EOP) and a risk factor for increased suicide attempts in adolescents. Increased knowledge of AVH characteristics can lead to better prediction of risk and precision of diagnosis and help identify individuals with AVH who need care. As 98% of Norwegian adolescents aged 12 to 16 years own a mobile phone, the use of mobile phone apps in symptom assessment and patient communication is a promising new tool. However, when introducing new technology to patients, their subjective experiences are crucial in identifying risks, further development, and potential integration into clinical care. Objective: The objective was to explore the feasibility and acceptability of a newly developed mobile phone app in adolescents with EOP by examining compliance with the app and user experiences. Indication of validity was explored by examining associations between AVH dimensions, which were correlated and analyzed. Methods: Three adolescents with EOP and active AVH were enrolled. Real-time AVH were logged on an iPod touch using the experience sampling method (ESM), for seven or more consecutive days. The app included five dimensions of AVH characteristics and was programmed with five daily notifications. Feasibility and acceptability were examined using the mean response rate of data sampling and by interviewing the participants. Validity was assessed by examining associations between the AVH dimensions using nonparametric correlation analysis and by visual inspection of temporal fluctuations of the AVH dimensions. Results: One participant was excluded from the statistical analyses but completed the interview and was included in the examination of acceptability. The sampling period of the two participants was mean 12 (SD 6) days with overall completed sampling rate of 74% (SD 30%), indicating adequate to high compliance with the procedure. The user experiences from the interviews clustered into four categories: (1) increased awareness, (2) personal privacy, (3) design and procedure, and (4) usefulness and clinical care. One participant experienced more commenting voices during the sampling period, and all three participants had concerns regarding personal privacy when using electronic devices in symptom assessment. The AVH dimensions of content, control, and influence showed moderate to strong significant correlations with all dimensions (P<.001). Days of data sampling showed weak to moderate correlations with localization (P<.001) and influence (P=.03). Visual inspection indicated that the app was able to capture fluctuations within and across days for all AVH dimensions. Conclusions: This study demonstrates the value of including patients’ experiences in the development and pilot-testing of new technology. Based on the small sample size, the use of mobile phones with ESM seems feasible for patients with EOP, but the acceptability of using apps should be considered. Further investigation with larger samples is warranted before definitive conclusions are made. %M 31094321 %R 10.2196/13882 %U http://formative.jmir.org/2019/2/e13882/ %U https://doi.org/10.2196/13882 %U http://www.ncbi.nlm.nih.gov/pubmed/31094321 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13963 %T Development and Implementation of a Mobile Phone–Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique %A Kawakyu,Nami %A Nduati,Ruth %A Munguambe,Khátia %A Coutinho,Joana %A Mburu,Nancy %A DeCastro,Georgina %A Inguane,Celso %A Zunt,Andrew %A Abburi,Neil %A Sherr,Kenneth %A Gimbel,Sarah %+ Center for Global Health Nursing, University of Washington, Box 357263, Seattle, WA, 98195, United States, 1 206 221 7477, nkawakyu@uw.edu %K mHealth %K quality improvement %K engineering %K HIV %K mother to child transmission %K implementation science %D 2019 %7 13.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention of mother-to-child HIV transmission (PMTCT) care cascade failures drive pediatric HIV infections in sub-Saharan Africa. As nurses’ clinical and management role in PMTCT expand, decision-support tools for nurses are needed to facilitate identification of cascade inefficiencies and solutions. The mobile phone–based PMTCT cascade analysis tool (mPCAT) provides health facility staff a quick summary of the number of patients and percentage drop-off at each step of the PMCTC care cascade, as well as how many women-infant pairs would be retained if a step was optimized. Objective: The objective of this study was to understand and improve the mPCAT’s core usability factors and assess the health workers’ experience with using the mPCAT. Methods: Overall, 2 rounds of usability testing were conducted with health workers from 4 clinics and leading experts in maternal and child health in Kenya and Mozambique using videotaped think aloud assessment techniques. Semistructured group interviews gauged the understanding of mPCAT’s core usability factors, based on the Nielsen Usability Framework, followed by development of cognitive demand tables describing the needed mPCAT updates. Post adaptation, feasibility was assessed in 3 high volume clinics over 12 weeks. Participants completed a 5-point Likert questionnaire designed to measure ease of use, convenience of integration into work, and future intention to use the mPCAT. Focus group discussions with nurse participants at each facility and in-depth interviews with nurse managers were also conducted to assess the acceptability, use, and recommendations for adaptations of the mPCAT. Results: Usability testing with software engineers enabled real-time feedback to build a tool following empathic design principles. The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page. Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp. Coding was simplified to enable future revisions by nontechnical staff—critical for context-specific adaptations for scale-up. Health care workers and facility managers found the tool easy to use (mean=4.3), used the tool very often (mean=4.1), and definitely intended to continue to use the tool (mean=4.8). Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making. Conclusions: The mPCAT was well accepted by frontline health workers and facility managers. The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow. The mPCAT gave frontline health workers and facility managers an immediate, direct, and tangible way to use their clinical documentation and routinely reported data for decision making for their own clinical practice and facility-level improvements. %M 31094351 %R 10.2196/13963 %U http://mhealth.jmir.org/2019/5/e13963/ %U https://doi.org/10.2196/13963 %U http://www.ncbi.nlm.nih.gov/pubmed/31094351 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e11442 %T Usability and Usefulness of a Mobile Health App for Pregnancy-Related Work Advice: Mixed-Methods Approach %A van Beukering,Monique %A Velu,Adeline %A van den Berg,Liesbeth %A Kok,Marjolein %A Mol,Ben Willem %A Frings-Dresen,Monique %A de Leeuw,Robert %A van der Post,Joris %A Peute,Linda %+ Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Room H4-222, PO Box 22660, Amsterdam, 1100 DD, Netherlands, 31 657514795, m.d.vanbeukering@amc.uva.nl %K mHealth %K eHealth %K mobile phone %K pregnancy %K work %K occupation %K occupational exposure %K qualitative research %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnant women are often unaware of the potential risks that working conditions can cause to them and their unborn child. A mobile health (mHealth) app, the Pregnancy and Work (P and W) app, developed by a multidisciplinary team and based on an evidence-based guideline for occupational physicians, aims to provide advice on work adjustment during pregnancy. Objective: This study evaluates the usability of the mHealth P and W app and the perceived usefulness of the work advice, the main goal of the app, by potential end users. Methods: A total of 12 working pregnant women participated in think aloud usability sessions and performed 9 tasks. All think aloud sessions were recorded, transcribed, and coanalyzed. The usability problems were rated for their severity in accordance with Nielsen severity scale. The completion rates and time taken for completion of tasks were registered. In addition, participants were questioned on demographics and user characteristics and were asked to evaluate the value of the app by filling in the Intrinsic Motivation Inventory (IMI) score and the System Usability Scale (SUS) questionnaire. Results: In total, 82 usability problems with a severity ≥1 were identified, of which 40 had severity ≥3. The main usability problems concerned the interpretation of terminology used in the app’s questionnaires and difficulties in finding and understanding the work advice. Furthermore, 10 out of 12 participants were able to open the work advice page in the app. Only 7 out of these 10 participants understood and intended to follow the work advice. The overall mean IMI score was relatively high (5 out of 7), indicating that the participants did indeed value the use of the app. This IMI score corresponded to the overall mean SUS score (68 out of 100) and the mean grade given to the P and W app (7 out of 10). Conclusions: This think aloud usability study showed that the information provided in the P and W app was considered valuable by the end users, working pregnant women, and it meets their needs; however, usability issues severely impacted the perceived usefulness of the work advice given in the app. %M 31094353 %R 10.2196/11442 %U https://mhealth.jmir.org/2019/5/e11442/ %U https://doi.org/10.2196/11442 %U http://www.ncbi.nlm.nih.gov/pubmed/31094353 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13555 %T Clinicians’ Role in the Adoption of an Oncology Decision Support App in Europe and Its Implications for Organizational Practices: Qualitative Case Study %A Jacob,Christine %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, Cambridge,, United Kingdom, 41 798769376, christine.k.jacob@gmail.com %K telemedicine %K smartphone %K cell phone %K oncologists %K electronic health record %K workflow %K workload %K workplace %K public health practice %K technology %K perception %K health education %K mHealth %K mobile health %K telehealth %K eHealth %D 2019 %7 03.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the existence of adequate technological infrastructure and clearer policies, there are situations where users, mainly physicians, resist mobile health (mHealth) solutions. This is of particular concern, bearing in mind that several studies, both in developed and developing countries, showed that clinicians’ adoption is the most influential factor in such solutions’ success. Objective: The aim of this study was to focus on understanding clinicians’ roles in the adoption of an oncology decision support app, the factors impacting this adoption, and its implications for organizational and social practices. Methods: A qualitative case study of a decision support app in oncology, called ONCOassist, was conducted. The data were collected through 17 in-depth interviews with clinicians and nurses in the United Kingdom, Ireland, France, Italy, Spain, and Portugal. Results: This case demonstrates the affordances and constraints of mHealth technology at the workplace, its implications for the organization of work, and clinicians’ role in its constant development and adoption. The research findings confirmed that factors such as app operation and stability, ease of use, usefulness, cost, and portability play a major role in the adoption decision; however, other social factors such as endorsement, neutrality of the content, attitude toward technology, existing workload, and internal organizational politics are also reported as key determinants of clinicians’ adoption. Interoperability and cultural views of mobile usage at work are the key workflow disadvantages, whereas higher efficiency and performance, sharpened practice, and location flexibility are the main workflow advantages. Conclusions: Several organizational implications emerged, suggesting the need for some actions such as fostering a work culture that embraces new technologies and the creation of new digital roles for clinicians both on the hospitals or clinics and on the development sides but also more collaboration between health care organizations and digital health providers to enable electronic medical record integration and solving of any interoperability issues. From a theoretical perspective, we also suggest the addition of a fourth step to Leonardi’s methodological guidance that accounts for user engagement; embedding the users in the continuous design and development processes ensures the understanding of user-specific affordances that can then be made more obvious to other users and increase the potential of such tools to go beyond their technological features and have a higher impact on workflow and the organizing process. %M 31066710 %R 10.2196/13555 %U https://mhealth.jmir.org/2019/5/e13555/ %U https://doi.org/10.2196/13555 %U http://www.ncbi.nlm.nih.gov/pubmed/31066710 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e13009 %T Patients’ Experiences of Using a Consumer mHealth App for Self-Management of Heart Failure: Mixed-Methods Study %A Woods,Leanna Sarah %A Duff,Jed %A Roehrer,Erin %A Walker,Kim %A Cummings,Elizabeth %+ School of Nursing, University of Tasmania, 1 Leichhardt Street, Darlinghurst, 2010, Australia, 61 0285727930, leannaj@utas.edu.au %K heart failure %K mobile health (mHealth) %K mobile apps %K usability study %K Mobile Application Rating Scale %K patient experience %K self-management %K mobile phone %D 2019 %7 02.05.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To support the self-management of heart failure, a team of hospital clinicians, patients, and family caregivers have co-designed the consumer mobile health app, Care4myHeart. Objective: This research aimed to determine patient experiences of using the app to self-manage heart failure. Methods: Patients with heart failure used the app for 14 days on their own smart device in a home setting, following which a mixed-methods evaluation was performed. Eight patients were recruited, of whom six completed the Mobile Application Rating Scale and attended an interview. Results: The overall app quality score was “acceptable” with 3.53 of 5 points, with the aesthetics (3.83/5) and information (3.78/5) subscales scoring the highest. The lowest mean score was in the app-specific subscale representing the perceived impact on health behavior change (2.53/5). Frequently used features were weight and fluid restriction tracking, with graphical representation of data particularly beneficial for improved self-awareness and ongoing learning. The use of technology for self-management will fundamentally differ from current practices and require a change in daily routines. However, app use was correlated with potential utility for daily management of illness with benefits of accurate recording and review of personal health data and as a communication tool for doctors to assist with care planning, as all medical information is available in one place. Technical considerations included participants’ attitudes toward technology, functionality and data entry issues, and relatively minor suggested changes. Conclusions: The findings from this usability study suggest that a significant barrier to adoption is the lack of integration of technology into everyday life in the context of already established disease self-management routines. Future studies should explore the barriers to adoption and sustainability of consumer mobile health interventions for chronic conditions, particularly whether introducing such apps is more beneficial at the commencement of a self-management regimen. %M 31045504 %R 10.2196/13009 %U http://humanfactors.jmir.org/2019/2/e13009/ %U https://doi.org/10.2196/13009 %U http://www.ncbi.nlm.nih.gov/pubmed/31045504 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 2 %P e11462 %T Influence of Patient Characteristics and Psychological Needs on Diabetes Mobile App Usability in Adults With Type 1 or Type 2 Diabetes: Crossover Randomized Trial %A Fu,Helen NC %A Adam,Terrence J %A Konstan,Joseph A %A Wolfson,Julian A %A Clancy,Thomas R %A Wyman,Jean F %+ Center for Aging Science and Care Innovation, School of Nursing, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN, 55455, United States, 1 612 624 2132, helen007@umn.edu %K mHealth %K diabetes %K self-management %K usability %K Self-Determination Theory %K mobile apps %K user satisfaction %D 2019 %7 30.04.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: More than 1100 diabetes mobile apps are available, but app usage by patients is low. App usability may be influenced by patient factors such as age, sex, and psychological needs. Objective: Guided by Self-Determination Theory, the purposes of this study were to (1) assess the effect of patient characteristics on app usability, and (2) determine whether patient characteristics and psychological needs (competence, autonomy, and connectivity)—important for motivation in diabetes care—are associated with app usability. Methods: Using a crossover randomized design, 92 adults with type 1 or 2 diabetes tested two Android apps (mySugr and OnTrack) for seven tasks including data entry, blood glucose (BG) reporting, and data sharing. We used multivariable linear regression models to examine associations between patient characteristics, psychological needs, user satisfaction, and user performance (task time, success, and accuracy). Results: Participants had a mean age of 54 (range 19-74) years, and were predominantly white (62%, 57/92), female (59%, 54/92), with type 2 diabetes (70%, 64/92), and had education beyond high school (67%, 61/92). Participants rated an overall user satisfaction score of 62 (SD 18), which is considered marginally acceptable. The satisfaction mean score for each app was 55 (SD 18) for mySugr and 68 (SD 15) for OnTrack. The mean task completion time for all seven tasks was 7 minutes, with a mean task success of 82% and an accuracy rate of 68%. Higher user satisfaction was observed for patients with less education (P=.04) and those reporting more competence (P=.02), autonomy (P=.006), or connectivity with a health care provider (P=.03). User performance was associated with age, sex, education, diabetes duration, and autonomy. Older patients required more time (95% CI 1.1-3.2) and had less successful task completion (95% CI 3.5-14.3%). Men needed more time (P=.01) and more technical support than women (P=.04). High school education or less was associated with lower task success (P=.003). Diabetes duration of ≥10 years was associated with lower task accuracy (P=.02). Patients who desired greater autonomy and were interested in learning their patterns of BG and carbohydrates had greater task success (P=.049). Conclusions: Diabetes app usability was associated with psychological needs that are important for motivation. To enhance patient motivation to use diabetes apps for self-management, clinicians should address competence, autonomy, and connectivity by teaching BG pattern recognition and lifestyle planning, customizing BG targets, and reviewing home-monitored data via email. App usability could be improved for older male users and those with less education and greater diabetes duration by tailoring app training and providing ongoing technical support. %M 31038468 %R 10.2196/11462 %U https://diabetes.jmir.org/2019/2/e11462/ %U https://doi.org/10.2196/11462 %U http://www.ncbi.nlm.nih.gov/pubmed/31038468 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e13226 %T A Digital Cognitive Aid for Anesthesia to Support Intraoperative Crisis Management: Results of the User-Centered Design Process %A Schild,Stefanie %A Sedlmayr,Brita %A Schumacher,Ann-Kathrin %A Sedlmayr,Martin %A Prokosch,Hans-Ulrich %A St.Pierre,Michael %A , %+ Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, 91058, Germany, 49 9131 85 26785, stefanie.schild@fau.de %K anesthesiology %K checklist %K crew resource management, healthcare %K emergency treatment %K ergonomics %K human factors %K practice guideline %K reference books, medical %K resuscitation %K user-computer interface %D 2019 %7 29.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stressful situations during intraoperative emergencies have negative impact on human cognitive functions. Consequently, task performance may decrease and patient safety may be compromised. Cognitive aids can counteract these effects and support anesthesiologists in their crisis management. The Professional Association of German Anesthesiologists set up a project to develop a comprehensive set of digital cognitive aids for intraoperative emergencies. A parallel development for several software platforms and stationary and mobile devices will accommodate the inhomogeneity of the information technology infrastructure within German anesthesia departments. Objective: This paper aimed to provide a detailed overview of how the task of developing a digital cognitive aid for intraoperative crisis management in anesthesia was addressed that meets user requirements and is highly user-friendly. Methods: A user-centered design (UCD) process was conducted to identify, specify, and supplement the requirements for a digital cognitive aid. The study covered 4 aspects: analysis of the context of use, specification of user requirements, development of design solutions, and evaluation of design solutions. Three prototypes were developed and evaluated by end users of the application. Following each evaluation, the new requirements were prioritized and used for redesign. For the first and third prototype, the System Usability Scale (SUS) score was determined. The second prototype was evaluated with an extensive Web-based questionnaire. The evaluation of the third prototype included a think-aloud protocol. Results: The chosen methods enabled a comprehensive collection of requirements and helped to improve the design of the application. The first prototype achieved an average SUS score of 74 (SD 12), indicating good usability. The second prototype included the following main revisions: 2-column layout, initial selection of patient type (infant, adult, or parturient), 4 offered search options, and the option to check off completed action steps. Its evaluation identified the following major revision points: add quick selection for resuscitation checklists, design the top bar and tabs slightly larger, and add more pictograms to the text. The third prototype achieved an average SUS score of 77 (SD 15). The evaluation of the think-aloud protocol revealed a good intuitiveness of the application and identified a missing home button as the main issue. Conclusions: Anesthesiology—as an acute medical field—is particularly characterized by its high demands on decision making and action in dynamic, or time-critical situations. The integration of usability aspects is essential for everyday and emergency suitability. The UCD process allowed us to develop a prototypical digital cognitive aid, exhibiting high usability and user satisfaction in the demanding environment of anesthesiological emergencies. Both aspects are essential to increase the acceptance of the application in later stages. The study approach, combining different methods for determining user requirements, may be useful for other implementation projects in a highly demanding environment. %M 31033445 %R 10.2196/13226 %U http://mhealth.jmir.org/2019/4/e13226/ %U https://doi.org/10.2196/13226 %U http://www.ncbi.nlm.nih.gov/pubmed/31033445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11656 %T The Iterative Convergent Design for Mobile Health Usability Testing: Mixed Methods Approach %A Alwashmi,Meshari F %A Hawboldt,John %A Davis,Erin %A Fetters,Michael D %+ Memorial University, 230 Elizabeth Ave, St John's, NL, A1B 3X9, Canada, 1 7096910728, mfa720@mun.ca %K mHealth %K mixed methods %K usability %K eHealth %K methods %D 2019 %7 26.04.2019 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Although patients express an interest in using mobile health (mHealth) interventions to manage their health and chronic conditions, many current mHealth interventions are difficult to use. Usability testing is critical for the success of novel mHealth interventions. Researchers recognize the utility of using qualitative and quantitative approaches for usability testing, but many mHealth researchers lack the awareness of integration approaches from advances in mixed methods research that can add value to mHealth technology.As efficient usability testing proceeds iteratively, we introduce a novel mixed methods design developed specifically for mHealth researchers. The iterative convergent mixed methods design involves simultaneous qualitative and quantitative data collection and analysis that continues cyclically through multiple rounds of mixed methods data collection and analysis until the mHealth technology under evaluation is found to work to the satisfaction of the researcher. In cyclical iterations, early development is more qualitatively driven but progressively becomes more quantitatively driven. Using this design, mHealth researchers can leverage mixed methods integration procedures in the research question, data collection, data analysis, interpretation, and dissemination dimensions.This study demonstrates how the iterative convergent mixed methods design provides a novel framework for generating unique insights into multifaceted phenomena impacting mHealth usability. Understanding these practices can help developers and researchers leverage the strengths of an integrated mixed methods design. %M 31025951 %R 10.2196/11656 %U http://mhealth.jmir.org/2019/4/e11656/ %U https://doi.org/10.2196/11656 %U http://www.ncbi.nlm.nih.gov/pubmed/31025951 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12982 %T An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies %A Setiawan,I Made Agus %A Zhou,Leming %A Alfikri,Zakiy %A Saptono,Andi %A Fairman,Andrea D %A Dicianno,Brad Edward %A Parmanto,Bambang %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6025 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K mHealth %K adaptive mHealth %K mobile apps %K telemedicine %K personalized medicine %K self-management %K self-care %K caregivers %K chronic disease %K persons with disabilities %D 2019 %7 25.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs’ self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. Objective: The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. Methods: A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs’ evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. Results: The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. Conclusions: We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs. %M 31021324 %R 10.2196/12982 %U http://formative.jmir.org/2019/2/e12982/ %U https://doi.org/10.2196/12982 %U http://www.ncbi.nlm.nih.gov/pubmed/31021324 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e13204 %T Usage Patterns of GlucoNote, a Self-Management Smartphone App, Based on ResearchKit for Patients With Type 2 Diabetes and Prediabetes %A Yamaguchi,Satoko %A Waki,Kayo %A Nannya,Yasuhito %A Nangaku,Masaomi %A Kadowaki,Takashi %A Ohe,Kazuhiko %+ Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 9129, kwaki-tky@umin.ac.jp %K telemedicine %K mHealth %K self-management %K diabetes mellitus %D 2019 %7 24.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Preventing progression from prediabetes to diabetes—or slowing the progression of diabetes—is an urgent task worldwide. Previous studies have shown that mobile health (mHealth) may powerfully support self-management for patients with type 2 diabetes. Certainly, mHealth improves health care efficiency and gives patients convenient access to self-management of their own health. Many health care apps are available right now, and their use in clinical studies with large-scale real-life data is expected. However, the usage patterns of those apps—especially in the absence of intervention by medical professionals—remain unknown. Objective: We developed GlucoNote, an app that uses Apple’s ResearchKit to support self-management for patients with type 2 diabetes and prediabetes; the app does not require prescription or intervention by medical professionals. We evaluated its usage patterns via a remotely conducted study. Methods: iPhone users across Japan who have type 2 diabetes or prediabetes were free to download GlucoNote and to participate in the study after they provided consent electronically on the app. The 522 users who enrolled in the study within 1 year of its release were analyzed. We analyzed the retention rates of 357 participants who recorded at least 1 of 4 items—body weight, blood sugar, blood pressure, or dietary information. Characteristics of participants who used GlucoNote longer than 4 weeks (robust users) were compared with those of participants who did not (nonrobust users). The changes among robust users were evaluated. Results: The median observation and retention durations were 382 days (interquartile range [IQR] 275-423) and 8 days (IQR 1-63), respectively. The retention rates for 2 days and for 4, 8, and 12 weeks were 0.627 (95% CI 0.575-0.675), 0.353 (0.304-0.403), 0.272 (0.227-0.319), and 0.220 (0.179-0.265), respectively. Men were more likely to be robust users than women (P=.02). At week 0, robust users were more likely than nonrobust users to have a higher daily energy intake (median 1595 [IQR 1198-1788] kcal vs 1451 [IQR 769-1657] kcal; P=.04) and have higher daily step counts (median 6108 [IQR 3797-9227] vs 5171 [IQR 2885-7258]; P=.001). Among robust users, body weight decreased from weeks 0 to 4 (mean 71.3 [SD 14.1] kg to 70.8 [SD 13.9] kg; P=.002) by mean 0.6% (SD 1.6). Conclusions: GlucoNote offered a valuable opportunity to evaluate usage patterns of apps. Future challenges include improving low retention rates and evaluating their effects. %M 31017586 %R 10.2196/13204 %U http://mhealth.jmir.org/2019/4/e13204/ %U https://doi.org/10.2196/13204 %U http://www.ncbi.nlm.nih.gov/pubmed/31017586 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10216 %T A Mobile Web App to Improve Health Screening Uptake in Men (ScreenMen): Utility and Usability Evaluation Study %A Teo,Chin Hai %A Ng,Chirk Jenn %A Lo,Sin Kuang %A Lim,Chip Dong %A White,Alan %+ Department of Primary Care Medicine, University of Malaya eHealth Initiative, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia, 60 37949 ext 2306, ngcj@um.edu.my %K internet %K mHealth %K eHealth %K mass screening %K health behavior %K men’s health %D 2019 %7 15.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, the uptake of health screening is suboptimal, especially in men and those of younger age. In view of the increasing internet access and mobile phone ownership, ScreenMen, a mobile Web app, was developed to improve health screening uptake in men. Objective: This study aimed to evaluate the utility and usability of ScreenMen. Methods: This study used both qualitative and quantitative methods. Healthy men working in a banking institution were recruited to participate in this study. They were purposively sampled according to job position, age, education level, and screening status. Men were asked to use ScreenMen independently while the screen activities were being recorded. Once completed, retrospective think aloud with playback was conducted with men to obtain their feedback. They were asked to answer the System Usability Scale (SUS). Intention to undergo screening pre- and postintervention was also measured. Qualitative data were analyzed using a framework approach followed by thematic analysis. For quantitative data, the mean SUS score was calculated and change in intention to screening was analyzed using McNemar test. Results: In total, 24 men participated in this study. On the basis of the qualitative data, men found ScreenMen useful as they could learn more about their health risks and screening. They found ScreenMen convenient to use, which might trigger men to undergo screening. In terms of usability, men thought that ScreenMen was user-friendly and easy to understand. The key revision done on utility was the addition of a reminder function, whereas for usability, the revisions done were in terms of attracting and gaining users’ trust, improving learnability, and making ScreenMen usable to all types of users. To attract men to use it, ScreenMen was introduced to users in terms of improving health instead of going for screening. Another important revision made was emphasizing the screening tests the users do not need, instead of just informing them about the screening tests they need. A Quick Assessment Mode was also added for users with limited attention span. The quantitative data showed that 8 out of 23 men (35%) planned to attend screening earlier than intended after using the ScreenMen. Furthermore, 4 out of 12 (33%) men who were in the precontemplation stage changed to either contemplation or preparation stage after using ScreenMen with P=.13. In terms of usability, the mean SUS score of 76.4 (SD 7.72) indicated that ScreenMen had good usability. Conclusions: This study showed that ScreenMen was acceptable to men in terms of its utility and usability. The preliminary data suggested that ScreenMen might increase men’s intention to undergo screening. This paper also presented key lessons learned from the beta testing, which is useful for public health experts and researchers when developing a user-centered mobile Web app. %M 30985280 %R 10.2196/10216 %U https://mhealth.jmir.org/2019/4/e10216/ %U https://doi.org/10.2196/10216 %U http://www.ncbi.nlm.nih.gov/pubmed/30985280 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12551 %T A Mobile Phone App for Bedside Nursing Care: Design and Development Using an Adapted Software Development Life Cycle Model %A Ehrler,Frederic %A Lovis,Christian %A Blondon,Katherine %+ Division of Medical Information Sciences, University Hospitals of Geneva, 4, Gabrielle-Perret-Gentil, Geneva, 1205, Switzerland, 41 223728697, frederic.ehrler@hcuge.ch %K mHealth %K nursing %K hospital information systems %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nurses are increasingly spending time on computers, and providing them with a tailored tool to access clinical information and perform documentation at the bedside could help to improve their efficiency. Designing an app to support nurses’ work at the bedside is a challenging task, given the complexity of the care process. Objective: This study aimed to present the design, development, and testing of a smartphone app for nurses guided by an adapted software development life cycle model that takes into consideration the complexity and constraints of a health care setting. Methods: The model drives us through an iterative development process intersected by 3 stages of formative evaluation of growing ecological validity. Results: The initial requirements identification stage included 11 participants who helped us select the most important functionalities to integrate into the tool. Starting with a usability evaluation allowed for the identification of design issues that could have caused misuse. Then, making on-site evaluations under the supervision of an investigator helped to understand the adequacy of the tool with limited risks. Finally, the on-site evaluation allowed us to validate the acceptance of the app by caregivers. Conclusions: The interpretation of the collected evaluation confirms the necessary involvement of end users early in the process to help address the heterogeneity of the nursing workflow processes in the different wards. We also highlight the delicate balance between high-security measures to protect access to patient data and maintaining ease of access for efficiency and usability. Although a close collaboration with clinicians throughout the entire project facilitated the development of a tailored solution, it was also important to involve all stakeholders, in particular, the information technology (IT) security officers. %M 30973339 %R 10.2196/12551 %U http://mhealth.jmir.org/2019/4/e12551/ %U https://doi.org/10.2196/12551 %U http://www.ncbi.nlm.nih.gov/pubmed/30973339 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11500 %T The mHealth App Usability Questionnaire (MAUQ): Development and Validation Study %A Zhou,Leming %A Bao,Jie %A Setiawan,I Made Agus %A Saptono,Andi %A Parmanto,Bambang %+ Department of Health Information Management, University of Pittsburgh, 6021 Forbes Tower, 3600 Forbes Ave at Meyran Ave, Pittsburgh, PA, 15260, United States, 1 412 383 6653, lmzhou@gmail.com %K questionnaire design %K reliability and validity %K mobile apps %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: After a mobile health (mHealth) app is created, an important step is to evaluate the usability of the app before it is released to the public. There are multiple ways of conducting a usability study, one of which is collecting target users’ feedback with a usability questionnaire. Different groups have used different questionnaires for mHealth app usability evaluation: The commonly used questionnaires are the System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ). However, the SUS and PSSUQ were not designed to evaluate the usability of mHealth apps. Self-written questionnaires are also commonly used for evaluation of mHealth app usability but they have not been validated. Objective: The goal of this project was to develop and validate a new mHealth app usability questionnaire. Methods: An mHealth app usability questionnaire (MAUQ) was designed by the research team based on a number of existing questionnaires used in previous mobile app usability studies, especially the well-validated questionnaires. MAUQ, SUS, and PSSUQ were then used to evaluate the usability of two mHealth apps: an interactive mHealth app and a standalone mHealth app. The reliability and validity of the new questionnaire were evaluated. The correlation coefficients among MAUQ, SUS, and PSSUQ were calculated. Results: In this study, 128 study participants provided responses to the questionnaire statements. Psychometric analysis indicated that the MAUQ has three subscales and their internal consistency reliability is high. The relevant subscales correlated well with the subscales of the PSSUQ. The overall scale also strongly correlated with the PSSUQ and SUS. Four versions of the MAUQ were created in relation to the type of app (interactive or standalone) and target user of the app (patient or provider). A website has been created to make it convenient for mHealth app developers to use this new questionnaire in order to assess the usability of their mHealth apps. Conclusions: The newly created mHealth app usability questionnaire—MAUQ—has the reliability and validity required to assess mHealth app usability. %M 30973342 %R 10.2196/11500 %U http://mhealth.jmir.org/2019/4/e11500/ %U https://doi.org/10.2196/11500 %U http://www.ncbi.nlm.nih.gov/pubmed/30973342 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e9832 %T The Use of Wearable Activity Trackers Among Older Adults: Focus Group Study of Tracker Perceptions, Motivators, and Barriers in the Maintenance Stage of Behavior Change %A Kononova,Anastasia %A Li,Lin %A Kamp,Kendra %A Bowen,Marie %A Rikard,RV %A Cotten,Shelia %A Peng,Wei %+ Department of Advertising and Public Relations, Michigan State University, Room 319, 404 Wilson Road, East Lansing, MI, 48824, United States, 1 5174325129, kononova@msu.edu %K aging %K wearable electronic devices %K biobehavioral sciences %K transtheoretical model of behavior change %K exercise %K physical activity %D 2019 %7 05.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers offer the opportunity to increase physical activity through continuous monitoring. Viewing tracker use as a beneficial health behavior, we explored the factors that facilitate and hinder long-term activity tracker use, applying the transtheoretical model of behavior change with the focus on the maintenance stage and relapse. Objective: The aim of this study was to investigate older adults’ perceptions and uses of activity trackers at different points of use: from nonuse and short-term use to long-term use and abandoned use to determine the factors to maintain tracker use and prevent users from discontinuing tracker usage. Methods: Data for the research come from 10 focus groups. Of them, 4 focus groups included participants who had never used activity trackers (n=17). These focus groups included an activity tracker trial. The other 6 focus groups (without the activity tracker trial) were conducted with short-term (n=9), long-term (n=11), and former tracker users (n=11; 2 focus groups per user type). Results: The results revealed that older adults in different tracker use stages liked and wished for different tracker features, with long-term users (users in the maintenance stage) being the most diverse and sophisticated users of the technology. Long-term users had developed a habit of tracker use whereas other participants made an effort to employ various encouragement strategies to ensure behavior maintenance. Social support through collaboration was the primary motivator for long-term users to maintain activity tracker use. Short-term and former users focused on competition, and nonusers engaged in vicarious tracker use experiences. Former users, or those who relapsed by abandoning their trackers, indicated that activity tracker use was fueled by curiosity in quantifying daily physical activity rather than the desire to increase physical activity. Long-term users saw a greater range of pros in activity tracker use whereas others focused on the cons of this behavior. Conclusions: The results suggest that activity trackers may be an effective technology to encourage physical activity among older adults, especially those who have never tried it. However, initial positive response to tracker use does not guarantee tracker use maintenance. Maintenance depends on recognizing the long-term benefits of tracker use, social support, and internal motivation. Nonadoption and relapse may occur because of technology’s limitations and gaining awareness of one’s physical activity without changing the physical activity level itself. %M 30950807 %R 10.2196/mhealth.9832 %U https://mhealth.jmir.org/2019/4/e9832/ %U https://doi.org/10.2196/mhealth.9832 %U http://www.ncbi.nlm.nih.gov/pubmed/30950807 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e10187 %T Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain %A Boceta,Jaime %A Samper,Daniel %A de la Torre,Alejandro %A Sánchez-de la Rosa,Rainel %A González,Gloria %+ Unidad de Hospitalización Domiciliaria y Cuidados Paliativos, Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Avd. Doctor Fedriani, 3, Sevilla, 41071, Spain, 34 955 00 80 00, bocetajaime@gmail.com %K breakthrough cancer pain %K mHealth %K mobile app %K App INES·DIO %D 2019 %7 01.04.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Breakthrough pain is a major problem and a source of distress in patients with cancer. We hypothesized that health care professionals may benefit from a real-time mobile app to assist in the diagnosis and monitoring of breakthrough cancer pain (BTcP). Objective: This study aimed to test the usability, acceptability, and usefulness in real-world practice of the mobile App INES·DIO developed for the management of patients with BTcP. Methods: This study consisted of a survey of a multidisciplinary sample of 175 physicians who evaluated the mobile app after testing it with 4 patients with BTcP each (for a total of 700 patients). The digital profile of the physicians, use of the different resources contained in the app, usefulness of the resources, acceptability, usability, potential improvements, intention to use, and additional resources to add were recorded. Results: Of the 175 physicians, 96% (168/175) were working in public hospitals. They had an average of 12 (SD 7) years of experience in BTcP and almost all (174/175, 99.43%) had an active digital profile. The Eastern Cooperative Oncology Group and Karnofsky performance scales, the Visual Analogue Scale, and the Davies algorithm to diagnose BTcP were the most frequently used tools with patients and were assessed as very useful by more than 80% (140/175) of physicians. The majority (157/175, 90%) answered that App INES·DIO was well designed and 94% (165/175) would probably or very probably recommend it to other colleagues. More than two-thirds indicated that the report provided by the app was worth being included in patients’ clinical records. The most valued resource in the app was the recording of the number, duration, and intensity of pain flares each day and baseline pain control to enhance diagnosis of BTcP. Additional patient-oriented cancer pain educational content was suggested for inclusion in future versions of App INES·DIO. Conclusions: Our study showed that App INES·DIO is easy to use and useful for physicians to help diagnose and monitor breakthrough pain in patients with cancer. Participants suggested the implementation of additional educational content about breakthrough pain. They agreed on the importance of adding new clinical guidelines/protocols for the management of BTcP, improving their communication skills with patients, and introducing an evidence-based video platform that gathers new educational material on BTcP. %M 30932862 %R 10.2196/10187 %U https://cancer.jmir.org/2019/1/e10187/ %U https://doi.org/10.2196/10187 %U http://www.ncbi.nlm.nih.gov/pubmed/30932862 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10044 %T Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study %A Manini,Todd Matthew %A Mendoza,Tonatiuh %A Battula,Manoj %A Davoudi,Anis %A Kheirkhahan,Matin %A Young,Mary Ellen %A Weber,Eric %A Fillingim,Roger Benton %A Rashidi,Parisa %+ Department of Biomedical Engineering, University of Florida, 1064 Center Drive, NEB 459, Gainesville, FL, 32611, United States, 1 352 392 9469, parisa.rashidi@ufl.edu %K smartwatch %K focus group %K ecological momentary assessment (EMA) %K patient-reported outcomes (PRO) %D 2019 %7 26.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient’s long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate. Objective: The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool. Methods: A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants’ attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes. Results: We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers. Conclusions: All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales. %M 30912756 %R 10.2196/10044 %U http://mhealth.jmir.org/2019/3/e10044/ %U https://doi.org/10.2196/10044 %U http://www.ncbi.nlm.nih.gov/pubmed/30912756 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11516 %T Sensor-Based Passive Remote Monitoring and Discordant Values: Qualitative Study of the Experiences of Low-Income Immigrant Elders in the United States %A Berridge,Clara %A Chan,Keith T %A Choi,Youngjun %+ University of Washington, 4101 15th Ave NE, Seattle, WA, 98105, United States, 1 206 685 2180, clarawb@uw.edu %K immigrants %K ubiquitous sensing %K acculturation %K passive monitoring %K independent living %K family caregiving %K culturally appropriate technology %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Remote monitoring technologies are positioned to mitigate the problem of a dwindling care workforce and disparities in access to care for the growing older immigrant population in the United States. To achieve these ends, designers and providers need to understand how these supports can be best provided in the context of various sociocultural environments that shape older adults’ expectations and care relationships, yet few studies have examined how the same remote monitoring technologies may produce different effects and uses depending on what population is using them in a particular context. Objective: This study aimed to examine the experiences and insights of low-income, immigrant senior residents, family contacts, and staff of housing that offered a sensor-based passive monitoring system designed to track changes in movement around the home and trigger alerts for caregivers. The senior housing organization had been offering the QuietCare sensor system to its residents for 6 years at the time of the study. We are interested in adoption and discontinuation decisions and use over time, rather than projected acceptance. Our research question is how do cultural differences influence use and experiences with this remote monitoring technology? The study does not draw generalizable conclusions about how cultural groups interact with a given technology, but rather, it examines how values are made visible in elder care technology interactions. Methods: A total of 41 participants (residents, family, and staff) from 6 large senior housing independent living apartment buildings were interviewed. Interviews were conducted in English and Korean with these participants who collectively had immigrated to the United States from 10 countries. Results: The reactions of immigrant older adults to the passive monitoring system reveal that this tool offered to them was often mismatched with their values, needs, and expectations. Asian elders accepted the intervention social workers offered largely to appease them, but unlike their US-born counterparts, they adopted reluctantly without hope that it would ameliorate their situation. Asian immigrants discontinued use at the highest rate of all residents, and intergenerational family cultural conflict contributed to this termination. Social workers reported that none of the large population of Russian-speaking residents agreed to use QuietCare. Bilingual and bicultural social workers played significant roles as cultural navigators in the promotion of QuietCare to residents. Conclusions: This research into the interactions of culturally diverse people with the same monitoring technology reveals the significant role that social values and context play in shaping how people and families interact with and experience elder care interventions. If technology-based care services are to reach their full potential, it will be important to identify the ways in which cultural values produce different uses and responses to technologies intended to help older adults live independently. %M 30907741 %R 10.2196/11516 %U http://mhealth.jmir.org/2019/3/e11516/ %U https://doi.org/10.2196/11516 %U http://www.ncbi.nlm.nih.gov/pubmed/30907741 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12535 %T Mobile Health Features Supporting Self-Management Behavior in Patients With Chronic Arthritis: Mixed-Methods Approach on Patient Preferences %A Geuens,Jonas %A Geurts,Luc %A Swinnen,Thijs W %A Westhovens,Rene %A Vanden Abeele,Vero %+ e-Media Research Lab, Katholieke Universiteit Leuven, A Vesaliusstraat 13, Leuven, 3000, Belgium, 32 16301111, jonas.geuens@kuleuven.be %K mobile applications %K arthritis %K self-management %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with chronic arthritis (CA) ideally apply self-management behaviors between consultations. This enduring, tedious task of keeping track of disease-related parameters, adhering to medication schemes, and engaging in physical therapy may be supported by using a mobile health (mHealth) app. However, further research is needed to determine which self-management features are valued most by adult patients with CA patients. Objective: The aim of this study was to determine the preference of features for an mHealth app to support self-management behavior in patients with CA. In addition, we aimed to explore the motives behind these ratings. Methods: A mixed-methods approach was used to gather information from 31 adult patients (14 females), aged 23 to 71 years (mean 51 [SD 12.16]), with CA. Structured interviews were conducted to gather data pertaining to preferences of app features. Interviews were analyzed qualitatively, whereas ratings for each of the 28 features studied were analyzed quantitatively. Results: In general, patients with CA favored the use of features pertaining to supporting active and direct disease management, (eg, medication intake and detecting and alarming of bad posture), helping them to keep a close watch on their disease status and inform their health care professional (eg, providing a means to log and report disease-related data) and receiving personalized information (eg, offering tailored information based on the patient’s health data). Patients strongly disliked features that provide a means of social interaction or provide incentivization for disease-related actions (eg, being able to compare yourself with other patients, cooperating toward a common goal, and receiving encouragement from friends and/or family). Driving these evaluations is the finding that every patient with CA hurts in his/her own way, the way the disease unfolds over time and manifests itself in the patient and social environment is different for every patient, and patients with CA are well aware of this. Conclusions: We have offered an insight into how patients with CA favor mHealth features for self-management apps. The results of this research can inform the design and development of prospective self-management apps for patients with CA. %M 30907737 %R 10.2196/12535 %U http://mhealth.jmir.org/2019/3/e12535/ %U https://doi.org/10.2196/12535 %U http://www.ncbi.nlm.nih.gov/pubmed/30907737 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 1 %P e10350 %T Perceptions and Acceptability of Text Messaging for Diabetes Care in Primary Care in Argentina: Exploratory Study %A Moyano,Daniela %A Morelli,Daniela %A Santero,Marilina %A Belizan,Maria %A Irazola,Vilma %A Beratarrechea,Andrea %+ Institute for Clinical Effectiveness and Health Policy (IECS), Dr Emilio Ravignani 2024, Buenos Aires, C1414CPV, Argentina, 54 114777 8767, dmoyano@iecs.org.ar %K mobile phones %K short message service %K diabetes mellitus %K public health %K qualitative research %D 2019 %7 18.03.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: Engagement in self-care behaviors that are essential to optimize diabetes care is challenging for many patients with diabetes. mHealth interventions have been shown to be effective in improving health care outcomes in diabetes. However, more research is needed on patient perceptions to support these interventions, especially in resource settings in low- and middle-income countries. Objective: The goal of the research was to explore perceptions and acceptability of a short message service (SMS) text messaging intervention for diabetes care in underserved people with diabetes in Argentina. Methods: A qualitative exploratory methodology was adopted as part of the evaluation of a program to strengthen diabetes services in primary care clinics located in low-resource settings. The diabetes program included a text messaging intervention for people with diabetes. A total of 24 semistructured telephone interviews were conducted with people with diabetes. Results: Twenty-four middle-aged persons with diabetes were interviewed. Acceptability was considered adequate in terms of its actual use, frequency, and the role of texts as a reminder. We found that text messages could be a mediating device in the patient’s learning processes. Also, being exposed to the texts seemed to help bring about changes in risk perception and care practices and to function as psychosocial support. Another relevant finding was the role of text messaging as a potential facilitator in diabetes care. In this sense, we observed a strong association between receiving text messages and having a better patient-physician relationship. Additionally, social barriers that affect diabetes care such as socioeconomic and psychosocial vulnerability were identified. Conclusions: Our findings show positive contributions of a text messaging intervention for the care of people with diabetes. We consider that an SMS strategy has potential to be replicated in other contexts. However, further studies are needed to explore its sustainability and long-term impact from the perspective of patients. %M 30882362 %R 10.2196/10350 %U http://diabetes.jmir.org/2019/1/e10350/ %U https://doi.org/10.2196/10350 %U http://www.ncbi.nlm.nih.gov/pubmed/30882362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11296 %T User Experience of an App-Based Treatment for Stress Urinary Incontinence: Qualitative Interview Study %A Asklund,Ina %A Samuelsson,Eva %A Hamberg,Katarina %A Umefjord,Göran %A Sjöström,Malin %+ Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, The Research Unit, Region Jämtland Härjedalen, Box 654, Umeå, SE-831 27, Sweden, 46 704788148, ina.asklund@umu.se %K mobile applications %K urinary incontinence %K stress %K pelvic floor muscle training %K self-management %K qualitative research %K grounded theory %K women’s health %D 2019 %7 14.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Stress urinary incontinence (SUI) affects 10%-39% of women. Its first-line treatment consists of lifestyle interventions and pelvic floor muscle training (PFMT), which can be performed supervised or unsupervised. Health apps are increasing in number and can be used to improve adherence to treatments. We developed the Tät app, which provides a 3-month treatment program with a focus on PFMT for women with SUI. The app treatment was evaluated in a randomized controlled trial, which demonstrated efficacy for improving incontinence symptoms and quality of life. In this qualitative interview study, we investigated participant experiences of the app-based treatment. Objective: This study aimed to explore women’s experiences of using an app-based treatment program for SUI. Methods: This qualitative study is based on telephone interviews with 15 selected women, with a mean age of 47 years, who had used the app in the previous randomized controlled trial. A semistructured interview guide with open-ended questions was used, and the interviews were transcribed verbatim. Data were analyzed according to the grounded theory. Results: The results were grouped into three categories: “Something new!” “Keeping motivation up!” and “Good enough?” A core category, “Enabling my independence,” was identified. The participants appreciated having a new and modern way to access a treatment program for SUI. The use of new technology seemed to make incontinence treatment feel more prioritized and less embarrassing for the subjects. The closeness to their mobile phone and app features like reminders and visual graphs helped support and motivate the women to carry through the PFMT. The participants felt confident that they could perform the treatment program on their own, even though they expressed some uncertainty about whether they were doing the pelvic floor muscle contractions correctly. They felt that the app-based treatment increased their self-confidence and enabled them to take responsibility for their treatment. Conclusions: Use of the app-based treatment program for SUI empowered the women in this study and helped them self-manage their incontinence treatment. They appreciated the app as a new tool for supporting their motivation to carry through a slightly challenging PFMT program. Trial Registration: ClinicalTrials.gov NCT01848938; https://clinicaltrials.gov/ct2/show/NCT01848938 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01848938) %M 30869644 %R 10.2196/11296 %U http://www.jmir.org/2019/3/e11296/ %U https://doi.org/10.2196/11296 %U http://www.ncbi.nlm.nih.gov/pubmed/30869644 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10750 %T Comparison of Developers’ and End-Users’ Perspectives About Smoking Cessation Support Through the Crush the Crave App %A Struik,Laura Louise %A Bottorff,Joan L %A Baskerville,N Bruce %A Oliffe,John %A Crichton,Susan %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4520, laurastruik134@hotmail.com %K mobile app %K smoking cessation %K tobacco control %K young adult %K qualitative research %D 2019 %7 07.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High smoking rates among end-users, combined with their high rates of app use, render this age group as a particularly captive audience for quit smoking apps. There is emerging evidence that apps are an effective way to support smoking cessation among end-users. How the expectations behind the design of apps align with the needs and preferences of end-users, and if this differs by gender, is poorly understood, limiting the ability to evaluate and scale these interventions. Objective: The objective of this qualitative case study was to detail how the overall design approach of Crush the Crave (CTC), a quit smoking app that targets end-users, compares with young adult women’s and men’s perspectives and experiences, with consideration for the influence of gender. Methods: Semistructured interviews were conducted with 15 developers involved in the development of CTC and 31 young adult CTC users. Data were analyzed inductively to derive thematic findings of the perceived pros and cons of CTC by both developers and end-users. Findings were grouped under 4 categories (1) technology and platforms utilized for the app, (2) foundation of app content, (3) underlying focus of the app, and (4) look, feel and functionality of the app. Results: Under the category, technology and platforms utilized for the app, it was found that both developers and end-users agreed that apps aligned with the needs and preferences of young adult smokers. Major limitations with the technology identified by end-users were the frequent “glitches” and requirement for internet or data. For the category, foundation of app content,developers agreed that the strength of CTC was in its strong evidence-base. What mattered to end-users, however, was that the content was packaged positively, focusing on the benefits of quitting versus the consequences of smoking. It was found under the category, underlying focus of the app, that the individually-led focus of the app resonated with both developers and end-users, especially young men. Under the final category, look, feel and functionality of the app, it was found that developers were very positive about the app's aesthetics but end-users thought that the aesthetics incited a negative effect. Also, while end-users found it easy to use, they did not find the app intuitive. Finally, end-users thought that, because the app functions were largely based on a user’s quit date versus their ongoing efforts, this often lent to unmeaningful data. Conclusions: The current study findings highlight the importance of understanding multiple perspectives of stakeholders involved in a mobile-based intervention. By gathering the viewpoints of developers and end-users, both problematic and effective approaches that underlie development goals were revealed as a means of informing the development, implementation, and evaluation of future electronic health (eHealth) interventions. %M 30843864 %R 10.2196/10750 %U https://mhealth.jmir.org/2019/3/e10750/ %U https://doi.org/10.2196/10750 %U http://www.ncbi.nlm.nih.gov/pubmed/30843864 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12349 %T Impact of Training and Integration of Apps Into Dietetic Practice on Dietitians’ Self-Efficacy With Using Mobile Health Apps and Patient Satisfaction %A Chen,Juliana %A Allman-Farinelli,Margaret %+ The University of Sydney, Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, Level 4 East, Charles Perkins Centre (D17), John Hopkins Drive, The University of Sydney, Camperdown, 2006, Australia, 61 2 8627 0843, jche6526@uni.sydney.edu.au %K dietetics %K medical nutrition therapy %K mHealth %K patient satisfaction %K smartphone %D 2019 %7 04.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile health (mHealth) apps in dietetic practice could support the delivery of nutrition care in medical nutrition therapy. However, apps are underutilized by dietitians in patient care. Objective: This study aimed to determine the feasibility of an intervention consisting of education, training, and integration of apps in improving dietitians’ perceived self-efficacy with using mHealth apps. Methods: Private practice Accredited Practising Dietitians who were not regular users or recommenders of mHealth apps were recruited into the intervention. The intervention consisted of 2 phases: (1) a workshop that incorporated an educational lecture and skill-building activities to target self-efficacy, capability, opportunity, and motivation factors and (2) a 12-week intervention phase allowing for the integration of an app into dietetic practice via an app platform. During the 12-week intervention phase, dietitians prescribed an Australian commercial nutrition app to new (intervention) patients receiving nutrition care. Existing (control) patients were also recruited to provide a measure of patient satisfaction before the apps were introduced. New patients completed their patient satisfaction surveys at the end of the 12 weeks. Usability feedback about the app and app platform was gathered from intervention patients and dietitians. Results: A total of 5 dietitians participated in the study. On the basis of an analysis of variance with the Tukey post hoc tests, the educational and skills training workshop component of the intervention produced immediate improvements in mean ratings for dietitians’ self-efficacy with using mHealth apps compared with baseline (P=.02), particularly with regard to familiarity with apps factor (P<.001). The self-efficacy factor integration into dietetic work systems achieved significant improvements from baseline to 12 weeks (P=.03). Patient satisfaction with dietetic services did not differ significantly between intervention (n=17) and control patients (n=13). Overall, dietitians and their patients indicated that they would continue using the app platform and app, respectively, and would recommend it to others. To improve usability, enhancing patient-dietitian communication mediums in the app platform and reducing the burden of entering in meals cooked at home should be considered. Conclusions: Administering an educational and skills training workshop in conjunction with integrating an app platform into dietetic practice was a feasible method for improving the self-efficacy of dietitians toward using mHealth apps. Further translational research will be required to determine how the broader dietetic profession responds to this intervention. %M 30829577 %R 10.2196/12349 %U http://mhealth.jmir.org/2019/3/e12349/ %U https://doi.org/10.2196/12349 %U http://www.ncbi.nlm.nih.gov/pubmed/30829577 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11636 %T Exploring Users’ Experiences of the Uptake and Adoption of Physical Activity Apps: Longitudinal Qualitative Study %A Baretta,Dario %A Perski,Olga %A Steca,Patrizia %+ Department of Psychology, University of Milano-Bicocca, U6 Building, 3rd Floor, Piazza dell'Ateneo Nuovo,1, Milano, 20126, Italy, 39 3405946987, d.baretta@campus.unimib.it %K physical activity %K smartphone apps %K engagement %K person-based approach %K longitudinal qualitative study %K thematic analysis %D 2019 %7 08.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although smartphone apps might support physical activity (PA), engagement with them tends to be low. Objective: This study aimed to examine potential users’ needs and preferences regarding their engagement with PA apps during a first exposure to a never-used PA app and after 2 weeks’ usage. Methods: A longitudinal, one-arm qualitative study was conducted with potential PA app users. At baseline, participants (N=20) were asked to explore 1 of 3 randomly allocated PA apps while thinking aloud. Semistructured interview techniques allowed participants to elaborate on their statements. After 2 weeks, follow-up interviews explored participants’ (n=17) lived experiences of real-world app use. Verbal reports from both time points were analyzed using inductive thematic analysis. Results: Features that promote a fair and simple user experience, support users’ self-regulation skills, and address users’ exercise motives were considered important for engagement both during a first exposure and after a 2-week use of PA apps. Features that support users’ need for relatedness as well as those that facilitate users to implement their intentions were expected to be important for engagement mainly during a first exposure to PA apps. Proactive and tailored features that integrate behavioral, psychological, and contextual information to provide adaptive exercise plans and just-in-time support were considered relevant to sustain engagement over time. Conclusions: App features that address users’ exercise motives, promote self-regulation, and fulfill users’ need for relatedness might promote engagement with PA apps. Tailored and proactive features were expected to promote sustained engagement. %M 30735143 %R 10.2196/11636 %U http://mhealth.jmir.org/2019/2/e11636/ %U https://doi.org/10.2196/11636 %U http://www.ncbi.nlm.nih.gov/pubmed/30735143 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11638 %T Change in Patient Comfort Using Mobile Phones Following the Use of an App to Monitor Tuberculosis Treatment Adherence: Longitudinal Study %A Do,Diana %A Garfein,Richard S %A Cuevas-Mota,Jazmine %A Collins,Kelly %A Liu,Lin %+ University of California San Diego, School of Medicine, 9500 Gilman Drive, MC-0507, La Jolla, CA, 92093-0507, United States, 1 1 858 822 3018, rgarfein@ucsd.edu %K mHealth %K medication adherence monitoring %K mobile phone %K video technology %K tuberculosis %D 2019 %7 01.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As mHealth apps proliferate, it is necessary for patients to feel capable and comfortable using devices that run them. However, limited research is available on changes in comfort level before and after the use of an mHealth app. Objective: The objective of this study was to determine whether patients with tuberculosis who used an mHealth app called Video Directly Observed Therapy (VDOT) to monitor their antituberculosis treatment became more comfortable using mobile phones after the intervention and to identify factors associated with change in comfort. Methods: We analyzed data from a longitudinal study assessing the feasibility and acceptability of the VDOT app among patients receiving antituberculosis treatment from public health departments in San Diego, San Francisco, and New York City. Comfort levels on six domains of mobile phone use (making phone calls, taking pictures, recording videos, text messaging, internet and email use on the phone) were measured on a 10-point scale (1=very uncomfortable; 10=very comfortable) at the start and end of treatment using VDOT via telephone interviews. The main outcomes were change in comfort level on each domain (recoded as binary measures) and an overall change score (sum of individual measures). Linear and logistic regression analyses were performed to assess whether sociodemographics, risk factors, and VDOT perceptions were associated with change of comfort measures. Results: Among 120 participants with complete data, mean age was 39.8 years (SD 14.8, range 18-87 years), 46.7% (56/120) were female, and 76.7% (92/120) were foreign born. The combined comfort level at baseline was high overall (mean 48.8, SD 14.2, interquartile range 43.0-60.0) and the mean comfort score increased by 1.92 points at follow-up (P=.07). Statistically significant increases in comfort on individual domains included taking pictures (P=.02) and recording videos (P=.002). Females were more likely to have increased comfort in using the internet on the phone compared to males (odds ratio [OR] 3.03, 95% CI 1.08-8.52, P=.04). Participants who worked less hours per week were more likely to have increased comfort recording videos although this did not meet statistical significance (OR 1.03, 95% CI 1.00-1.05, P=.06). Conclusions: Findings suggest that, despite a high level of comfort using mobile phones at baseline, experience using the VDOT app was associated with increased comfort using mobile phone features. Additional research involving participants with lower baseline mobile phone experience is needed. An implication of these findings is that as patients begin to use mHealth apps for one health condition, they could acquire skills and confidence to more quickly adapt to using mHealth apps for other conditions. %M 30707103 %R 10.2196/11638 %U https://mhealth.jmir.org/2019/2/e11638/ %U https://doi.org/10.2196/11638 %U http://www.ncbi.nlm.nih.gov/pubmed/30707103 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e11598 %T Supporting Older Adults in Exercising With a Tablet: A Usability Study %A Mehra,Sumit %A Visser,Bart %A Cila,Nazli %A van den Helder,Jantine %A Engelbert,Raoul HH %A Weijs,Peter JM %A Kröse,Ben JA %+ CREATE-IT Applied Research Centre, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Wibautstraat 2-4, Amsterdam, 1091GM, Netherlands, 31 0621156956, s.mehra@hva.nl %K frail elderly %K aged %K activities of daily living %K exercise %K health behavior %K telemedicine %K mobile devices %K tablet computers %K usability testing %K mobile phone %D 2019 %7 01.02.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback. Objective: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home. Methods: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers. Results: The participants spent 13-85 seconds time-on-task. Moreover, 79% (11/14)-100% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks. Conclusions: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies. %M 30707106 %R 10.2196/11598 %U http://humanfactors.jmir.org/2019/1/e11598/ %U https://doi.org/10.2196/11598 %U http://www.ncbi.nlm.nih.gov/pubmed/30707106 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11954 %T Exploring Community Smokers’ Perspectives for Developing a Chat-Based Smoking Cessation Intervention Delivered Through Mobile Instant Messaging: Qualitative Study %A Luk,Tzu Tsun %A Wong,Sze Wing %A Lee,Jung Jae %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong,, China (Hong Kong), 852 39176636, mpwang@hku.hk %K chat intervention %K instant messaging %K mHealth %K mobile phone %K social media %K smoking cessation %K tobacco dependence %K WhatsApp %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in mobile communication technologies provide a promising avenue for the delivery of tobacco dependence treatment. Although mobile instant messaging (IM) apps (eg, WhatsApp, Facebook messenger, and WeChat) are an inexpensive and widely used communication tool, evidence on its use for promoting health behavior, including smoking cessation, is scarce. Objective: This study aims to explore the perception of using mobile IM as a modality to deliver a proposed chat intervention for smoking cessation in community smokers in Hong Kong, where the proportion of smartphone use is among the highest in the world. Methods: We conducted 5 focus group, semistructured qualitative interviews on a purposive sample of 15 male and 6 female current cigarette smokers (age 23-68 years) recruited from the community in Hong Kong. All interviews were audiotaped and transcribed. Two investigators independently analyzed the transcripts using thematic analyses. Results: Participants considered mobile IM as a feasible and acceptable platform for the delivery of a supportive smoking cessation intervention. The ability to provide more personalized and adaptive behavioral support was regarded as the most valued utility of the IM–based intervention. Other perceived utilities included improved perceived psychosocial support and identification of motivator to quit. In addition, participants provided suggestions on the content and design of the intervention, which may improve the acceptability and usability of the IM–based intervention. These include avoiding health warning information, positive messaging, using former smokers as counselors, and adjusting the language style (spoken vs written) according to the recipients’ preference. Conclusions: This qualitative study provides the first evidence that mobile IM may be an alternative mobile health platform for the delivery of a smoking cessation intervention. Furthermore, the findings inform the development of a chat-based, IM smoking cessation program being evaluated in a community trial. %M 30702431 %R 10.2196/11954 %U https://mhealth.jmir.org/2019/1/e11954/ %U https://doi.org/10.2196/11954 %U http://www.ncbi.nlm.nih.gov/pubmed/30702431 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11919 %T Mobile Phone Apps Targeting Medication Adherence: Quality Assessment and Content Analysis of User Reviews %A Park,Jamie Yea Eun %A Li,Jenny %A Howren,Alyssa %A Tsao,Nicole Wen %A De Vera,Mary %+ Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 2138, mdevera@mail.ubc.ca %K medication adherence %K mobile apps %K mHealth %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the accessibility and widespread use of mobile phones, mobile phone apps targeting medication adherence may be useful tools to help patients take medications as prescribed. Objective: Our objectives were to (1) characterize and assess mobile phone medication adherence apps guided by a conceptual framework on the focus of adherence interventions and (2) conduct a content analysis of Web-based reviews to explore users’ perspectives and experiences with mobile phone medication adherence apps. Methods: We searched for mobile phone medication adherence apps using keyword searches in Apple and Android operating systems. We characterized all apps in terms of number of downloads, ratings, languages, cost, and disease target. We categorized apps according to 4 key features of (1) alerting to take medication, (2) tracking medication taking, (3) reminding to refill or indicating amount of medication left, and (4) storing medication information. We then selected representative apps from each operating system for detailed quality assessment and user testing. We also downloaded Web-based reviews for these selected apps and conducted a qualitative content analysis using an inductive approach involving steps of initial open coding, construction of categories, and abstraction into themes. Results: We identified 704 apps (443 from Apple and 261 from Android). The majority of apps across both operating systems had 1 or 2 features—specifically, 37.2% (165/443) and 38.1% (169/443) of Apple apps, respectively, and 41.4% (108/261) and 31.4% (108/261) of Android apps, respectively. Quality assessment and user testing of 20 selected apps revealed apps varied in quality and commonly focused on behavioral strategies to enhance medication adherence through alerts, reminders, and logs. A total of 1323 eligible Web-based reviews from these 20 selected apps were analyzed, and the following themes emerged: (1) features and functions appreciated by users, which included the ability to set up customized medication regimen details and reminders, monitor other health information (eg, vitals, supplements, and manage multiple people or pets), support health care visits (eg, having a list of medications and necessary health information in 1 app); (2) negative user experiences that captured technical difficulties (glitches, confusing app navigation, and poor interoperability), dosage schedule, and reminder setup inflexibility; and (3) desired functions and features related to optimization of information input, improvement of reminders, and upgrading app performance (better synchronization or backup of data and interoperability). Conclusions: A large number of mobile phone medication adherence apps are currently available. The majority of apps have features representing a behavioral approach to intervention. Findings of the content analysis offer mostly positive feedback as well as insights into current limitations and improvements that could be addressed in current and future medication adherence apps. %M 30702435 %R 10.2196/11919 %U http://mhealth.jmir.org/2019/1/e11919/ %U https://doi.org/10.2196/11919 %U http://www.ncbi.nlm.nih.gov/pubmed/30702435 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e11779 %T A Smartphone App to Support Carers of People Living With Cancer: A Feasibility and Usability Study %A Heynsbergh,Natalie %A Heckel,Leila %A Botti,Mari %A Livingston,Patricia M %+ School of Nursing and Midwifery, Faculty of Health, Deakin University, , Geelong,, Australia, 61 392446333, nheynsb@deakin.edu.au %K cancer %K carer %K mobile app %K smartphone %K technology %K mobile phone %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Carers experience unique needs while caring for someone with cancer. Interventions that address carers’ needs and well-being have been developed and tested; however, the use of smartphone apps to support adult carers looking after another adult with cancer has not been assessed. Objective: The objective of this study was to test the feasibility, usability, and acceptability of a smartphone app, called the Carer Guide App, for carers of people with colorectal cancer. Methods: We recruited carers of people with colorectal cancer from outpatient day oncology units and provided them with access to the smartphone app for 30 days. Carers had access to video instructions and email contact details for technical support. Carers received 2 email messages per week that directed them to resources available within the app. Carers completed demographic questions at baseline and questions related to feasibility and usability at 30 days post app download. We used recruitment and attrition rates to determine feasibility and relevance of content to carers’ needs as self-reported by carers. We assessed usability through the ease of navigation and design and use of technical support or instructional videos. Acceptability was measured through self-reported usage, usage statistics provided by Google Analytics, and comments for improvement. Results: We recruited 31% (26/85) eligible carers into the trial. Of the 26 carers, the majority were female (19, 73%), on average 57 years of age, were caring for a spouse with cancer (19, 73%), and held a university degree (19, 73%). Regarding feasibility, carers perceived the content of the Carer Guide App as relevant to the information they were seeking. Regarding usability, carers perceived the navigation and design of the app as easy to use. Of the 26 carers, 4 (15%) viewed the downloading and navigation video and 7 (27%) used the contact email address for queries and comments. Acceptability: On average, carers used the smartphone app for 22 minutes (SD 21 minutes) over the 30-day trial. Of 26 participants, 19 completed a follow-up questionnaire. Of 19 carers, 7 (37%) logged on 3 to 4 times during the 30 days and 5 (26%) logged on more than 5 times. The majority (16/19, 84%) of carers stated that they would recommend the app be available for all carers. Comments for improvement included individualized requests for specific content. Conclusions: The Carer Guide App was feasible and usable among carers of people with colorectal cancer. Acceptability can be improved through the inclusion of a variety of information and resources. A randomized controlled trial is required to assess the impact of the Carer Guide App on carers’ health and well-being. %M 30702432 %R 10.2196/11779 %U http://cancer.jmir.org/2019/1/e11779/ %U https://doi.org/10.2196/11779 %U http://www.ncbi.nlm.nih.gov/pubmed/30702432 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e12160 %T Usability Challenges for Health and Wellness Mobile Apps: Mixed-Methods Study Among mHealth Experts and Consumers %A Liew,Mei Shan %A Zhang,Jian %A See,Jovis %A Ong,Yen Leng %+ Alliance Manchester Business School, Booth Street West, Manchester, M15 6PB, United Kingdom, 44 161 820 8344, liewmeishan@gmail.com %K mobile applications %K health and wellness mobile applications %K mHealth apps %K health and wellness mobile applications users %K mHealth users %K health and wellness mobile applications insiders %K mHealth insiders %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: By 2019, there will be an estimated 4.68 billion mobile phone users globally. This increase comes with an unprecedented proliferation in mobile apps, a plug-and-play product positioned to improve lives in innumerable ways. Within this landscape, medical apps will see a 41% compounded annual growth rate between 2015 and 2020, but paradoxically, prevailing evidence indicates declining downloads of such apps and decreasing “stickiness” with the intended end users. Objective: As usability is a prerequisite for success of health and wellness mobile apps, this paper aims to provide insights and suggestions for improving usability experience of the mobile health (mHealth) app by exploring the degree of alignment between mHealth insiders and consumers.  Methods: Usability-related major themes were selected from over 20 mHealth app development studies. The list of themes, grouped into 5 categories using the Nielsen usability model, was then used as a framework to identify and classify the responses from mHealth expert (insider) interviews. Responses from the qualitative phase were integrated into some questions for a quantitative consumer survey. Subsequently, categorical data from qualitative mHealth insider interviews and numerical data from a quantitative consumer survey were compared in order to identify common usability themes and areas of divergence. Results: Of the 5 usability attributes described in Nielsen model,  Satisfaction ranked as the top attribute for both mHealth insiders and consumers. Satisfaction refers to user likability, comfort, and pleasure. The consumer survey yielded 451 responses. Out of 9 mHealth insiders’ top concerns, 5 were similar to those of the consumers. On the other hand, consumers did not grade themes such as Intuitiveness as important, which was deemed vital by mHealth insiders. Other concerns of the consumers include in-app charges and advertisements. Conclusions: This study supports and contributes to the existing pool of mixed-research studies. Strengthening the connectivity between suppliers and users (through the designed research tool) will help increase uptake of mHealth apps. In a holistic manner, this will have a positive overall outcome for the mHealth app ecosystem. %M 30698528 %R 10.2196/12160 %U http://mhealth.jmir.org/2019/1/e12160/ %U https://doi.org/10.2196/12160 %U http://www.ncbi.nlm.nih.gov/pubmed/30698528 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11325 %T Barriers to and Facilitators of Engagement With mHealth Technology for Remote Measurement and Management of Depression: Qualitative Analysis %A Simblett,Sara %A Matcham,Faith %A Siddi,Sara %A Bulgari,Viola %A Barattieri di San Pietro,Chiara %A Hortas López,Jorge %A Ferrão,José %A Polhemus,Ashley %A Haro,Josep Maria %A de Girolamo,Giovanni %A Gamble,Peter %A Eriksson,Hans %A Hotopf,Matthew %A Wykes,Til %A , %+ Institute of Psychology, Psychiatry and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 207 848 0762, sara.simblett@kcl.ac.uk %K acceptability %K barriers %K depression %K facilitators %K feasibility %K mHealth %K qualitative %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology has the potential to provide accurate, impactful data on the symptoms of depression, which could improve health management or assist in early detection of relapse. However, for this potential to be achieved, it is essential that patients engage with the technology. Although many barriers to and facilitators of the use of this technology are common across therapeutic areas and technology types, many may be specific to cultural and health contexts. Objective: This study aimed to determine the potential barriers to and facilitators of engagement with mobile health (mHealth) technology for remote measurement and management of depression across three Western European countries. Methods: Participants (N=25; 4:1 ratio of women to men; age range, 25-73 years) who experienced depression participated in five focus groups held in three countries (two in the United Kingdom, two in Spain, and one in Italy). The focus groups investigated the potential barriers to and facilitators of the use of mHealth technology. A systematic thematic analysis was used to extract themes and subthemes. Results: Facilitators and barriers were categorized as health-related factors, user-related factors, and technology-related factors. A total of 58 subthemes of specific barriers and facilitators or moderators emerged. A core group of themes including motivation, potential impact on mood and anxiety, aspects of inconvenience, and ease of use was noted across all countries. Conclusions: Similarities in the barriers to and facilitators of the use of mHealth technology have been observed across Spain, Italy, and the United Kingdom. These themes provide guidance on ways to promote the design of feasible and acceptable cross-cultural mHealth tools. %M 30698535 %R 10.2196/11325 %U http://mhealth.jmir.org/2019/1/e11325/ %U https://doi.org/10.2196/11325 %U http://www.ncbi.nlm.nih.gov/pubmed/30698535 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e10814 %T Usability and Acceptability of a Text Message-Based Developmental Screening Tool for Young Children: Pilot Study %A Johnson,Pamela Ryden %A Bushar,Jessica %A Dunkle,Margaret %A Leyden,Sharon %A Jordan,Elizabeth T %+ Voxiva, Inc, 1101 Wilson Boulevard, Arlington, VA, 22209, United States, 1 202 251 1423, pamelajohnson999@gmail.com %K developmental screening %K EPSDT %K ITP %K low income %K Medicaid %K mHealth %K mobile health %K Text4baby %K text messaging %K PEDS:DM %K WIC %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Only 30% of parents of children aged 9-35 months report that their child received a developmental screening in the previous year. Screening rates are even lower in low-income households, where the rates of developmental delays are typically higher than those in high-income households. Seeking to evaluate ways to increase developmental screening, Text4baby, a national perinatal texting program, created an interactive text message-based version of a validated developmental screening tool for parents. Objective: This study aimed to assess whether a text message-based developmental screening tool is usable and acceptable by low-income mothers. Methods: Low-income mothers of infants aged 8-10 months were recruited from the Women, Infants and Children Program clinics in Prince George’s County, MD. Once enrolled, participants used text messages to receive and respond to six developmental screening questions from the Parents’ Evaluation of Developmental Status: Developmental Milestones. After confirming their responses, participants received the results and feedback. Project staff conducted a follow-up phone survey and invited a subset of survey respondents to attend focus groups. A representative of the County’s Infants and Toddlers Program met with or called participants whose results indicated that their infants “may be behind.” Results: Eighty-one low-income mothers enrolled in the study, 93% of whom reported that their infants received Medicaid (75/81). In addition, 49% of the mothers were Hispanic/Latina (40/81) and 42% were African American (34/81). A total of 80% participated in follow-up surveys (65/81), and 14 mothers attended focus groups. All participants initiated the screening and responded to all six screening questions. Of the total, 79% immediately confirmed their responses (64/81), and 21% made one or more changes (17/81). Based on the final responses, 63% of participants received a text that the baby was “doing well” in all six developmental domains (51/81); furthermore, 37% received texts listing domains where their baby was “doing well” and one or more domains where their baby “may be behind” (30/81). All participants received a text with resources for follow-up. In a follow-up survey reaching 65 participants, all respondents said that they would like to answer screening questions again when their baby was older. All but one participant would recommend the tool to a friend and rated the experience of answering questions and receiving feedback by text as “very good” or “good.” Conclusions: A mobile text version of a validated developmental screening tool was both usable and acceptable by low-income mothers, including those whose infants “may be behind.” Our results may inform further research on the use of the tool at older ages and options for a scalable, text-based developmental screening tool such as that in Text4baby. %M 31518329 %R 10.2196/10814 %U http://pediatrics.jmir.org/2019/1/e10814/ %U https://doi.org/10.2196/10814 %U http://www.ncbi.nlm.nih.gov/pubmed/31518329 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e11596 %T The Table to Tablet (T2T) Speech and Language Therapy Software Development Roadmap %A Jesus,Luis MT %A Santos,Joaquim %A Martinez,Joana %+ University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193 Aveiro, Portugal, 351 234372458 ext 22117, lmtj@ua.pt %K software %K tablets %K children %K speech sound disorders %K design-based research %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Few studies have analyzed gains in using computers in speech and language therapy interventions for children with speech and/or language disorders when compared to a control group, but virtual tutors and computer-based visual feedback have been gaining interest in the literature. Previous systematic reviews mainly focused on development technological details of computer-based speech training systems or the potential of integrating mobile technology into education and rehabilitation, but recent systematic reviews have also evaluated the efficacy of computer-based speech and language therapy for children and how digital technology can support different activities, at school or elsewhere. Objective: This study aimed to analyze a continuous communication and joint team approach to develop solutions focused on the real needs of end users, which digitally emulate reliable and validated physical intervention materials for children with speech sound disorders (SSD). Methods: The Table to Tablet (T2T) software was developed using a design-based research methodology, which included four phases: activities development; ethnographic pretesting with a sample from the target population; software development; and beta-testing. The technology used to develop the software, the method used to ensure satisfaction and replay ability of the intervention materials, and results from the ethnographic and beta-testing phases are presented. Results: Nineteen activities were developed during the first phase, which were then tested, with 7 service users, using a physical prototype. The beta-test approach included extensive testing and reformulation, supported by direct, nonparticipant observation and data collection using a questionnaire designed for children. Feedback was used to improve the software and interaction with users. Conclusions: The use of T2T-based intervention programmes by speech and language therapists (SLTs) will allow these professionals to make a better and more effective communication intervention, based on proven methodologies, that coexists in a structured physical and a digital version. These versions provide a full, 6-week intervention program, with minimal effort in preparing the session by the SLTs while delivering a very consistent intervention, with high replay value. A continuous communication and joint team approach was beneficial to the project and to the development of a solution focused on the real needs of SLTs and children with SSD. All problems were approached as a team with different skills and expertise, which minimized errors (eg, the developer making choices that would save him from spending time doing something that would not be used) and time spent. To add to this, the importance of integrating the end users as testers and collecting their opinions and actions per session allowed the production of better-targeted activities. Trial Registration: ClinicalTrials.gov NCT02490826; https://clinicaltrials.gov/ct2/show/NCT02490826 %M 30698534 %R 10.2196/11596 %U http://www.researchprotocols.org/2019/1/e11596/ %U https://doi.org/10.2196/11596 %U http://www.ncbi.nlm.nih.gov/pubmed/30698534 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10956 %T A Patient-Centered Mobile Health System That Supports Asthma Self-Management (breathe): Design, Development, and Utilization %A Morita,Plinio Pelegrini %A Yeung,Melanie S %A Ferrone,Madonna %A Taite,Ann K %A Madeley,Carole %A Stevens Lavigne,Andrea %A To,Teresa %A Lougheed,M Diane %A Gupta,Samir %A Day,Andrew G %A Cafazzo,Joseph A %A Licskai,Christopher %+ School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 31372, plinio.morita@uwaterloo.ca %K smartphone %K asthma %K self report %K self-management %K patient compliance %K telemedicine %K risk reduction behavior %K internet %K monitoring, physiologic %K mobile applications %D 2019 %7 28.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Uncontrolled asthma poses substantial negative personal and health system impacts. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes. Objective: The aim of this study was to design, develop, and assess the utilization of an asthma collaborative self-management (CSM) platform (breathe) using content based on international evidence-based clinical guidelines. Methods: We designed and developed breathe as a Web-based mobile health (mHealth) platform accessible on smartphones, tablets, or desktop with user-centered design methods and International Organization for Standardization–certified quality development processes. Moreover, breathe was envisioned as a multifunctional, CSM mHealth platform, with content based on international clinical practice guidelines and compliant with national privacy and security specifications. The system enabled CSM (patient, provider, and breathe) and self-monitoring of asthma patients through (1) assessment of asthma control, (2) real-time access to a dynamic asthma action plan, (3) access to real-time environmental conditions, and (4) risk-reduction messaging. The data collection protocol collected user data for 12 months, with clinic visits at baseline and 6 and 12 months. Utilization outcomes included user interactions with the platform, user impressions, self-reported medication use, asthma symptom profile, reported peak flow measurement, and the delivery and impact of email reminders. Results: We enrolled 138 patients with a mean age of 45.3 years to receive the breathe intervention. Majority were female (100/138, 72.5%), had a smartphone (92/138, 66.7%), and had a mean Asthma Control Test score of 18.3 (SD 4.9). A majority reported that breathe helped in the management of their asthma. Moreover, breathe scored 71.1 (SD 18.9) on the System Usability Scale. Overall, 123 patients had complete usage analytics datasets. The platform sent 7.96 reminder emails per patient per week (pppw), patients accessed breathe 3.08 times, journaled symptoms 2.56 times, reported medication usage 0.30 times, and reported peak flow measurements 0.92 times pppw. Furthermore, breathe calculated patients’ action plan zone of control 2.72 times pppw, with patients being in the green (well-controlled) zone in 47.71% (8300/17,396) of the total calculations. Usage analysis showed that 67.5% (83/123) of the participants used the app at week 4 and only 57.7% (71/123) by week 45. Physician visits, email reminders, and aged 50 years and above were associated with higher utilization. Conclusions: Individuals with asthma reported good usability and high satisfaction levels, reacted to breathe notifications, and had confidence in the platform’s assessment of asthma control. Strong utilization was seen at the intervention’s initiation, followed by a rapid reduction in use. Patient reminders, physician visits, and being aged 50 years and above were associated with higher utilization. Trial Registration: ClinicalTrials.gov NCT01964469; https://clinicaltrials.gov/ct2/show/NCT01964469 %M 30688654 %R 10.2196/10956 %U http://mhealth.jmir.org/2019/1/e10956/ %U https://doi.org/10.2196/10956 %U http://www.ncbi.nlm.nih.gov/pubmed/30688654 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10353 %T Mobile Apps for Management of Tinnitus: Users’ Survey, Quality Assessment, and Content Analysis %A Sereda,Magdalena %A Smith,Sandra %A Newton,Kiri %A Stockdale,David %+ National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom, 44 1158232600, Magdalena.Sereda@nottingham.ac.uk %K tinnitus %K mobile apps %K disease management %K surveys and questionnaires %K Mobile Apps Rating Scale %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tinnitus is the perception of a sound without any outside source. It affects 6 million people in the United Kingdom. Sound therapy is a core component of many tinnitus management programs. Potential mechanisms of benefit include making tinnitus less noticeable, habituation, distracting attention from tinnitus, relaxation, and promoting neuroplastic changes within the brain. In recent years, there has been a substantial increase in the use of mobile technology. This provided an additional medium through which people with tinnitus can access different tinnitus management options, including sound therapy. Objective: The aim of this study was to (1) generate the list of apps that people use for management of their tinnitus, (2) explore reasons for app use and nonuse, (3) perform quality assessment of the most cited apps, and (4) perform content analysis to explore and describe options and management techniques available in the most cited apps. Methods: A Web-based survey consisting of 33 open and closed questions captured (1) demographic information, information about tinnitus, and hearing loss and (2) mobile app–specific information about the motivation to use an app, the apps which respondents used for tinnitus, important factors when choosing an app, devices used to access apps, and reasons for not using apps. The quality of the most cited apps was assessed using the Mobile Apps Rating Scale (MARS). Content and features of the most cited apps were analyzed. Results: Data from 643 respondents were analyzed. The majority of respondents (482/643, 75.0%) had never used an app for management of tinnitus mainly because of lack of awareness (381/643, 59.3%). The list of the 55 apps that people use for their tinnitus was generated. These included apps that were developed specifically for the management of tinnitus; however, the majority of cited apps were developed for other problems (eg, sleep, depression or anxiety, and relaxation). Quality assessment of the 18 most popular apps using MARS resulted in a range of mean scores from 1.6 to 4.2 (out of 5). In line with the current model of tinnitus management, sound was the main focus of the majority of the apps. Other components included relaxation exercises, elements of cognitive behavioral therapy, information and education, and hypnosis. Conclusions: People used apps for the management of their tinnitus; however, this was done mostly as a self-help option, without conjunction with management provided by hearing health care professionals. Further research should consider the place for apps in tinnitus management (stand-alone self-management intervention vs part of the management by a hearing professional). As the content of the apps varies with respect to sound options, information, and management strategies, it seems that the choice of the best management app should be guided by individual patient’s needs and preferences. %M 30672739 %R 10.2196/10353 %U http://mhealth.jmir.org/2019/1/e10353/ %U https://doi.org/10.2196/10353 %U http://www.ncbi.nlm.nih.gov/pubmed/30672739 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9836 %T Assessing the Quality of Mobile Phone Apps for Weight Management: User-Centered Study With Employees From a Lebanese University %A Bardus,Marco %A Ali,Ahmed %A Demachkieh,Farah %A Hamadeh,Ghassan %+ Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, PO Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon, 961 1 350 000 ext 4694, marco.bardus@gmail.com %K mobile apps %K weight loss %K physical activity %K healthy diet %K workplace %K mHealth %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evaluating the quality of mobile health apps for weight loss and weight management is important to understand whether these can be used for obesity prevention and treatment. Recent reviews call for more research on multidimensional aspects of app quality, especially involving end users, as there are already many expert reviews on this domain. However, no quantitative study has investigated how laypersons see popular apps for weight management and perceive different dimensions of app quality. Objective: This study aimed to explore how laypersons evaluate the quality of 6 free weight management apps (My Diet Coach, SparkPeople, Lark, MyFitnessPal, MyPlate, and My Diet Diary), which achieved the highest quality ratings in a related and recent expert review. Methods: A user-centered study was conducted with 36 employees of a Lebanese university. Participants enrolled in the study on a rolling basis between October 2016 and March 2017. Participants were randomly assigned an app to use for 2 weeks. App quality was evaluated at the end of the trial period using the Mobile App Rating Scale user version (uMARS). uMARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. Internal consistency and interrater agreement were examined. The associations between uMARS scores and users’ demographic characteristics were also explored using nonparametric tests. Analyses were completed in November 2017. Results: Overall, the 6 apps were of moderately good quality (median uMARS score 3.6, interquartile range [IQR] 0.3). The highest total uMARS scores were achieved by Lark (mean 4.0 [SD 0.5]) and MyPlate (mean 3.8 [SD 0.4]), which also achieved the highest subjective quality scores (Lark: mean 3.3 [SD 1.4]; MyPlate: mean 3.3 [SD 0.8]). Functionality was the domain with the highest rating (median 3.9, IQR 0.3), followed by aesthetics (median 3.7, IQR 0.5), information (median 3.7, IQR 0.1), and engagement (median 3.3, IQR 0.2). Subjective quality was judged low (median 2.5, IQR 0.9). Overall, subjective quality was strongly and positively related (P<.001) with total uMARS score (ρ=.75), engagement (ρ=.68), information, and aesthetics (ρ=.60) but not functionality (ρ=.40; P=.02). Higher engagement scores were reported among healthy (P=.003) and obese individuals (P=.03), who also showed higher total uMARS (P=.04) and subjective quality (P=.05) scores. Conclusions: Although the apps were considered highly functional, they were relatively weak in engagement and subjective quality scores, indicating a low propensity of using the apps in the future. As engagement was the subdomain most strongly associated with subjective quality, app developers and researchers should focus on creating engaging apps, holding constant the functionality, aesthetics, and information quality. The tested apps (in particular Lark and MyPlate) were perceived as more engaging and of higher quality among healthy, obese individuals, making them a promising mode of delivery for self-directed interventions promoting weight control among the sampled population or in similar and comparable settings. %M 30672742 %R 10.2196/mhealth.9836 %U https://mhealth.jmir.org/2019/1/e9836/ %U https://doi.org/10.2196/mhealth.9836 %U http://www.ncbi.nlm.nih.gov/pubmed/30672742 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11730 %T Public Views on Using Mobile Phone Call Detail Records in Health Research: Qualitative Study %A Jones,Kerina Helen %A Daniels,Helen %A Heys,Sharon %A Ford,David Vincent %+ Population Data Science, School of Medicine, Swansea University, , Swansea,, United Kingdom, 44 1792602764, k.h.jones@swansea.ac.uk %K qualitative research %K mobile phone use %D 2019 %7 16.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone call detail records (CDRs) are increasingly being used in health research. The location element in CDRs is used in various health geographic studies, for example, to track population movement and infectious disease transmission. Vast volumes of CDRs are held by multinational organizations, which may make them available for research under various data governance regimes. However, there is an identified lack of public engagement on using CDRs for health research to contribute to an ethically founded framework. Objective: This study aimed to explore public views on the use of call detail records in health research. Methods: Views on using CDRs in health research were gained via a series of three public workshops (N=61) informed by a pilot workshop of 25 people. The workshops included an initial questionnaire to gauge participants’ prior views, discussion on health research using CDRs, and a final questionnaire to record workshop outcome views. The resulting data were analyzed for frequencies and emerging themes. Results: At the outset, most participants (66%, 40/61) knew that location data were collected by operators, but only 3% (2/61) knew they were being used for health research. Initially, the majority of the participants (62%, 38/61) was content for their anonymous CDRs to be used, and this increased (80%, 49/61) after the discussion explained that safeguards were in place. Participants highlighted that terms and conditions should be clearer, as should information to phone users on data collection, privacy safeguards, sharing, and uses in research. Conclusions: This is the first known study exploring public views of using mobile phone CDRs in health research. It revealed a lack of knowledge among the public on uses of CDRs and indicated that people are generally amenable to the use of anonymized data for research, but they want to be properly informed and safeguarded. We recommend that public views be incorporated into an ethically founded framework for the use of CDRs in health research to promote awareness and social acceptability in data use. %M 30664467 %R 10.2196/11730 %U https://mhealth.jmir.org/2019/1/e11730/ %U https://doi.org/10.2196/11730 %U http://www.ncbi.nlm.nih.gov/pubmed/30664467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e12269 %T Investigating the Adoption of Mobile Health Services by Elderly Users: Trust Transfer Model and Survey Study %A Meng,Fanbo %A Guo,Xitong %A Peng,Zeyu %A Lai,Kee-Hung %A Zhao,Xinli %+ eHealth Research Institute, School of Management, Harbin Institute of Technology, 92 Xidazhi Street, Nangang District, Harbin,, China, 86 451 86414022, xitongguo@hit.edu.cn %K mobile health %K trust %K health services for the elderly %K adoption %K health behavior %D 2019 %7 08.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although elderly users comprise a major user group in the field of mobile health (mHealth) services, their adoption rate of such services is relatively low compared with their use of traditional health services. Increasing the adoption rate of mHealth services among elderly users is beneficial to the aging process. Objective: This study aimed to examine the determinants of mHealth service use intentions using a trust transfer model among elderly users facing declining physiological conditions and lacking support from hospitals. Methods: A survey comprising 395 users aged 60 years and above was conducted in China to validate our research model and hypotheses. Results: The results reveal that (1) trust in mHealth services positively influences use intentions, (2) trust in offline health services positively influences trust in mHealth services, (3) declining physiological conditions strengthen the effects of trust in offline health services regarding trust in mHealth services, (4) support from hospitals weakens the effects of trust in mHealth services on use intentions, and (5) the relationship between trust in offline health services and intention to use mHealth services is partially mediated by trust in mHealth services. The independent variables and moderators collectively explain a 48.3% variance in the use intention of mHealth services. Conclusions: We conclude that the trust transfer theory is useful in explaining the development of initial trust in mHealth services. In addition, declining physiological conditions and support from hospitals are important factors for investigating the adoption of mHealth services among elderly users. %M 30622092 %R 10.2196/12269 %U http://mhealth.jmir.org/2019/1/e12269/ %U https://doi.org/10.2196/12269 %U http://www.ncbi.nlm.nih.gov/pubmed/30622092 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e202 %T An mHealth App for Users with Dexterity Impairments: Accessibility Study %A Yu,Daihua %A Parmanto,Bambang %A Dicianno,Brad %+ Health & Rehab Informatics, Department of Health Information Management, University of Pittsburgh, 6026 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K accessibility %K dexterity impairments %K disability %K mHealth %K self-management %K smartphone apps %K spina bifida %K spinal cord injury %K wellness %K mobile phone %D 2019 %7 08.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A mobile health (mHealth) system called iMHere (interactive mobile health and rehabilitation) was developed to support individuals with chronic conditions and disability in their self-management regimens. The initial design of iMHere, however, lacked sufficient accessibility for users with a myriad of dexterity impairments. The accessibility of self-management apps is essential in ensuring usability. Objective: This study aims to increase the usability of the iMHere system for users with dexterity impairments by increasing the app’s accessibility. Methods: We targeted the accessibility redesign by focusing on the physical presentation and the navigability of the iMHere apps. Six participants presenting with dexterity impairments were included in the usability study of the original and redesigned apps. Results: We observed a lower number of touches needed to complete tasks (P=.09) and time to complete individual tasks (P=.06) with the redesigned app than with the original app; a significantly lower time for users to complete all tasks (P=.006); and a significantly lower error rate (P=.01) with the redesigned app than with the original app. In fact, no errors occurred with use of the redesigned app. Participant-reported overall average usability of the redesigned app (P=.007) and usability of individual modules (P<.001) were significantly higher than that of the original app due mostly to better ease of use and learnability, interface quality, and reliability. Conclusions: Improved usability was achieved using a redesigned app. This study offers insight into the importance of personalization in enhancing the accessibility and also identifies strategies for improving usability in app development. %M 30622096 %R 10.2196/mhealth.9931 %U https://mhealth.jmir.org/2019/1/e202/ %U https://doi.org/10.2196/mhealth.9931 %U http://www.ncbi.nlm.nih.gov/pubmed/30622096 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e12232 %T Usability Testing of a Mobile App to Report Medication Errors Anonymously: Mixed-Methods Approach %A George,Doris %A Hassali,Mohamed Azmi %A HSS,Amar-Singh %+ Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, 11800, Malaysia, 60 052085555 ext 5293, doris.moh.gov@gmail.com %K mobile app %K usability %K medication error reporting %K anonymous %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Reporting of medication errors is one of the essential mechanisms to identify risky health care systems and practices that lead to medication errors. Unreported medication errors are a real issue; one of the identified causes is a burdensome medication error reporting system. An anonymous and user-friendly mobile app for reporting medication errors could be an alternative method of reporting medication error in busy health care settings. Objective: The objective of this paper is to report usability testing of the Medication Error Reporting App (MERA), a mobile app for reporting medication errors anonymously. Methods: Quantitative and qualitative methods were employed involving 45 different testers (pharmacists, doctors, and nurses) from a large tertiary hospital in Malaysia. Quantitative data was retrieved using task performance and rating of MERA and qualitative data were retrieved through focus group discussions. Three sessions, with 15 testers each session, were conducted from January to March 2018. Results: The majority of testers were pharmacists (23/45, 51%), female (35/45, 78%), and the mean age was 36 (SD 9) years. A total of 135 complete reports were successfully submitted by the testers (three reports per tester) and 79.2% (107/135) of the reports were correct. There was significant improvement in mean System Usability Scale scores in each session of the development process (P<.001) and mean time to report medication errors using the app was not significantly different between each session (P=.70) with an overall mean time of 6.7 (SD 2.4) minutes. Testers found the app easy to use, but doctors and nurses were unfamiliar with terms used especially medication process at which error occurred and type of error. Although, testers agreed the app can be used in the future for reporting, they were apprehensive about security, validation, and abuse of feedback featured in the app. Conclusions: MERA can be used to report medication errors easily by various health care personnel and it has the capacity to provide feedback on reporting. However, education on medication error reporting should be provided to doctors and nurses in Malaysia and the security of the app needs to be established to boost reporting by this method. %M 30578216 %R 10.2196/12232 %U http://humanfactors.jmir.org/2018/4/e12232/ %U https://doi.org/10.2196/12232 %U http://www.ncbi.nlm.nih.gov/pubmed/30578216 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11468 %T Unveiling the Black Box of Diagnostic and Clinical Decision Support Systems for Antenatal Care: Realist Evaluation %A Abejirinde,Ibukun-Oluwa Omolade %A Zweekhorst,Marjolein %A Bardají,Azucena %A Abugnaba-Abanga,Rudolf %A Apentibadek,Norbert %A De Brouwere,Vincent %A van Roosmalen,Jos %A Marchal,Bruno %+ Athena Institute, Faculty of Science, Vrije Universiteit, WN Building, S-544, De Boelelaan 1105, Amsterdam, 1081HV, Netherlands, 31 205983143, i.o.abejirinde@vu.nl %K systems analysis %K Ghana %K clinical decision support %K antenatal care %K mHealth %K program evaluation %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital innovations have shown promise for improving maternal health service delivery. However, low- and middle-income countries are still at the adoption-utilization stage. Evidence on mobile health has been described as a black box, with gaps in theoretical explanations that account for the ecosystem of health care and their effect on adoption mechanisms. Bliss4Midwives, a modular integrated diagnostic kit to support antenatal care service delivery, was piloted for 1 year in Northern Ghana. Although both users and beneficiaries valued Bliss4Midwives, results from the pilot showed wide variations in usage behavior and duration of use across project sites. Objective: To strengthen the design and implementation of an improved prototype, the study objectives were two-fold: to identify causal factors underlying the variation in Bliss4Midwives usage behavior and understand how to overcome or leverage these in subsequent implementation cycles. Methods: Using a multiple case study design, a realist evaluation of Bliss4Midwives was conducted. A total of 3 candidate program theories were developed and empirically tested in 6 health facilities grouped into low and moderate usage clusters. Quantitative and qualitative data were collected and analyzed using realist thinking to build configurations that link intervention, context, actors, and mechanisms to program outcomes, by employing inductive and deductive reasoning. Nonparametric t test was used to compare the perceived usefulness and perceived ease of use of Bliss4Midwives between usage clusters. Results: We found no statistically significant differences between the 2 usage clusters. Low to moderate adoption of Bliss4Midwives was better explained by fear, enthusiasm, and high expectations for service delivery, especially in the absence of alternatives. Recognition from pregnant women, peers, supervisors, and the program itself was a crucial mechanism for device utilization. Other supportive mechanisms included ownership, empowerment, motivation, and adaptive responses to the device, such as realignment and negotiation. Champion users displayed high adoption-utilization behavior in contexts of participative or authoritative supervision, yet used the device inconsistently. Intervention-related (technical challenges, device rotation, lack of performance feedback, and refresher training), context-related (staff turnover, competing priorities, and workload), and individual factors (low technological self-efficacy, baseline knowledge, and internal motivation) suppressed utilization mechanisms. Conclusions: This study shed light on optimal conditions necessary for Bliss4Midwives to thrive in a complex social and organizational setting. Beyond usability and viability studies, advocates of innovative technologies for maternal care need to consider how implementation strategies and contextual factors, such as existing collaborations and supervision styles, trigger mechanisms that influence program outcomes. In addition to informing scale-up of the Bliss4Midwives prototype, our results highlight the need for interventions that are guided by research methods that account for complexity. %M 30578177 %R 10.2196/11468 %U http://mhealth.jmir.org/2018/12/e11468/ %U https://doi.org/10.2196/11468 %U http://www.ncbi.nlm.nih.gov/pubmed/30578177 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10932 %T Usability Evaluation of a Mobile Phone–Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study %A Moradian,Saeed %A Krzyzanowska,Monika K %A Maguire,Roma %A Morita,Plinio P %A Kukreti,Vishal %A Avery,Jonathan %A Liu,Geoffrey %A Cafazzo,Joseph %A Howell,Doris %+ Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, , Toronto, ON,, Canada, 1 416 946 4501 ext 3419, Doris.Howell@uhn.ca %K mobile apps %K mobile health %K mobile phone %K patient-centered care %K patient remote monitoring %K self-care %K symptom management %K usability testing %K mobile phone %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: As most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients with cancer, using patient-reported outcomes questionnaires and a clinician alerting system. Objective: This study aims to evaluate the usability of the ASyMS, a mobile phone–based technology, from the perspective of Canadian patients with cancer receiving chemotherapy to identify existing design, functionality, and usability issues and elicit their views, experiences, and satisfaction with the ASyMS. Methods: We used a mixed-method approach to data collection with user-based testing, a think-aloud technique, semistructured interviews, and short answer questionnaires with a purposive sample of 10 patients with cancer. Participants attended usability testing sessions at the Centre for Global eHealth Innovation, University Health Network, and performed specific tasks on the ASyMS device. The test was videorecorded and each task was timed during the test. After the usability sessions, participants completed a posttest questionnaire and participated in a semistructured qualitative interview. A thematic analysis was used to code and categorize the identified issues into themes that summarized the type and frequency of occurrence. Results: The thematic analysis generated 3 overarching themes as follows: ASyMS user-friendliness; usefulness of ASyMS (content quality and richness); and intention to use. Results from the posttest questionnaire indicated that 80% (8/10) of participants had great motivation to use the ASyMS, 70% (7/10) had positive perceptions of the successful use of the ASyMS, and all (10/10, 100%) had a positive attitude toward using the ASyMS in the future. Most identified design and functionality issues were related to the navigation of the ASyMS device and a desire for a more attractive design with advanced functionality and features. The main general design recommendations were as follows: enhance the readability of the screen; implement advance options (eg, search option); and support better navigation. Conclusions: The ASyMS has shown positive perceptions of patients in usability testing and qualitative interviews. An evaluation of the effects of the ASyMS on symptom outcomes in a clinical trial is needed. %M 30578238 %R 10.2196/10932 %U http://cancer.jmir.org/2018/2/e10932/ %U https://doi.org/10.2196/10932 %U http://www.ncbi.nlm.nih.gov/pubmed/30578238 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11692 %T Developing Typologies of User Engagement With the BRANCH Alcohol-Harm Reduction Smartphone App: Qualitative Study %A Milward,Joanna %A Deluca,Paolo %A Drummond,Colin %A Kimergård,Andreas %+ Addictions Department, King's College London, Addictions Sciences Building, 4 Windsor Walk, London, SE58BB, United Kingdom, 44 02087 848 0437, joanna.milward@kcl.ac.uk %K young adults %K binge drinking %K drinking %K smartphone %K mobile phone %K mHealth %D 2018 %7 13.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Understanding how users engage with electronic screening and brief intervention (eSBI) is a critical research objective to improve effectiveness of app-based interventions to reduce harmful alcohol consumption. Although quantitative measures of engagement provide a strong indicator of how the user engages with an app at the group level, they do not elucidate finer-grained details of how apps function from an individual, experiential perspective and why, or how, users engage with an intervention in a particular manner. Objective: The aim of this study was to (1) understand why and how participants engaged with the BRANCH app, (2) explore facilitators and barriers to engagement with app features, (3) explore how the BRANCH app impacted drinking behavior, (4) use these data to identify typologies of users of the BRANCH app in terms of engagement behaviors, and (5) identify future eSBI app design implications. Methods: In total, 20 one-to-one semistructured telephone interviews were conducted with participants recruited from a randomized controlled trial, which evaluated the effectiveness of engagement-promoting strategies in the BRANCH app targeting harmful drinking in young adults (aged 18-30 years). The topic guide explored users’ current engagement levels with existing health promotion apps, their views toward the effectiveness of such apps, and what they liked and disliked about BRANCH, specifically focusing on how they engaged with the app. Framework analysis was used to develop typologies of user engagement. Results: The study identified 3 typologies of engagers. Trackers were defined by their motivations to use health-tracking apps to monitor and understand quantified self-data. They did not have intentions necessarily to cut down and predominantly used only the drinking diary. Cut-downers were motivated to use the app because they wanted to reduce their alcohol consumption Unlike Trackers, they did not use a range of different health apps daily, but saw the BRANCH app as an opportunity to test out a different method of trying to cut down their alcohol use. This typology used more features than Trackers, such as the goal setting function. Noncommitters were characterized as a group of users who were initially enthusiastic about using the app; however, this enthusiasm quickly waned and they gained no benefit from it. Conclusions: This was the first study to identify typologies of user engagement with eSBI apps. Although in need of replication, it provides a first step in understanding independent categories of eSBI users, who may benefit from apps tailored to a user’s typology or motivation. It also provides new evidence to suggest that apps may be used more effectively as a tool to raise awareness of drinking, instead of reducing alcohol use, and be a step in the care pathway, identifying at-risk individuals and signposting them to more intensive treatment. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN70980706; http://www.isrctn.com /ISRCTN70980706 (Archived by WebCite at http://www.webcitation.org/73vfDXYEZ) %M 30545806 %R 10.2196/11692 %U https://mhealth.jmir.org/2018/12/e11692/ %U https://doi.org/10.2196/11692 %U http://www.ncbi.nlm.nih.gov/pubmed/30545806 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11176 %T Providing a Smart Healthy Diet for the Low-Income Population: Qualitative Study on the Usage and Perception of a Designed Cooking App %A Régnier,Faustine %A Dugré,Manon %A Darcel,Nicolas %A Adamiec,Camille %+ Institut National de la Recherche Agronomique, Alimentation et Sciences Sociales Unité de Recherche 1303, University of Paris Saclay, 65 boulevard de Brandebourg, Ivry-sur-Seine cedex, 94205, France, 33 49596914, faustine.regnier@inra.fr %K health %K cooking %K mobile phone %K low-income population %K social networks %K utilization %D 2018 %7 23.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health behaviors among low-income groups have become a major issue in the context of increasing social inequalities. The low-income population is less likely to be receptive to nutritional recommendations, but providing cooking advice could be more effective. In this domain, taking advantage of digital devices can be a bonus with its own challenges. Objective: The aim of this study was to develop and deploy NutCracker, a social network–based cooking app for low-income population, including cooking tips and nutritional advices, aiming at creating small online communities. We further determined the usefulness, perceptions, barriers, and motivators to use NutCracker. Methods: The smartphone app, designed jointly with beneficiaries of the social emergency services, was implemented in a disadvantaged neighborhood of Magny, (Paris region, France). Once the app became available, 28 subjects, living in the neighborhood, tested the app for a 6-month period. Logs to the app and usages were collected by the software. In total, 12 in-depth, semistructured interviews were conducted among the users and the social workers to analyze their uses and perceptions of the app relative to their interest in cooking, cooking skills, socioeconomic constraints, and social integration. These interviews were compared with 21 supplementary interviews conducted among low-income individuals in the general population. Results: NutCracker was developed as a social network–based app, and it includes cooking tips, nutritional advice, and Web-based quizzes. We identified barriers to uses (especially technical barriers, lack of knowledge in the field of new technologies and written comprehension, and search for real contacts) and motivators (in particular, good social integration, previous use of social networks, and help of children as intermediaries). Cooking skills were both a barrier and a lever. Conclusions: Targeting the low-income groups through a cooking app to promote healthier behaviors offers many advantages but has not been fully explored. However, the barriers in low-income milieu remain high, especially among the less socially integrated strata. Lessons from this intervention allow us to identify barriers and possible levers to improve nutrition promotion and awareness in deprived areas, especially in the time of social crisis. %M 30470677 %R 10.2196/11176 %U http://mhealth.jmir.org/2018/11/e11176/ %U https://doi.org/10.2196/11176 %U http://www.ncbi.nlm.nih.gov/pubmed/30470677 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e196 %T Preferences of Underserved Chilean Women on a Mobile Technology Intervention for Cervical Cancer Screening: Qualitative Study %A Soto,Mauricio %A Martinez-Gutierrez,Javiera %A Momany,McKenzie %A Capurro,Daniel %A Ciampi Spode,Francis %A Cea,Emilia %A Mergudich,Tania %A Puschel,Klaus %+ Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4686, Macul, Santiago,, Chile, 56 223548688, jmartigu@uc.cl %K mHealth %K cancer screening %K Latina women %D 2018 %7 20.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations. Objective: The objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates. Methods: We conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)–based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis. Results: Focus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates. Conclusions: This study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations. %M 30459141 %R 10.2196/mhealth.9494 %U http://mhealth.jmir.org/2018/11/e196/ %U https://doi.org/10.2196/mhealth.9494 %U http://www.ncbi.nlm.nih.gov/pubmed/30459141 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11066 %T Usability Study of Mainstream Wearable Fitness Devices: Feature Analysis and System Usability Scale Evaluation %A Liang,Jun %A Xian,Deqiang %A Liu,Xingyu %A Fu,Jing %A Zhang,Xingting %A Tang,Buzhou %A Lei,Jianbo %+ Center for Medical Informatics, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 8280 5901, jblei@hsc.pku.edu.cn %K wearable devices %K usability %K System Usability Scale %K function comparison %K fitness %D 2018 %7 08.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable devices have the potential to promote a healthy lifestyle because of their real-time data monitoring capabilities. However, device usability is a critical factor that determines whether they will be adopted on a large scale. Usability studies on wearable devices are still scarce. Objective: This study aims to compare the functions and attributes of seven mainstream wearable devices and to evaluate their usability. Methods: The wearable devices selected were the Apple Watch, Samsung Gear S, Fitbit Surge, Jawbone Up3, Mi Band, Huawei Honor B2, and Misfit Shine. A mixed method of feature comparison and a System Usability Scale (SUS) evaluation based on 388 participants was applied; the higher the SUS score, the better the usability of the product. Results: For features, all devices had step counting, an activity timer, and distance recording functions. The Samsung Gear S had a unique sports track recording feature and the Huawei Honor B2 had a unique wireless earphone. The Apple Watch, Samsung Gear S, Jawbone Up3, and Fitbit Surge could measure heart rate. All the devices were able to monitor sleep, except the Apple Watch. For product characteristics, including attributes such as weight, battery life, price, and 22 functions such as step counting, activity time, activity type identification, sleep monitoring, and expandable new features, we found a very weak negative correlation between the SUS scores and price (r=−.10, P=.03) and devices that support expandable new features (r=−.11, P=.02), and a very weak positive correlation between the SUS scores and devices that support the activity type identification function (r=.11, P=.02). The Huawei Honor B2 received the highest score of mean 67.6 (SD 16.1); the lowest Apple Watch score was only 61.4 (SD 14.7). No significant difference was observed among brands. The SUS score had a moderate positive correlation with the user’s experience (length of time the device was used) (r=.32, P<.001); participants in the medical and health care industries gave a significantly higher score (mean 61.1, SD 17.9 vs mean 68.7, SD 14.5, P=.03). Conclusions: The functions of wearable devices tend to be homogeneous and usability is similar across various brands. Overall, Mi Band had the lowest price and the lightest weight. Misfit Shine had the longest battery life and most functions, and participants in the medical and health care industries had the best evaluation of wearable devices. The perceived usability of mainstream wearable devices is unsatisfactory and customer loyalty is not high. A consumer’s SUS rating for a wearable device is related to their personal situation instead of the device brand. Device manufacturers should put more effort into developing innovative functions and improving the usability of their products by integrating more cognitive behavior change techniques. %M 30409767 %R 10.2196/11066 %U http://mhealth.jmir.org/2018/11/e11066/ %U https://doi.org/10.2196/11066 %U http://www.ncbi.nlm.nih.gov/pubmed/30409767 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12136 %T A Tool to Measure Young Adults’ Food Intake: Design and Development of an Australian Database of Foods for the Eat and Track Smartphone App %A Wellard-Cole,Lyndal %A Potter,Melisa %A Jung,Jisu (Joseph) %A Chen,Juliana %A Kay,Judy %A Allman-Farinelli,Margaret %+ School of Life and Environmental Science, The University of Sydney, Level 4 East, Charles Perkins Centre D17, University of Sydney, 2006, Australia, 61 286274854, lwel3754@uni.sydney.edu.au %K diet surveys %K smartphone %K mobile phone %K young adult %D 2018 %7 07.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietary assessment is reliant on the collection of accurate food and beverage consumption data. Technology has been harnessed to standardize recording and provide automatic nutritional analysis to reduce cost and researcher burden. Objective: To better assess the diet of young adults, especially relating to the contribution of foods prepared outside the home, a database was needed to support a mobile phone data collection app. The app also required usability testing to assure ease of entry of foods and beverages. This paper describes the development of the Eat and Track app (EaT app) and the database underpinning it. Methods: The Australian Food and Nutrient Database 2011-13, consisting of 5740 food items was modified. Four steps were undertaken: (1) foods not consumed by young adults were removed, (2) nutritionally similar foods were merged, (3) foods available from the 30 largest ready-to-eat food chains in Australia were added, and (4) long generic food names were shortened and simplified. This database was used to underpin the EaT app. Qualitative, iterative usability testing of the EaT app was conducted in three phases using the “Think Aloud” method. Responses were sorted and coded using content analysis. The System Usability Scale (SUS) was administered to measure the EaT app’s perceived usability. Results: In total, 1694 (29.51%) foods were removed from the Australian Food and Nutrient Database, including 608 (35.89%) ingredients, 81 (4.78%) foods already captured in the fast food chain information, 52 (3.07%) indigenous foods, 25 (1.48%) nutrients/dietary supplements, and 16 (0.94%) child-specific foods. The remaining 912 (53.84%) foods removed were not consumed by young adults in previous surveys or were “not defined” in the Australian Food and Nutrient Database. Another 220 (3.83%) nutritionally similar foods were combined. The final database consisted of 6274 foods. Fifteen participants completed usability testing. Issues identified by participants fell under six themes: keywords for searching, history list of entered foods, amounts and units, the keypad, food names, and search function. Suggestions for improvement were collected, incorporated, and tested in each iteration of the app. The SUS of the final version of the EaT app was rated 69. Conclusions: A food and beverage database has been developed to underpin the EaT app, enabling data collection on the eating-out habits of 18- to 30-year-old Australians. The development process has resulted in a database with commonly used food names, extensive coverage of foods from ready-to-eat chains, and commonly eaten portion sizes. Feedback from app usability testing led to enhanced keyword searching and the addition of functions to enhance usability such as adding brief instructional screens. There is potential for the features of the EaT app to facilitate the collection of more accurate dietary intake data. The database and the app will be valuable dietary assessment resources for researchers. %M 30404768 %R 10.2196/12136 %U http://mhealth.jmir.org/2018/11/e12136/ %U https://doi.org/10.2196/12136 %U http://www.ncbi.nlm.nih.gov/pubmed/30404768 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e11344 %T Exploring Social Media Group Use Among Breastfeeding Mothers: Qualitative Analysis %A Skelton,Kara Renee %A Evans,Retta %A LaChenaye,Jenna %A Amsbary,Jonathan %A Wingate,Martha %A Talbott,Laura %+ Department of Health, Behavior and Society, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, United States, 1 205 563 3412, kara.skelton@jhu.edu %K social media %K milk %K human %K breastfeeding %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Breastfeeding is well known as the optimal source of nutrition for the first year of life. However, suboptimal exclusively breastfeeding rates in the United States are still prevalent. Given the extent of social media use and the accessibility of this type of peer-to-peer support, the role of social networking sites in enabling and supporting breastfeeding mothers needs to be further explored. Objective: This study aimed to leverage mothers’ attitudes and behaviors of social media usage to understand effects on breastfeeding outcomes. Methods: Participants were recruited from 1 probreastfeeding social media group with over 6300 members throughout the United States. Online focus group discussions were conducted with 21 women; interviews were conducted with 12 mothers. Qualitative data were aggregated for thematic analysis. Results: Participants indicated that the social media group formed a community of support for breastfeeding, with normalizing breastfeeding, empowerment for breastfeeding, resource for breastfeeding, and shared experiences in breastfeeding as additional themes. Conclusions: According to participants, social media groups can positively influence breastfeeding-related attitudes, knowledge, and behaviors as well as lead to longer duration of breastfeeding. The results of this study should be taken into account when designing interventions for breastfeeding mothers. %M 31518305 %R 10.2196/11344 %U http://pediatrics.jmir.org/2018/2/e11344/ %U https://doi.org/10.2196/11344 %U http://www.ncbi.nlm.nih.gov/pubmed/31518305 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11131 %T Simulated Clinical Encounters Using Patient-Operated mHealth: Experimental Study to Investigate Patient-Provider Communication %A Tunnell,Harry %A Faiola,Anthony %A Bolchini,Davide %A Bartlett Ellis,Rebecca %+ School of Informatics and Computing, Department of Human-Centered Computing, Indiana University, 535 West Michigan Street, IT 475, Indianapolis, IN, 46202, United States, 1 317 278 4636, hadtunne@iupui.edu %K medical informatics %K personal health record %K medication reconciliation %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: This study investigates patient-centered mobile health (mHealth) technology in terms of the secondary user experience (UX). Specifically, it examines how personal mobile technology, under patient control, can be used to improve patient-provider communication about the patient’s health care during their first visit to a provider. Common ground, a theory about language use, is used as the theoretical basis to examine interactions. A novel concept of this study is that it is one of the first empirical studies to explore the relative meaningfulness of a secondary UX for specific health care tasks. Objective: The objective of this study was to investigate the extent that patient-operated mHealth technology can be designed to improve the communication between the patient and provider during an initial face-to-face encounter. Methods: The experimental study was conducted in 2 large Midwestern cities from February 2016 to May 2016. A custom-designed smartphone app prototype was used as the study treatment. The experimental design was posttest-only control group and included video-recorded simulated face-to-face clinical encounters in which an actor role-played a patient. Experienced clinicians consisting of doctors (n=4) and nurses (n=8) were the study participants. A thematic analysis of qualitative data was performed. Quantitative data collected from time on task measurements were analyzed using descriptive statistics. Results: Three themes that represent how grounding manifested during the encounter, what it meant for communication during the encounter, and how it influenced the provider’s perception of the patient emerged from the qualitative analysis. The descriptive statistics were important for inferring evidence of efficiency and effectiveness of communication for providers. Overall, encounter and task times averaged slightly faster in almost every instance for the treatment group than that in the control group. Common ground clearly was better in the treatment group, indicating that the idea of designing for the secondary UX to improve provider outcomes has merit. Conclusions: Combining the notions of common ground, human-computer interaction design, and smartphone technology resulted in a prototype that improved the efficiency and effectiveness of face-to-face collaboration for secondary users. The experimental study is one of the first studies to demonstrate that an investment in the secondary UX for high payoff tasks has value but that not all secondary UXs are meaningful for design. This observation is useful for prioritizing how resources should be applied when considering the secondary UX. %M 30389652 %R 10.2196/11131 %U https://mhealth.jmir.org/2018/11/e11131/ %U https://doi.org/10.2196/11131 %U http://www.ncbi.nlm.nih.gov/pubmed/30389652 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e184 %T Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews %A Marent,Benjamin %A Henwood,Flis %A Darking,Mary %A , %+ School of Applied Social Science, University of Brighton, Watson Building, Falmer, BN1 9PH, United Kingdom, 44 1273643914, b.marent@brighton.ac.uk %K mHealth %K mobile applications %K telemedicine %K information technology %K sexual health %K HIV %K self-management %K patient participation %K sociology, medical %K community-based participatory research %K health services %D 2018 %7 19.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth. Objective: The goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth. Methods: Between January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques. Results: Findings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform’s implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care. Conclusions: Our approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process. %M 30339132 %R 10.2196/mhealth.9856 %U http://mhealth.jmir.org/2018/10/e184/ %U https://doi.org/10.2196/mhealth.9856 %U http://www.ncbi.nlm.nih.gov/pubmed/30339132 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11076 %T Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study %A Klingberg,Anders %A Wallis,Lee Alan %A Hasselberg,Marie %A Yen,Po-Yin %A Fritzell,Sara Caroline %+ Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm,, Sweden, 46 733357727, anders.klingberg@ki.se %K mobile phone %K referral and consultation %K emergency medicine %K mHealth %K teleconsultations %K burns %K usability evaluation %K think-aloud %K video analysis %K South Africa %D 2018 %7 19.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. Objective: The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries. Methods: A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors. Results: The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings. Conclusions: We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words. %M 30341047 %R 10.2196/11076 %U http://mhealth.jmir.org/2018/10/e11076/ %U https://doi.org/10.2196/11076 %U http://www.ncbi.nlm.nih.gov/pubmed/30341047 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e182 %T mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies %A Nguyen,Amy D %A Frensham,Lauren J %A Wong,Michael XC %A Meslin,Sylvain MM %A Martin,Paige %A Lau,Annie YS %A Baysari,Melissa T %A Day,Richard O %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, 2109, Australia, 61 2 9850 2412, amy.nguyen@mq.edu.au %K mobile apps %K gout %K self-management %K chronic disease %K uric acid %D 2018 %7 15.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. Objective: The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. Methods: Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. Results: Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. Conclusions: These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app’s presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients. %M 30322835 %R 10.2196/mhealth.9811 %U http://mhealth.jmir.org/2018/10/e182/ %U https://doi.org/10.2196/mhealth.9811 %U http://www.ncbi.nlm.nih.gov/pubmed/30322835 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10291 %T Patient Perceptions of Their Own Data in mHealth Technology–Enabled N-of-1 Trials for Chronic Pain: Qualitative Study %A Whitney,Robin L %A Ward,Deborah H %A Marois,Maria T %A Schmid,Christopher H %A Sim,Ida %A Kravitz,Richard L %+ Department of Internal Medicine, University of California, San Francisco Fresno Medical Education Program, University of California, San Francisco, 155 North Fresno Street, Fresno, CA, 93701, United States, 1 559 499 6642, rwhitney@fresno.ucsf.edu %K mHealth %K patient-generated health data %K self-management %K chronic pain %K qualitative research %K N-of-1 trials %K mobile phones %D 2018 %7 11.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: N-of-1 (individual comparison) trials are a promising approach for comparing the effectiveness of 2 or more treatments for individual patients; yet, few studies have qualitatively examined how patients use and make sense of their own patient-generated health data (PGHD) in the context of N-of-1 trials. Objective: The objective of our study was to explore chronic pain patients’ perceptions about the PGHD they compiled while comparing 2 chronic pain treatments and tracking their symptoms using a smartphone N-of-1 app in collaboration with their clinicians. Methods: Semistructured interviews were recorded with 33 patients, a consecutive subset of the intervention group in a primary study testing the feasibility and effectiveness of the Trialist N-of-1 app. Interviews were transcribed verbatim, and a descriptive thematic analysis was completed. Results: Patients were enthusiastic about recording and accessing their own data. They valued sharing data with clinicians but also used their data independently. Conclusions: N-of-1 trials remain a promising approach to evidence-based decision making. Patients appear to value their roles as trial participants but place as much or more importance on the independent use of trial data as on comparative effectiveness results. Future efforts to design patient-centered N-of-1 trials might consider adaptable designs that maximize patient flexibility and autonomy while preserving a collaborative role with clinicians and researchers. %M 30309834 %R 10.2196/10291 %U http://mhealth.jmir.org/2018/10/e10291/ %U https://doi.org/10.2196/10291 %U http://www.ncbi.nlm.nih.gov/pubmed/30309834 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11192 %T Assessing the Attitudes and Perceptions Regarding the Use of Mobile Health Technologies for Living Kidney Donor Follow-Up: Survey Study %A Eno,Ann K %A Thomas,Alvin G %A Ruck,Jessica M %A Van Pilsum Rasmussen,Sarah E %A Halpern,Samantha E %A Waldram,Madeleine M %A Muzaale,Abimereki D %A Purnell,Tanjala S %A Massie,Allan B %A Garonzik Wang,Jacqueline M %A Lentine,Krista L %A Segev,Dorry L %A Henderson,Macey L %+ Department of Surgery, Johns Hopkins University School of Medicine, 2000 East Monument Street, Baltimore, MD, 21205, United States, 1 443 287 6649, macey@jhmi.edu %K follow-up %K kidney transplantation %K living kidney donor %K mobile phone, mHealth %D 2018 %7 09.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In 2013, the Organ Procurement and Transplantation Network began requiring transplant centers in the United States to collect and report postdonation living kidney donor follow-up data at 6 months, 1 year, and 2 years. Despite this requirement, <50% of transplant centers have been able to collect and report the required data. Previous work identified a number of barriers to living kidney donor follow-up, including logistical and administrative barriers for transplant centers and cost and functional barriers for donors. Novel smartphone-based mobile health (mHealth) technologies might reduce the burden of living kidney donor follow-up for centers and donors. However, the attitudes and perceptions toward the incorporation of mHealth into postdonation care among living kidney donors are unknown. Understanding donor attitudes and perceptions will be vital to the creation of a patient-oriented mHealth system to improve living donor follow-up in the United States. Objective: The goal of this study was to assess living kidney donor attitudes and perceptions associated with the use of mHealth for follow-up. Methods: We developed and administered a cross-sectional 14-question survey to 100 living kidney donors at our transplant center. All participants were part of an ongoing longitudinal study of long-term outcomes in living kidney donors. The survey included questions on smartphone use, current health maintenance behaviors, accessibility to health information, and attitudes toward using mHealth for living kidney donor follow-up. Results: Of the 100 participants surveyed, 94 owned a smartphone (35 Android, 58 iPhone, 1 Blackberry), 37 had accessed their electronic medical record on their smartphone, and 38 had tracked their exercise and physical activity on their smartphone. While 77% (72/93) of participants who owned a smartphone and had asked a medical question in the last year placed the most trust with their doctors, nurses, or other health care professionals regarding answering a health-related question, 52% (48/93) most often accessed health information elsewhere. Overall, 79% (74/94) of smartphone-owning participants perceived accessing living kidney donor information and resources on their smartphone as useful. Additionally, 80% (75/94) perceived completing some living kidney donor follow-up via mHealth as useful. There were no significant differences in median age (60 vs 59 years; P=.65), median years since donation (10 vs 12 years; P=.45), gender (36/75, 36%, vs 37/75, 37%, male; P=.57), or race (70/75, 93%, vs 18/19, 95%, white; P=.34) between those who perceived mHealth as useful for living kidney donor follow-up and those who did not, respectively. Conclusions: Overall, smartphone ownership was high (94/100, 94.0%), and 79% (74/94) of surveyed smartphone-owning donors felt that it would be useful to complete their required follow-up with an mHealth tool, with no significant differences by age, sex, or race. These results suggest that patients would benefit from an mHealth tool to perform living donor follow-up. %M 30305260 %R 10.2196/11192 %U http://mhealth.jmir.org/2018/10/e11192/ %U https://doi.org/10.2196/11192 %U http://www.ncbi.nlm.nih.gov/pubmed/30305260 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10157 %T A Smartphone App to Foster Power in the Everyday Management of Living With Schizophrenia: Qualitative Analysis of Young Adults’ Perspectives %A Terp,Malene %A Jørgensen,Rikke %A Laursen,Birgitte Schantz %A Mainz,Jan %A Bjørnes,Charlotte D %+ Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, Aalborg, 9000, Denmark, 45 40128333, m.terp@rn.dk %K mental health %K mHealth %K mobile app %K participatory design %K patient empowerment %K patient involvement %K patient participation %K schizophrenia %K smartphone %K young adults %D 2018 %7 01.10.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Literature indicates that using smartphone technology is a feasible way of empowering young adults recently diagnosed with schizophrenia to manage everyday living with their illness. The perspective of young adults on this matter, however, is unexplored. Objective: This study aimed at exploring how young adults recently diagnosed with schizophrenia used and perceived a smartphone app (MindFrame) as a tool to foster power in the everyday management of living with their illness. Methods: Using participatory design thinking and methods, MindFrame was iteratively developed. MindFrame consists of a smartphone app that allows young adults to access resources to aid their self-management. The app is affiliated with a website to support collaboration with their health care providers (HCPs). From January to December 2016, community-dwelling young adults with a recent diagnosis of schizophrenia were invited to use MindFrame as part of their care. They customized the resources while assessing their health on a daily basis. Then, they were invited to evaluate the use and provide their perspective on the app. The evaluation was qualitative, and data were generated from in-depth interviews. Data were analyzed using a hermeneutical approach. Results: A total of 98 individuals were eligible for the study (mean age 24.8, range 18-36). Of these, 27 used MindFrame and 13 participated in the evaluation. The analysis showed that to the young adults, MindFrame served to foster power in their everyday management of living with schizophrenia. When MindFrame was used with the HCPs consistently for more than a month, it could provide them with the power to keep up their medication, to keep a step ahead of their illness, and to get appropriate help based on their needs. This empowered them to stay on track with their illness, thus in control of it. It was also reported that MindFrame could fuel the fear of restraint and illness exacerbation, thereby disempowering some from feeling certain and secure. Conclusions: The findings demonstrate that young adults diagnosed with schizophrenia are amenable to use a smartphone app to monitor their health, manage their medication, and stay alert of the early signs of illness exacerbation. This may empower them to stay on track with their illness, thus in control of it. This indicates the potential of smartphone-based care being capable of aiding this specific population to more confidently manage their new life situation. The potentially disempowering aspect of MindFrame accentuates a need for further research to understand the best uptake and the limitations of smartphone-based schizophrenia care of young adults. %M 30274966 %R 10.2196/10157 %U https://mental.jmir.org/2018/4/e10157/ %U https://doi.org/10.2196/10157 %U http://www.ncbi.nlm.nih.gov/pubmed/30274966 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 9 %P e11031 %T Development of a Path to Home Mobile App for the Geriatric Rehabilitation Program at Bruyère Continuing Care: Protocol for User-Centered Design and Feasibility Testing Studies %A Backman,Chantal %A Harley,Anne %A Peyton,Liam %A Kuziemsky,Craig %A Mercer,Jay %A Monahan,Mary Anne %A Schmidt,Sandra %A Singh,Harvinder %A Gravelle,Deborah %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, Roger Guindon, RGN 3239, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada, 1 613 562 5800 ext 8418, chantal.backman@uottawa.ca %K patient discharge %K care transition %K user-centered design %K geriatric rehabilitation %K mHealth %K transitional care %K rehabilitation %K health services for the aged %K telemedicine %D 2018 %7 24.9.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: As the population ages, the need for appropriate geriatric rehabilitation services will also increase. Pressures faced by hospitals to reduce length of stay and reduce costs have driven the need for more complex care being delivered in the home or community setting. As a result, a multifaceted approach that can provide geriatric rehabilitation patients with safe and effective person- and family-centered care during transitions from hospital to home is required. We hypothesize that a technology-supported person- and family-centered care transition could empower geriatric rehabilitation patients, engage them in shared decision making, and ultimately help them to safely manage their personalized needs during care transitions from hospital to home. Objective: The purpose of this study is to design and test the feasibility of a novel Path to Home mobile app to manage the personalized needs of geriatric rehabilitation patients during their transitions from hospital to home. Methods: This study will consist of (1) codesigning a patient- and provider-tailored mobile app, and (2) feasibility pilot testing of the mobile app to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we will follow a user-centered design process integrated with a modern agile software development methodology to iteratively codesign the personalized care transition Path to Home mobile app. In phase 2, we will conduct a single-arm feasibility pilot test with geriatric rehabilitation patients using the personalized care transition Path to Home mobile app to manage their needs during the transition from hospital to home. Results: The project was funded in May 2018, and enrollment and data analysis are underway. First results are expected to be submitted for publication in 2019. Conclusions: Our findings will help validate the use of this technology for geriatric rehabilitation patients discharged from the hospital to home. Future research will more rigorously evaluate the health and economic benefits to inform wide-scale adoption of the technology. Registered Report Identifier: RR1-10.2196/11031 %M 30249591 %R 10.2196/11031 %U http://www.researchprotocols.org/2018/9/e11031/ %U https://doi.org/10.2196/11031 %U http://www.ncbi.nlm.nih.gov/pubmed/30249591 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e11450 %T A Mobile Health Intervention for HIV Prevention Among Racially and Ethnically Diverse Young Men: Usability Evaluation %A Cho,Hwayoung %A Powell,Dakota %A Pichon,Adrienne %A Thai,Jennie %A Bruce,Josh %A Kuhns,Lisa M %A Garofalo,Robert %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123056201, hc2787@columbia.edu %K mobile apps %K mobile health %K information technology %K health information technology %K usability evaluation %K adolescents %K HIV prevention %K men who have sex with men %D 2018 %7 07.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have the potential to be a useful mode of delivering HIV prevention information, particularly for young men (13-24 years) who account for 21% of new HIV diagnoses in the United States. We translated an existing evidence-based, face-to-face HIV prevention curriculum into a portable platform and developed a mobile Web app: MyPEEPS Mobile. Objective: The purpose of this study was to assess the usability of MyPEEPS Mobile from both expert and end user perspectives. Methods: We conducted a heuristic evaluation with five experts in informatics to identify violations of usability principles and end user usability testing with 20 young men aged 15 to 18 years in New York, NY, Birmingham, AL, and Chicago, IL to identify potential obstacles to their use of the app. Results: Mean scores of the overall severity of the identified heuristic violations rated by experts ranged from 0.4 and 2.6 (0=no usability problem to 4=usability catastrophe). Overall, our end users successfully completed the tasks associated with use case scenarios and provided comments/recommendations on improving usability of MyPEEPS Mobile. The mean of the overall Post-Study System Usability Questionnaire scores rated by the end users was 1.63 (SD 0.65), reflecting strong user acceptance of the app. Conclusions: The comments made by experts and end users will be used to refine MyPEEPS Mobile prior to a pilot study assessing the acceptability of the app across diverse sexual minority young men in their everyday lives. %M 30194060 %R 10.2196/11450 %U http://mhealth.jmir.org/2018/9/e11450/ %U https://doi.org/10.2196/11450 %U http://www.ncbi.nlm.nih.gov/pubmed/30194060 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e11432 %T Mobile Apps for Oral Health Promotion: Content Review and Heuristic Usability Analysis %A Tiffany,Brooks %A Blasi,Paula %A Catz,Sheryl L %A McClure,Jennifer B %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA,, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K oral health %K oral hygiene %K dental care %K mobile health %K eHealth %K review %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been an increase in consumer-facing mobile health (mHealth) apps in recent years. Prior reviews have characterized the availability, usability, or quality of popular mHealth apps targeting a range of health behaviors, but none has examined apps that promote better oral health care. Oral disease affects billions of people worldwide and mobile phone use is on the rise, so the market for well-designed and effective oral health apps is substantial. Objective: We examined the content and usability of popular oral health promotion apps to better understand the current state of these self-help interventions and inform the need and opportunity for future app development. Methods: Between February and March 2018, we identified oral health-focused apps that were designed for Android or iOS, available in English, and targeted adult consumers (as opposed to children or dental health professionals). The sample was limited to the most popular and highly rated apps on each platform. For each app reviewed, we assessed its basic descriptive characteristics (eg, platform, cost), evidence of a theoretical basis or empirical validation, key program functionality, and the extent to which the app addressed diet and tobacco and alcohol use as risk factors for oral disease. We characterized the framing (ie, gain vs loss) of all persuasive messaging and conducted a heuristic analysis to assess each app’s usability as a persuasive health technology. Results: Thirty-three apps were eligible for review based on the selection criteria. Two-thirds (22/33, 67%) were geared toward the general public as opposed to dental clinic patients, insurance plan members, or owners of specific electric toothbrushes. Most (31/33, 94%) were free to download, and a majority (19/33, 58%) were sponsored by software developers as opposed to oral health experts. None offered any theoretical basis for the content or had been empirically validated. Common program features included tools for tracking or reminding one to brush their teeth and assistance scheduling dental appointments. Nineteen apps (58%) included educational or persuasive content intended to influence oral health behavior. Only 32% (6/19) of these included a larger proportion of gain-framed than loss-framed messaging. Most of the apps did not mention diet, alcohol or tobacco—important risk factors for oral disease. Overall, the apps performed poorly on standard usability heuristics recommended for persuasive health technologies. Conclusions: The quality of the reviewed apps was generally poor. Important opportunities exist to develop oral health promotion apps that have theoretically grounded content, are empirically validated, and adhere to good design principles for persuasive health technologies. %M 30181114 %R 10.2196/11432 %U http://mhealth.jmir.org/2018/9/e11432/ %U https://doi.org/10.2196/11432 %U http://www.ncbi.nlm.nih.gov/pubmed/30181114 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e171 %T mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience %A Irfan Khan,Anum %A Gill,Ashlinder %A Cott,Cheryl %A Hans,Parminder Kaur %A Steele Gray,Carolyn %+ Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street, Health Sciences Building, Suite 425, Toronto, ON, M5T3M6, Canada, 1 6478868344, anumirfan.khan@mail.utoronto.ca %K primary care %K mHealth %K self-management %K multimorbidity %D 2018 %7 28.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Given the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions. Objective: The objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts. Methods: We conducted a 4-week pilot study of the ePRO tool. Patients’ and providers’ experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method. Results: In this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool’s potential in helping to improve access to different providers in a team-based primary care setting. Conclusions: This study identifies a more explicit recognition of the contextual factors that influence patients’ ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial. %M 30154073 %R 10.2196/mhealth.8593 %U http://mhealth.jmir.org/2018/8/e171/ %U https://doi.org/10.2196/mhealth.8593 %U http://www.ncbi.nlm.nih.gov/pubmed/30154073 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e54 %T A Mobile App–Based Intervention for Depression: End-User and Expert Usability Testing Study %A Fuller-Tyszkiewicz,Matthew %A Richardson,Ben %A Klein,Britt %A Skouteris,Helen %A Christensen,Helen %A Austin,David %A Castle,David %A Mihalopoulos,Cathrine %A O'Donnell,Renee %A Arulkadacham,Lilani %A Shatte,Adrian %A Ware,Anna %+ School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 392517344, matthewf@deakin.edu.au %K depression %K eHealth %K mHealth %K young adult %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the growing number of mental health apps available for smartphones, the perceived usability of these apps from the perspectives of end users or health care experts has rarely been reported. This information is vital, particularly for self-guided mHealth interventions, as perceptions of navigability and quality of content are likely to impact participant engagement and treatment compliance. Objective: The aim of this study was to conduct a usability evaluation of a personalized, self-guided, app-based intervention for depression. Methods: Participants were administered the System Usability Scale and open-ended questions as part of a semistructured interview. There were 15 participants equally divided into 3 groups: (1) individuals with clinical depression who were the target audience for the app, (2) mental health professionals, and (3) researchers who specialize in the area of eHealth interventions and/or depression research. Results: The end-user group rated the app highly, both in quantitative and qualitative assessments. The 2 expert groups highlighted the self-monitoring features and range of established psychological treatment options (such as behavioral activation and cognitive restructuring) but had concerns that the amount and layout of content may be difficult for end users to navigate in a self-directed fashion. The end-user data did not confirm these concerns. Conclusions: Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging, may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects. %M 30139722 %R 10.2196/mental.9445 %U http://mental.jmir.org/2018/3/e54/ %U https://doi.org/10.2196/mental.9445 %U http://www.ncbi.nlm.nih.gov/pubmed/30139722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10125 %T Game Plan: Development of a Web App Designed to Help Men Who Have Sex With Men Reduce Their HIV Risk and Alcohol Use %A Wray,Tyler %A Kahler,Christopher W %A Simpanen,Erik M %A Operario,Don %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI,, United States, 1 401 863 6659, tyler_wray@brown.edu %K alcohol %K HIV risk %K internet %K intervention %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Men who have sex with men (MSM) are at high risk for HIV, and alcohol use is a major risk factor for HIV infection. Internet-facilitated brief interventions have been shown to reduce alcohol use and HIV-risk behavior in other at-risk populations, but have so far incorporated limited content and have not been tested among MSM. Objective: This manuscript describes Game Plan, an interactive, tablet-optimized web application designed to help heavy drinking, high-risk MSM consider reducing their alcohol use and sexual risk behavior. In this paper, we discuss the rationale, goals, and flow for each of Game Plan’s components, which were modelled after common in-person and web-based brief motivational interventions for these behaviors. Methods: The development of Game Plan was informed by a thorough user-focused design research process that included (1) audits of existing interventions, (2) focus groups with stakeholders and (3) intended users (high-risk, heavy drinking MSM), and (4) usability testing. The aesthetic, features, and content of the app were designed iteratively throughout this process Results: The fully-functional Game Plan app provides (1) specific and personal feedback to users about their level of risk, (2) exercises to help prompt users to reflect on whether their current behavior aligns with other important life goals and values, and for those open to change, (3) exercises to help users understand factors that contribute to risk, and (4) a change planning module. In general, this flow was constructed to roughly align with the two phases described in early accounts of motivational interviewing (MI): (1) Content intended to elicit intrinsic motivation for change, and when/if sufficient motivation is present, (2) content intended to translate that motivation into specific goals and plans for change. This sequence first focuses on the user’s HIV risk behavior, followed by their alcohol use and the connection between the two. The app’s overall aesthetic (eg, branding, color palettes, icons/graphics) and its onboarding sequence was also designed to align with the “spirit” of MI by conveying respect for autonomy, open-mindedness (ie, avoiding judgment), and empathy. Conclusions: Should future research support its efficacy in facilitating behavior change, Game Plan could represent a wide-reaching and scalable tool that is well-suited for use in settings where delivering evidence-based, in-person interventions would be difficult or cost-prohibitive. %M 30684415 %R 10.2196/10125 %U http://formative.jmir.org/2018/2/e10125/ %U https://doi.org/10.2196/10125 %U http://www.ncbi.nlm.nih.gov/pubmed/30684415 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e169 %T Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences %A Wexler,Catherine %A Brown,Melinda %A Hurley,Emily A %A Ochieng,Martin %A Goggin,Kathy %A Gautney,Brad %A Maloba,May %A Lwembe,Raphael %A Khamadi,Samoel %A Finocchario-Kessler,Sarah %+ Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS,, United States, 1 913 945 7077, cwexler@kumc.edu %K early infant diagnosis (EID) %K HIV/AIDS %K eHealth %K mHealth %K implementation science %K Kenya %D 2018 %7 22.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Literature suggests that electronic health (eHealth) interventions can improve the efficiency and accuracy of health service delivery and improve health outcomes and are generally well received by patients; however, there are limited data on provider experiences using eHealth interventions in resource-limited settings. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants. Objective: We aimed to compare provider experiences with standard EID and HITSystem implementation at 6 Kenyan hospitals and 3 laboratories. The objective of this study was to better understand provider experiences implementing and using the HITSystem in order to assess facilitators and barriers that may impact adoption and sustainability of this eHealth intervention. Methods: As part of a randomized controlled trial to evaluate the HITSystem, we conducted semistructured interviews with 17 EID providers at participating intervention and control hospitals and laboratories. Results: Providers emphasized the perceived usefulness of the HITSystem, including improved efficiency in sample tracking and patient follow-up, strengthened communication networks among key stakeholders, and improved capacity to meet patient needs compared to standard EID. These advantages were realized from an intervention that providers saw as easy to use and largely compatible with workflow. However, supply stock outs and patient psychosocial factors (including fear of HIV status disclosure and poverty) provided ongoing challenges to EID service provision. Furthermore, slow or sporadic internet access and heavy workload prevented real-time HITSystem data entry for some clinicians. Conclusions: Provider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals. To maximize implementation success, care should be taken in intervention design and implementation to ensure that end users see clear advantages to using the technology and to account for variations in workflows, patient populations, and resource levels by allowing flexibility to suit user needs. Trial Registration: ClinicalTrials.gov NCT02072603; https://clinicaltrials.gov/ct2/show/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm) %M 30135052 %R 10.2196/mhealth.9725 %U http://mhealth.jmir.org/2018/8/e169/ %U https://doi.org/10.2196/mhealth.9725 %U http://www.ncbi.nlm.nih.gov/pubmed/30135052 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e172 %T A Mobile App (iBeni) With a Neuropsychological Basis for Cognitive Stimulation for Elderly Adults: Pilot and Validation Study %A Martínez-Alcalá,Claudia I %A Rosales-Lagarde,Alejandra %A Hernández-Alonso,Esmeralda %A Melchor-Agustin,Roberto %A Rodriguez-Torres,Erika E %A Itzá-Ortiz,Benjamín A %+ Consejo Nacional de Ciencia y Tecnología, Av Insurgentes Sur 1582, Col Crédito Constructor, Del Benito Juárez, Ciudad de México, 03940, Mexico, 52 (771) 71 72 000 ext 4332, c_isabel_alcala@hotmail.com %K mobile application %K cognitive stimulation %K cognitive impairment %K older adults %K neuropsychological evaluation. %D 2018 %7 21.08.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cognitive impairment is considered one of the most feared chronic conditions among the older adult population since its incidence is approximately twice more frequent than that of dementia. In Mexico, no studies or reports of older adults using technology for cognitive interventions have been published, given that institutions usually frame cognitive stimulation tasks in paper and pencil (ie, in the traditional manner). Objective: The objective of this study was to create and analyze the effect, viability, and impact of a mobile app for cognitive stimulation implemented among a group of elderly adults (over 60 years of age) from the state of Hidalgo in Mexico. Methods: This study was a nonprobabilistic pilot trial using convenience sampling. An intervention was implemented among a group of 22 older adults between 60 and 80 years of age over 12 weeks. Half of the older adults were stimulated with the mobile app (experimental group) and the other half followed the traditional paper and pencil training (control group). Assessments with the Mini-Mental State Examination (MMSE) and the Neuropsi, a neuropsychological test validated in Mexico, were done before and after both cognitive stimulations. Results: According to the analyzed data, 6/11 (55%) participants from the experimental group obtained better results in their cognitive skills, and 5 (45%) of the adults maintained their score, given that the participants were able to execute the exercises repetitively. Meanwhile, for the control group, only 3/11 (27%) participants obtained better results in the postevaluation. Significant values for results of the MMSE were obtained in the postevaluation for the experimental group compared to the control group, while results did not show significant differences in the Neuropsi. Regarding the validation of the app, all the participants evaluated its pertinence positively. Conclusions: The intervention data show that the experimental group obtained better results in the postevaluation given that the participants were able to execute the exercises repetitively. The control group could not accomplish this since they had to respond on the manual and no further attempts were provided. However, both groups increased their score in the neuropsychological evaluations. This suggests that a longer and more frequent intervention is required. Registered Report Identifier: RR1-10.2196/9603 %M 30131319 %R 10.2196/resprot.9603 %U http://www.researchprotocols.org/2018/8/e172/ %U https://doi.org/10.2196/resprot.9603 %U http://www.ncbi.nlm.nih.gov/pubmed/30131319 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10126 %T A Novel 12-Lead Electrocardiographic System for Home Use: Development and Usability Testing %A Steijlen,Annemarijn SM %A Jansen,Kaspar MB %A Albayrak,Armagan %A Verschure,Derk O %A Van Wijk,Diederik F %+ Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, 32-B-3-040, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 152781819, a.s.m.steijlen@tudelft.nl %K 12-lead ECG system %K electrocardiography %K home use %K handheld %K user-centered design %D 2018 %7 30.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. Early diagnosis is of pivotal importance for patients with cardiac arrhythmias and ischemia to minimize the consequences like strokes and myocardial infarctions. The chance of capturing signals of arrhythmias or ischemia is substantially high when a 12-lead electrocardiogram (ECG) can be recorded at the moment when a patient experiences the symptoms. However, until now, available diagnostic systems (Holter monitors and other wearable ECG sensors) have not enabled patients to record a reliable 12-lead ECG at home. Objective: The objective of this project was to develop a user-friendly system that enables persons with cardiac complaints to record a reliable 12-lead ECG at home to improve the diagnostic process and, consequently, reduce the time between the onset of symptoms and adequate treatment. Methods: Using an iterative design approach, ECGraph was developed. The system consists of an ECG measurement system and a mobile app, which were developed with the help of several concept tests. To evaluate the design, a prototype of the final design was built and a final technical performance test and usability test were executed. Results: The ECG measurement system consists of a belt and 4 limb straps. Ten wet Ag/AgCl electrodes are placed in the belt to optimize skin-electrode contact. The product is controlled via an app on the mobile phone of the user. Once a person experiences symptoms, he or she can put on the belt and record ECGs within a few minutes. Short instructions, supported by visualizations, offer guidance during use. ECGs are sent wirelessly to the caregiver, and the designated expert can quickly interpret the results. Usability tests with the final prototype (n=6) showed that the participants were able to put on the product within 8 minutes during first-time use. However, we expect that the placement of the product can be executed faster when the user becomes more familiar with the product. Areas of improvement focus mainly on confidence during product use. In the technical performance test, a 12-lead ECG was made and reproduced 6 times. Conclusions: We developed a new 12-lead ECG system for home use. The product is expected to be more user-friendly than current hospital ECG systems and is designed to record more reliable data than current ECG systems for home use, which makes it suitable for expert interpretation. The system has great potential to be incorporated into an outpatient practice, so that arrhythmias and ischemia can be diagnosed and treated as early as possible. %M 30061094 %R 10.2196/10126 %U http://mhealth.jmir.org/2018/7/e10126/ %U https://doi.org/10.2196/10126 %U http://www.ncbi.nlm.nih.gov/pubmed/30061094 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10671 %T You Will Know That Despite Being HIV Positive You Are Not Alone: Qualitative Study to Inform Content of a Text Messaging Intervention to Improve Prevention of Mother-to-Child HIV Transmission %A Fairbanks,Jade %A Beima-Sofie,Kristin %A Akinyi,Pamela %A Matemo,Daniel %A Unger,Jennifer A %A Kinuthia,John %A O'Malley,Gabrielle %A Drake,Alison L %A John-Stewart,Grace %A Ronen,Keshet %+ Department of Global Health, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States, 1 206 685 4363, keshet@uw.edu %K HIV %K ART %K PMTCT %K SMS text messaging %K adherence %K retention %D 2018 %7 19.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention of mother-to-child HIV transmission (PMTCT) relies on long-term adherence to antiretroviral therapy (ART). Mobile health approaches, such as text messaging (short message service, SMS), may improve adherence in some clinical contexts, but it is unclear what SMS content is desired to improve PMTCT-ART adherence. Objective: We aimed to explore the SMS content preferences related to engagement in PMTCT care among women, male partners, and health care workers. The message content was used to inform an ongoing randomized trial to enhance the PMTCT-ART adherence. Methods: We conducted 10 focus group discussions with 87 HIV-infected pregnant or postpartum women and semistructured individual interviews with 15 male partners of HIV-infected women and 30 health care workers from HIV and maternal child health clinics in Kenya. All interviews were recorded, translated, and transcribed. We analyzed transcripts using deductive and inductive approaches to characterize women’s, partners’, and health care workers’ perceptions of text message content. Results: All women and male partners, and most health care workers viewed text messages as a useful strategy to improve engagement in PMTCT care. Women desired messages spanning 3 distinct content domains: (1) educational messages on PMTCT and maternal child health, (2) reminder messages regarding clinic visits and adherence, and (3) encouraging messages that provide emotional support. While all groups valued reminder and educational messages, women highlighted emotional support more than the other groups (partners or health care workers). In addition, women felt that encouraging messages would assist with acceptance of their HIV status, support disclosure, improve patient-provider relationship, and provide support for HIV-related challenges. All 3 groups valued not only messages to support PMTCT or HIV care but also messages that addressed general maternal child health topics, stressing that both HIV- and maternal child health–related messages should be part of an SMS system for PMTCT. Conclusions: Women, male partners, and health care workers endorsed SMS text messaging as a strategy to improve PMTCT and maternal child health outcomes. Our results highlight the specific ways in which text messaging can encourage and support HIV-infected women in PMTCT to remain in care, adhere to treatment, and care for themselves and their children. Trial Registration: ClinicalTrials.gov NCT02400671; https://clinicaltrials.gov/ct2/show/NCT02400671 (Archived by WebCite at http://www.webcitation.org/70W7SVIVJ) %M 30026177 %R 10.2196/10671 %U http://mhealth.jmir.org/2018/7/e10671/ %U https://doi.org/10.2196/10671 %U http://www.ncbi.nlm.nih.gov/pubmed/30026177 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e160 %T Digital Food Records in Community-Based Interventions: Mixed-Methods Pilot Study %A Fowler,Lauren A %A Yingling,Leah R %A Brooks,Alyssa T %A Wallen,Gwenyth R %A Peters-Lawrence,Marlene %A McClurkin,Michael %A Wiley Jr,Kenneth L %A Mitchell,Valerie M %A Johnson,Twanda D %A Curry,Kendrick E %A Johnson,Allan A %A Graham,Avis P %A Graham,Lennox A %A Powell-Wiley,Tiffany M %+ Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, 10-CRC, Room 5-5332, Bethesda, MD, 20892, United States, 1 3015943735, tiffany.powell-wiley@nih.gov %K mHealth %K diet %K community-based participatory research %K qualitative research %K focus group, obesity %D 2018 %7 17.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A pressing need exists to understand and optimize the use of dietary assessment tools that can be used in community-based participatory research (CBPR) interventions. A digital food record, which uses a mobile device to capture the dietary intake through text and photography inputs, is a particularly promising mobile assessment method. However, little is understood about the acceptability and feasibility of digital food records in CBPR and how to best tailor dietary assessment tools to the needs of a community. Objective: The objective of our study was to evaluate the acceptability and feasibility of digital food records among church-based populations in resource-limited wards of Washington, DC, USA, using a mixed-methods approach. Methods: This community-based pilot study was conducted as part of the Washington, DC Cardiovascular Health and Needs Assessment. Participants (n=17) received a mobile device (iPod Touch) to photodocument their dietary intake for a 3-day digital food record using a mobile app, FitNinja (Vibrent Health). The acceptability of the digital food record was explored through the thematic analysis of verbatim transcripts from a moderated focus group (n=8). In addition, the feasibility was evaluated by the percentage of participants complying with instructions (ie, capturing both before and after meal photos for at least 2 meals/day for 3 days). Results: Qualitative themes identified were related to (1) the feasibility and acceptability of the mobile device and app, including issues in recording the dietary information and difficulty with photodocumentation; (2) suggestions for additional support and training experiences; and (3) comparisons with other mobile apps. Overall, the participants accepted the digital food record by demonstrating satisfaction with the tool and intent to continue the use (eg, participants recorded an average of 5.2, SD 7, consecutive days). Furthermore, of the 17 participants, 15 photodocumented at least 1 meal during the study period and 3 fully complied with the digital food record instructions. Conclusions: This study demonstrated digital food records as an acceptable tool in CBPR and identified contributors and barriers to the feasibility of digital food records for future research. Engaging community members in the implementation of novel assessment methods allows for the tailoring of technology to the needs of the community and optimizing community-based interventions. Trial Registration: ClinicalTrials.gov NCT01927783; https://www.clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/70WzaFWb6) %M 30021705 %R 10.2196/mhealth.9729 %U http://mhealth.jmir.org/2018/7/e160/ %U https://doi.org/10.2196/mhealth.9729 %U http://www.ncbi.nlm.nih.gov/pubmed/30021705 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e148 %T Learnability of a Configurator Empowering End Users to Create Mobile Data Collection Instruments: Usability Study %A Schobel,Johannes %A Pryss,Rüdiger %A Probst,Thomas %A Schlee,Winfried %A Schickler,Marc %A Reichert,Manfred %+ Institute of Databases and Information Systems, Ulm University, James-Franck-Ring, Ulm, 89081, Germany, 49 731 50 24229, johannes.schobel@uni-ulm.de %K mHealth %K data collection %K mobile apps %D 2018 %7 29.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many research domains still heavily rely on paper-based data collection procedures, despite numerous associated drawbacks. The QuestionSys framework is intended to empower researchers as well as clinicians without programming skills to develop their own smart mobile apps in order to collect data for their specific scenarios. Objective: In order to validate the feasibility of this model-driven, end-user programming approach, we conducted a study with 80 participants. Methods: Across 2 sessions (7 days between Session 1 and Session 2), participants had to model 10 data collection instruments (5 at each session) with the developed configurator component of the framework. In this context, performance measures like the time and operations needed as well as the resulting errors were evaluated. Participants were separated into two groups (ie, novices vs experts) based on prior knowledge in process modeling, which is one fundamental pillar of the QuestionSys framework. Results: Statistical analysis (t tests) revealed that novices showed significant learning effects for errors (P=.04), operations (P<.001), and time (P<.001) from the first to the last use of the configurator. Experts showed significant learning effects for operations (P=.001) and time (P<.001), but not for errors as the experts’ errors were already very low at the first modeling of the data collection instrument. Moreover, regarding the time and operations needed, novices got significantly better at the third modeling task than experts were at the first one (t tests; P<.001 for time and P=.002 for operations). Regarding errors, novices did not get significantly better at working with any of the 10 data collection instruments than experts were at the first modeling task, but novices’ error rates for all 5 data collection instruments at Session 2 were not significantly different anymore from those of experts at the first modeling task. After 7 days of not using the configurator (from Session 1 to Session 2), the experts’ learning effect at the end of Session 1 remained stable at the beginning of Session 2, but the novices’ learning effect at the end of Session 1 showed a significant decay at the beginning of Session 2 regarding time and operations (t tests; P<.001 for time and P=.03 for operations). Conclusions: In conclusion, novices were able to use the configurator properly and showed fast (but unstable) learning effects, resulting in their performances becoming as good as those of experts (which were already good) after having little experience with the configurator. Following this, researchers and clinicians can use the QuestionSys configurator to develop data collection apps for smart mobile devices on their own. %M 29959107 %R 10.2196/mhealth.9826 %U http://mhealth.jmir.org/2018/6/e148/ %U https://doi.org/10.2196/mhealth.9826 %U http://www.ncbi.nlm.nih.gov/pubmed/29959107 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e10415 %T Veterans’ Perspectives on Fitbit Use in Treatment for Post-Traumatic Stress Disorder: An Interview Study %A Ng,Ada %A Reddy,Madhu %A Zalta,Alyson K %A Schueller,Stephen M %+ People, Information, and Technology Changing Health Lab, Technology and Social Behavior Program, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, United States, 1 847 491 7023, adang@u.northwestern.edu %K fitness trackers %K patient generated health data %K consumer health informatics %K stress disorders, post-traumatic %K PTSD %K mental health %K veterans %D 2018 %7 15.06.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: The increase in availability of patient data through consumer health wearable devices and mobile phone sensors provides opportunities for mental health treatment beyond traditional self-report measurements. Previous studies have suggested that wearables can be effectively used to benefit the physical health of people with mental health issues, but little research has explored the integration of wearable devices into mental health care. As such, early research is still necessary to address factors that might impact integration including patients' motivations to use wearables and their subsequent data. Objective: The aim of this study was to gain an understanding of patients’ motivations to use or not to use wearables devices during an intensive treatment program for post-traumatic stress disorder (PTSD). During this treatment, they received a complementary Fitbit. We investigated the following research questions: How did the veterans in the intensive treatment program use their Fitbit? What are contributing motivators for the use and nonuse of the Fitbit? Methods: We conducted semistructured interviews with 13 veterans who completed an intensive treatment program for PTSD. We transcribed and analyzed interviews using thematic analysis. Results: We identified three major motivations for veterans to use the Fitbit during their time in the program: increase self-awareness, support social interactions, and give back to other veterans. We also identified three major reasons certain features of the Fitbit were not used: lack of clarity around the purpose of the Fitbit, lack of meaning in the Fitbit data, and challenges in the veteran-provider relationship. Conclusions: To integrate wearable data into mental health treatment programs, it is important to understand the patient’s perspectives and motivations in using wearables. We also discuss how the military culture and PTSD may have contributed to our participants' behaviors and attitudes toward Fitbit usage. We conclude with possible approaches for integrating patient-generated data into mental health treatment settings that may address the challenges we identified. %M 29907556 %R 10.2196/10415 %U http://mental.jmir.org/2018/2/e10415/ %U https://doi.org/10.2196/10415 %U http://www.ncbi.nlm.nih.gov/pubmed/29907556 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 3 %N 2 %P e10 %T New-Onset Diabetes Educator to Educate Children and Their Caregivers About Diabetes at the Time of Diagnosis: Usability Study %A Bernier,Angelina %A Fedele,David %A Guo,Yi %A Chavez,Sarah %A Smith,Megan D %A Warnick,Jennifer %A Lieberman,Leora %A Modave,François %+ Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, CTRB 3217, Gainesville, FL, 32610, United States, 1 3522945984, modavefp@ufl.edu %K mHealth %K information technology %K diabetes education %K pediatrics %D 2018 %7 06.06.2018 %9 Original Paper %J JMIR Diabetes %G English %X Background: Diabetes self-management education is essential at the time of diagnosis. We developed the New-Onset Diabetes Educator (NODE), an animation-based educational web application for type 1 diabetes mellitus patients. Objective: Our hypothesis is that NODE is a feasible, effective and user-friendly intervention in improving diabetes self-management education delivery to child/caregiver-dyads at the time of diagnosis. Methods: We used a pragmatic parallel randomized trial design. Dyads were recruited within 48 hours of diagnosis and randomized into a NODE-enhanced diabetes self-management education or a standard diabetes self-management education group. Dyads randomized in the NODE group received the intervention on an iPad before receiving the standard diabetes self-management education with a nurse educator. The Diabetes Knowledge Test 2 assessed disease-specific knowledge pre- and postintervention in both groups, and was compared using t tests. Usability of the NODE mobile health intervention was assessed in the NODE group. Results: We recruited 16 dyads (mean child age 10.75, SD 3.44). Mean Diabetes Knowledge Test 2 scores were 14.25 (SD 4.17) and 18.13 (SD 2.17) pre- and postintervention in the NODE group, and 15.50 (SD 2.67) and 17.38 (SD 2.26) in the standard diabetes self-management education group. The effect size was medium (Δ=0.56). Usability ratings of NODE were excellent. Conclusions: NODE is a feasible mobile health strategy for type 1 diabetes education. It has the potential to be an effective and scalable tool to enhance diabetes self-management education at time of diagnosis, and consequently, could lead to improved long-term clinical outcomes for patients living with the disease. %M 30291069 %R 10.2196/diabetes.9202 %U http://diabetes.jmir.org/2018/2/e10/ %U https://doi.org/10.2196/diabetes.9202 %U http://www.ncbi.nlm.nih.gov/pubmed/30291069 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10422 %T Implementing Systematically Collected User Feedback to Increase User Retention in a Mobile App for Self-Management of Low Back Pain: Retrospective Cohort Study %A Clement,Innocent %A Lorenz,Andreas %A Ulm,Bernhard %A Plidschun,Anne %A Huber,Stephan %+ Kaia Health Software, Infanteriestr 11a, Munich, D-80797, Germany, 49 89 20207057, stephan@kaia-health.com %K low back pain %K app %K mHealth %K retrospective cohort study %K self-management %K user feedback %K quality management %K usability %D 2018 %7 06.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Promising first results for Kaia, a mobile app digitalizing multidisciplinary rehabilitation for low back pain, were recently published. It remains unclear whether the implementation of user feedback in an updated version of this app leads to desired effects in terms of increased app usage and clinical outcomes. Objective: The aim is to elucidate the effect on user retention and clinical outcomes of an updated version of the Kaia app where user feedback was included during development. Methods: User feedback of the initial app versions (0.x) was collected in a quality management system and systematically analyzed to define requirements of a new version. For this study, the anonymized data of Kaia users was analyzed retrospectively and users were grouped depending on the available version at the time of the sign-up (0.x vs 1.x). The effect on the duration of activity of users in the app, the number of completed exercises of each type, and user-reported pain levels were compared. Results: Overall, data of 1251 users fulfilled the inclusion criteria, of which 196 users signed up using version 0.x and 1055 users signed up with version 1.x. There were significant differences in the demographic parameters for both groups. A log-rank test showed no significant differences for the duration of activity in the app between groups (P=.31). Users signing up during availability of the 1.x version completed significantly more exercises of each type in the app (physical exercises: 0.x mean 1.99, SD 1.61 units/week vs 1.x mean 3.15, SD1.72 units/week; P<.001; mindfulness exercises: 0.x mean 1.36, SD 1.43 units/week vs 1.x mean 2.42, SD 1.82 units/week; P<.001; educational content: 0.x mean 1.51, SD 1.42 units/week vs 1.x mean 2.71, SD 1.89 units/week; P<.001). This translated into a stronger decrease in user-reported pain levels in versions 1.x (F1,1233=7.084, P=.008). Conclusions: Despite the limitations of retrospective cohort studies, this study indicates that the implementation of systematically collected user feedback during development of updated versions can contribute to improvements in terms of frequency of use and potentially even clinical endpoints such as pain level. The clinical efficiency of the Kaia app needs to be validated in prospective controlled trials to exclude bias. %R 10.2196/10422 %U http://mhealth.jmir.org/2018/6/e10422/ %U https://doi.org/10.2196/10422 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e133 %T Digital Health Intervention for Asthma: Patient-Reported Value and Usability %A Merchant,Rajan %A Inamdar,Rubina %A Henderson,Kelly %A Barrett,Meredith %A Su,Jason G %A Riley,Jesika %A Van Sickle,David %A Stempel,David %+ Dignity Health Woodland Clinic Medical Group, 632 West Gibson Road, Woodland, CA, 95695, United States, 1 530 668 2601, Rajan.Merchant@dignityhealth.org %K asthma %K mHealth %K surveys and questionnaires %K patient satisfaction %K perception %K self-management %D 2018 %7 04.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although digital health tools are increasingly recognized as effective in improving clinical outcomes such as asthma control and medication adherence, few studies have assessed patient experiences and perception of value. Objective: The aim of this study was to evaluate patient satisfaction, perception of usability and value, and desire to continue after 12 months of using a digital health intervention to support asthma management. Methods: Participants were enrolled in a randomized controlled study evaluating the impact of a digital health platform for asthma management. Participants used electronic inhaler sensors to track medication use and accessed their information in a digital health platform. Electronic surveys were administered to intervention arm participants aged 12 years and older after 12 months of use. The survey assessed asthma control, patient satisfaction with the sensor device, and perception of the usability and value of the digital health platform through closed-ended and open-ended questions. Logistic regression models were used to assess the impact of participants’ characteristics on survey completion, satisfaction, and perception of value. Results: Of the 207 intervention arm participants aged 12 years and older, 89 submitted survey responses (42.9% response rate). Of these 89 participants, 70 reported being very satisfied (79%, 70/89) or somewhat satisfied (20%, 18/89) with the inhaler sensor device. Moreover, 93% (83/89) expressed satisfaction with the reports, and 90% (80/89) found the information from the reports useful for learning about their asthma. In addition, 72% (64/89) of the participants reported that they were interested in continuing to use the sensor and platform beyond the study. There were no significant differences in satisfaction with the device or the platform across participants’ characteristics, including device type, age, sex, insurance type, asthma control, or syncing history; however, participants with smartphones and longer participation were more likely to take the survey. Conclusions: Electronic sensors and a digital health platform were well received by participants who reported satisfaction and perceived value. These results were consistent across multiple participants’ characteristics. These findings can add to a limited literature to keep improving digital health interventions and ensure the meaningful and enduring impact on patient outcomes. %R 10.2196/mhealth.7362 %U http://mhealth.jmir.org/2018/6/e133/ %U https://doi.org/10.2196/mhealth.7362 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e127 %T Designing a Tablet-Based Software App for Mapping Bodily Symptoms: Usability Evaluation and Reproducibility Analysis %A Neubert,Till-Ansgar %A Dusch,Martin %A Karst,Matthias %A Beissner,Florian %+ Somatosensory and Autonomic Therapy Research, Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, 30625, Germany, 49 511 53508413, beissner.florian@mh-hannover.de %K pain drawing %K symptom drawing %K body outline %K usability testing %K reproducibility %K tablet computers %K eHealth %K app %K chronic pain %D 2018 %7 30.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Symptom drawings are widely used as a qualitative and quantitative method of assessing pain symptoms for both clinical and research purposes. As electronic drawings offer many advantages over classical pen-and-paper drawings, the last years have seen a shift toward tablet-based acquisition of symptom drawings. However, software that is used in clinical care requires special attention to usability aspects and design to provide easy access for physically impaired or elderly patients. Objective: The aims of this project were to develop a new tablet-based software app specifically designed to collect patients’ and doctors’ drawings of pain and related bodily symptoms and test it for usability in 2 samples of chronic pain patients (Aim 1) and their treating doctors (Aim 2) as well as for test-retest reliability (Aim 3). Methods: In 2 separate studies, symptom drawings from 103 chronic pain patients and their treating doctors were collected using 2 different versions of the app. Both patients and doctors evaluated usability aspects of the app through questionnaires. Results from study 1 were used to improve certain features of the app, which were then evaluated in study 2. Furthermore, a subgroup of 25 patients in study 2 created 2 consecutive symptom drawings for test-retest reproducibility analysis. Usability of both app versions was compared, and reproducibility was calculated for symptom extent, number of symptom clusters, and the whole symptom pattern. Results: The changes we made to the app and the body outline led to significant improvements in patients’ usability evaluation regarding the identification with the body outline (P=.007) and the evaluation of symptom depth (P=.02), and the overall difficultness of the drawing process (P=.003) improved significantly. Doctors’ usability evaluation of the final app showed good usability with 75.63 (SD 19.51) points on the System Usability Scale, Attrakdiff 2 scores from 0.93 to 1.41, and ISONORM 9241/10 scores from −0.05 to 1.80. Test-retest analysis showed excellent reproducibility for pain extent (intraclass correlation coefficient, ICC=0.92) and good results for the number of symptom clusters (ICC=0.70) and a mean overlap of 0.47 (Jaccard index). Conclusions: We developed a tablet-based symptom drawing app and improved it based on usability assessment in a sample of chronic pain patients and their treating doctors. Increases in usability of the improved app comprised identification with the body outline, symptom depth evaluation, and difficultness of the drawing process. Test-retest reliability of symptom drawings by chronic pain patients showed fair to excellent reproducibility. Patients’ usability evaluation is an important factor that should not be neglected when designing apps for mobile or eHealth apps. %R 10.2196/mhealth.8409 %U http://mhealth.jmir.org/2018/5/e127/ %U https://doi.org/10.2196/mhealth.8409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e125 %T Acceptability of an mHealth App Intervention for Persons With Type 2 Diabetes and its Associations With Initial Self-Management: Randomized Controlled Trial %A Torbjørnsen,Astrid %A Småstuen,Milada Cvancarova %A Jenum,Anne Karen %A Årsand,Eirik %A Ribu,Lis %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4 St. Olavs plass, Oslo, 0130, Norway, 47 92633075, astrid.torbjornsen@oslomet.no %K diabetes mellitus, type 2 %K patient acceptance of health care %K acceptability of health care %K self-care %K mobile apps %K smartphone %K telemedicine %K regression analysis %K factor analysis %K statistical %D 2018 %7 21.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health interventions are increasingly used in health care. The level of acceptability may indicate whether and how such digital solutions will be used. Objective: This study aimed to explore associations between the level of acceptability of a mobile diabetes app and initial ability of self-management for patients with type 2 diabetes. Methods: Participants with type 2 diabetes were recruited from primary health care settings to a 3-armed randomized controlled trial in the Norwegian study in the RENEWING HEALTH project. At the 1-year follow-up, 75 out of 101 participants from the intervention groups completed an acceptability questionnaire (The Service User Technology Acceptability Questionnaire). In the randomized controlled trial, the 2 intervention groups (n=101 in total) received a mobile phone with a diabetes diary app, and one of the groups received additional health counseling given by telephone calls from a diabetes specialist nurse (n=50). At baseline, we collected clinical variables from medical records, whereas demographic data and self-management (The Health Education Impact Questionnaire) measures were self-reported. Log data from the use of the app by self-monitoring were registered continuously. Associations between initial ability to self-manage at baseline and acceptability of the diabetes diary app after 1 year were analyzed using linear regression. Results: We found statistically significant associations between 5 of the 8 self-management domains and perceived benefit, one of the acceptability factors. However, when adjusting for age, gender, and frequency of use, only 1 domain, skill and technique acquisition, remained independently associated with perceived benefit. Frequency of use of the app was the factor that revealed the strongest association with the acceptability domain perceived benefit. Conclusions: Our findings indicate that persons with diabetes may accept the app, despite its perceived benefit being associated with only one of the 8 domains of their initial level of self-management. Trial Registration: ClinicalTrials.gov NCT01315756; https://clinicaltrials.gov/show/NCT01315756 (Archived by WebCite at http://www.webcitation.org/6z46qPhWl) %M 29784635 %R 10.2196/mhealth.8824 %U http://mhealth.jmir.org/2018/5/e125/ %U https://doi.org/10.2196/mhealth.8824 %U http://www.ncbi.nlm.nih.gov/pubmed/29784635 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e21 %T Development of a Just-in-Time Adaptive mHealth Intervention for Insomnia: Usability Study %A Pulantara,I Wayan %A Parmanto,Bambang %A Germain,Anne %+ Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, 6026 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K Just-in-Time Adaptive Intervention %K JITAI %K mobile health %K mHealth %K sleep %K insomnia %K usability %K smartphone %K iREST %D 2018 %7 17.05.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, developing efficient treatment delivery methods for insomnia can have significant societal and personal health impacts. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment of insomnia but access is currently limited for patients, since treatment must occur in specialty sleep clinics, which suffer from an insufficient number of trained clinicians. Smartphone-based interventions offer a promising means for improving the delivery of CBTI. Furthermore, novel features such as real-time monitoring and assessment, personalization, dynamic adaptations of the intervention, and context awareness can enhance treatment personalization and effectiveness, and reduce associated costs. Ultimately, this “Just in Time Adaptive Intervention” for insomnia—an intervention approach that is acceptable to patients and clinicians, and is based on mobile health (mHealth) platform and tools—can significantly improve patient access and clinician delivery of evidence-based insomnia treatments. Objective: This study aims to develop and assess the usability of a Just in Time Adaptive Intervention application platform called iREST (“interactive Resilience Enhancing Sleep Tactics”) for use in behavioral insomnia interventions. iREST can be used by both patients and clinicians. Methods: The development of iREST was based on the Iterative and Incremental Development software development model. Requirement analysis was based on the case study’s description, workflow and needs, clinician inputs, and a previously conducted BBTI military study/implementation of the Just in Time Adaptive Intervention architecture. To evaluate the usability of the iREST mHealth tool, a pilot usability study was conducted. Additionally, this study explores the feasibility of using an off-the-shelf wearable device to supplement the subjective assessment of patient sleep patterns. Results: The iREST app was developed from the mobile logical architecture of Just in Time Adaptive Intervention. It consists of a cross-platform smartphone app, a clinician portal, and secure 2-way communications platform between the app and the portal. The usability study comprised 19 Active Duty Service Members and Veterans between the ages of 18 and 60. Descriptive statistics based on in-app questionnaires indicate that on average, 12 (mean 12.23, SD 8.96) unique devices accessed the clinician portal per day for more than two years, while the app was rated as “highly usable”, achieving a mean System Usability Score score of 85.74 (SD 12.37), which translates to an adjective rating of “Excellent”. The participants also gave high scores on “ease of use and learnability” with an average score of 4.33 (SD 0.65) on a scale of 1 to 5. Conclusions: iREST provides a feasible platform for the implementation of Just in Time Adaptive Intervention in mHealth-based and remote intervention settings. The system was rated highly usable and its cross-platformness made it readily implemented within the heavily segregated smartphone market. The use of wearables to track sleep is promising; yet the accuracy of this technology needs further improvement. Ultimately, iREST demonstrates that mHealth-based Just in Time Adaptive Intervention is not only feasible, but also works effectively. %M 29773529 %R 10.2196/humanfactors.8905 %U http://humanfactors.jmir.org/2018/2/e21/ %U https://doi.org/10.2196/humanfactors.8905 %U http://www.ncbi.nlm.nih.gov/pubmed/29773529 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e10308 %T Translation, Cross-Cultural Adaptation, and Validation of the Malay Version of the System Usability Scale Questionnaire for the Assessment of Mobile Apps %A Mohamad Marzuki,Muhamad Fadhil %A Yaacob,Nor Azwany %A Yaacob,Najib Majdi %+ Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia, 60 97676621, fadhilmarzuki@gmail.com %K usability %K System Usability Scale %K Malay %K questionnaire translation %K questionnaire validation %K mobile app %D 2018 %7 14.05.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A mobile app is a programmed system designed to be used by a target user on a mobile device. The usability of such a system refers not only to the extent to which product can be used to achieve the task that it was designed for, but also its effectiveness and efficiency, as well as user satisfaction. The System Usability Scale is one of the most commonly used questionnaires used to assess the usability of a system. The original 10-item version of System Usability Scale was developed in English and thus needs to be adapted into local languages to assess the usability of a mobile apps developed in other languages. Objective: The aim of this study is to translate and validate (with cross-cultural adaptation) the English System Usability Scale questionnaire into Malay, the main language spoken in Malaysia. The development of a translated version will allow the usability of mobile apps to be assessed in Malay. Methods: Forward and backward translation of the questionnaire was conducted by groups of Malay native speakers who spoke English as their second language. The final version was obtained after reconciliation and cross-cultural adaptation. The content of the Malay System Usability Scale questionnaire for mobile apps was validated by 10 experts in mobile app development. The efficacy of the questionnaire was further probed by testing the face validity on 10 mobile phone users, followed by reliability testing involving 54 mobile phone users. Results: The content validity index was determined to be 0.91, indicating good relevancy of the 10 items used to assess the usability of a mobile app. Calculation of the face validity index resulted in a value of 0.94, therefore indicating that the questionnaire was easily understood by the users. Reliability testing showed a Cronbach alpha value of .85 (95% CI 0.79-0.91) indicating that the translated System Usability Scale questionnaire is a reliable tool for the assessment of usability of a mobile app. Conclusions: The Malay System Usability Scale questionnaire is a valid and reliable tool to assess the usability of mobile app in Malaysia. %M 29759955 %R 10.2196/10308 %U http://humanfactors.jmir.org/2018/2/e10308/ %U https://doi.org/10.2196/10308 %U http://www.ncbi.nlm.nih.gov/pubmed/29759955 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e9 %T Acceptability of a Mobile Phone App for Measuring Time Use in Breast Cancer Survivors (Life in a Day): Mixed-Methods Study %A Ainsworth,Matthew Cole %A Pekmezi,Dori %A Bowles,Heather %A Ehlers,Diane %A McAuley,Edward %A Courneya,Kerry S %A Rogers,Laura Q %+ Department of Nutrition Sciences, University of Alabama at Birmingham, Webb 222, 1720 2nd Avenue South, Birmingham, AL, 35294 3360, United States, 1 205 975 1667, rogersl@uab.edu %K cancer %K technology %K time management %K mHealth %K physical activity %D 2018 %7 14.05.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Advancements in mobile technology allow innovative data collection techniques such as measuring time use (ie, how individuals structure their time) for the purpose of improving health behavior change interventions. Objective: The aim of this study was to examine the acceptability of a 5-day trial of the Life in a Day mobile phone app measuring time use in breast cancer survivors to advance technology-based measurement of time use. Methods: Acceptability data were collected from participants (N=40; 100% response rate) using a self-administered survey after 5 days of Life in a Day use. Results: Overall, participants had a mean age of 55 years (SD 8) and completed 16 years of school (SD 2). Participants generally agreed that learning to use Life in a Day was easy (83%, 33/40) and would prefer to log activities using Life in a Day over paper-and-pencil diary (73%, 29/40). A slight majority felt that completing Life in a Day for 5 consecutive days was not too much (60%, 24/40) or overly time-consuming (68%, 27/40). Life in a Day was rated as easy to read (88%, 35/40) and navigate (70%, 32/40). Participants also agreed that it was easy to log activities using the activity timer at the start and end of an activity (90%, 35/39). Only 13% (5/40) downloaded the app on their personal phone, whereas 63% (19/30) of the remaining participants would have preferred to use their personal phone. Overall, 77% (30/39) of participants felt that the Life in a Day app was good or very good. Those who agreed that it was easy to edit activities were significantly more likely to be younger when compared with those who disagreed (mean 53 vs 58 years, P=.04). Similarly, those who agreed that it was easy to remember to log activities were more likely to be younger (mean 52 vs 60 years, P<.001). Qualitative coding of 2 open-ended survey items yielded 3 common themes for Life in a Day improvement (ie, convenience, user interface, and reminders). Conclusions: A mobile phone app is an acceptable time-use measurement modality. Improving convenience, user interface, and memory prompts while addressing the needs of older participants is needed to enhance app utility. Trial Registration: ClinicalTrials.gov NCT00929617; https://clinicaltrials.gov/ct2/show/NCT00929617 (Archived by WebCite at http://www.webcitation.org/6z2bZ4P7X) %M 29759953 %R 10.2196/cancer.8951 %U http://cancer.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/cancer.8951 %U http://www.ncbi.nlm.nih.gov/pubmed/29759953 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e112 %T “The Doctor Needs to Know”: Acceptability of Smartphone Location Tracking for Care Coordination %A Liss,David T %A Serrano,Eloisa %A Wakeman,Julie %A Nowicki,Christine %A Buchanan,David R %A Cesan,Ana %A Brown,Tiffany %+ Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 3232, david.liss@northwestern.edu %K delivery of health care %K primary care %K health information technology %K smartphone %K mHealth %D 2018 %7 04.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Care coordination can be highly challenging to carry out. When care is fragmented across health systems and providers, there is an increased likelihood of hospital readmissions and wasteful health care spending. During and after care transitions, smartphones have the potential to bolster information transfer and care coordination. However, little research has examined patients’ perceptions of using smartphones to coordinate care. Objective: This study’s primary objective was to explore patient acceptability of a smartphone app that could facilitate care coordination in a safety net setting. Our secondary objective was to identify how clinicians and other members of primary care teams could use this app to coordinate care. Methods: This qualitative study was conducted at a federally qualified health center in metropolitan Chicago, IL. We conducted four focus groups (two in English, two in Spanish) with high-risk adults who owned a smartphone and received services from an organizational care management program. We also conducted structured interviews with clinicians and a group interview with care managers. Focus groups elicited patients’ perceptions of a smartphone app designed to: (1) identify emergency department (ED) visits and inpatient stays using real-time location data; (2) send automated notifications (ie, alerts) to users’ phones, asking whether they were a patient in the hospital; and (3) send automated messages to primary care teams to notify them about patients’ confirmed ED visits and inpatient stays. Focus group transcripts were coded based on emergent themes. Clinicians and care managers were asked about messages they would like to receive from the app. Results: Five main themes emerged in patient focus group discussions. First, participants expressed a high degree of willingness to use the proposed app during inpatient stays. Second, participants expressed varying degrees of willingness to use the app during ED visits, particularly for low acuity ED visits. Third, participants stated their willingness to have their location tracked by the proposed app due to its perceived benefits. Fourth, the most frequently mentioned barriers to acceptability were inconveniences such as “false alarm” notifications and smartphone battery drainage. Finally, there was some tension between how to maximize usability without unnecessarily increasing user burden. Both clinicians and care managers expressed interest in receiving messages from the app at the time of hospital arrival and at discharge. Clinicians were particularly interested in conducting outreach during ED visits and inpatient stays, while care managers expressed more interest in coordinating postdischarge care. Conclusions: High-risk primary care patients in a safety net setting reported a willingness to utilize smartphone location tracking technology to facilitate care coordination. Further research is needed on the development and implementation of new smartphone-based approaches to care coordination. %M 29728349 %R 10.2196/mhealth.9726 %U http://mhealth.jmir.org/2018/5/e112/ %U https://doi.org/10.2196/mhealth.9726 %U http://www.ncbi.nlm.nih.gov/pubmed/29728349 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e117 %T Determinants of Intention to Use Mobile Phone Caller Tunes to Promote Voluntary Blood Donation: Cross-Sectional Study %A Appiah,Bernard %A Burdine,James N %A Aftab,Ammar %A Asamoah-Akuoko,Lucy %A Anum,David A %A Kretchy,Irene A %A Samman,Elfreda W %A Appiah,Patience B %A Bates,Imelda %+ Research Program on Public and International Engagement for Health, Department of Environmental and Occupational Health, Texas A&M School of Public Health, Texas A&M University, 1266 TAMU, College Station, Texas, TX, 77843, United States, 1 9794369456, appiah@sph.tamhsc.edu %K caller tunes %K blood donation %K sub-Saharan Africa %K technology acceptance model %K mobile health %D 2018 %7 04.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Voluntary blood donation rates are low in sub-Saharan Africa. Sociobehavioral factors such as a belief that donated blood would be used for performing rituals deter people from donating blood. There is a need for culturally appropriate communication interventions to encourage individuals to donate blood. Health care interventions that use mobile phones have increased in developing countries, although many of them focus on SMS text messaging (short message service, SMS). A unique feature of mobile phones that has so far not been used for aiding blood donation is caller tunes. Caller tunes replace the ringing sound heard by a caller to a mobile phone before the called party answers the call. In African countries such as Ghana, instead of the typical ringing sound, a caller may hear a message or song. Despite the popularity of such caller tunes, there is a lack of empirical studies on their potential use for promoting blood donation. Objective: The aim of this study was to use the technology acceptance model to explore the influence of the factors—perceived ease of use, perceived usefulness, attitude, and free of cost—on intentions of blood or nonblood donors to download blood donation-themed caller tunes to promote blood donation, if available. Methods: A total of 478 blood donors and 477 nonblood donors were purposively sampled for an interviewer-administered questionnaire survey at blood donation sites in Accra, Ghana. Data were analyzed using descriptive statistics, exploratory factor analysis, and confirmatory factory analysis or structural equation modeling, leading to hypothesis testing to examine factors that determine intention to use caller tunes for blood donation among blood or nonblood donors who use or do not use mobile phone caller tunes. Results: Perceived usefulness had a significant effect on intention to use caller tunes among blood donors with caller tunes (beta=.293, P<.001), blood donors without caller tunes (beta=.165, P=.02, nonblood donors with caller tunes (beta=.278, P<.001), and nonblood donors without caller tunes (beta=.164, P=.01). Attitudes had significant effect on intention to use caller tunes among blood donors without caller tunes (beta=.351, P<.001), nonblood donors with caller tunes (beta=.384, P<.001), nonblood donors without caller tunes (beta=.539, P<.001) but not among blood donors with caller tunes (beta=.056, P=.44). The effect of free-of-cost caller tunes on the intention to use for blood donation was statistically significant (beta=.169, P<.001) only in the case of nonblood donors without caller tunes, whereas this path was statistically not significant in other models. Conclusions: Our results provide empirical evidence for designing caller tunes to promote blood donation in Ghana. The study found that making caller tunes free is particularly relevant for nonblood donors with no caller tunes. %M 29728343 %R 10.2196/mhealth.9752 %U http://mhealth.jmir.org/2018/5/e117/ %U https://doi.org/10.2196/mhealth.9752 %U http://www.ncbi.nlm.nih.gov/pubmed/29728343 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e108 %T Users’ Perspectives on mHealth Self-Management of Bipolar Disorder: Qualitative Focus Group Study %A Switsers,Lise %A Dauwe,Arthur %A Vanhoudt,Anneleen %A Van Dyck,Hilde %A Lombaerts,Koen %A Oldenburg,JFE %+ Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, 1050, Belgium, 32 02 629 26 74, lise.switsers@vub.be %K bipolar disorder %K self-management %K mHealth %K focus groups %D 2018 %7 02.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent research indicates that current mHealth apps for bipolar disorders (BDs) show crucial shortcomings. They lack important functionality, are of inconsistent quality, and are insufficiently evidence-based. mHealth apps need to be better adapted to the needs of users. The perspectives of adult service users with BD regarding mHealth apps have not been well investigated. Objective: The objective of this study was to examine the needs and expectations of adults with BD regarding mHealth apps. Methods: Two focus group sessions were organized in which patients’ views on self-management and design and functionality of an mHealth app for BD were assessed. During session 1, four focus groups were organized to identify users’ needs regarding support for self-management. Session 2 contained three cocreation focus groups. Through this method, the desired functionality and design were explored. Results: Participants indicated that they were in need of support in various ways. Not only support in psychoeducation, including daily routine, sleep pattern, maintaining social contacts, maintaining a healthy lifestyle, and avoidance of stimuli, was considered important for them but also gaining insight into their illness was found to be crucial. Conclusions: According to the participants, their illness-related information is a key factor in gaining insight into their mood pattern. Participants wanted a functional design that would increase daily use and prevent overstimulation. The results of this study should be taken into account when developing new mHealth apps. %M 29720363 %R 10.2196/mhealth.9529 %U http://mhealth.jmir.org/2018/5/e108/ %U https://doi.org/10.2196/mhealth.9529 %U http://www.ncbi.nlm.nih.gov/pubmed/29720363 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e34 %T A Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study %A Hightow-Weidman,Lisa %A Muessig,Kathryn %A Knudtson,Kelly %A Srivatsa,Mala %A Lawrence,Ellena %A LeGrand,Sara %A Hotten,Anna %A Hosek,Sybil %+ Institute of Global Health and Infectious Diseases, University of North Carolina, Bioinformatics Building, Suite 2154, 130 Mason Farm Road, Chapel Hill, NC, 27599-7030, United States, 1 919 843 0033, lisa_hightow@med.unc.edu %K YMSM %K antiretroviral adherence %K smartphone app %K gamification %K social networking %D 2018 %7 30.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among YMSM is an urgent public health priority. Technology-based interventions—particularly mobile health platforms—can provide tailored adherence interventions and allow YMSM to engage and connect with others. Objective: The objective of this study was to describe the development of AllyQuest, a novel, theoretically-based, smartphone app designed to improve engagement in care and ART adherence and social support among HIV-positive YMSM. Methods: AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics, such as challenges, points, and rewards. A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific; a calendar allows for reflection on adherence over time. After iterative development with input from two youth advisory boards, usability testing was conducted to assess app functionality, comprehension of the educational content, use of intervention features, and overall impressions of app relevance and appeal. A 28-day pilot trial was conducted with 20 HIV+ YMSM to evaluate intervention feasibility and acceptability. Results: Mean age of participants was 21.8 years (range 19-24), and 95% (19/20) of the participants were nonwhite. The mean time of app use was 158.4 min (SD 114.1), with a range of 13 to 441 min. There was a mean of 21.2 days of use (out of a total possible 28 days). There were 222 posts to the daily discussion social wall. Feasibility and acceptability ratings were high. Overall, participants found the app easy to use and navigate, not intrusive, and had few reported technical issues. Higher levels of app usage were positively correlated with HIV self-management outcomes, and there was a statistically significant (P<.05) positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications. Conclusions: AllyQuest represents a new, highly scalable solution that is well-suited to meet the specific prevention and care needs of HIV+ YMSM. The development of this intervention is both timely and vital, given the urgency of the ongoing HIV epidemic among YMSM. %M 29712626 %R 10.2196/publichealth.8923 %U http://publichealth.jmir.org/2018/2/e34/ %U https://doi.org/10.2196/publichealth.8923 %U http://www.ncbi.nlm.nih.gov/pubmed/29712626 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e8 %T MedFit App, a Behavior-Changing, Theoretically Informed Mobile App for Patient Self-Management of Cardiovascular Disease: User-Centered Development %A Duff,Orlaith %A Walsh,Deirdre %A Malone,Shauna %A McDermott,Lauri %A Furlong,Brona %A O'Connor,Noel %A Moran,Kieran %A Woods,Catherine %+ School of Health and Human Performance, Dublin City University, Glasnevin,, Dublin, 9, Ireland, 353 17008011, kieran.moran@dcu.ie %K app development %K cardiac rehabilitation %K telemedicine %K exercise %K mHealth %K focus groups %K usability testing %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The MedFit app is designed to facilitate participation of people with cardiovascular disease (CVD) in an exercise-based rehabilitation program remotely. This paper details the development for the MedFit app. Objective: The aim of this research was to develop a behavior change, theoretically informed exercise rehabilitation mobile app for adults with CVD by following the early stages of the formative research: development and feasibility testing. Methods: Adhering to the mobile health (mHealth) development evaluation framework, the stages of the formative research process including (1) development and (2) feasibility were undertaken. The content and format of the MedFit app were developed based on (1) theory, (2) usability testing, and (3) content design. Results: A systematic review of the literature was undertaken to identify the most appropriate theories from which to develop the app. This led to the creation of the MedFit app. The app went through iterative rounds of usability focus group testing with adults with CVD to provide feedback on the app. This process was framed by the unified theory of acceptance and use of technology model. Feedback was then translated into feasible technical improvements to be executed through close collaboration with the technical team, who adapted and made modifications to the app based on this codesign process. Conclusions: The formative research process of the app development involved theoretical underpinning, usability testing, and content design. mHealth interventions may play a key role in the future of health care, potentially addressing the barriers to participation in cardiac rehabilitation. This work will provide guidance for future research aiming to develop mobile apps by incorporating a best practice framework for mHealth intervention development and a user-centered design approach. %M 30684426 %R 10.2196/formative.9550 %U http://formative.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/formative.9550 %U http://www.ncbi.nlm.nih.gov/pubmed/30684426 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e18 %T Enhancing Home Health Mobile Phone App Usability Through General Smartphone Training: Usability and Learnability Case Study %A Harte,Richard %A Hall,Tony %A Glynn,Liam %A Rodríguez-Molinero,Alejandro %A Scharf,Thomas %A Quinlan,Leo R %A ÓLaighin,Gearóid %+ Physiology, School of Medicine, NUI Galway, University Road, Galway,, Ireland, 353 91493710, leo.quinlan@nuigalway.ie %K smartphone %K aged %K elderly %K wearable electronic devices %K telemedicine %K user-computer interface %K education %K user centered-design %K usability %K connected health %K human factors %K falls detection %D 2018 %7 26.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Each year, millions of older adults fall, with more than 1 out of 4 older people experiencing a fall annually, thereby causing a major social and economic impact. Falling once doubles one’s chances of falling again, making fall prediction an important aspect of preventative strategies. In this study, 22 older adults aged between 65 and 85 years were trained in the use of a smartphone-based fall prediction system. The system is designed to continuously assess fall risk by measuring various gait and balance parameters using a smart insole and smartphone, and is also designed to detect falls. The use case of the fall prediction system in question required the users to interact with the smartphone via an app for device syncing, data uploads, and checking system status. Objective: The objective of this study was to observe the effect that basic smartphone training could have on the user experience of a group that is not technically proficient with smartphones when using a new connected health system. It was expected that even short rudimentary training could have a large effect on user experience and therefore increase the chances of the group accepting the new technology. Methods: All participants received training on how to use the system smartphone app; half of the participants (training group) also received extra training on how to use basic functions of the smartphone, such as making calls and sending text messages, whereas the other half did not receive this extra training (no extra training group). Comparison of training group and no extra training group was carried out using metrics such as satisfaction rating, time taken to complete tasks, cues required to complete tasks, and errors made during tasks. Results: The training group fared better in the first 3 days of using the system. There were significant recorded differences in number of cues required and errors committed between the two groups. By the fourth and fifth day of use, both groups were performing at the same level when using the system. Conclusions: Supplementary basic smartphone training may be critical in trials where a smartphone app–based system for health intervention purposes is being introduced to a population that is not proficient with technology. This training could prevent early technology rejection and increase the engagement of older participants and their overall user experience with the system. %M 29699969 %R 10.2196/humanfactors.7718 %U http://humanfactors.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/humanfactors.7718 %U http://www.ncbi.nlm.nih.gov/pubmed/29699969 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e16 %T Relationship Between Evidence Requirements, User Expectations, and Actual Experiences: Usability Evaluation of the Twazon Arabic Weight Loss App %A Alnasser,Aroub %A Kyle,Janet %A Alkhalifah,Abdulrahman %A Marais,Debbi %+ Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, PO Box 86683, Riyadh, 11632, Saudi Arabia, 966 118056476, aroub@ksu.edu.sa %K mHealth %K weight loss %K obesity %K smartphones %K mobile applications %K Saudi Arabia %K women's health %D 2018 %7 17.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Saudi Arabia has faced a steady growth in the prevalence of obesity. The concurrent and ubiquitous use of mobile technology, such as smartphones and apps, provides an opportunity for the implementation of mHealth technology, a method for delivering behavioral interventions. Despite their effectiveness in promoting lifestyle and diet modification, culturally adapted weight loss apps and related interventions are lacking in Gulf Cooperation Council countries. Objective: The objective of our study was to identify the relationship between adherence to evidence-informed practices, potential user expectations, and actual user experiences in order to enhance the understanding of the overall usability of the Twazon Arabic weight loss app. Methods: In 2 previous studies, 39 Saudi women were recruited for focus group discussions and 240 Saudi women were recruited for an app-based weight loss intervention. Usability of the Twazon Arabic weight loss app was evaluated by analyzing the opinions and experiences of 26 participants who engaged with the Twazon app for 4 months; the System Usability Scale (SUS) and word clouds were used. The results were triangulated with potential user expectations obtained in the focus group discussion and with the findings from an Arabic app screening for evidence-informed practices. Results: The average reported SUS score was 69.3. The most favored features were the calorie counter, step counter, and physical activity calorie counter. The features in need of improvement were the social network, notifications, and the Twazon Saudi Food Database. Twazon users preferred and found useful 7 of the 13 evidence-informed weight loss practices that were integrated into the features of the app. Conclusions: Triangulation identified the most notable relationship to be the disparity between user experience and 2 of the evidence-informed practices, namely a minimum weight loss goal of 0.5 to 1 kg/week and social support; no relationship was found between user expectations and evidence-informed weight loss practices. The overall usability of the Twazon Arabic weight loss app ranged between high marginal and acceptable, indicating that some improvements to the app should be considered for implementation in future app-based weight loss interventions of this kind. %M 29666042 %R 10.2196/humanfactors.9765 %U http://humanfactors.jmir.org/2018/2/e16/ %U https://doi.org/10.2196/humanfactors.9765 %U http://www.ncbi.nlm.nih.gov/pubmed/29666042 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e97 %T Mobile App Usage Patterns of Patients Prescribed a Smoking Cessation Medicine: Prospective Observational Study %A Bruno,Marianna %A Wright,Marcia %A Baker,Christine L %A Emir,Birol %A Carda,Eric %A Clausen,Michelle %A Sigler,Catherine %A Patel,Aanal %+ Pfizer, 1002 Waverly Ave, Nashville, TN,, United States, 1 913 481 6562, Marcia.Wright@Pfizer.com %K smartphone %K mobile apps %K technology %K patient engagement %K patient satisfaction %K patient adherence %K surveys %K smoking cessation %D 2018 %7 17.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking is the leading preventable cause of death and is responsible for more than 480,000 deaths per year in the United States. Smoking cessation is challenging for many patients. Regardless of available treatment options, most quit attempts are unaided, and it takes multiple attempts before a patient is successful. With the ever-increasing use of smartphones, mobile apps hold promise in supporting cessation efforts. This study evaluates the ease of use and user satisfaction with the Pfizer Meds app to support smoking cessation among patients prescribed varenicline (Chantix). Objective: Study participants included varenicline users who downloaded and used the app on their personal smartphone. The main objectives were to report mobile app download frequency and usage details and to describe the participant-reported satisfaction with and usefulness of the app over the 14-week follow-up study period. Methods: Adults aged 18 years or older who had been prescribed varenicline were identified from the Express Scripts Incorporated pharmacy claims database. After meeting privacy restrictions, subjects were sent an invitation letter and second reminder letter with instructions on how to download the Pfizer Meds mobile app. Participants received a push notification to complete a smartphone-enabled survey regarding the utility of the app 12 weeks after downloading the app. Descriptive statistics summarized sociodemographics, use of varenicline, and details of use and satisfaction with the mobile app. Results: Of the 38,129 varenicline users who were sent invitation letters, 1281 participants (3.35%) downloaded the Pfizer Meds app. Of the 1032 users with demographic and other data, 585 (56.68%) were females, and 446 (43.22%) were males; mean age was 46.4 years (SD 10.8). The mean number of app sessions per participant was 4.0 (SD 6.8). The end-of-study survey was completed by 131 survey respondents (10.23%, 131/1281); a large number of participants (117/131, 89.3%) reported being extremely, very, or moderately satisfied with the app. A total of 97 survey respondents (97/131, 74.0%) reported setting up a quit date in the app. Of those, 74 (74/97, 76%) reported quitting on their quit date. Conclusions: Positive patient engagement was observed in this study based on app download and usage. This study quantified how the Pfizer Meds app performed in an observational real-world data setting. The findings demonstrate the willingness of participants to set a quit date and use the app for support in medication adherence, refill reminders, and information regarding how to take the medication. This study provides real-world evidence of the contribution apps can make to the continued encouragement of smokers to improve their health by smoking cessation. %M 29666043 %R 10.2196/mhealth.9115 %U http://mhealth.jmir.org/2018/4/e97/ %U https://doi.org/10.2196/mhealth.9115 %U http://www.ncbi.nlm.nih.gov/pubmed/29666043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e85 %T Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women’s Perceptions %A Zhu,Jiemin %A Ebert,Lyn %A Guo,Dongmei %A Yang,Sumei %A Han,Qiuying %A Chan,Sally Wai-Chi %+ Nursing Department, Medical School, Xiamen University, Room 208, Alice Building,, Xiangan Nan Road, Xiangan District, Xiamen, 361102, Fujian Province, China, 86 15960212649, jiemin.zhu@uon.edu.au %K mobile app %K breast cancer %K chemotherapy %D 2018 %7 11.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women with breast cancer undergoing chemotherapy experience difficulty in accessing adequate cancer care in China. Mobile apps have the potential to provide easily accessible support for these women. However, there remains a paucity of randomized controlled trials to evaluate the effectiveness of app-based programs targeting specifically women with breast cancer undergoing chemotherapy. Moreover, women’s perceptions and experiences related to using and interacting within the app-based program have rarely been reported. Therefore, an app-based Breast Cancer e-Support program was developed and evaluated using a randomized controlled trial. Based on the incorporation of Bandura’s self-efficacy and social exchange theory, Breast Cancer e-Support program lasted for 12 weeks covering 4 cycles of chemotherapy and had 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. Objective: As a part of the randomized controlled trial, the aim of this study was to explore the participants’ perception of Breast Cancer e-Support program, its strengths and weaknesses, and suggestions to improve the program. Methods: A descriptive qualitative study was employed. Thirteen women with breast cancer from 2 university-affiliated hospitals in China, who were randomly allocated to the Breast Cancer e-Support program in the randomized controlled trial, were interviewed from November 2016 to February 2017. Purposive sampling was used based on women’s scores of self-efficacy after the completion of the intervention. Inductive content analysis was used to analyze the transcripts, allowing the categories and subcategories to flow from the data. Results: The qualitative interviews revealed that participants perceived the Breast Cancer e-Support program to be helpful in enhancing knowledge, improving confidence level, and promoting emotional well-being. Women also identified access to tailored advice from experts and convenience as the benefits of this program. Physical or psychological health status, stigma related with breast cancer, and app instability were mentioned as the challenges to engagement. Suggestions for improvement included adding message reminders to prompt instant communication and search engine to locate information quickly, supplementing more interesting and practical knowledge, updating the information more often, and quickening the responses to women’s questions. The participants recommended the Breast Cancer e-Support program to be incorporated as routine care to support women during chemotherapy. Conclusions: This study demonstrates the potential of the Breast Cancer e-Support program to support women during chemotherapy. Future app-based programs should apply a family-centered approach and provide more support on stigma associated with the disease to encourage engagement with the app. Suggestions of improvement regarding the design, content, and operation of the app-based intervention should be addressed in future studies. It is promising to incorporate the Breast Cancer e-Support program into routine care to generalize the benefits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ ACTRN12616000639426.aspx (Archived by WebCite at http://www.webcitation.org/6v1n9hGZq) %M 29643056 %R 10.2196/mhealth.9311 %U http://mhealth.jmir.org/2018/4/e85/ %U https://doi.org/10.2196/mhealth.9311 %U http://www.ncbi.nlm.nih.gov/pubmed/29643056 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e86 %T Wearable Activity Tracker Use Among Australian Adolescents: Usability and Acceptability Study %A Ridgers,Nicola D %A Timperio,Anna %A Brown,Helen %A Ball,Kylie %A Macfarlane,Susie %A Lai,Samuel K %A Richards,Kara %A Mackintosh,Kelly A %A McNarry,Melitta A %A Foster,Megan %A Salmon,Jo %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 3 9244 6718, nicky.ridgers@deakin.edu.au %K qualitative research %K fitness trackers %K physical activity %D 2018 %7 11.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptability. Objective: The aim of this study was to examine the usability and acceptability of a wearable activity tracker among adolescents. A secondary aim was to determine adolescents’ awareness and use of the different functions and features in the wearable activity tracker and accompanying app. Methods: Sixty adolescents (aged 13-14 years) in year 8 from 3 secondary schools in Melbourne, Australia, were provided with a wrist-worn Fitbit Flex and accompanying app, and were asked to use it for 6 weeks. Demographic data (age, sex) were collected via a Web-based survey completed during week 1 of the study. At the conclusion of the 6-week period, all adolescents participated in focus groups that explored their perceptions of the usability and acceptability of the Fitbit Flex, accompanying app, and Web-based Fitbit profile. Qualitative data were analyzed using pen profiles, which were constructed from verbatim transcripts. Results: Adolescents typically found the Fitbit Flex easy to use for activity tracking, though greater difficulties were reported for monitoring sleep. The Fitbit Flex was perceived to be useful for tracking daily activities, and adolescents used a range of features and functions available through the device and the app. Barriers to use included the comfort and design of the Fitbit Flex, a lack of specific feedback about activity levels, and the inability to wear the wearable activity tracker for water-based sports. Conclusions: Adolescents reported that the Fitbit Flex was easy to use and that it was a useful tool for tracking daily activities. A number of functions and features were used, including the device’s visual display to track and self-monitor activity, goal-setting in the accompanying app, and undertaking challenges against friends. However, several barriers to use were identified, which may impact on sustained use over time. Overall, wearable activity trackers have the potential to be integrated into physical activity interventions targeted at adolescents, but both the functionality and wearability of the monitor should be considered. %M 29643054 %R 10.2196/mhealth.9199 %U http://mhealth.jmir.org/2018/4/e86/ %U https://doi.org/10.2196/mhealth.9199 %U http://www.ncbi.nlm.nih.gov/pubmed/29643054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e76 %T Women’s Perceptions of Using Mobile Phones for Maternal and Child Health Support in Afghanistan: Cross-Sectional Survey %A Yamin,Fazal %A Kaewkungwal,Jaranit %A Singhasivanon,Pratap %A Lawpoolsri,Saranath %+ Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithee Road, Ratchathewi, Bangkok,, Thailand, 66 2 306 9188, saranath.law@mahidol.ac.th %K Afghanistan %K mobile health %K maternal health, child health %K perception %K mobile phone %D 2018 %7 10.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Growing rates of global mobile subscriptions pave the way for implementation of mobile health (mHealth) initiatives, especially among hard-to-reach populations. Objective: This study aimed to determine the perceptions of Afghan women regarding the use of mobile phones for maternal and child health services. Methods: A cross-sectional survey was conducted in both rural and urban districts of Nangarhar Province, Afghanistan. The interviewer-administered questionnaire was used to assess participants’ demographic profile, mobile phone usage, and perception of respondents toward different aspects of health care delivery via mobile phones. Results: Of the 240 participants, 142 (59.2%) owned mobile phones and 220 (91.7%) routinely used mobile phones. Approximately 209 (87.1%) of participants were willing to receive health messages via a mobile phone. Automated voice call was the most preferred method for sending health messages. More than 90% of the women reported that they would like to receive reminders for their children’s vaccinations and antenatal care visits. Conclusions: Users’ perception was associated with mobile phone ownership, literacy level, and experience using mobile phones. In the study area, where the literacy rate is low, mHealth was well perceived. %M 29636317 %R 10.2196/mhealth.9504 %U http://mhealth.jmir.org/2018/4/e76/ %U https://doi.org/10.2196/mhealth.9504 %U http://www.ncbi.nlm.nih.gov/pubmed/29636317 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e80 %T Perceptions of Adolescents With Cancer Related to a Pain Management App and Its Evaluation: Qualitative Study Nested Within a Multicenter Pilot Feasibility Study %A Jibb,Lindsay A %A Stevens,Bonnie J %A Nathan,Paul C %A Seto,Emily %A Cafazzo,Joseph A %A Johnston,Donna L %A Hum,Vanessa %A Stinson,Jennifer N %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, K1H8M, Canada, 1 613 562 5800 ext 4253, ljibb@uottawa.ca %K pain %K adolescent %K cancer %K supportive care %K mHealth %K qualitative %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain in adolescents with cancer is common and negatively impacts health-related quality of life. The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (ie, systematic review, consensus conference and vetting, iterative usability testing cycles). A 28-day Pain Squad+ pilot was conducted with 40 adolescents with cancer to evaluate the feasibility of implementing the app in a future clinical trial and to obtain estimates of treatment effect. Objective: The objective of our nested qualitative study was to elucidate the perceptions of adolescents with cancer to determine the acceptability and perceived helpfulness of Pain Squad+, suggestions for app improvement, and satisfaction with the pilot study protocol. Methods: Post pilot study participation, telephone-based, semistructured, and audio-recorded exit interviews were conducted with 20 adolescents with cancer (12-18 years). All interviews were transcribed and independently coded by 2 study team members. Content analysis was conducted to identify data categories and overarching themes. Results: Five major themes comprising multiple categories and codes emerged. These themes focused on the acceptability of the intervention, acceptability of the study, the perceived active ingredients of the intervention, the suitability of the intervention to adolescents’ lives, and recommendations for intervention improvement. Conclusions: Overall, Pain Squad+ and the pilot study protocol were acceptable to adolescents with cancer. Suggestions for intervention and study improvements will be incorporated into the design of a future randomized clinical trial (RCT) aimed at assessing the effectiveness of Pain Squad+ on adolescents with cancer health outcomes. %M 29625951 %R 10.2196/mhealth.9319 %U http://mhealth.jmir.org/2018/4/e80/ %U https://doi.org/10.2196/mhealth.9319 %U http://www.ncbi.nlm.nih.gov/pubmed/29625951 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e72 %T Evaluating an mHealth App for Health and Well-Being at Work: Mixed-Method Qualitative Study %A de Korte,Elsbeth Marieke %A Wiezer,Noortje %A Janssen,Joris H %A Vink,Peter %A Kraaij,Wessel %+ Netherlands Organisation for Applied Scientific Research, Schipholweg 77-89, Leiden, 2316 ZL, Netherlands, 31 6 211 34434, elsbeth.dekorte@tno.nl %K mHealth %K work %K qualitative research methods %K interview %K focus group %K technology acceptance %K user satisfaction %K usability %K well-being %K prevention %D 2018 %7 28.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To improve workers’ health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available. Objective: The objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts. Methods: Employees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories. Results: Interviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results. Conclusions: Findings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users’ characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees’ mental models; practicability; resources; and skills required of experts and users. %M 29592846 %R 10.2196/mhealth.6335 %U http://mhealth.jmir.org/2018/3/e72/ %U https://doi.org/10.2196/mhealth.6335 %U http://www.ncbi.nlm.nih.gov/pubmed/29592846 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e75 %T Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users’ Willingness to Pay: Web-Based Survey Among Older Adults %A Rasche,Peter %A Mertens,Alexander %A Brandl,Christopher %A Liu,Shan %A Buecking,Benjamin %A Bliemel,Christopher %A Horst,Klemens %A Weber,Christian David %A Lichte,Philipp %A Knobe,Matthias %+ Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Bergdriesch 27, Aachen, 52062, Germany, 49 0241 80 99 ext 477, p.rasche@iaw.rwth-aachen.de %K prevention %K cell phone %K accidents %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective: The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods: A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results: Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). Conclusions: The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention. %M 29588268 %R 10.2196/mhealth.9467 %U http://mhealth.jmir.org/2018/3/e75/ %U https://doi.org/10.2196/mhealth.9467 %U http://www.ncbi.nlm.nih.gov/pubmed/29588268 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e68 %T Patient and Family Engagement in the Design of a Mobile Health Solution for Pediatric Asthma: Development and Feasibility Study %A McWilliams,Andrew %A Reeves,Kelly %A Shade,Lindsay %A Burton,Elizabeth %A Tapp,Hazel %A Courtlandt,Cheryl %A Gunter,Andrew %A Dulin,Michael F %+ Center for Outcomes Research and Evaluation, Carolinas HealthCare System, Research Office Building, 1540 Garden Terrace, Suite 406, Charlotte, NC, 28203, United States, 1 704 351 6835, andrew.mcwilliams@carolinas.org %K engagement %K pediatric asthma %K shared decision-making %K health information technology %D 2018 %7 22.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Asthma is a highly prevalent, chronic disease with significant morbidity, cost, and disparities in health outcomes. While adherence to asthma treatment guidelines can improve symptoms and decrease exacerbations, most patients receive care that is not guideline-based. New approaches that incorporate shared decision-making (SDM) and health information technology (IT) are needed to positively impact asthma management. Despite the promise of health IT to improve efficiency and outcomes in health care, new IT solutions frequently suffer from a lack of widespread adoption and do not achieve desired results, as a consequence of not involving end-users in design. Objective: To describe a case study of a pediatric asthma SDM health IT solution’s development and demonstrate a methodology for engaging actual patients and families in IT development. Perspectives are shared from the vantage point of the research team and a parent of a child with asthma, who participated on the development team. Methods: We adapted user-centric design principles to engage actual users across three main development phases: project initiation, ideation, and usability testing. To facilitate the necessary level of user engagement, our approach included: (1) a Development Workgroup consisting of patients, caregivers, and providers who met regularly with the research team; and (2) “real-world users” consisting of patients, caregivers, and providers recruited from a variety of care locations, including safety-net clinics. Results: Using this methodology, we successful partnered with asthma patients and families to create an interactive, digital solution called Carolinas Asthma Coach. Carolinas Asthma Coach incorporates SDM principles to elicit patient information, including goals and preferences, and provides health-literate, tailored education with specific guideline-based recommendations for patients and their providers. Of the patients, caregivers, and providers surveyed, 100% (n=60) said they would recommend Carolinas Asthma Coach to a friend or colleague. Qualitative feedback from users provided support for the usability and engaging nature of the app. Conclusions: This project demonstrates the feasibility and benefits of deploying user-centric design methods that engage real patients and caregivers throughout the health IT design process. %M 29567637 %R 10.2196/mhealth.8849 %U http://mhealth.jmir.org/2018/3/e68/ %U https://doi.org/10.2196/mhealth.8849 %U http://www.ncbi.nlm.nih.gov/pubmed/29567637 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e57 %T A Mobile App (BEDSide Mobility) to Support Nurses’ Tasks at the Patient's Bedside: Usability Study %A Ehrler,Frederic %A Weinhold,Thomas %A Joe,Jonathan %A Lovis,Christian %A Blondon,Katherine %+ Division of Medical Information Sciences, University Hospitals of Geneva, 4 Gabrielle-Perret-Gentil, Geneva, 1205, Switzerland, 41 0223728697, frederic.ehrler@hcuge.ch %K clinical information system %K mobile health %K usability testing %D 2018 %7 21.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The introduction of clinical information systems has increased the amount of clinical documentation. Although this documentation generally improves patient safety, it has become a time-consuming task for nurses, which limits their time with the patient. On the basis of a user-centered methodology, we have developed a mobile app named BEDSide Mobility to support nurses in their daily workflow and to facilitate documentation at the bedside. Objective: The aim of the study was to assess the usability of the BEDSide Mobility app in terms of the navigation and interaction design through usability testing. Methods: Nurses were asked to complete a scenario reflecting their daily work with patients. Their interactions with the app were captured with eye-tracking glasses and by using the think aloud protocol. After completing the tasks, participants filled out the system usability scale questionnaire. Descriptive statistics were used to summarize task completion rates and the users’ performance. Results: A total of 10 nurses (aged 21-50) participated in the study. Overall, they were satisfied with the navigation, layout, and interaction design of the app, with the exception of one user who was unfamiliar with smartphones. The problems identified were related to the ambiguity of some icons, the navigation logic, and design inconsistency. Conclusions: Besides the usability issues identified in the app, the participants’ results do indicate good usability, high acceptance, and high satisfaction with the developed app. However, the results must be taken with caution because of the poor ecological validity of the experimental setting. %M 29563074 %R 10.2196/mhealth.9079 %U http://mhealth.jmir.org/2018/3/e57/ %U https://doi.org/10.2196/mhealth.9079 %U http://www.ncbi.nlm.nih.gov/pubmed/29563074 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e53 %T Quality of Publicly Available Physical Activity Apps: Review and Content Analysis %A Bondaronek,Paulina %A Alkhaldi,Ghadah %A Slee,April %A Hamilton,Fiona L %A Murray,Elizabeth %+ eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 20 3002 878, p.bondaronek@ucl.ac.uk %K exercise %K health behavior %K mobile applications %K health promotion %K mHealth %K eHealth review %D 2018 %7 21.03.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Within the new digital health landscape, the rise of health apps creates novel prospects for health promotion. The market is saturated with apps that aim to increase physical activity (PA). Despite the wide distribution and popularity of PA apps, there are limited data on their effectiveness, user experience, and safety of personal data. Objective: The purpose of this review and content analysis was to evaluate the quality of the most popular PA apps on the market using health care quality indicators. Methods: The top-ranked 400 free and paid apps from iTunes and Google Play stores were screened. Apps were included if the primary behavior targeted was PA, targeted users were adults, and the apps had stand-alone functionality. The apps were downloaded on mobile phones and assessed by 2 reviewers against the following quality assessment criteria: (1) users’ data privacy and security, (2) presence of behavior change techniques (BCTs) and quality of the development and evaluation processes, and (3) user ratings and usability. Results: Out of 400 apps, 156 met the inclusion criteria, of which 65 apps were randomly selected to be downloaded and assessed. Almost 30% apps (19/65) did not have privacy policy. Every app contained at least one BCT, with an average number of 7 and a maximum of 13 BCTs. All but one app had commercial affiliation, 12 consulted an expert, and none reported involving users in the app development. Only 12 of 65 apps had a peer-reviewed study connected to the app. User ratings were high, with only a quarter of the ratings falling below 4 stars. The median usability score was excellent—86.3 out of 100. Conclusions: Despite the popularity of PA apps available on the commercial market, there were substantial shortcomings in the areas of data safety and likelihood of effectiveness of the apps assessed. The limited quality of the apps may represent a missed opportunity for PA promotion. %M 29563080 %R 10.2196/mhealth.9069 %U http://mhealth.jmir.org/2018/3/e53/ %U https://doi.org/10.2196/mhealth.9069 %U http://www.ncbi.nlm.nih.gov/pubmed/29563080 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e51 %T More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design %A Giunti,Guido %A Mylonopoulou,Vasiliki %A Rivera Romero,Octavio %+ Salumedia Tecnologias, Avda. Republica Argentina nº 24, Edificio Torre de los Remedios 5ª planta modulo A, Sevilla, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K multiple sclerosis %K telemedicine %K fatigue %K mobile applications %K video games %K qualitative research %K exercise %K chronic disease %K user-computer interface %K software design %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users’ needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it. %M 29500159 %R 10.2196/mhealth.9437 %U http://mhealth.jmir.org/2018/3/e51/ %U https://doi.org/10.2196/mhealth.9437 %U http://www.ncbi.nlm.nih.gov/pubmed/29500159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e45 %T Mobile App Delivery of the EORTC QLQ-C30 Questionnaire to Assess Health-Related Quality of Life in Oncological Patients: Usability Study %A Kessel,Kerstin A %A Vogel,Marco ME %A Alles,Anna %A Dobiasch,Sophie %A Fischer,Hanna %A Combs,Stephanie E %+ Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 0894140 ext 4502, kerstin.kessel@tum.de %K radiation oncology %K healthcare surveys %K mobile applications %K mobile apps %K telemedicine %K health-related quality of life %K questionnaires %K oncology  %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are evolving in the medical field. However, ongoing discussions have questioned whether such apps are really valuable and whether patients will accept their use in day-to-day clinical life. Therefore, we initiated a usability study in our department. Objective: We present our results of the first app prototype and patient testing of health-related quality of life (HRQoL) assessment in oncological patients. Methods: We developed an app prototype for the iOS operating system within eight months in three phases: conception, initial development, and pilot testing. For the HRQoL assessment, we chose to implement only the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30; German version 3). Usability testing was conducted for three months. Participation was voluntary and pseudonymized. After completion of the QLQ-C30 questionnaire using iPads provided by our department, we performed a short survey with 10 questions. This survey inquired about patients’ opinions regarding general aspects, including technical advances in medicine, mobile and app assistance during cancer treatment, and the app-specific functions (eg, interface and navigation). Results: After logging into the app, the user can choose between starting a questionnaire, reviewing answers (administrators only), and logging out. The questionnaire is displayed with the same information, questions, and answers as on the original QLQ-C30 sheet. No alterations in wording were made. Usability was tested with 81 patients; median age was 55 years. The median time for completing the HRQoL questionnaire on the iPad was 4.0 minutes. Of all participants, 84% (68/81) owned a mobile device. Similarly, 84% (68/81) of participants would prefer a mobile version of the HRQoL questionnaire instead of a paper-based version. Using the app in daily life during and after cancer treatment would be supported by 83% (67/81) of participants. In the prototype version of the app, data were stored on the device; in the future, 79% (64/81) of the patients would agree to transfer data via the Internet. Conclusions: Our usability test showed good results regarding attractiveness, operability, and understandability. Moreover, our results demonstrate a high overall acceptance of mobile apps and telemedicine in oncology. The HRQoL assessment via the app was accepted thoroughly by patients, and individuals are keen to use it in clinical routines, while data privacy and security must be ensured. %M 29463489 %R 10.2196/mhealth.9486 %U http://mhealth.jmir.org/2018/2/e45/ %U https://doi.org/10.2196/mhealth.9486 %U http://www.ncbi.nlm.nih.gov/pubmed/29463489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e44 %T A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study %A Simons,Dorien %A De Bourdeaudhuij,Ilse %A Clarys,Peter %A De Cocker,Katrien %A Vandelanotte,Corneel %A Deforche,Benedicte %+ Health Promotion and Education Unit, Department of Public Health, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium, 32 498457442, dorien.simons@ugent.be %K mHealth %K young adult %K mobile applications %K physical activity %K active transport %K health promotion %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. Objective: The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. Methods: The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. Results: A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. Conclusions: By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process. %M 29463491 %R 10.2196/mhealth.8287 %U http://mhealth.jmir.org/2018/2/e44/ %U https://doi.org/10.2196/mhealth.8287 %U http://www.ncbi.nlm.nih.gov/pubmed/29463491 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e3 %T Enhancing User Experience Through User Study: Design of an mHealth Tool for Self-Management and Care Engagement of Cardiovascular Disease Patients %A Baek,Hyunyoung %A Suh,Jung-Won %A Kang,Si-Hyuck %A Kang,Seungjin %A Lim,Tae Ho %A Hwang,Hee %A Yoo,Sooyoung %+ Healthcare Information and Communication Technology Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, 13605, Republic Of Korea, 82 317878980, yoosoo0@snubh.org %K cardiovascular disease %K mHealth %K mobile application %K app %K user-centered design %D 2018 %7 09.02.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the app can be used continuously. Objective: The purpose of the study was to provide insightful information for developing mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors. Methods: To drive the mobile functions and services needed to manage diseases in CVD patients, user research was conducted on patients and doctors at a tertiary general university hospital located in the Seoul metropolitan area of South Korea. Interviews and a survey were performed on patients (35 participants) and a focus group interview was conducted with doctors (5 participants). A mock-up mobile app was developed based on the user survey results, and a usability test was then conducted (8 participants) to identify factors that should be considered to improve usability. Results: The majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Functional features, such as communication with doctors, self-risk assessment, exercise, tailored education, blood pressure management, and health status recording had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were perceived to be useful to patients. The results of the mock-up usability test showed that inputting and visualizing blood pressure and other health conditions was required to be easier. The doctors requested a function that offered a comprehensive view of the patient’s daily health status by linking the mHealth app data with the hospital’s electronic health record system. Conclusions: Insights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel between patients and doctors, may be helpful to improve patient engagement in care. %M 31758783 %R 10.2196/cardio.9000 %U http://cardio.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/cardio.9000 %U http://www.ncbi.nlm.nih.gov/pubmed/31758783 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e37 %T Exploring the Specific Needs of Persons with Multiple Sclerosis for mHealth Solutions for Physical Activity: Mixed-Methods Study %A Giunti,Guido %A Kool,Jan %A Rivera Romero,Octavio %A Dorronzoro Zubiete,Enrique %+ Salumedia Tecnologias, Avda Republica Argentina nº 24, Edificio Torre de los Remedios 5ª Planta Modulo A, Seville, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K multiple sclerosis %K telemedicine %K fatigue %K mobile applications %K video games %K qualitative research %K exercise %K chronic disease %D 2018 %7 09.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders, with symptoms such as fatigue, cognitive problems, and issues with mobility. Evidence suggests that physical activity (PA) helps people with MS reduce fatigue and improve quality of life. The use of mobile technologies for health has grown in recent years with little involvement from relevant stakeholders. User-centered design (UCD) is a design philosophy with the goal of creating solutions specific to the needs and tasks of the intended users. UCD involves stakeholders early and often in the design process. In a preliminary study, we assessed the landscape of commercially available MS mobile health (mHealth) apps; to our knowledge, no study has explored what persons with MS and their formal care providers think of mHealth solutions for PA. Objective: The aim of this study was to (1) explore MS-specific needs for MS mHealth solutions for PA, (2) detect perceived obstacles and facilitators for mHealth solutions from persons with MS and health care professionals, and (3) understand the motivational aspects behind adoption of mHealth solutions for MS. Methods: A mixed-methods design study was conducted in Kliniken Valens, Switzerland, a clinic specializing in neurological rehabilitation. We explored persons with MS and health care professionals who work with them separately. The study had a qualitative part comprising focus groups and interviews, and a quantitative part with standardized tools such as satisfaction with life scale and electronic health (eHealth) literacy. Results: A total of 12 persons with relapsing-remitting MS and 12 health care professionals from different backgrounds participated in the study. Participants were well-educated with an even distribution between genders. Themes identified during analysis were MS-related barriers and facilitators, mHealth design considerations, and general motivational aspects. The insights generated were used to create MS personas for design purposes. Desired mHealth features were as follows: (1) activity tracking, (2) incentives for completing tasks and objectives, (3) customizable goal setting, (4) optional sociability, and (5) game-like attitude among others. Potential barriers to mHealth apps adoption were as follows: (1) rough on-boarding experiences, (2) lack of clear use benefits, and (3) disruption of the health care provider-patient relationship. Potential facilitators were identified: (1) endorsements from experts, (2) playfulness, and (3) tailored to specific persons with MS needs. A total of 4 MS personas were developed to provide designers and computer scientists means to help in the creation of future mHealth solutions for MS. Conclusions: mHealth solutions for increasing PA in persons with MS hold promise. Allowing for realistic goal setting and positive feedback, while minimizing usability burdens, seems to be critical for the adoption of such apps. Fatigue management is especially important in this population; more attention should be brought to this area. %M 29426814 %R 10.2196/mhealth.8996 %U http://mhealth.jmir.org/2018/2/e37/ %U https://doi.org/10.2196/mhealth.8996 %U http://www.ncbi.nlm.nih.gov/pubmed/29426814 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e33 %T A Wearable Sensor-Based Exercise Biofeedback System: Mixed Methods Evaluation of Formulift %A O'Reilly,Martin Aidan %A Slevin,Patrick %A Ward,Tomas %A Caulfield,Brian %+ Insight Centre for Data Analytics, University College Dublin, O'Brien Centre for Science, 3rd Fl, Belfield, Dublin, D4, Ireland, 353 871245972, martin.oreilly@insight-centre.org %K mHealth %K feedback %K posture %K exercise therapy %K biomedical technology %K lower extremity %K physical therapy specialty %D 2018 %7 31.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Formulift is a newly developed mobile health (mHealth) app that connects to a single inertial measurement unit (IMU) worn on the left thigh. The IMU captures users’ movements as they exercise, and the app analyzes the data to count repetitions in real time and classify users’ exercise technique. The app also offers feedback and guidance to users on exercising safely and effectively. Objective: The aim of this study was to assess the Formulift system with three different and realistic types of potential users (beginner gym-goers, experienced gym-goers, and qualified strength and conditioning [S&C] coaches) under a number of categories: (1) usability, (2) functionality, (3) the perceived impact of the system, and (4) the subjective quality of the system. It was also desired to discover suggestions for future improvements to the system. Methods: A total of 15 healthy volunteers participated (12 males; 3 females; age: 23.8 years [SD 1.80]; height: 1.79 m [SD 0.07], body mass: 78.4 kg [SD 9.6]). Five participants were beginner gym-goers, 5 were experienced gym-goers, and 5 were qualified and practicing S&C coaches. IMU data were first collected from each participant to create individualized exercise classifiers for them. They then completed a number of nonexercise-related tasks with the app. Following this, a workout was completed using the system, involving squats, deadlifts, lunges, and single-leg squats. Participants were then interviewed about their user experience and completed the System Usability Scale (SUS) and the user version of the Mobile Application Rating Scale (uMARS). Thematic analysis was completed on all interview transcripts, and survey results were analyzed. Results: Qualitative and quantitative analysis found the system has “good” to “excellent” usability. The system achieved a mean (SD) SUS usability score of 79.2 (8.8). Functionality was also deemed to be good, with many users reporting positively on the systems repetition counting, technique classification, and feedback. A number of bugs were found, and other suggested changes to the system were also made. The overall subjective quality of the app was good, with a median star rating of 4 out of 5 (interquartile range, IQR: 3-5). Participants also reported that the system would aid their technique, provide motivation, reassure them, and help them avoid injury. Conclusions: This study demonstrated an overall positive evaluation of Formulift in the categories of usability, functionality, perceived impact, and subjective quality. Users also suggested a number of changes for future iterations of the system. These findings are the first of their kind and show great promise for wearable sensor-based exercise biofeedback systems. %M 29386171 %R 10.2196/mhealth.8115 %U http://mhealth.jmir.org/2018/1/e33/ %U https://doi.org/10.2196/mhealth.8115 %U http://www.ncbi.nlm.nih.gov/pubmed/29386171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e27 %T A Breastfeed-Promoting Mobile App Intervention: Usability and Usefulness Study %A Wang,Chih-Jau %A Chaovalit,Pimwadee %A Pongnumkul,Suporn %+ National Electronics and Computer Technology Center, 112 Phahonyothin Road, Khlong Nueng, Khlong Luang District, Pathum Thani, 12120, Thailand, 66 2 564 6900 ext 72293, wang.chihjau@gmail.com %K mobile health %K breast feeding %K mobile applications %K health promotion %K usability %K usefulness %D 2018 %7 26.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants; however, 6-month exclusive breastfeeding rate remains below 20% in Thailand. Although the number of research literature and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae has been developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records. Objective: The aim of this study was to evaluate the usability and usefulness of MoomMae, a mobile phone app designed to support breastfeeding women. Methods: Our study was reviewed and approved by Thailand’s National Science and Technology Development Agency (NSTDA) ethics committee. A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. The study process for each participant was as follows: the participant was requested to attend a preuse interview and given the app to use for 4 weeks. Following this period, a postuse interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audiorecorded for qualitative analysis. Results: The mean scores of usability and usefulness from the postuse survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral), and comments on usefulness were relatively positive (56 positive, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement. Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae has a great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system. %M 29374000 %R 10.2196/mhealth.8337 %U http://mhealth.jmir.org/2018/1/e27/ %U https://doi.org/10.2196/mhealth.8337 %U http://www.ncbi.nlm.nih.gov/pubmed/29374000 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e1 %T Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results %A Kinner,Ellen M %A Armer,Jessica S %A McGregor,Bonnie A %A Duffecy,Jennifer %A Leighton,Susan %A Corden,Marya E %A Gauthier Mullady,Janine %A Penedo,Frank J %A Lutgendorf,Susan K %+ Department of Psychological & Brain Sciences, University of Iowa, W322 Seashore Hall, Iowa City, IA, 52242, United States, 1 319 335 2432, susan-lutgendorf@uiowa.edu %K ovarian cancer %K quality of life %K feasibility studies %K eHealth %K psychological stress %D 2018 %7 15.01.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site. Objective: The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop. Methods: In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time. Results: Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home. Conclusions: An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors. %M 29335233 %R 10.2196/cancer.8430 %U http://cancer.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/cancer.8430 %U http://www.ncbi.nlm.nih.gov/pubmed/29335233 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e11 %T Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study %A Danbjørg,Dorthe Boe %A Villadsen,Allan %A Gill,Ester %A Rothmann,Mette Juel %A Clemensen,Jane %+ Centre for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Sdr Boulevard 29, Odense, 5000, Denmark, 45 26202186, dortheboe@gmail.com %K arthritis %K rehabilitation %K telemedicine %D 2018 %7 11.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends. Objective: This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app. Methods: The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation. Results: Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience. Conclusions: This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users’ needs, including motivational and other behavioral factors. %M 29326092 %R 10.2196/mhealth.7734 %U https://mhealth.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/mhealth.7734 %U http://www.ncbi.nlm.nih.gov/pubmed/29326092 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e4 %T Health Information Technology Usability Evaluation Scale (Health-ITUES) for Usability Assessment of Mobile Health Technology: Validation Study %A Schnall,Rebecca %A Cho,Hwayoung %A Liu,Jianfang %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K mobile technology %K usability %K mobile health apps %K psychometric evaluation %D 2018 %7 05.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology has become a ubiquitous technology and can be particularly useful in the delivery of health interventions. This technology can allow us to deliver interventions to scale, cover broad geographic areas, and deliver technologies in highly tailored ways based on the preferences or characteristics of users. The broad use of mobile technologies supports the need for usability assessments of these tools. Although there have been a number of usability assessment instruments developed, none have been validated for use with mobile technologies. Objective: The goal of this work was to validate the Health Information Technology Usability Evaluation Scale (Health-ITUES), a customizable usability assessment instrument in a sample of community-dwelling adults who were testing the use of a new mobile health (mHealth) technology. Methods: A sample of 92 community-dwelling adults living with HIV used a new mobile app for symptom self-management and completed the Health-ITUES to assess the usability of the app. They also completed the Post-Study System Usability Questionnaire (PSSUQ), a widely used and well-validated usability assessment tool. Correlations between these scales and each of the subscales were assessed. Results: The subscales of the Health-ITUES showed high internal consistency reliability (Cronbach alpha=.85-.92). Each of the Health-ITUES subscales and the overall scale was moderately to strongly correlated with the PSSUQ scales (r=.46-.70), demonstrating the criterion validity of the Health-ITUES. Conclusions: The Health-ITUES has demonstrated reliability and validity for use in assessing the usability of mHealth technologies in community-dwelling adults living with a chronic illness. %M 29305343 %R 10.2196/mhealth.8851 %U http://mhealth.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/mhealth.8851 %U http://www.ncbi.nlm.nih.gov/pubmed/29305343 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e203 %T Insights From Google Play Store User Reviews for the Development of Weight Loss Apps: Mixed-Method Analysis %A Frie,Kerstin %A Hartmann-Boyce,Jamie %A Jebb,Susan %A Albury,Charlotte %A Nourse,Rebecca %A Aveyard,Paul %+ Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865289317, kerstin.frie@phc.ox.ac.uk %K weight loss %K mobile applications %K telemedicine %K consumer behavior %D 2017 %7 22.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Significant weight loss takes several months to achieve, and behavioral support can enhance weight loss success. Weight loss apps could provide ongoing support and deliver innovative interventions, but to do so, developers must ensure user satisfaction. Objective: The aim of this study was to conduct a review of Google Play Store apps to explore what users like and dislike about weight loss and weight-tracking apps and to examine qualitative feedback through analysis of user reviews. Methods: The Google Play Store was searched and screened for weight loss apps using the search terms weight loss and weight track*, resulting in 179 mobile apps. A content analysis was conducted based on the Oxford Food and Activity Behaviors taxonomy. Correlational analyses were used to assess the association between complexity of mobile health (mHealth) apps and popularity indicators. The sample was then screened for popular apps that primarily focus on weight-tracking. For the resulting subset of 15 weight-tracking apps, 569 user reviews were sampled from the Google Play Store. Framework and thematic analysis of user reviews was conducted to assess which features users valued and how design influenced users’ responses. Results: The complexity (number of components) of weight loss apps was significantly positively correlated with the rating (r=.25; P=.001), number of reviews (r=.28; P<.001), and number of downloads (r=.48; P<.001) of the app. In contrast, in the qualitative analysis of weight-tracking apps, users expressed preference for simplicity and ease of use. In addition, we found that positive reinforcement through detailed feedback fostered users’ motivation for further weight loss. Smooth functioning and reliable data storage emerged as critical prerequisites for long-term app usage. Conclusions: Users of weight-tracking apps valued simplicity, whereas users of comprehensive weight loss apps appreciated availability of more features, indicating that complexity demands are specific to different target populations. The provision of feedback on progress can motivate users to continue their weight loss attempts. Users value seamless functioning and reliable data storage. %M 29273575 %R 10.2196/mhealth.8791 %U http://mhealth.jmir.org/2017/12/e203/ %U https://doi.org/10.2196/mhealth.8791 %U http://www.ncbi.nlm.nih.gov/pubmed/29273575 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e31 %T Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study %A Lau,Annie YS %A Piper,Kalman %A Bokor,Desmond %A Martin,Paige %A Lau,Victor SL %A Coiera,Enrico %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6/75 Talavera Rd Macquarie Park, Sydney, 2109, Australia, 61 431599890, annie.lau@mq.edu.au %K mobile application %K mobile health %K personal health record %K patients %K health services %K medical informatics %K surgery %K orthopedics %K shoulder %K rotator cuff %K rehabilitation %D 2017 %7 07.12.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings. Objective: The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting. Methods: A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results: Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions: Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians. %M 29217504 %R 10.2196/humanfactors.8096 %U http://humanfactors.jmir.org/2017/4/e31/ %U https://doi.org/10.2196/humanfactors.8096 %U http://www.ncbi.nlm.nih.gov/pubmed/29217504 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e173 %T User Acceptance of Wrist-Worn Activity Trackers Among Community-Dwelling Older Adults: Mixed Method Study %A Puri,Arjun %A Kim,Ben %A Nguyen,Olivier %A Stolee,Paul %A Tung,James %A Lee,Joon %+ Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Lyle Hallman North, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada, 1 5198884567 ext 31567, joon.lee@uwaterloo.ca %K health %K mHealth %K fitness trackers %K older adults %D 2017 %7 15.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer-grade wearable activity trackers are increasingly ubiquitous in the market, but the attitudes toward, as well as acceptance and voluntary use of, these trackers in older population are poorly understood. Objective: The aim of this study was to assess acceptance and usage of wearable activity trackers in Canadian community-dwelling older adults, using the potentially influential factors as identified in literature and technology acceptance model. Methods: A mixed methods design was used. A total of 20 older adults aged 55 years and older were recruited from Southwestern Ontario. Participants used 2 different wearable activity trackers (Xiaomi Mi Band and Microsoft Band) separately for each segment in the crossover design study for 21 days (ie, 42 days total). A questionnaire was developed to capture acceptance and experience at the end of each segment, representing 2 different devices. Semistructured interviews were conducted with 4 participants, and a content analysis was performed. Results: Participants ranged in age from 55 years to 84 years (mean age: 64 years). The Mi Band gained higher levels of acceptance (16/20, 80%) compared with the Microsoft Band (10/20, 50%). The equipment characteristics dimension scored significantly higher for the Mi Band (P<.05). The amount a participant was willing to pay for the device was highly associated with technology acceptance (P<.05). Multivariate logistic regression with 3 covariates resulted in an area under the curve of 0.79. Content analysis resulted in the formation of the following main themes: (1) smartphones as facilitators of wearable activity trackers; (2) privacy is less of a concern for wearable activity trackers, (3) value proposition: self-awareness and motivation; (4) subjective norm, social support, and sense of independence; and (5) equipment characteristics matter: display, battery, comfort, and aesthetics. Conclusions: Older adults were mostly accepting of wearable activity trackers, and they had a clear understanding of its value for their lives. Wearable activity trackers were uniquely considered more personal than other types of technologies, thereby the equipment characteristics including comfort, aesthetics, and price had a significant impact on the acceptance. Results indicated that privacy was less of concern for older adults, but it may have stemmed from a lack of understanding of the privacy risks and implications. These findings add to emerging research that investigates acceptance and factors that may influence acceptance of wearable activity trackers among older adults. %M 29141837 %R 10.2196/mhealth.8211 %U http://mhealth.jmir.org/2017/11/e173/ %U https://doi.org/10.2196/mhealth.8211 %U http://www.ncbi.nlm.nih.gov/pubmed/29141837 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e172 %T Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers %A Gray,Justin %A Beatty,Jessica R %A Svikis,Dace S %A Puder,Karoline S %A Resnicow,Ken %A Konkel,Janine %A Rice,Shetoya %A McGoron,Lucy %A Ondersma,Steven J %+ Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 71 East Ferry, Detroit, MI, 48202, United States, 1 3136642518, jbeatty@wayne.edu %K pregnancy %K marijuana %K intervention study %K text messaging %D 2017 %7 08.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. Objective: The objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: The findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate. %M 29117931 %R 10.2196/mhealth.7927 %U http://mhealth.jmir.org/2017/11/e172/ %U https://doi.org/10.2196/mhealth.7927 %U http://www.ncbi.nlm.nih.gov/pubmed/29117931 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e153 %T Willingness to Use Mobile Phone Apps for HIV Prevention Among Men Who Have Sex with Men in London: Web-Based Survey %A Goedel,William C %A Mitchell,Jason W %A Krebs,Paul %A Duncan,Dustin T %+ Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY,, United States, 1 6465012715, wcg219@nyu.edu %K mobile phone apps %K mHealth %K men who have sex with men (MSM) %K HIV %D 2017 %7 11.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many men who have sex with men (MSM) use apps to connect with and meet other MSM. Given that these apps are often used to arrange sexual encounters, it is possible that apps may be suitable venues for messages and initiatives related to HIV prevention such as those to increase HIV testing rates among this population. Objective: The purpose of this study was to assess willingness to use a new app for reminders of when to be tested for HIV infection among a sample of MSM in London who use apps to arrange sexual encounters. Methods: Broadcast advertisements targeted users of a popular social-networking app for MSM in London. Advertisements directed users to a Web-based survey of sexual behaviors and sexual health needs. Willingness to use apps for reminders of when to be tested for HIV was assessed. In addition, participants responded to items assessing recent sexual behaviors, substance use, and demographic characteristics. Exploratory analyses were undertaken to examine differences in willingness to use an app by demographic and behavioral characteristics. Results: Broadcast advertisements yielded a sample of 169 HIV-negative MSM. Overall, two-thirds (108/169, 63.9%) reported willingness to use an app to remind them when to be tested for HIV. There were no significant differences in willingness to use these apps based on demographic characteristics, but MSM who reported recent binge drinking and recent club drug use more frequently reported willingness to use this app compared to their nonusing counterparts. Conclusions: MSM in this sample are willing to use a new app for HIV testing reminders. Given the high levels of willingness to use them, these types of apps should be developed, evaluated, and made available for this population. %M 29021132 %R 10.2196/mhealth.8143 %U http://mhealth.jmir.org/2017/10/e153/ %U https://doi.org/10.2196/mhealth.8143 %U http://www.ncbi.nlm.nih.gov/pubmed/29021132 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e143 %T A Mobile Phone-Based Life Skills Training Program for Substance Use Prevention Among Adolescents: Pre-Post Study on the Acceptance and Potential Effectiveness of the Program, Ready4life %A Haug,Severin %A Paz Castro,Raquel %A Meyer,Christian %A Filler,Andreas %A Kowatsch,Tobias %A Schaub,Michael P %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8031, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K coping skills %K social skills %K substance use disorder %K adolescents %K students %K mobile phone %D 2017 %7 04.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use and misuse often first emerge during adolescence. Generic life skills training that is typically conducted within the school curriculum is effective at preventing the onset and escalation of substance use among adolescents. However, the dissemination of such programs is impeded by their large resource requirements in terms of personnel, money, and time. Life skills training provided via mobile phones might be a more economic and scalable approach, which additionally matches the lifestyle and communication habits of adolescents. Objective: The aim of this study was to test the acceptance and initial effectiveness of an individually tailored mobile phone–based life skills training program in vocational school students. Methods: The fully automated program, named ready4life, is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Program participants received up to 3 weekly text messages (short message service, SMS) over 6 months. Active program engagement was stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition with prizes in which program users collected credits with each interaction. Generalized estimating equation (GEE) analyses were used to investigate for changes between baseline and 6-month follow-up in the following outcomes: perceived stress, self-management skills, social skills, at-risk alcohol use, tobacco smoking, and cannabis use. Results: The program was tested in 118 school classes at 13 vocational schools in Switzerland. A total of 1067 students who owned a mobile phone and were not regular cigarette smokers were invited to participate in the life skills program. Of these, 877 (82.19%, 877/1067; mean age=17.4 years, standard deviation [SD]=2.7; 58.3% females) participated in the program and the associated study. A total of 43 students (4.9%, 43/877) withdrew their program participation during the intervention period. The mean number of interactive program activities that participants engaged in was 15.5 (SD 13.3) out of a total of 39 possible activities. Follow-up assessments were completed by 436 of the 877 (49.7%) participants. GEE analyses revealed decreased perceived stress (odds ratio, OR=0.93; 95% CI 0.87-0.99; P=.03) and increases in several life skills addressed between baseline and the follow-up assessment. The proportion of adolescents with at-risk alcohol use declined from 20.2% at baseline to 15.5% at follow-up (OR 0.70, 95% CI 0.53-0.93; P=.01), whereas no significant changes were obtained for tobacco (OR 0.94, 95% CI 0.65-1.36; P=.76) or cannabis use (OR 0.91, 95% CI 0.67-1.24; P=.54). Conclusions: These results reveal high-level acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented. A reasonable next step would be to test the efficacy of this program within a controlled trial. %M 28978498 %R 10.2196/mhealth.8474 %U https://mhealth.jmir.org/2017/10/e143/ %U https://doi.org/10.2196/mhealth.8474 %U http://www.ncbi.nlm.nih.gov/pubmed/28978498 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e24 %T Lack of Adoption of a Mobile App to Support Patient Self-Management of Diabetes and Hypertension in a Federally Qualified Health Center: Interview Analysis of Staff and Patients in a Failed Randomized Trial %A Thies,Kathleen %A Anderson,Daren %A Cramer,Benjamin %+ Community Health Center, Inc., Weitzman Institute, 631 Main St, Middletown, CT, 06457, United States, 1 603 661 9113, thiesk@chc1.com %K telehealth %K mobile health %K mHealth %K underserved patients %K HIT %K usability %D 2017 %7 03.10.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Thousands of mobile health (mHealth) apps have been developed to support patients’ management of their health, but the effectiveness of many of the apps remains unclear. While mHealth apps appear to hold promise for improving the self-management of chronic conditions across populations, failure to balance the system demands of the app with the needs, interests, or resources of the end users can undermine consumers’ adoption of these technologies. Objective: The original aim of this study was to evaluate the effectiveness of a commercial mHealth app in improving clinical outcomes for adult patients in a Federally Qualified Health Center (FQHC) with uncontrolled diabetes and/or hypertension. Patients entered clinical data into the app, which also supported messaging between patients and providers. After a 4-month period of vigorous recruitment, the trial was suspended due to low enrollment and inconsistent use of the app by enrolled patients. The project aim was changed to understanding why the trial was unsuccessful. Methods: We used the user-task-context (eUTC) usability framework to develop a set of interview questions for patients and staff who were involved in the trial. All interviews were done by phone and lasted 20 to 30 minutes. Interviews were not recorded. Results: There was a poor fit between the app, end users, and recruitment and treatment approaches in our setting. Usability testing might have revealed this prior to launch but was not an option. There was not sufficient time during routine care for clinical staff to familiarize patients with the app or to check clinical data and messages, which are unreimbursed activities. Some patients did not use the app appropriately. The lack of integration with the electronic health record (EHR) was cited as a problem for both patients and staff who also said the app was just one more thing to attend to. Conclusions: This brief trial underscores the pitfalls in the utilization of mHealth apps. Effective use of mHealth tools requires a good fit between the app, the users’ electronic health (eHealth) literacy, the treatment approach, staff time, and reimbursement for services. The last 3 are contextual factors of the setting that affected the adoption of the app and context is an important factor in implementation science. We recommend that researchers address contextual factors in the trial and adoption of mHealth technologies. %M 28974481 %R 10.2196/humanfactors.7709 %U https://humanfactors.jmir.org/2017/4/e24/ %U https://doi.org/10.2196/humanfactors.7709 %U http://www.ncbi.nlm.nih.gov/pubmed/28974481 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 9 %P e140 %T Social Communication Coaching Smartglasses: Well Tolerated in a Diverse Sample of Children and Adults With Autism %A Keshav,Neha U %A Salisbury,Joseph P %A Vahabzadeh,Arshya %A Sahin,Ned T %+ Brain Power, 1 Broadway 14th Floor, Cambridge, MA,, United States, 1 617 331 8401, sahin@post.harvard.edu %K autism %K tech %K digital health %K smartglasses %K augmented reality %K autism spectrum disorder %K technology %K medtech %K education %D 2017 %7 21.09.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Augmented reality (AR) smartglasses are an emerging technology that is under investigation as a social communication aid for children and adults with autism spectrum disorder (ASD) and as a research tool to aid with digital phenotyping. Tolerability of this wearable technology in people with ASD is an important area for research, especially as these individuals may experience sensory, cognitive, and attentional challenges. Objective: The aim of this study was to assess the tolerability and usability of a novel smartglasses system that has been designed as a social communication aid for children and adults with autism (the Brain Power Autism System [BPAS]). BPAS runs on Google Glass Explorer Edition and other smartglasses, uses both AR and affective artificial intelligence, and helps users learn key social and emotional skills. Methods: A total of 21 children and adults with ASD across a spectrum of severity used BPAS for a coaching session. The user’s tolerability to the smartglasses, user being able to wear the smartglasses for 1 minute (initial tolerability threshold), and user being able to wear the smartglasses for the entire duration of the coaching session (whole session tolerability threshold) were determined through caregiver report. Results: Of 21 users, 19 (91%) demonstrated tolerability on all 3 measures. Caregivers reported 21 out of 21 users (100%) as tolerating the experience, while study staff found only 19 out of 21 users managed to demonstrate initial tolerability (91%). Of the 19 users who demonstrated initial tolerability, all 19 (100%) were able to use the smartglasses for the entire session (whole session tolerability threshold). Caregivers reported that 19 out of 21 users (91%) successfully used BPAS, and users surpassed caregiver expectations in 15 of 21 cases (71%). Users who could communicate reported BPAS as being comfortable (94%). Conclusions: This preliminary report suggests that BPAS is well tolerated and usable to a diverse age- and severity-range of people with ASD. This is encouraging as these devices are being developed as assistive technologies for people with ASD. Further research should focus on improving smartglasses design and exploring their efficacy in helping with social communication in children and adults with ASD. %M 28935618 %R 10.2196/mhealth.8534 %U http://mhealth.jmir.org/2017/9/e140/ %U https://doi.org/10.2196/mhealth.8534 %U http://www.ncbi.nlm.nih.gov/pubmed/28935618 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 2 %P e22 %T Views of Patients on Using mHealth to Monitor and Prevent Diabetic Foot Ulcers: Qualitative Study %A Boodoo,Chris %A Perry,Julie Ann %A Hunter,Paul John %A Duta,Dragos Ioan %A Newhook,Samuel Carl Paul %A Leung,General %A Cross,Karen %+ Department of Medical Imaging, St Michael’s Hospital, 30 Bond Street, Toronto, ON,, Canada, 1 416 864 6060 ext 2871, LeungGe@smh.ca %K mHealth %K telemedicine %K diabetic foot ulcer %K diabetes %K qualitative research %D 2017 %7 15.09.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: People with diabetes are at risk for diabetic foot ulcers (DFUs), which can lead to limb loss and a significant decrease in quality of life. Evidence suggests that mHealth can be an effective tool in diabetes self-management. mHealth presents an opportunity for the prevention and monitoring of DFUs. However, there is a paucity of research that explores its effectiveness in the DFU patient population, as well as the views and attitudes of these patients toward technology and mHealth. Objective: This study aimed to explore the views, attitudes, and experiences of a diabetic patient population with or at risk of DFUs regarding technology, mHealth, and the diabetic foot. Methods: We used a qualitative research approach using in-depth interviews with 8 patients with DFUs. Questions were structured around experience with technology, current health practices related to diabetic foot care, and thoughts on using an mHealth device that prevents and monitors DFUs. We transcribed and thematically analyzed all interviews. Results: All patients had positive responses for an mHealth intervention aimed at preventing and monitoring DFUs. We found 4 themes in the data: diversity in use of technology, feet-checking habits, 2-way communication with health care professionals (HCPs), and functionality. There were varying levels of familiarity with and dependence on technology within this patient population. These relationships correlated with distinct generations found in North America, including baby boomers and Generation X. Furthermore, we found that most patients performed daily feet checks to monitor any changes in health. However, some did not perform feet checks prior to the development of a DFU. Patients expressed interest in 2-way communication with HCPs that would allow for easier appointment scheduling, sharing of medical data, decreased number of visits, and use of alerts for when medical attention is required. Patients also identified conditions of functionality for the mHealth intervention. These included consideration of debilitating complications because of diabetes, such as retinopathy and decreased mobility; ease of use of the intervention; and implementation of virtual communities to support continued use of the intervention. Conclusions: Our patient population expressed an interest in mHealth for preventing and monitoring DFUs, although some participants were not frequent users of technology. mHealth continues to show potential in improving patient outcomes, and this study provides a foundation for designing interventions specific to a DFU population. Further research is needed to confirm these findings. %M 30291089 %R 10.2196/diabetes.8505 %U http://diabetes.jmir.org/2017/2/e22/ %U https://doi.org/10.2196/diabetes.8505 %U http://www.ncbi.nlm.nih.gov/pubmed/30291089 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e118 %T Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study %A Webb,Marianne Julie %A Wadley,Greg %A Sanci,Lena Amanda %+ Department of General Practice, Melbourne Medical School, Faculty of Medicine, University of Melbourne, Ground Floor, 200 Berkeley Street, Parkville, 3010, Australia, 61 390355011, webbm@unimelb.edu.au %K adolescent %K needs assessment %K general practice %K primary prevention %K health behavior %K health information technology %K patient-centered care %D 2017 %7 11.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people’s routine health care. Objective: The aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people’s assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people’s acceptance and experience of using a screening app during regular health care. Methods: This was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey. Results: The exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86% (73/85) of young people felt the app was a “good idea” and only 1% (1/85) thought it a “bad idea.” Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration. Conclusions: Integrating a health and lifestyle-screening app into face-to-face care can enrich young people’s experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth. %M 28801302 %R 10.2196/mhealth.7816 %U http://mhealth.jmir.org/2017/8/e118/ %U https://doi.org/10.2196/mhealth.7816 %U http://www.ncbi.nlm.nih.gov/pubmed/28801302 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 3 %P e18 %T Exploring User Learnability and Learning Performance in an App for Depression: Usability Study %A Stiles-Shields,Colleen %A Montague,Enid %A Lattie,Emily G %A Schueller,Stephen M %A Kwasny,Mary J %A Mohr,David C %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 0414, ecsshields@uchicago.edu %K apps %K learning %K cognitive therapy %K usability testing %K depression %D 2017 %7 11.08.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental health apps tend to be narrow in their functioning, with their focus mostly being on tracking, management, or psychoeducation. It is unclear what capability such apps have to facilitate a change in users, particularly in terms of learning key constructs relating to behavioral interventions. Thought Challenger (CBITs, Chicago) is a skill-building app that engages users in cognitive restructuring, a core component of cognitive therapy (CT) for depression. Objective: The purpose of this study was to evaluate the learnability and learning performance of users following initial use of Thought Challenger. Methods: Twenty adults completed in-lab usability testing of Thought Challenger, which comprised two interactions with the app. Learnability was measured via completion times, error rates, and psychologist ratings of user entries in the app; learning performance was measured via a test of CT knowledge and skills. Nonparametric tests were conducted to evaluate the difference between individuals with no or mild depression to those with moderate to severe depression, as well as differences in completion times and pre- and posttests. Results: Across the two interactions, the majority of completion times were found to be acceptable (5 min or less), with minimal errors (1.2%, 10/840) and successful completion of CT thought records. Furthermore, CT knowledge and skills significantly improved after the initial use of Thought Challenger (P=.009). Conclusions: The learning objectives for Thought Challenger during initial uses were successfully met in an evaluation with likely end users. The findings therefore suggest that apps are capable of providing users with opportunities for learning of intervention skills. %M 28801301 %R 10.2196/humanfactors.7951 %U http://humanfactors.jmir.org/2017/3/e18/ %U https://doi.org/10.2196/humanfactors.7951 %U http://www.ncbi.nlm.nih.gov/pubmed/28801301 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e109 %T Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults %A Milward,Joanna %A Deluca,Paolo %A Drummond,Colin %A Watson,Rod %A Dunne,Jacklyn %A Kimergård,Andreas %+ Addictions Department, King's College London, 4 Windsor Walk, Denmark Hill, London, SE58BB, United Kingdom, 44 7590829898, joanna.milward@kcl.ac.uk %K alcohol %K drinking %K young adults %K mHealth %K brief intervention %K apps %K usability testing %K user experience %K focus group %D 2017 %7 08.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As “Digital Natives,” young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. Objective: The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. Methods: The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. Results: The first theme, “Functionality” referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, “Design” described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, “Content” described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. Conclusions: There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization. %M 28790022 %R 10.2196/mhealth.7836 %U http://mhealth.jmir.org/2017/8/e109/ %U https://doi.org/10.2196/mhealth.7836 %U http://www.ncbi.nlm.nih.gov/pubmed/28790022 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 8 %P e151 %T Systematic Review Protocol to Assess the Effectiveness of Usability Questionnaires in mHealth App Studies %A Zhou,Leming %A Bao,Jie %A Parmanto,Bambang %+ University of Pittsburgh, Department of Health Information Management, 6021 Forbes Tower, 3600 Forbes Ave at Atwood St, Pittsburgh, PA, 15260, United States, 1 412 383 6653, lmzhou@gmail.com %K usability %K questionnaire %K mobile health app %K systematic review %D 2017 %7 01.08.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Usability questionnaires have a wide use in mobile health (mHealth) app usability studies. However, no systematic review has been conducted for assessing the effectiveness of these questionnaires. Objective: This paper describes a protocol for conducting a systematic review of published questionnaire-based mHealth app usability studies. Methods: In this systematic review, we will select recently published (2008-2017) articles from peer-reviewed journals and conferences that describe mHealth app usability studies and implement at least one usability questionnaire. The search strategy will include terms such as “mobile app” and “usability.” Multiple databases such as PubMed, CINAHL, IEEE Xplore, ACM Digital Library, and INSPEC will be searched. There will be 2 independent reviewers in charge of screening titles and abstracts as well as determining those articles that should be included for a full-text review. The third reviewer will act as a mediator between the other 2 reviewers. Moreover, a data extraction form will be created and used during the full article data analysis. Notably, the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines will be followed in reporting this protocol. Results: A preliminary search produced 1271 articles, 40 of which are duplicate records. The inclusion-exclusion criteria are being strictly followed in performing the ongoing study selection. Conclusions: Usability questionnaires are an important tool in mHealth app usability studies. This review will summarize the usability questionnaires used in published research articles while assessing the efficacy of these questionnaires in determining the usability of mHealth apps. %M 28765101 %R 10.2196/resprot.7826 %U http://www.researchprotocols.org/2017/8/e151/ %U https://doi.org/10.2196/resprot.7826 %U http://www.ncbi.nlm.nih.gov/pubmed/28765101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e235 %T Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration %A Nightingale,Ruth %A Hall,Andrew %A Gelder,Carole %A Friedl,Simone %A Brennan,Eileen %A Swallow,Veronica %+ Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London,, United Kingdom, 44 7825 098844, ruth.nightingale@gosh.nhs.uk %K child %K adolescent %K long-term condition %K chronic condition %K self-management %K self-care %K mobile apps %K apps %K qualitative %D 2017 %7 04.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective: To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods: Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results: Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint—5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is “dry” and “boring,” could be “scary,” and was either hard to understand or not relevant to individuals’ circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a “normal” life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a “normal” life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Conclusions: Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. %M 28676470 %R 10.2196/jmir.7760 %U http://www.jmir.org/2017/7/e235/ %U https://doi.org/10.2196/jmir.7760 %U http://www.ncbi.nlm.nih.gov/pubmed/28676470 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e83 %T Users’ Adoption of Mental Health Apps: Examining the Impact of Information Cues %A Huang,Hsiao-Ying %A Bashir,Masooda %+ School of Information Sciences, University of Illinois at Urbana-Champaign, 501 Daniel St., Champaign, IL, 61802, United States, 1 217 244 1139, mnb@illinois.edu %K user interaction design %K recommendation system %K mobile app search %K mental health %K anxiety %D 2017 %7 28.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous mental health apps have been developed and made available to users on the current app market. Users may find it difficult and overwhelming to select apps from the hundreds of choices that are available in the app marketplace. Clarifying what information cues may impact a user’s selection and adoption of mental health apps is now a critical and pressing issue. Objective: The aim of this study was to investigate the impact of information cues on users’ adoption of anxiety apps using observational data from the Android app market. Methods: A systematic search of anxiety apps was conducted on the Android app store by using keywords search. The title and metadata information of a total of 274 apps that met our criteria were collected and analyzed. Three trained researchers recorded the app rankings from the search results page on different dates and Web browsers. Results: Our results show that ratings (r=.56, P<.001) and reviews (r=.39, P<.001) have significant positive correlations with the number of installs, and app prices have significant negative correlations with installs (r=−.36). The results also reveal that lower-priced apps have higher ratings (r=−.23, P<.001) and a greater number of app permission requests (r=.18, P=.002) from the device. For app titles, we found that apps with titles related to symptoms have significantly lower installs than apps with titles that are not related to symptoms (P<.001). Conclusions: This study revealed a relationship between information cues and users’ adoption of mental health apps by analyzing observational data. As the first of its kind, we found impactful indicators for mental health app adoptions. We also discovered a labeling effect of app titles that could hinder mental health app adoptions and which may provide insight for future designs of mental health apps and their search mechanisms. %M 28659256 %R 10.2196/mhealth.6827 %U http://mhealth.jmir.org/2017/6/e83/ %U https://doi.org/10.2196/mhealth.6827 %U http://www.ncbi.nlm.nih.gov/pubmed/28659256 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e112 %T Systematic and Iterative Development of a Smartphone App to Promote Sun-Protection Among Holidaymakers: Design of a Prototype and Results of Usability and Acceptability Testing %A Rodrigues,Angela M %A Sniehotta,Falko F %A Birch-Machin,Mark A %A Olivier,Patrick %A Araújo-Soares,Vera %+ Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, United Kingdom, 44 01912088974, angela.rodrigues@newcastle.ac.uk %K sun-protection %K sunburn %K sunscreening agents %K sunbathing %K health behavior %K health promotion %K formative research %K intervention %D 2017 %7 12.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Sunburn and intermittent exposure to ultraviolet rays are risk factors for melanoma. Sunburn is a common experience during holidays, making tourism settings of particular interest for skin cancer prevention. Holidaymakers are a volatile populations found at different locations, which may make them difficult to reach. Given the widespread use of smartphones, evidence suggests that this might be a novel, convenient, scalable, and feasible way of reaching the target population. Objective: The main objective of this study was to describe and appraise the process of systematically developing a smartphone intervention (mISkin app) to promote sun-protection during holidays. Methods: The iterative development process of the mISkin app was conducted over four sequential stages: (1) identify evidence on the most effective behavior change techniques (BCTs) used (active ingredients) as well as theoretical predictors and theories, (2) evidence-based intervention design, (3) co-design with users of the mISkin app prototype, and (4) refinement of the app. Each stage provided key findings that were subsequently used to inform the design of the mISkin app. Results: The sequential approach to development integrates different strands of evidence to inform the design of an evidence-based intervention. A systematic review on previously tested interventions to promote sun-protection provided cues and constraints for the design of this intervention. The development and design of the mISkin app also incorporated other sources of information, such as other literature reviews and experts’ consultations. The developed prototype of the mISkin app was evaluated by engaging potential holidaymakers in the refinement and further development of the mISkin app through usability (ease-of-use) and acceptability testing of the intervention prototype. All 17 participants were satisfied with the mISkin prototype and expressed willingness to use it. Feedback on the app was integrated in the optimization process of the mISkin app. Conclusions: The mISkin app was designed to promote sun-protection among holidaymakers and was based on current evidence, experts’ knowledge and experience, and user involvement. Based on user feedback, the app has been refined and a fully functional version is ready for formal testing in a feasibility pilot study. %M 28606892 %R 10.2196/resprot.7172 %U http://www.researchprotocols.org/2017/6/e112/ %U https://doi.org/10.2196/resprot.7172 %U http://www.ncbi.nlm.nih.gov/pubmed/28606892 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e71 %T Human-Centered Design Study: Enhancing the Usability of a Mobile Phone App in an Integrated Falls Risk Detection System for Use by Older Adult Users %A Harte,Richard %A Quinlan,Leo R %A Glynn,Liam %A Rodríguez-Molinero,Alejandro %A Baker,Paul MA %A Scharf,Thomas %A ÓLaighin,Gearóid %+ NUI Galway, Physiology, School of Medicine, University Road, Galway,, Ireland, 353 91 493710, leo.quinlan@nuigalway.ie %K human-centered design %K user-centered design %K human-computer interface %K human factors engineering %K eHealth %K engineering psychology %K mHealth %D 2017 %7 30.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Design processes such as human-centered design (HCD), which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of HCD can often conflict with the necessary rapid product development life-cycles associated with the competitive connected health industry. Objective: The aim of this study was to apply a structured HCD methodology to the development of a smartphone app that was to be used within a connected health fall risk detection system. Our methodology utilizes so called discount usability engineering techniques to minimize the burden on resources during development and maintain a rapid pace of development. This study will provide prospective designers a detailed description of the application of a HCD methodology. Methods: A 3-phase methodology was applied. In the first phase, a descriptive “use case” was developed by the system designers and analyzed by both expert stakeholders and end users. The use case described the use of the app and how various actors would interact with it and in what context. A working app prototype and a user manual were then developed based on this feedback and were subjected to a rigorous usability inspection. Further changes were made both to the interface and support documentation. The now advanced prototype was exposed to user testing by end users where further design recommendations were made. Results: With combined expert and end-user analysis of a comprehensive use case having originally identified 21 problems with the system interface, we have only seen and observed 3 of these problems in user testing, implying that 18 problems were eliminated between phase 1 and 3. Satisfactory ratings were obtained during validation testing by both experts and end users, and final testing by users shows the system requires low mental, physical, and temporal demands according to the NASA Task Load Index (NASA-TLX). Conclusions: From our observation of older adults’ interactions with smartphone interfaces, there were some recurring themes. Clear and relevant feedback as the user attempts to complete a task is critical. Feedback should include pop-ups, sound tones, color or texture changes, or icon changes to indicate that a function has been completed successfully, such as for the connection sequence. For text feedback, clear and unambiguous language should be used so as not to create anxiety, particularly when it comes to saving data. Warning tones or symbols, such as caution symbols or shrill tones, should only be used if absolutely necessary. Our HCD methodology, designed and implemented based on the principles of the International Standard Organizaton (ISO) 9241-210 standard, produced a functional app interface within a short production cycle, which is now suitable for use by older adults in long term clinical trials. %M 28559227 %R 10.2196/mhealth.7046 %U http://mhealth.jmir.org/2017/5/e71/ %U https://doi.org/10.2196/mhealth.7046 %U http://www.ncbi.nlm.nih.gov/pubmed/28559227 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e78 %T Mobile App Design, Development, and Publication for Adverse Drug Reaction Assessments of Causality, Severity, and Preventability %A Ithnin,Muslimah %A Mohd Rani,Mohd Dzulkhairi %A Abd Latif,Zuraidah %A Kani,Paveethra %A Syaiful,Asmalita %A Nor Aripin,Khairun Nain %A Tengku Mohd,Tengku Amatullah Madeehah %+ Universiti Sains Islam Malaysia, Tingkat 13, Menara B, Persiaran MPAJ, Jalan Pandan Utama, Pandan Indah, Kuala Lumpur, 55100, Malaysia, 60 3 4289 2400, madeehah@usim.edu.my %K mobile applications %K computer-assisted decision making %K drug monitoring %K pharmacovigilance %K adverse drug reactions %D 2017 %7 30.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality. Improved assessment of ADRs to identify the causal relationship, the severity, and the preventability will aid ADRs prevention or reduce patient burden. Objective: The aim of this study was to develop mobile apps in assisting clinical decision in ADR assessments of causality, severity, and preventability using validated tools. The usability of the apps was assessed. Methods: We designed mobile apps using validated assessment tools for ADRs. They are the Liverpool ADRs Causality Assessment Tool, Hartwig’s Severity Assessment Scale, and the Modified Schumock and Thronton Preventability Scale. The apps were named “Adverse Drug ReactionCausality,” “Adverse Drug ReactionSeverity,” and “Adverse Drug RxnPreventability.” A survey was conducted using the System Usability Scale (SUS) to assess the usability of the developed apps among health care professionals. Results: These apps are available for download through Google Play Store for free since January 2015. From the survey, the mean SUS score was 70.9 based on 26 responses from the pediatric ward of Hospital Ampang, Malaysia. Conclusions: The developed apps received an overall acceptable usability among health care professionals. The usage of these apps will improve detection, assessment, and avoidance of future ADRs. They will also contribute to future research on ADRs, thus increasing drug safety. %M 28559222 %R 10.2196/mhealth.6261 %U http://mhealth.jmir.org/2017/5/e78/ %U https://doi.org/10.2196/mhealth.6261 %U http://www.ncbi.nlm.nih.gov/pubmed/28559222 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e94 %T Using Beta-Version mHealth Technology for Team-Based Care Management to Support Stroke Prevention: An Assessment of Utility and Challenges %A Ramirez,Magaly %A Wu,Shinyi %A Ryan,Gery %A Towfighi,Amytis %A Vickrey,Barbara G %+ Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, 650 Charles Young Dr S, 31-293A, Los Angeles, CA, 90095-1772, United States, 1 310 825 2594, ramirezma@ucla.edu %K community health workers %K stroke %K patient care management %K patient care team %K mobile devices %K mobile applications %K health care information systems %D 2017 %7 23.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Beta versions of health information technology tools are needed in service delivery models with health care and community partnerships to confirm the key components and to assess the performance of the tools and their impact on users. We developed a care management technology (CMT) for use by community health workers (CHWs) and care managers (CMs) working collaboratively to improve risk factor control among recent stroke survivors. The CMT was expected to enhance the efficiency and effectiveness of the CHW-CM team. Objective: The primary objective was to describe the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) CMT and investigate CM and CHW perceptions of the CMT’s usefulness and challenges for team-based care management. Methods: We conducted qualitative interviews with all users of the beta-version SUCCEED CMT, namely two CMs and three CHWs. They were asked to demonstrate and describe their perceptions of the CMT’s ease of use and usefulness for completing predefined key care management activities. They were also probed about their general perceptions of the CMT’s information quality, ease of use, usefulness, and impact on CM and CHW roles. Interview transcripts were coded using a priori codes. Coded excerpts were grouped into broader themes and then related in a conceptual model of how the CMT facilitated care management. We also conducted a survey with 14 patients to obtain their perspective on CHW tablet use during CHW-patient interactions. Results: Care managers and community health workers expressed that the CMT helped them keep track of patient interactions and plan their work. It guided CMs in developing and sharing care plans with CHWs. For CHWs, the CMT enabled electronic collection of clinical assessment data, provided decision support, and provided remote access to patients’ risk factor values. Long loading times and downtimes due to outages were the most significant challenges encountered. Additional issues included extensive use of free-text responses and manual data transfer from the electronic medical record. Despite these challenges, patients overall did not perceive the tablet as interfering with CHW-patient interactions. Conclusions: Our findings suggest useful functionalities of CMTs supporting health care and community partners in collaborative chronic care management. However, usability issues need to be addressed during the development process. The SUCCEED CMT is an initial step toward the development of effective health information technology tools to support collaborative, team-based models of care and will need to be modified as the evidence base grows. Future research should assess the CMT’s effects on team performance. %M 28536094 %R 10.2196/resprot.7106 %U http://www.researchprotocols.org/2017/5/e94/ %U https://doi.org/10.2196/resprot.7106 %U http://www.ncbi.nlm.nih.gov/pubmed/28536094 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e63 %T North American Public Opinion Survey on the Acceptability of Crowdsourcing Basic Life Support for Out-of-Hospital Cardiac Arrest With the PulsePoint Mobile Phone App %A Dainty,Katie N %A Vaid,Haris %A Brooks,Steven C %+ Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 6474482485, daintyk@smh.ca %K sudden cardiac death %K surveys and questionnaires %K cardiopulmonary resuscitation %K PulsePoint %K North America %D 2017 %7 17.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The PulsePoint Respond app is a novel system that can be implemented in emergency dispatch centers to crowdsource basic life support (BLS) for patients with cardiac arrest and facilitate bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use while first responders are en route. Objective: The aim of this study was to conduct a North American survey to evaluate the public perception of the above-mentioned strategy, including acceptability and willingness to respond to alerts. Methods: We designed a Web-based survey administered by IPSOS Reid, an established external polling vendor. Sampling was designed to ensure broad representation using recent census statistics. Results: A total of 2415 survey responses were analyzed (1106 from Canada and 1309 from the United States). It was found that 98.37% (1088/1106) of Canadians and 96% (1259/1309) of Americans had no objections to PulsePoint being implemented in their community; 84.27% (932/1106) of Canadians and 55.61% (728/1309) of Americans said they would download the app to become a potential responder to cardiac arrest, respectively. Among Canadians, those who said they were likely to download PulsePoint were also more likely to have ever had CPR training (OR 1.7, 95% CI 1.2-2.4; P=.002); however, this was not true of American respondents (OR 1.0, 95% CI 0.79-1.3; P=.88). When asked to imagine themselves as a cardiac arrest victim, 95.39% (1055/1106) of Canadians and 92.44% (1210/1309) of Americans had no objections to receiving crowdsourced help in a public setting; 88.79% (982/1106) of Canadians and 84.87% (1111/1309) of Americans also had no objections to receiving help in a private setting, respectively. The most common concern identified with respect to PulsePoint implementation was a responder’s lack of ability, training, or access to proper equipment in a public setting. Conclusions: The North American public finds the concept of crowdsourcing BLS for out-of-hospital cardiac arrest to be acceptable. It demonstrates willingness to respond to PulsePoint CPR notifications and to accept help from others alerted by the app if they themselves suffered a cardiac arrest. %M 28526668 %R 10.2196/mhealth.6926 %U http://mhealth.jmir.org/2017/5/e63/ %U https://doi.org/10.2196/mhealth.6926 %U http://www.ncbi.nlm.nih.gov/pubmed/28526668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e149 %T Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing %A Boudreaux,Edwin D %A Brown,Gregory K %A Stanley,Barbara %A Sadasivam,Rajani S %A Camargo,Carlos A %A Miller,Ivan W %+ University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 334 3817, edwin.boudreaux@umassmed.edu %K technology %K safety %K health planning %K suicide %K computers %K telemedicine %D 2017 %7 15.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. Objective: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. Methods: We employed a user-centered software design strategy led by a multidisciplinary team. The application was tested for usability with a target sample of suicidal patients. Detailed observations, structured usability ratings, and Think Aloud procedures were used. Suicidal ideation intensity and perceived ability to cope were assessed pre-post engagement with the Web application. Results: A total of 30 participants were enrolled. Usability ratings were generally strong, and all patients successfully built a safety plan. However, the completeness of the safety plan varied. The mean number of steps completed was 5.5 (SD 0.9) out of 6, with 90% (27/30) of participants completing at least 5 steps and 67% (20/30) completing all 6 steps. Some safety planning steps were viewed as inapplicable to some individuals. Some confusion in instructions led to modifications to improve understandability of each step. Ratings of suicide intensity after completion of the application were significantly lower than preratings, pre: mean 5.11 (SD 2.9) versus post: mean 4.46 (SD 3.0), t27=2.49, P=.02. Ratings of ability to cope with suicidal thoughts after completion of the application were higher than preratings, with the difference approaching statistical significance, pre: mean 5.93 (SD 2.9), post: mean 6.64 (SD 2.4), t27=−2.03, P=.05. Conclusions: We have taken the first step toward identifying the components needed to maximize usability of a self-administered, Web-based safety planning application. Results support initial consideration of the application as an adjunct to clinical contact. This allows for the clinician or other personnel to provide clarification, when needed, to help the patient build the plan, and to help review and revise the draft. %M 28506957 %R 10.2196/jmir.6816 %U http://www.jmir.org/2017/5/e149/ %U https://doi.org/10.2196/jmir.6816 %U http://www.ncbi.nlm.nih.gov/pubmed/28506957 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e112 %T The Development of an Interactive Voice Response Survey for Noncommunicable Disease Risk Factor Estimation: Technical Assessment and Cognitive Testing %A Gibson,Dustin G %A Farrenkopf,Brooke A %A Pereira,Amanda %A Labrique,Alain B %A Pariyo,George William %+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N Wolfe St, Baltimore, MD, 21231, United States, 1 4432878763, dgibso28@jhu.edu %K interactive voice response %K noncommunicable disease %K survey methodology %K public health surveillance %K cellular phone %K risk factors %D 2017 %7 05.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The rise in mobile phone ownership in low- and middle-income countries (LMICs) presents an opportunity to transform existing data collection and surveillance methods. Administering surveys via interactive voice response (IVR) technology—a mobile phone survey (MPS) method—has potential to expand the current surveillance coverage and data collection, but formative work to contextualize the survey for LMIC deployment is needed. Objective: The primary objectives of this study were to (1) cognitively test and identify challenging questions in a noncommunicable disease (NCD) risk factor questionnaire administered via an IVR platform and (2) assess the usability of the IVR platform. Methods: We conducted two rounds of pilot testing the IVR survey in Baltimore, MD. Participants were included in the study if they identified as being from an LMIC. The first round included individual interviews to cognitively test the participant’s understanding of the questions. In the second round, participants unique from those in round 1 were placed in focus groups and were asked to comment on the usability of the IVR platform. Results: A total of 12 participants from LMICs were cognitively tested in round 1 to assess their understanding and comprehension of questions in an IVR-administered survey. Overall, the participants found that the majority of the questions were easy to understand and did not have difficulty recording most answers. The most frequent recommendation was to use country-specific examples and units of measurement. In round 2, a separate set of 12 participants assessed the usability of the IVR platform. Overall, participants felt that the length of the survey was appropriate (average: 18 min and 31 s), but the majority reported fatigue in answering questions that had a similar question structure. Almost all participants commented that they thought an IVR survey would lead to more honest, accurate responses than face-to-face questionnaires, especially for sensitive topics. Conclusions: Overall, the participants indicated a clear comprehension of the IVR-administered questionnaire and that the IVR platform was user-friendly. Formative research and cognitive testing of the questionnaire is needed for further adaptation before deploying in an LMIC. %M 28476724 %R 10.2196/jmir.7340 %U http://www.jmir.org/2017/5/e112/ %U https://doi.org/10.2196/jmir.7340 %U http://www.ncbi.nlm.nih.gov/pubmed/28476724 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e67 %T Evaluation of a Mindfulness-Based Mobile App Aimed at Promoting Awareness of Weight-Related Behaviors in Adolescents: A Pilot Study %A Turner,Tami %A Hingle,Melanie %+ Department of Nutritional Sciences, The University of Arizona, 1177 E 4th St, Shantz Bldg, Room 328, Tucson, AZ,, United States, 1 520 626 7112, tamiturner@email.arizona.edu %K mindfulness %K adolescent %K mHealth %K diet %K physical activity %K app %D 2017 %7 26.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Mindfulness-based interventions are reported to be highly acceptable and have positive effects on youth, yet most are clinic- or school-based aimed at emotional regulation or academic performance. To provide flexible program delivery, we developed and tested a standalone mindfulness-based app aimed at improving weight-related behaviors (eg, diet, physical activity, sleep) in adolescents. Objective: Our objective was to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. Methods: In a single-arm pilot study, 15 adolescents (14-18 years) were prompted to access the app once a day, every day for 6 weeks. Outcomes were measured by in-app and poststudy surveys, and descriptive statistical analyses were performed. Time within a mindfulness state was self-reported during weekly timed practices. Results: The app was rated highly for content and encouraging the practice of activities to promote mindfulness states. Teens reported increased awareness of eating behaviors and high adherence, particularly during physically active practices. Average self-reported time spent in a mindfulness state increased 2.5 times by week 6 (78 [SD 17] seconds) compared to week 1 (31 [SD 21] seconds). Conclusions: The high acceptability and utility ratings of the app, increases in reported time in mindfulness states, and high frequency of participation, including mindful eating and physical activity, suggest the mindfulness-based mobile app has the potential to improve awareness of weight-related behaviors. %M 28446423 %R 10.2196/resprot.6695 %U http://www.researchprotocols.org/2017/4/e67/ %U https://doi.org/10.2196/resprot.6695 %U http://www.ncbi.nlm.nih.gov/pubmed/28446423 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e63 %T Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study %A Hayashi,Aki %A Yamaguchi,Satoko %A Waki,Kayo %A Fujiu,Katsuhito %A Hanafusa,Norio %A Nishi,Takahiro %A Tomita,Hyoe %A Kobayashi,Haruka %A Fujita,Hideo %A Kadowaki,Takashi %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo,, Japan, 81 3 3815 5411 ext 34462, kwaki-tky@umin.ac.jp %K telemedicine %K mobile phone app %K hemodialysis %K self-management %D 2017 %7 20.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management. Objective: Our objective is to investigate the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients. Methods: We developed the Self-Management and Recording System for Dialysis (SMART-D), which supports self-monitoring of three mortality-related factors that can be modified by lifestyle: interdialytic weight gain and predialysis serum potassium and phosphorus concentrations. Data is displayed graphically, with all data evaluated automatically to determine whether they achieve the values suggested by the Japanese Society for Dialysis Therapy guidelines. In a pilot study, 9 dialysis patients used SMART-D system for 2 weeks. A total of 7 of them completed questionnaires rating their assessment of SMART-D’s usability and their satisfaction with the system. In addition, the Kidney Disease Quality of Life scale was compared before and after the study period. Results: All 9 participants were able to use SMART-D with no major problems. Completion rates for body weight, pre- and postdialysis weight, and serum potassium and phosphorus concentrations were, respectively, 89% (SD 23), 95% (SD 7), and 78% (SD 44). Of the 7 participants who completed the usability survey, all were motivated by the sense of security derived from using the system, and 6 of the 7 (86%) reported that using SMART-D helped improve their lifestyle and self-management. Conclusions: Using SMART-D was feasible, and the system was well regarded by patients. Further study with larger scale cohorts and longer study and follow-up periods is needed to evaluate the effects of SMART-D on clinical outcomes and quality of life. %M 28428168 %R 10.2196/resprot.7105 %U http://www.researchprotocols.org/2017/4/e63/ %U https://doi.org/10.2196/resprot.7105 %U http://www.ncbi.nlm.nih.gov/pubmed/28428168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e124 %T Using Persuasive Technology to Increase Physical Activity in People With Chronic Obstructive Pulmonary Disease by Encouraging Regular Walking: A Mixed-Methods Study Exploring Opinions and Preferences %A Bartlett,Yvonne Kiera %A Webb,Thomas L %A Hawley,Mark S %+ Manchester Centre for Health Psychology, Manchester Academic Health Science Centre, The School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M139PL, United Kingdom, 44 161306436 ext 65436, kiera.bartlett@manchester.ac.uk %K persuasive technology %K chronic obstructive pulmonary disease %K physical activity %K walking %K mHealth %K mobile apps %D 2017 %7 20.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: People with chronic obstructive pulmonary disease (PwCOPD) often experience breathlessness and fatigue, making physical activity challenging. Although many persuasive technologies (such as mobile phone apps) have been designed to support physical activity among members of the general population, current technologies aimed at PwCOPD are underdeveloped and only use a limited range of persuasive technology design principles. Objective: The aim of this study was to explore how acceptable different persuasive technology design principles were considered to be in supporting and encouraging physical activity among PwCOPD. Methods: Three prototypes for mobile apps using different persuasive technology design principles as defined by the persuasive systems design (PSD) model—namely, dialogue support, primary task support, and social support—were developed. Opinions of these prototypes were explored through 28 interviews with PwCOPD, carers, and the health care professionals (HCPs) involved in their care and questionnaires completed by 87 PwCOPD. Participants also ranked how likely individual techniques (eg, competition) would be to convince them to use a technology designed to support physical activity. Data were analyzed using framework analysis, Friedman tests, and Wilcoxon signed rank tests and a convergent mixed methods design was used to integrate findings. Results: The prototypes for mobile apps were received positively by participants. The prototype that used a dialogue support approach was identified as the most likely to be used or recommended by those interviewed, and was perceived as more persuasive than both of the other prototypes (Z=−3.06, P=.002; Z=−5.50, P<.001) by those who completed the questionnaire. PwCOPD identified dialogue support and primary task support techniques as more likely to convince them to use a technology than social support techniques (Z=−5.00, P<.001; Z=−4.92, P<.001, respectively). Opinions of social support techniques such as competition and collaboration were divided. Conclusions: Dialogue support and primary task support approaches are considered to be both acceptable and likely to be persuasive by PwCOPD, carers, and HCPs. In the future, these approaches should be considered when designing apps to encourage physical activity by PwCOPD. %M 28428155 %R 10.2196/jmir.6616 %U http://www.jmir.org/2017/4/e124/ %U https://doi.org/10.2196/jmir.6616 %U http://www.ncbi.nlm.nih.gov/pubmed/28428155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e51 %T User Interest in Digital Health Technologies to Encourage Physical Activity: Results of a Survey in Students and Staff of a German University %A Salzwedel,Annett %A Rabe,Sophie %A Zahn,Thomas %A Neuwirth,Julia %A Eichler,Sarah %A Haubold,Kathrin %A Wachholz,Anne %A Reibis,Rona %A Völler,Heinz %+ Center of Rehabilitation Research, University of Potsdam, House 12, Am Neuen Palais 10, Potsdam, 14469, Germany, 49 331 977 4062, heinz.voeller@uni-potsdam.de %K physical activity %K telemedicine %K primary prevention %K healthy lifestyle %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle. %M 28428156 %R 10.2196/mhealth.7192 %U http://mhealth.jmir.org/2017/4/e51/ %U https://doi.org/10.2196/mhealth.7192 %U http://www.ncbi.nlm.nih.gov/pubmed/28428156 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e45 %T Assessing the Medication Adherence App Marketplace From the Health Professional and Consumer Vantage Points %A Dayer,Lindsey E %A Shilling,Rebecca %A Van Valkenburg,Madalyn %A Martin,Bradley C %A Gubbins,Paul O %A Hadden,Kristie %A Heldenbrand,Seth %+ Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, 4301 W Markham, Little Rock, AR, 72205, United States, 1 501 526 4211, ledayer@uams.edu %K smartphone %K apps %K adherence %K medication %K health literacy %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. Objective: The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings. Methods: Two independent reviewers assessed the features and functionality using a 4-domain rating tool of all adherence apps identified based on developer claims. The same reviewers downloaded and tested the 100 highest-ranking apps including an additional domain for assessment of HL. Pearson product correlations were estimated between the consumer ratings and our domain and total scores. Results: A total of 824 adherence apps were identified; of these, 645 unique apps were evaluated after applying exclusion criteria. The median initial score based on descriptions was 14 (max of 68; range 0-60). As a result, 100 of the highest-scoring unique apps underwent user testing. The median overall user-tested score was 31.5 (max of 73; range 0-60). The majority of the user tested the adherence apps that underwent user testing reported a consumer rating score in their respective online marketplace. The mean consumer rating was 3.93 (SD 0.84). The total user-tested score was positively correlated with consumer ratings (r=.1969, P=.04). Conclusions: More adherence apps are available in the Web-based marketplace, and the quality of these apps varies considerably. Consumer ratings are positively but weakly correlated with user-testing scores suggesting that our rating tool has some validity but that consumers and clinicians may assess adherence app quality differently. %M 28428169 %R 10.2196/mhealth.6582 %U http://mhealth.jmir.org/2017/4/e45/ %U https://doi.org/10.2196/mhealth.6582 %U http://www.ncbi.nlm.nih.gov/pubmed/28428169 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e53 %T Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents %A Holtz,Bree E %A Murray,Katharine M %A Hershey,Denise D %A Dunneback,Julie K %A Cotten,Shelia R %A Holmstrom,Amanda J %A Vyas,Arpita %A Kaiser,Molly K %A Wood,Michael A %+ Department of Advertising and Public Relations, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48824, United States, 1 5178844537, bholtz@msu.edu %K mHealth %K qualitative research %K type 1 diabetes %K family %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective: The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods: This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan’s family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results: Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions: A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents. %M 28428167 %R 10.2196/mhealth.6654 %U http://mhealth.jmir.org/2017/4/e53/ %U https://doi.org/10.2196/mhealth.6654 %U http://www.ncbi.nlm.nih.gov/pubmed/28428167 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e46 %T Technology Use and Preferences for Mobile Phone–Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research %A Holloway,Ian W %A Winder,Terrell JA %A Lea III,Charles Herbert %A Tan,Diane %A Boyd,Donte %A Novak,David %+ Department of Social Welfare, Luskin School of Public Affairs, University of California, 3250 Public Affairs Building, Box 951656, Los Angeles, CA, 90095, United States, 1 310 825 7840, holloway@luskin.ucla.edu %K HIV %K AIDS %K mobile applications %K African Americans %K men’s health %K homosexuality %K bisexuality %K young adult %D 2017 %7 13.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Black young men who have sex with men (BYMSM) experience higher human immunodeficiency virus (HIV) incidence than their white and Latino counterparts. Objective: The aim of our study was to understand BYMSM’s preferences for mobile phone–based HIV prevention and treatment in order to inform culturally tailored interventions to reduce the spread of HIV and improve HIV treatment outcomes in this population. Methods: Qualitative focus groups (N=6) with BYMSM aged 18-29 years (N=41; 46%, 19/41 HIV-positive) were conducted to elucidate their preferences for the design and delivery of mobile phone–based HIV prevention and treatment interventions. A modified grounded theory approach to data analysis was undertaken using ATLAS.ti textual analysis software. Results: Participants preferred holistic health interventions that did not focus exclusively on HIV prevention and treatment. Issues of privacy and confidentiality were paramount. Participants preferred functionality that enables discreet connections to culturally competent health educators and treatment providers who can address the range of health and psychosocial concerns faced by BYMSM. Conclusions: Mobile phone–based HIV prevention has the potential to increase engagement with HIV prevention and treatment resources among BYMSM. For these approaches to be successful, researchers must include BYMSM in the design and creation of these interventions. %M 28408360 %R 10.2196/mhealth.6436 %U http://mhealth.jmir.org/2017/4/e46/ %U https://doi.org/10.2196/mhealth.6436 %U http://www.ncbi.nlm.nih.gov/pubmed/28408360 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e43 %T Usability of a Novel Mobile Health iPad App by Vulnerable Populations %A Miller Jr,David P %A Weaver,Kathryn E %A Case,L Doug %A Babcock,Donald %A Lawler,Donna %A Denizard-Thompson,Nancy %A Pignone,Michael P %A Spangler,John G %+ Wake Forest School of Medicine, Department of Internal Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, United States, 1 336 713 4156, dmiller@wakehealth.edu %K decision support techniques %K technology assessment %K primary care %K health literacy %K vulnerable populations %D 2017 %7 11.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent advances in mobile technologies have created new opportunities to reach broadly into populations that are vulnerable to health disparities. However, mobile health (mHealth) strategies could paradoxically increase health disparities, if low socioeconomic status individuals lack the technical or literacy skills needed to navigate mHealth programs. Objective: The aim of this study was to determine whether patients from vulnerable populations could successfully navigate and complete an mHealth patient decision aid. Methods: We analyzed usability data from a randomized controlled trial of an iPad program designed to promote colorectal cancer (CRC) screening. The trial was conducted in six primary care practices and enrolled 450 patients, aged 50-74 years, who were due for CRC screening. The iPad program included a self-survey and randomly displayed either a screening decision aid or a video about diet and exercise. We measured participant ability to complete the program without assistance and participant-rated program usability. Results: Two-thirds of the participants (305/450) were members of a vulnerable population (limited health literacy, annual income < US $20,000, or black race). Over 92% (417/450) of the participants rated the program highly on all three usability items (90.8% for vulnerable participants vs 96.6% for nonvulnerable participants, P=.006). Only 6.9% (31/450) of the participants needed some assistance to complete the program. In multivariable logistic regression, being a member of a vulnerable population was not associated with needing assistance. Only older age, less use of text messaging (short message service, SMS), and lack of Internet use predicted needing assistance. Conclusions: Individuals who are vulnerable to health disparities can successfully use well-designed mHealth programs. Future research should investigate whether mHealth interventions can reduce health disparities. %M 28400354 %R 10.2196/mhealth.7268 %U http://mhealth.jmir.org/2017/4/e43/ %U https://doi.org/10.2196/mhealth.7268 %U http://www.ncbi.nlm.nih.gov/pubmed/28400354 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e9 %T Design and Usability of a Heart Failure mHealth System: A Pilot Study %A Alnosayan,Nagla %A Chatterjee,Samir %A Alluhaidan,Ala %A Lee,Edward %A Houston Feenstra,Linda %+ IDEA Laboratory, Center for Information Systems and Technology, Claremont Graduate University, 130 East 9th Street, Claremont, CA, 91711, United States, 1 (909) 541 1559, nagla.alnosayan@alumni.cgu.edu %K mHealth %K telehealth %K heart failure %K human factors engineering %K self-management %D 2017 %7 24.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite the advances in mobile health (mHealth) systems, little is known about patients’ and providers’ experiences using a new mHealth system design. Objective: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. Methods: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants’ feedback on the system’s design. Results: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users’ satisfaction with the system ranked 73%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. Conclusions: Understanding users’ experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes. %M 28341615 %R 10.2196/humanfactors.6481 %U http://humanfactors.jmir.org/2017/1/e9/ %U https://doi.org/10.2196/humanfactors.6481 %U http://www.ncbi.nlm.nih.gov/pubmed/28341615 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e36 %T Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study %A Sigler,Brittany Erika %+ Wellpass (formerly Sense Health), 821 Broadway, floor 5, New York, NY,, United States, 1 917 359 7114, bs2897@caa.columbia.edu %K communication %K health behavior %K Medicaid %K mHealth %K patient engagement %K safety-net providers %K text messaging %D 2017 %7 21.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting. Objective: The aim of our study was to investigate care coordinators’ perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI). Methods: Interviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement. Results: The interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients’ agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship. Conclusions: Messaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations. %M 28325711 %R 10.2196/mhealth.5892 %U http://mhealth.jmir.org/2017/3/e36/ %U https://doi.org/10.2196/mhealth.5892 %U http://www.ncbi.nlm.nih.gov/pubmed/28325711 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e26 %T Usability and Acceptability of a Mobile Comprehensive HIV Prevention App for Men Who Have Sex With Men: A Pilot Study %A Sullivan,Patrick S %A Driggers,Robert %A Stekler,Joanne D %A Siegler,Aaron %A Goldenberg,Tamar %A McDougal,Sarah J %A Caucutt,Jason %A Jones,Jeb %A Stephenson,Rob %+ Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047272038, pssulli@emory.edu %K homosexuality, male %K mobile applications %K pilot projects %K sexual minorities %K condoms %K pre-exposure prophylaxis %D 2017 %7 09.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Men who have sex with men (MSM) are the group most impacted by the human immunodeficiency virus (HIV) epidemic and the only subgroup in the United States among which new HIV diagnoses are not decreasing. To achieve the US National HIV/AIDS (acquired immunodeficiency syndrome) Strategy goals of reducing new diagnoses by 25%, high (eg, 30-50%) coverage of multiple HIV prevention interventions is needed in both urban and rural areas. Mobile phone “apps” are an important channel through which prevention services could be provided at scale and at low marginal cost. Objective: The aim of this study was to evaluate the usability and acceptability of a theory-based Android mobile phone app for HIV prevention. Methods: The app included self-assessment tools; prevention recommendations; commodity (condoms, HIV self-tests) ordering; reminders to MSM for basic HIV prevention services, HIV testing, condom use, screening for preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP); and prevention and treatment provider locators. The study recruited HIV-negative, Android-using MSM in Atlanta and Seattle who were asked to use the app for 4 months and complete a post-use survey. We measured the use of the app and its features, ordering of commodities, self-report of establishing an HIV testing plan, being HIV tested in the community, and starting PrEP or using nPEP. Usability was assessed using the system usability scale (SUS). Results: A total of 121 MSM were enrolled (59.5%, 72/121 from Atlanta; 40.5%, 49/121 from Seattle). Median age was 28. Nearly half (48.8%, 59/121) were nonwhite, and most (85.9%, 104/121) were gay-identified. Most had tested for HIV in the past (85.1%, 103/121), and 52 (43.0%, 52/121) had a plan to test for HIV regularly. Men used the app for an average of 17.7 minutes over the first 4 months. Over the 4-month period, over half ordered condoms (63.6%, 77/121) and HIV test kits (52.8%, 64/121) on the app. Eight of 86 (9%) PrEP-eligible MSM started PrEP during the 4-month period; of those, 6 of the 8 reported that the app influenced their decision to start PrEP. The mean SUS was 73 (above average). Conclusions: A theory-based mobile phone app was acceptable to MSM and was rated as having above-average usability. Most men used the commodity-ordering features of the app during the 4-month evaluation period, and nearly 1 in 10 PrEP-eligible men started PrEP, with most attributing their decision to start PrEP in part to the app. A broader, randomized controlled study of the impact of the app on uptake of prevention behaviors for MSM is warranted. %M 28279949 %R 10.2196/mhealth.7199 %U http://mhealth.jmir.org/2017/3/e26/ %U https://doi.org/10.2196/mhealth.7199 %U http://www.ncbi.nlm.nih.gov/pubmed/28279949 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e7 %T Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis %A Ferron,Joelle C %A Brunette,Mary F %A Geiger,Pamela %A Marsch,Lisa A %A Adachi-Mejia,Anna M %A Bartels,Stephen J %+ Health Promotion Research Center at Dartmouth, Department of Psychiatry, Dartmouth Hitchcock Medical Center, 105 Pleasant Street, Hugh Gallon Office Park, Main Bldg, Concord, NH, 03301, United States, 1 603 271 5044, joelle.ferron@dartmouth.edu %K mHealth %K mobile apps %K smoking cessation %K schizophrenia %K psychotic disorders %D 2017 %7 03.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia. Cessation treatment improves abstinence outcomes, but access is a barrier. Mobile phone apps are one way to increase access to cessation treatment; however, whether they are usable by people with psychotic disorders, who often have special learning needs, is not known. Objective: Researchers reviewed 100 randomly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions. We aimed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders. Methods: We identified 766 smoking cessation apps and randomly selected 100 for review. Two independent reviewers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence. Then, smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol. We analyzed quantitative results using descriptive statistics and t tests. Qualitative data were open-coded and analyzed for themes. Results: Regarding adherence to practice guidelines, most of the randomly sampled smoking cessation apps scored poorly—66% rated lower than 10 out of 100 on the Adherence Index (Mean 11.47, SD 11.8). Regarding usability, three common usability problems emerged: text-dense content, abstract symbols on the homepage, and subtle directions to edit features. Conclusions: In order for apps to be effective and usable for this population, developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills. %M 28258047 %R 10.2196/humanfactors.5933 %U http://humanfactors.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/humanfactors.5933 %U http://www.ncbi.nlm.nih.gov/pubmed/28258047 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e21 %T Women’s Perceptions of Participation in an Extended Contact Text Message–Based Weight Loss Intervention: An Explorative Study %A Job,Jennifer R %A Spark,Lauren C %A Fjeldsoe,Brianna S %A Eakin,Elizabeth G %A Reeves,Marina M %+ Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Level 4, Public Health Building, Herston Road, Herston, Brisbane, 4006, Australia, 61 7 3345 5163, j.job@uq.edu.au %K exercise %K diet %K text messaging %K qualitative research %K overweight %K obesity %K weight loss %D 2017 %7 27.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Extending contact with participants after the end of an initial weight loss intervention has been shown to lead to maintained weight loss and related behavioral change. Mobile phone text messaging (short message service, SMS) offers a low-cost and efficacious method to deliver extended contact. In this rapidly developing area, formative work is required to understand user perspectives of text message technology. An extended contact intervention delivered by text messages following an initial telephone-delivered weight loss intervention in breast cancer survivors provided this opportunity. Objective: The aim of this study was to qualitatively explore women’s perceptions of participation in an extended contact intervention using text messaging to support long-term weight loss, physical activity, and dietary behavioral change. Methods: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention (versus usual care), participants received a 6-month extended contact intervention via tailored text messages. Participant perceptions of the different types of text messages, the content, tailoring, timing, and frequency of the text messages, and the length of the intervention were assessed through semistructured interviews conducted after the extended contact intervention. The interviews were transcribed verbatim and analyzed with key themes identified. Results: Participants (n=27) were a mean age of 56.0 years (SD 7.8) and mean body mass index of 30.4 kg/m2 (SD 4.2) and were at a mean of 16.1 months (SD 3.1) postdiagnosis at study baseline. Participants perceived the text messages to be useful behavioral prompts and felt the messages kept them accountable to their behavioral change goals. The individual tailoring of the text message content and schedules was a key to the acceptability of the messages; however, some women preferred the support and real-time discussion via telephone calls (during the initial intervention) compared with the text messages (during the extended contact intervention). Conclusions: Text message support was perceived as acceptable for the majority of women as a way of extending intervention contact for weight loss and behavioral maintenance. Text messages supported the maintenance of healthy behaviors established in the intervention phase and kept the women accountable to their goals. A combination of telephone calls and text message support was suggested as a more acceptable option for some of the women for an extended contact intervention. %M 28242595 %R 10.2196/mhealth.6325 %U http://mhealth.jmir.org/2017/2/e21/ %U https://doi.org/10.2196/mhealth.6325 %U http://www.ncbi.nlm.nih.gov/pubmed/28242595 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e19 %T Support for Sustainable Use of Personal Health Records: Understanding the Needs of Users as a First Step Towards Patient-Driven Mobile Health %A Jung,Se Young %A Lee,Keehyuck %A Hwang,Hee %A Yoo,Sooyoung %A Baek,Hyun Young %A Kim,Jeehyoung %+ Department of Pediatrics, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic Of Korea, 82 317877284, neuroandy@snubh.org %K electronic health record %K medical informatics %K personal health record %K hospital information systems %D 2017 %7 23.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The tethering of a personal health record (PHR) to an electronic medical record (EMR) may serve as a catalyst in accelerating the distribution of integrated PHRs. Creating shared health records for patients and their health care professionals using self-administered functions of EMR-tethered PHRs is crucial to support sustainable use of the system. Objective: This study assesses the factors related to active use of a self-administered function (Health Notes) in an EMR-tethered PHR (Health4U) in a tertiary academic hospital. Methods: This research is a cross-sectional study conducted in a tertiary academic hospital in South Korea. The enrollees included adults aged 19 years and older with experience accessing Health4U in the 13-month period after June 2013. The primary outcome was the adoption of Health Notes in accordance with the number of chronic diseases. Socio-demographic variables were included as confounding factors. Results: Subjects 71 years of age and older were less likely to become active users of Health Notes than those 30 years and younger. Moreover, compared with men, women had 44% and 40% lower tendencies to become Health Notes users and active users, respectively. Those who accessed the desktop page and/or mobile page had higher tendencies to become users of Health Notes. We found a consistent increase in the odds ratio as the number of chronic diseases increased in the active users. When considering specific diseases, patients who had cancer or chronic kidney disease had higher tendencies to become users of Health Notes. Conclusions: Patients with a greater number of chronic diseases tended to use PHR more actively, and used the self-administered function. Women and the elderly may have lower tendencies to actively use PHR. Therefore, items specific to the health of each demographic—women, the elderly, and those with chronic diseases—should be carefully considered to support sustainable use of PHRs. %M 28232300 %R 10.2196/mhealth.6021 %U http://mhealth.jmir.org/2017/2/e19/ %U https://doi.org/10.2196/mhealth.6021 %U http://www.ncbi.nlm.nih.gov/pubmed/28232300 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e11 %T Mixed-Methods Analysis of Factors Impacting Use of a Postoperative mHealth App %A Scott,Aaron R %A Alore,Elizabeth A %A Naik,Aanand D %A Berger,David H %A Suliburk,James W %+ Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, United States, 1 713 798 8070, suliburk@bcm.edu %K mHealth %K colorectal surgery %K smartphone apps %D 2017 %7 08.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Limited communication and care coordination following discharge from hospitals may contribute to surgical complications. Smartphone apps offer a novel mechanism for communication and care coordination. However, factors which may affect patient app use in a postoperative, at-home setting are poorly understood. Objective: The objectives of this study were to (1) gauge interest in smartphone app use among patients after colorectal surgery and (2) better understand factors affecting patient app use in a postoperative, at-home setting. Methods: A prospective feasibility study was performed at a hospital that principally serves low socioeconomic status patients. After colorectal surgery, patients were enrolled and given a smartphone app, which uses previously validated content to provide symptom-based recommendations. Patients were instructed to use the app daily for 14 days after discharge. Demographics and usability data were collected at enrollment. Usability was measured with the System Usability Scale (SUS). At follow-up, the SUS was repeated and patients underwent a structured interview covering ease of use, willingness to use, and utility of use. Two members of the research team independently reviewed the field notes from follow-up interviews and extracted the most consistent themes. Chart and app log reviews identified clinical endpoints. Results: We screened 115 patients, enrolled 20 patients (17.4%), and completed follow-up interviews with 17 patients (85%). Reasons for nonenrollment included: failure to meet inclusion criteria (47/115, 40.9%), declined to participate (26/115, 22.6%), and other reasons (22/115, 19.1%). There was no difference in patient ratings between usability at first-use and after extended use, with SUS scores greater than the 95th percentile at both time points. Despite high usability ratings, 6/20 (30%) of patients never used the app at home after hospital discharge and 2/20 (10%) only used the app once. Interviews revealed three themes related to app use: (1) patient-related barriers could prevent use even though the app had high usability scores; (2) patients viewed the app as a second opinion, rather than a primary source of information; and (3) many patients viewed the app as an external burden. Conclusions: Use patterns in this study, and response rates after prompts to contact the operative team, suggest that apps need to be highly engaging to be adopted by patients. The growing penetration of smartphones and the proliferation of app-based interventions are unlikely to improve care coordination and communication, unless apps address the barriers and patient perceptions identified in this study. This study shows that high usability alone is not sufficient to motivate patients to use smartphone apps in the postoperative period. %M 28179215 %R 10.2196/mhealth.6728 %U http://mhealth.jmir.org/2017/2/e11/ %U https://doi.org/10.2196/mhealth.6728 %U http://www.ncbi.nlm.nih.gov/pubmed/28179215 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e7 %T SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women’s Perceptions %A Munro,Sarah %A Hui,Amber %A Salmons,Vanessa %A Solomon,Carolyn %A Gemmell,Emily %A Torabi,Nahal %A Janssen,Patricia A %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 4026, patti.janssen@ubc.ca %K pregnancy %K text messaging %K prenatal education %K health behavior %D 2017 %7 07.02.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada. Objective: To explore women’s preferences for a prenatal education program by text messaging. Methods: We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women’s perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings. Results: A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages “all the time” (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol. Conclusions: This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes. %M 28174149 %R 10.2196/publichealth.6949 %U http://publichealth.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/publichealth.6949 %U http://www.ncbi.nlm.nih.gov/pubmed/28174149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 1 %P e3 %T Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study %A Robertson,Michael C %A Tsai,Edward %A Lyons,Elizabeth J %A Srinivasan,Sanjana %A Swartz,Maria C %A Baum,Miranda L %A Basen-Engquist,Karen M %+ Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, United States, 1 713 745 3123, kbasenen@mdanderson.org %K mHealth %K physical activity %K survivors %K technology %K focus groups %K smartphone %D 2017 %7 24.01.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective: The aim of this study was to take a qualitative approach to provide practical insight regarding this population’s preferences for the features and messages of an app to increase PA. Methods: A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results: Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69%) and mostly white (25/35, 71%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions: Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors’ preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors. %M 28119278 %R 10.2196/mhealth.6970 %U http://mhealth.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/mhealth.6970 %U http://www.ncbi.nlm.nih.gov/pubmed/28119278 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e229 %T Parent and Clinician Preferences for an Asthma App to Promote Adolescent Self-Management: A Formative Study %A Geryk,Lorie L %A Roberts,Courtney A %A Sage,Adam J %A Coyne-Beasley,Tamera %A Sleath,Betsy L %A Carpenter,Delesha M %+ Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Lane, Chapel Hill, NC, 27599, United States, 1 9198432278, llgeryk@email.unc.edu %K asthma %K self-management %K social support %K mHealth %K mobile apps %K adolescents %K parents %K clinicians %D 2016 %7 06.12.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Most youth asthma apps are not designed with parent and clinician use in mind, and rarely is the app development process informed by parent or clinician input. Objective: This study was conducted to generate formative data on the use, attitudes, and preferences for asthma mHealth app features among parents and clinicians, the important stakeholders who support adolescents with asthma and promote adolescent self-management skills. Methods: We conducted a mixed-methods study from 2013 to 2014 employing a user-centered design philosophy to acquire feedback from a convenience sample of 20 parents and 6 clinicians. Participants were given an iPod Touch and asked to evaluate 10 features on 2 existing asthma apps. Participant experiences using the apps were collected from questionnaires and a thematic analysis of audio-recorded and transcribed (verbatim) interviews using MAXQDA. Descriptive statistics were calculated to characterize the study sample and app feature feedback. Independent samples t tests were performed to compare parent and clinician ratings of app feature usefulness (ratings: 1=not at all useful to 5=very useful). Results: All parents were female (n=20), 45% were black, 20% had an income ≥US $50,000, and 45% had a bachelor’s degree or higher education. The clinician sample included 2 nurses and 4 physicians with a mean practice time of 13 years. Three main themes provided an understanding of how participants perceived their roles and use of asthma app features to support adolescent asthma self-management: monitoring and supervision, education, and communication/information sharing. Parents rated the doctor report feature highest, and clinicians rated the doctor appointment reminder highest of all evaluated app features on usefulness. The peak flow monitoring feature was the lowest ranked feature by both parents and clinicians. Parents reported higher usefulness for the doctor report (t(10)=2.7, P<.02), diary (t(10)=2.7, P<.03), and self-check quiz (t(14)=2.5, P<.02) features than clinicians. Specific participant suggestions for app enhancements (eg, a tutorial showing correct inhaler use, refill reminders, pop-up messages tied to a medication log, evidence-based management steps) were also provided. Conclusions: Parent and clinician evaluations and recommendations can play an important role in the development of an asthma app designed to help support youth asthma management. Two-way asthma care communication between families and clinicians and components involving families and clinicians that support adolescent self-management should be incorporated into adolescent asthma apps. %M 27923777 %R 10.2196/resprot.5932 %U http://www.researchprotocols.org/2016/4/e229/ %U https://doi.org/10.2196/resprot.5932 %U http://www.ncbi.nlm.nih.gov/pubmed/27923777 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 2 %P e28 %T Exploration of Deaf People’s Health Information Sources and Techniques for Information Delivery in Cape Town: A Qualitative Study for the Design and Development of a Mobile Health App %A Chininthorn,Prangnat %A Glaser,Meryl %A Tucker,William David %A Diehl,Jan Carel %+ Section of Design for Sustainability, Department of Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 1 15 27 87658, p.chininthorn@tudelft.nl %K Deafness %K sign language %K South Africa %K mHealth %K health %K qualitative research %K co-creation %K community-based co-design %D 2016 %7 11.11.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Many cultural and linguistic Deaf people in South Africa face disparity when accessing health information because of social and language barriers. The number of certified South African Sign Language interpreters (SASLIs) is also insufficient to meet the demand of the Deaf population in the country. Our research team, in collaboration with the Deaf communities in Cape Town, devised a mobile health app called SignSupport to bridge the communication gaps in health care contexts. We consequently plan to extend our work with a Health Knowledge Transfer System (HKTS) to provide Deaf people with accessible, understandable, and accurate health information. We conducted an explorative study to prepare the groundwork for the design and development of the system. Objectives: To investigate the current modes of health information distributed to Deaf people in Cape Town, identify the health information sources Deaf people prefer and their reasons, and define effective techniques for delivering understandable information to generate the groundwork for the mobile health app development with and for Deaf people. Methods: A qualitative methodology using semistructured interviews with sensitizing tools was used in a community-based codesign setting. A total of 23 Deaf people and 10 health professionals participated in this study. Inductive and deductive coding was used for the analysis. Results: Deaf people currently have access to 4 modes of health information distribution through: Deaf and other relevant organizations, hearing health professionals, personal interactions, and the mass media. Their preferred and accessible sources are those delivering information in signed language and with communication techniques that match Deaf people’s communication needs. Accessible and accurate health information can be delivered to Deaf people by 3 effective techniques: using signed language including its dialects, through health drama with its combined techniques, and accompanying the information with pictures in combination with simple text descriptions. Conclusions: We can apply the knowledge gained from this exploration to build the groundwork of the mobile health information system. We see an opportunity to design an HKTS to assist the information delivery during the patient-health professional interactions in primary health care settings. Deaf people want to understand the information relevant to their diagnosed disease and its self-management. The 3 identified effective techniques will be applied to deliver health information through the mobile health app. %M 27836819 %R 10.2196/humanfactors.6653 %U http://humanfactors.jmir.org/2016/2/e28/ %U https://doi.org/10.2196/humanfactors.6653 %U http://www.ncbi.nlm.nih.gov/pubmed/27836819 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e116 %T Engaging Gatekeeper-Stakeholders in Development of a Mobile Health Intervention to Improve Medication Adherence Among African American and Pacific Islander Elderly Patients With Hypertension %A Yazdanshenas,Hamed %A Bazargan,Mohsen %A Jones,Loretta %A Vawer,May %A Seto,Todd B %A Farooq,Summer %A Taira,Deborah A %+ College of Medicine, Departments of Family Medicine and Orthopedic Surgery, Charles R Drew University of Medicine and Science/University of California, Los Angeles (UCLA), 1748 East, LSRN Bldg, # N150, 118th St, Los Angeles, CA, 90059, United States, 1 3233573452, Yazdanshenas@ucla.edu %K health %K technology %K elderly %K minority %K hypertension %K mHealth %D 2016 %7 26.10.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 70 million people in the United States have hypertension. Although antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed. Objective: The goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American and Native Hawaiian and Pacific Islander patients with hypertension. Methods: In-depth interviews were conducted with 20 gatekeeper-stakeholders using targeted open-ended questions. Interviews were deidentified, transcribed, organized, and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors. Results: A number of similar themes regarding elements of a successful intervention emerged from our two groups of African American and Native Hawaiian and Pacific Islander gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications. Second, was the use of mobile phones for messaging and patients need to be able to access ongoing technical support. Third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among the African American group that the church be involved and that the intervention begin with group workshops, whereas the Native Hawaiian and Pacific Islander group seemed to believe that the teaching could occur on a one-to-one basis with the health care provider. Conclusions: Information from our gatekeeper-stakeholder (key informant) interviews suggests that the design of a mHealth intervention to improve adherence to antihypertensives among the elderly could be very similar for African Americans and Native Hawaiian and Pacific Islanders. The main difference might be in the way in which the program is initiated (possibly through church-based workshops for African Americans and by individual providers for Native Hawaiian and Pacific Islanders). Another difference might be who sends the messages with African Americans wanting someone outside the health care system, but Native Hawaiian and Pacific Islanders preferring a provider. %M 27784651 %R 10.2196/mhealth.5905 %U http://mhealth.jmir.org/2016/4/e116/ %U https://doi.org/10.2196/mhealth.5905 %U http://www.ncbi.nlm.nih.gov/pubmed/27784651 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e113 %T Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring %A Gunter,Rebecca %A Fernandes-Taylor,Sara %A Mahnke,Andrea %A Awoyinka,Lola %A Schroeder,Chad %A Wiseman,Jason %A Sullivan,Sarah %A Bennett,Kyla %A Greenberg,Caprice %A Kent,K Craig %+ Wisconsin Institute of Surgical Outcomes Research, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, United States, 1 608 565 3268, rgunter@uwhealth.org %K telemedicine %K smartphone %K surgical site infection %K postoperative wound infection %D 2016 %7 28.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Surgical patients are increasingly using mobile health (mHealth) platforms to monitor recovery and communicate with their providers in the postdischarge period. Despite widespread enthusiasm for mHealth, few studies evaluate the usability or user experience of these platforms. Objective: Our objectives were to (1) develop a novel image-based smartphone app for postdischarge surgical wound monitoring, and (2) rigorously user test it with a representative population of vascular and general surgery patients. Methods: A total of 9 vascular and general surgery inpatients undertook usability testing of an internally developed smartphone app that allows patients to take digital images of their wound and answer a survey about their recovery. We followed the International Organization for Standardization (ISO) 9241-11 guidelines, focusing on effectiveness, efficiency, and user satisfaction. An accompanying training module was developed by applying tenets of adult learning. Sessions were audio-recorded, and the smartphone screen was mirrored onto a study computer. Digital image quality was evaluated by a physician panel to determine usefulness for clinical decision making. Results: The mean length of time spent was 4.7 (2.1-12.8) minutes on the training session and 5.0 (1.4-16.6) minutes on app completion. 55.5% (5/9) of patients were able to complete the app independently with the most difficulty experienced in taking digital images of surgical wounds. Novice patients who were older, obese, or had groin wounds had the most difficulty. 81.8% of images were sufficient for diagnostic purposes. User satisfaction was high, with an average usability score of 83.3 out of 100. Conclusion: Surgical patients can learn to use a smartphone app for postoperative wound monitoring with high user satisfaction. We identified design features and training approaches that can facilitate ease of use. This protocol illustrates an important, often overlooked, aspect of mHealth development to improve surgical care. %M 27683059 %R 10.2196/mhealth.6023 %U http://mhealth.jmir.org/2016/3/e113/ %U https://doi.org/10.2196/mhealth.6023 %U http://www.ncbi.nlm.nih.gov/pubmed/27683059 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e112 %T Measuring Users’ Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study %A Huerta-Ramos,Elena %A Escobar-Villegas,Maria Soledad %A Rubinstein,Katya %A Unoka,Zsolt Szabolcs %A Grasa,Eva %A Hospedales,Margarita %A Jääskeläinen,Erika %A Rubio-Abadal,Elena %A Caspi,Asaf %A Bitter,István %A Berdun,Jesus %A Seppälä,Jussi %A Ochoa,Susana %A Fazekas,Kata %A , %A Corripio,Iluminada %A Usall,Judith %+ Parc Sanitari Sant Joan de Déu, CIBERSAM G11, Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain, 34 936406350 ext 12347, mehuerta@pssjd.org %K mHealth solution %K treatment-resistant schizophrenia %K intervention model %K qualitative research %K needs assessment %D 2016 %7 28.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice. Objective: The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST). Methods: Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework. Results: A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution. Conclusions: Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact. %M 27682896 %R 10.2196/mhealth.5716 %U http://mhealth.jmir.org/2016/3/e112/ %U https://doi.org/10.2196/mhealth.5716 %U http://www.ncbi.nlm.nih.gov/pubmed/27682896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e95 %T Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers’ Perspectives %A Hartzler,Andrea Lisabeth %A BlueSpruce,June %A Catz,Sheryl L %A McClure,Jennifer B %+ Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2030, hartzler.a@ghc.org %K mobile health %K human-centered design %K human-computer interaction %K smartphone %K smoking cessation %K telemedicine %K software design %D 2016 %7 05.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers’ preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used. Objective: The aim of this study was to understand smokers’ preferred design features of mHealth quit-smoking tools. Methods: We used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a “blue-sky” brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important. Results: Participants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one’s progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking. Conclusions: Future mHealth cessation aids should be designed with an understanding of smokers’ needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption and improve treatment outcomes. Grounded in the perspectives of smokers, we identify several design considerations, which should be prioritized when designing future mHealth cessation tools and which warrant additional empirical validation. %M 27496593 %R 10.2196/mhealth.5742 %U http://mhealth.jmir.org/2016/3/e95/ %U https://doi.org/10.2196/mhealth.5742 %U http://www.ncbi.nlm.nih.gov/pubmed/27496593 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e216 %T Depression Screening Using Daily Mental-Health Ratings from a Smartphone Application for Breast Cancer Patients %A Kim,Junetae %A Lim,Sanghee %A Min,Yul Ha %A Shin,Yong-Wook %A Lee,Byungtae %A Sohn,Guiyun %A Jung,Kyung Hae %A Lee,Jae-Ho %A Son,Byung Ho %A Ahn,Sei Hyun %A Shin,Soo-Yong %A Lee,Jong Won %+ Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic Of Korea, 82 2 3010 5603, jongwonlee116@gmail.com %K depression %K smartphone applications %K mental health %K breast cancer (neoplasms) %D 2016 %7 04.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile mental-health trackers are mobile phone apps that gather self-reported mental-health ratings from users. They have received great attention from clinicians as tools to screen for depression in individual patients. While several apps that ask simple questions using face emoticons have been developed, there has been no study examining the validity of their screening performance. Objective: In this study, we (1) evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression, (2) discuss three approaches to data processing (ratio, average, and frequency) for generating indicator variables, and (3) examine the impact of adherence on reporting using a mobile mental-health tracker and accuracy in depression screening. Methods: We analyzed 5792 sets of daily mental-health ratings collected from 78 breast cancer patients over a 48-week period. Using the Patient Health Questionnaire-9 (PHQ-9) as the measure of true depression status, we conducted a random-effect logistic panel regression and receiver operating characteristic (ROC) analysis to evaluate the screening performance of the mobile mental-health tracker. In addition, we classified patients into two subgroups based on their adherence level (higher adherence and lower adherence) using a k-means clustering algorithm and compared the screening accuracy between the two groups. Results: With the ratio approach, the area under the ROC curve (AUC) is 0.8012, indicating that the performance of depression screening using daily mental-health ratings gathered via mobile mental-health trackers is comparable to the results of PHQ-9 tests. Also, the AUC is significantly higher (P=.002) for the higher adherence group (AUC=0.8524) than for the lower adherence group (AUC=0.7234). This result shows that adherence to self-reporting is associated with a higher accuracy of depression screening. Conclusions: Our results support the potential of a mobile mental-health tracker as a tool for screening for depression in practice. Also, this study provides clinicians with a guideline for generating indicator variables from daily mental-health ratings. Furthermore, our results provide empirical evidence for the critical role of adherence to self-reporting, which represents crucial information for both doctors and patients. %M 27492880 %R 10.2196/jmir.5598 %U http://www.jmir.org/2016/8/e216/ %U https://doi.org/10.2196/jmir.5598 %U http://www.ncbi.nlm.nih.gov/pubmed/27492880 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e92 %T Overcoming Barriers: Adolescents’ Experiences Using a Mobile Phone Dietary Assessment App %A Svensson,Åsa %A Magnusson,Maria %A Larsson,Christel %+ Department of Food and Nutrition, and Sport Science, University of Gothenburg, Box 300, Gothenburg, 40530, Sweden, 46 70 911 65 19, christel.larsson@gu.se %K adolescents %K content analysis %K dietary assessment %K Self Determination Theory %K mobile phone app %D 2016 %7 29.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of new technology has the potential to increase participation rates in dietary studies and improve the validity of collected dietary data. However, to evaluate the usability of developed dietary methods, qualitative studies of participants’ experiences and perceptions are needed. Objective: To explore adolescents’ experiences using a newly developed mobile phone dietary assessment app, with a focus on factors that could affect their recording of dietary intake. Methods: Focus group interviews were conducted with 75 participants who had used a newly developed mobile phone dietary assessment app in a quantitative evaluation study. The interviews were analyzed using qualitative content analysis and the theoretical framework of Self Determination Theory was applied. Results: The adolescents’ use of the mobile phone dietary assessment app was characterized by their struggle to overcome several perceived barriers. Facilitators that helped adolescents complete the method were also identified. Motivation was found to be an important facilitator, and intrinsically motivated participants completed the method because they found it fun to use. The autonomous extrinsically motivated participants completed the method for the greater good, in order to contribute to the study. The controlled extrinsically motivated participants completed the method to get a reward or avoid punishment. Amotivated participants did not complete the method. More motivated participants were assumed to be more able to overcome barriers and needed less facilitators. Conclusions: Future studies that examine the recording of food intake should include systematic efforts that aim to minimize identified barriers and promote identified facilitators. Further research should specifically aim at studying methods for (and effects of) increasing intrinsic motivation by supporting autonomy, competence, and relatedness among adolescents asked to participate in dietary studies. %M 27473462 %R 10.2196/mhealth.5700 %U http://mhealth.jmir.org/2016/3/e92/ %U https://doi.org/10.2196/mhealth.5700 %U http://www.ncbi.nlm.nih.gov/pubmed/27473462 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 2 %P e19 %T Do Gender-Specific and High-Resolution Three Dimensional Body Charts Facilitate the Communication of Pain for Women? A Quantitative and Qualitative Study %A Egsgaard,Line Lindhardt %A Christensen,Trine Søby %A Petersen,Ida Munk %A Brønnum,Dorthe Scavenius %A Boudreau,Shellie Ann %+ Faculty of Medicine, SMI®, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D3, Aalborg Øst, 9220, Denmark, 45 99409829, sboudreau@hst.aau.dk %K mHealth %K app %K android %K pain measurement %K chronic pain %K three dimensional pain drawing %K digital communication %D 2016 %7 20.07.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic pain is more prevalent among women; however, the majority of standardized pain drawings are often collected using male-like androgynous body representations. Objective: The purpose of this study was to assess whether gender-specific and high-resolution three-dimensional (3D) body charts facilitate the communication of pain for women. Methods: Using mixed-methods and a cross-over design, female patients with chronic pain were asked to provide detailed drawings of their current pain on masculine and feminine two-dimensional (2D) body schemas (N=41, Part I) or on female 2D and 3D high-resolution body schemas (N=41, Part II) on a computer tablet. The consistency of the drawings between body charts were assessed by intraclass correlation coefficient (ICC) and Bland-Altman plots. Semistructured interviews and a preference questionnaire were then used to obtain qualitative and quantitative responses of the drawing experience. Results: The consistency between body charts were high (Part I: ICC=0.980, Part II: ICC=0.994). The preference ratio for the masculine to feminine body schemas were 6:35 and 18:23 for the 2D to 3D female body charts. Patients reported that the 3D body chart enabled a more accurate expression of their pain due to the detailed contours of the musculature and bone structure, however, patients also reported the 3D body chart was too human and believed that skin-like appearance limited ‘deep pain’ expressions. Conclusions: Providing gender-specific body charts may facilitate the communication of pain and the level of detail (2D vs 3D body charts) should be used according to patients’ needs. %M 27440737 %R 10.2196/humanfactors.5693 %U http://humanfactors.jmir.org/2016/2/e19/ %U https://doi.org/10.2196/humanfactors.5693 %U http://www.ncbi.nlm.nih.gov/pubmed/27440737 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e89 %T Variations in the Use of mHealth Tools: The VA Mobile Health Study %A Frisbee,Kathleen L %+ Connected Health, Office of Informatics and Analytics, Veterans Health Administration, Department of Veteran Affairs, 810 Vermont Ave (102PD), Washington, DC, 20420, United States, 1 202 461 5840, Kathleen.Frisbee@va.gov %K caregivers %K telemedicine %K stress (psychological) %K veterans health %D 2016 %7 19.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective: The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods: Veteran/family caregiver dyads (N=882) enrolled in VA’s Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results: Of the 882 dyads, 94.9% (837/882) of caregivers were women and 95.7% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8% (351/882) lived in rural locations. Most (89%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions: This mHealth Family Caregiver pilot project effectively establishes the VA’s first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities. %M 27436165 %R 10.2196/mhealth.3726 %U http://mhealth.jmir.org/2016/3/e89/ %U https://doi.org/10.2196/mhealth.3726 %U http://www.ncbi.nlm.nih.gov/pubmed/27436165 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e82 %T YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth %A Sheoran,Bhupendra %A Silva,Cara Lynn %A Lykens,James Elliot %A Gamedze,Londiwe %A Williams,Samantha %A Ford,Jessie VanNess %A Habel,Melissa A %+ YTH, 409 13th St, 14th Floor, Oakland, CA, 94612, United States, 1 510 835 9400, sheoran@yth.org %K mHealth %K homelessness %K youth %K STD %K sexually transmitted diseases %K mobile app %D 2016 %7 14.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Homeless and unstably housed (H/UH) youth are disproportionately affected by sexual health issues, including human immunodeficiency virus/sexually transmitted diseases, teen pregnancy, and dating violence, and are at a higher risk for poor mental health and underutilization of services. Research suggests that linking health care to H/UH adolescents might help improve their continuity of care, with most preferring to access health care information via the Internet. YTH StreetConnect is a dual-purpose mobile app that helps H/UH youth access health and vital services in Santa Clara County, CA, USA. We developed YTH StreetConnect PRO in parallel with the youth app as a companion tablet app for providers who serve H/UH youth. Objective: The objective of our study was to develop a mobile app to support H/UH youth and their providers in accessing health and vital resources, and to conduct usability and feasibility testing of the app among H/UH youth and technical consultants with local expertise in serving H/UH youth. Methods: Formative research included a literature review on H/UH youths’ mobile phone and Internet usage. In January 2015, we conducted interviews with medical and service providers of H/UH youth. Usability and feasibility testing were done with target audiences. Additionally, we conducted focus groups with youth regarding the app’s youth friendliness, accessibility, and usefulness. Results: H/UH youth and their providers noted the app’s functionality, youth friendliness, and resources. Usability testing proposed improvements to the app, including visual updates to the user interface, map icons, new underrepresented resource categories, and the addition of a peer rating system. Limitations included a small sample size among H/UH youth and providers and a single site for the study (Santa Clara County, CA), making the findings ungeneralizable to the US population. Conclusions: YTH StreetConnect is a promising way to increase service utilization, provide referral access, and share resources among H/UH youth and providers. Input from H/UH youth and providers offers insights on how to improve future models of YTH StreetConnect and similar programs that assist H/UH youth. %M 27417882 %R 10.2196/mhealth.5168 %U http://mhealth.jmir.org/2016/3/e82/ %U https://doi.org/10.2196/mhealth.5168 %U http://www.ncbi.nlm.nih.gov/pubmed/27417882 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e79 %T Deriving Requirements for Pervasive Well-Being Technology From Work Stress and Intervention Theory: Framework and Case Study %A Koldijk,Saskia %A Kraaij,Wessel %A Neerincx,Mark A %+ Delft University of Technology, Interactive Intelligence, Mekelweg 4, Delft,, Netherlands, 31 888665875, M.A.Neerincx@tudelft.nl %K psychological stress %K professional burn-out %K behavioral symptoms %K self-management %K health technology %K early medical intervention %D 2016 %7 05.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stress in office environments is a big concern, often leading to burn-out. New technologies are emerging, such as easily available sensors, contextual reasoning, and electronic coaching (e-coaching) apps. In the Smart Reasoning for Well-being at Home and at Work (SWELL) project, we explore the potential of using such new pervasive technologies to provide support for the self-management of well-being, with a focus on individuals' stress-coping. Ideally, these new pervasive systems should be grounded in existing work stress and intervention theory. However, there is a large diversity of theories and they hardly provide explicit directions for technology design. Objective: The aim of this paper is to present a comprehensive and concise framework that can be used to design pervasive technologies that support knowledge workers to decrease stress. Methods: Based on a literature study we identify concepts relevant to well-being at work and select different work stress models to find causes of work stress that can be addressed. From a technical perspective, we then describe how sensors can be used to infer stress and the context in which it appears, and use intervention theory to further specify interventions that can be provided by means of pervasive technology. Results: The resulting general framework relates several relevant theories: we relate “engagement and burn-out” to “stress”, and describe how relevant aspects can be quantified by means of sensors. We also outline underlying causes of work stress and how these can be addressed with interventions, in particular utilizing new technologies integrating behavioral change theory. Based upon this framework we were able to derive requirements for our case study, the pervasive SWELL system, and we implemented two prototypes. Small-scale user studies proved the value of the derived technology-supported interventions. Conclusions: The presented framework can be used to systematically develop theory-based technology-supported interventions to address work stress. In the area of pervasive systems for well-being, we identified the following six key research challenges and opportunities: (1) performing multi-disciplinary research, (2) interpreting personal sensor data, (3) relating measurable aspects to burn-out, (4) combining strengths of human and technology, (5) privacy, and (6) ethics. %M 27380749 %R 10.2196/mhealth.5341 %U http://mhealth.jmir.org/2016/3/e79/ %U https://doi.org/10.2196/mhealth.5341 %U http://www.ncbi.nlm.nih.gov/pubmed/27380749 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 2 %P e24 %T Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers %A Lord,Sarah %A Moore,Sarah K %A Ramsey,Alex %A Dinauer,Susan %A Johnson,Kimberly %+ Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, United States, 1 603 646 7989, sarah.e.lord@dartmouth.edu %K substance abuse %K relapse prevention %K mobile apps %D 2016 %7 28.06.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Research supports the effectiveness of technology-based treatment approaches for substance use disorders. These approaches have the potential to broaden the reach of evidence-based care. Yet, there is limited understanding of factors associated with implementation of technology-based care approaches in different service settings. Objectives: In this study, we explored provider and staff perceptions of facilitators and barriers to implementation of a mobile phone substance use recovery support app with clients in 4 service settings. Methods: Interviews were conducted with leadership and provider stakeholders (N=12) from 4 agencies in the first year of an implementation trial of the mobile phone app. We used the Consolidated Framework for Implementation Research as the conceptual foundation for identifying facilitators and barriers to implementation. Results: Implementation process facilitators included careful planning of all aspects of implementation before launch, engaging a dedicated team to implement and foster motivation, working collaboratively with the app development team to address technical barriers and adapt the app to meet client and agency needs, and consistently reviewing app usage data to inform progress. Implementation support strategies included training all staff to promote organization awareness about the recovery support app and emphasize its priority as a clinical care tool, encouraging clients to try the technology before committing to use, scaling rollout to clients, setting clear expectations with clients about use of the app, and using peer coaches and consistent client-centered messaging to promote engagement. Perceived compatibility of the mobile phone app with agency and client needs and readiness to implement emerged as salient agency-level implementation facilitators. Facilitating characteristics of the recovery support app itself included evidence of its impact for recovery support, perceived relative advantage of the app over usual care, the ability to adapt the app to improve client use, and its ease of use. The mobile phone itself was a strong motivation for clients to opt in to use the app in settings that provided phones. App access was limited in settings that did not provide phones owing to lack of mobile phone ownership or incompatibility of the app with clients’ mobile phones. Individual differences in technology literacy and provider beliefs about substance use care either facilitated or challenged implementation. Awareness of patient needs and resources facilitated implementation, whereas external policies and regulations regarding technology use introduced barriers to implementation. Conclusions: The conceptually grounded facilitators and barriers identified in this study can guide systematic targeting of strategies to improve implementation of mobile phone interventions in community treatment settings. Results also inform the design of technology-based therapeutic tools. This study highlights directions for research with regard to implementation of technology-based behavioral health care approaches. %M 27352884 %R 10.2196/mental.4927 %U http://mental.jmir.org/2016/2/e24/ %U https://doi.org/10.2196/mental.4927 %U http://www.ncbi.nlm.nih.gov/pubmed/27352884 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e81 %T Theory-Based Design and Development of a Socially Connected, Gamified Mobile App for Men About Breastfeeding (Milk Man) %A White,Becky K %A Martin,Annegret %A White,James A %A Burns,Sharyn K %A Maycock,Bruce R %A Giglia,Roslyn C %A Scott,Jane A %+ School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, 6845, Australia, 61 8 9266 9050, jane.scott@curtin.edu.au %K mHealth %K smartphone %K mobile phone %K app %K breastfeeding %K fathers %K gamification %K social connectivity %D 2016 %7 27.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite evidence of the benefits of breastfeeding, <15% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior. Objective: The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners. Methods: We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS). Results: Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5. Conclusions: To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative (ACTRN12614000605695). %M 27349756 %R 10.2196/mhealth.5652 %U http://mhealth.jmir.org/2016/2/e81/ %U https://doi.org/10.2196/mhealth.5652 %U http://www.ncbi.nlm.nih.gov/pubmed/27349756 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e76 %T Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer %A Arvidsson,Susann %A Gilljam,Britt-Mari %A Nygren,Jens %A Ruland,Cornelia Maria %A Nordby-Bøe,Trude %A Svedberg,Petra %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, SE-301 18, Sweden, 46 35 16 71 00, susann.arvidsson@hh.se %K cancer %K children %K communication %K mobile app %K participation %K validation %D 2016 %7 24.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a “traditional” conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym “Si det som det er” or “Tell it how it is”) is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a “voice” in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective: To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods: A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children’s views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results: Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions: Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels. %M 27343004 %R 10.2196/mhealth.5715 %U http://mhealth.jmir.org/2016/2/e76/ %U https://doi.org/10.2196/mhealth.5715 %U http://www.ncbi.nlm.nih.gov/pubmed/27343004 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e60 %T Stepwise Development of a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown) %A Ybarra,Michele L %A Prescott,Tonya L %A Espelage,Dorothy L %+ Center for Innovative Public Health Research, 555 N El Camino Real A347, San Clemente, CA, 92672, United States, 1 8773026858, Michele@InnovativePublicHealth.org %K bullying %K mhealth %K text messaging %K youth %K prevention %D 2016 %7 13.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Bullying is a significant public health issue among middle school-aged youth. Current prevention programs have only a moderate impact. Cell phone text messaging technology (mHealth) can potentially overcome existing challenges, particularly those that are structural (e.g., limited time that teachers can devote to non-educational topics). To date, the description of the development of empirically-based mHealth-delivered bullying prevention programs are lacking in the literature. Objective: To describe the development of BullyDown, a text messaging-based bullying prevention program for middle school students, guided by the Social-Emotional Learning model. Methods: We implemented five activities over a 12-month period: (1) national focus groups (n=37 youth) to gather acceptability of program components; (2) development of content; (3) a national Content Advisory Team (n=9 youth) to confirm content tone; and (4) an internal team test of software functionality followed by a beta test (n=22 youth) to confirm the enrollment protocol and the feasibility and acceptability of the program. Results: Recruitment experiences suggested that Facebook advertising was less efficient than using a recruitment firm to recruit youth nationally, and recruiting within schools for the pilot test was feasible. Feedback from the Content Advisory Team suggests a preference for 2-4 brief text messages per day. Beta test findings suggest that BullyDown is both feasible and acceptable: 100% of youth completed the follow-up survey, 86% of whom liked the program. Conclusions: Text messaging appears to be a feasible and acceptable delivery method for bullying prevention programming delivered to middle school students. %M 27296471 %R 10.2196/mhealth.4936 %U http://mhealth.jmir.org/2016/2/e60/ %U https://doi.org/10.2196/mhealth.4936 %U http://www.ncbi.nlm.nih.gov/pubmed/27296471 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e66 %T Experiences With a Self-Reported Mobile Phone-Based System Among Patients With Colorectal Cancer: A Qualitative Study %A Drott,Jenny %A Vilhelmsson,Maria %A Kjellgren,Karin %A Berterö,Carina %+ Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, IMH, Linköping, 581 83, Sweden, 46 013 286820, Jenny.Drott@liu.se %K cancer %K conventional content analysis %K informatics technology systems %K mHealth %K self-reported mobile phone-based system %K symptom monitoring %D 2016 %7 09.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In cancer care, mobile phone-based systems are becoming more widely used in the assessment, monitoring, and management of side effects. Objective: To explore the experiences of patients with colorectal cancer on using a mobile phone-based system for reporting neurotoxic side effects. Methods: Eleven patients were interviewed (ages 44-68 years). A semistructured interview guide was used to perform telephone interviews. The interviews were transcribed verbatim and analyzed with qualitative content analysis. Results: The patients' experiences of using a mobile phone-based system were identified and constructed as: “being involved,” “pacing oneself,” and “managing the questions.” “Being involved” refers to their individual feelings. Patients were participating in their own care by being observant of the side effects they were experiencing. They were aware that the answers they gave were monitored in real time and taken into account by health care professionals when planning further treatment. “Pacing oneself” describes how the patients can have an impact on the time and place they choose to answer the questions. Answering the questionnaire was easy, and despite the substantial number of questions, it was quickly completed. “Managing the questions” pointed out that the patients needed to be observant because of the construction of the questions. They could not routinely answer all the questions. Patients understood that side effects can vary during the cycles of treatment and need to be assessed repeatedly during treatment. Conclusions: This mobile phone-based system reinforced the patients’ feeling of involvement in their own care. The patients were comfortable with the technology and appreciated that the system was not time consuming. %M 27282257 %R 10.2196/mhealth.5426 %U http://mhealth.jmir.org/2016/2/e66/ %U https://doi.org/10.2196/mhealth.5426 %U http://www.ncbi.nlm.nih.gov/pubmed/27282257 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e70 %T Mobile Electronic Medical Records Promote Workflow: Physicians’ Perspective From a Survey %A Duhm,Julian %A Fleischmann,Robert %A Schmidt,Sein %A Hupperts,Hagen %A Brandt,Stephan A %+ Vision and Motor System Research Group, Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 560045, robert.fleischmann@charite.de %K tablet PC %K electronic health record %K usability %K health services %K inpatient care %D 2016 %7 06.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As a result of demographic changes, physicians are required to deliver needed services with limited resources. Research suggests that tablet PCs with access to patient data may streamline clinical workflow. A recent study found tablets with mobile electronic medical records (EMRs) can facilitate data retrieval and produce time savings across the clinical routine within hospital settings. However, the reasons for these time savings, including details on how tablets were being used, remain unclear. The same applies to physicians’ perceptions of this tool within an inpatient setting. Objective: This study examined physicians’ perception of tablets with EMRs in an inpatient setting. The rationale was to identify both subjective and objective factors that impacted the successful implementation and use of tablets running an EMR. Methods: We developed a 57-item survey questionnaire designed to examine users’ perception of and attitude toward tablets, which was administered to 14 participating physicians following 7 weeks of tablet use. Five participants volunteered to participate in a second study that investigated physicians’ patterns of tablet use within the EMR environment by digitally tracking and storing usage behavior. Statistical analyses of questionnaire results included mean values with their bootstrapped 95% confidence intervals and multivariate analysis of variance to identify predictors of tablet use. Results: Physicians reported high degrees of satisfaction with the tablets. There was a general consensus among physicians that tablet use streamlined clinical workflow through optimized data retrieval (rated 0.69, 0.23-1.15 points better than control) and improved communication with patients and other physicians (rated 0.85, 0.54-1.15 and 0.77, 0.38-1.15 points better than control, respectively). Age (F3,11=3.54, P=.04), occupational group (F1,11=7.17, P=.04), and attitude toward novel technologies (F1,11=10.54, P=.02) predicted physicians’ satisfaction with the devices and their motivation regarding their further use. Tracking data yielded that only a few of the available functions were used frequently. Conclusions: Although tablet PCs were consistently perceived as beneficial, several factors contributed to the fact that their full potential was not fully exploited. Training in functionality and providing a reliable infrastructure might foster successful tablet implementation. %M 27268720 %R 10.2196/mhealth.5464 %U http://mhealth.jmir.org/2016/2/e70/ %U https://doi.org/10.2196/mhealth.5464 %U http://www.ncbi.nlm.nih.gov/pubmed/27268720 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e58 %T The Electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients With Complex Chronic Disease and Disability in Primary Care Settings %A Steele Gray,Carolyn %A Gill,Ashlinder %A Khan,Anum Irfan %A Hans,Parminder Kaur %A Kuluski,Kerry %A Cott,Cheryl %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Suite 425, Toronto, ON, M5T 3M6, Canada, 1 4164618252 ext 2908, csteele@bridgepointhealth.ca %K eHealth %K mHealth %K multimorbidity %K primary care %K usability %K feasibility %K pilot %D 2016 %7 02.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage multiple discordant conditions and symptoms and often complex social challenges experienced by these patients. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges by supporting goal-oriented primary care delivery. Using the tool, patients and providers collaboratively develop health care goals on a portal linked to a mobile device to help patients and providers track progress between visits. Objectives: This study tested the usability and feasibility of adopting the ePRO tool into a single interdisciplinary primary health care practice in Toronto, Canada. The Fit between Individuals, Fask, and Technology (FITT) framework was used to guide our assessment and explore whether the ePRO tool is: (1) feasible for adoption in interdisciplinary primary health care practices and (2) usable from both the patient and provider perspectives. This usability pilot is part of a broader user-centered design development strategy. Methods: A 4-week pilot study was conducted in which patients and providers used the ePRO tool to develop health-related goals, which patients then monitored using a mobile device. Patients and providers collaboratively set goals using the system during an initial visit and had at least 1 follow-up visit at the end of the pilot to discuss progress. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system were extracted to provide information regarding tool usage. Results: Six providers and 11 patients participated in the study; 3 patients dropped out mainly owing to health issues. The remaining 8 patients completed 210 monitoring protocols, equal to over 1300 questions, with patients often answering questions daily. Providers and patients accessed the portal on an average of 10 and 1.5 times, respectively. Users found the system easy to use, some patients reporting that the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centered care delivery. Some providers found that the tool helped focus conversations on goal setting. However, the tool did not fit well with provider workflows, monitoring questions were not adequately tailored to individual patient needs, and daily reporting became tedious and time-consuming for patients. Conclusions: Although our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes and generally positive responses from both user groups regarding the potential of the tool to improve care for patients with CCDD. As is consistent with our user-centered design development approach, we have modified the tool based on user feedback, and are now testing the redeveloped tool through an exploratory trial. %M 27256035 %R 10.2196/mhealth.5331 %U http://mhealth.jmir.org/2016/2/e58/ %U https://doi.org/10.2196/mhealth.5331 %U http://www.ncbi.nlm.nih.gov/pubmed/27256035 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e43 %T Use of iPhones by Nurses in an Acute Care Setting to Improve Communication and Decision-Making Processes: Qualitative Analysis of Nurses’ Perspectives on iPhone Use %A Farrell,Maureen %+ University of Melbourne, Parkville, Victoria, 3010, Australia, 61 3 9035 ext 5511, maureen.farrell@unimelb.edu.au %K acute care %K clinical decision making %K communication %K iPhones %K nursing %D 2016 %7 31.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Smartphones and other mobile devices are having and will continue to have an impact on health care delivery in acute settings in Australia and overseas. Nurses, unlike physicians, have been slow to adopt these technologies and the reasons for this may relate to the status of both these professions within the hospital setting. Objective: To explore nurses’ perspectives on iPhone use within an acute care unit. We examined their experiences and views on how this device may improve communication and decision-making processes at the point of care. Methods: Two focus group discussions, using a semistructured interview, were conducted over the trial period. The discussions focused on the nurses’ experiences regarding ease of use, features, and capabilities of the device. The focus groups were recorded, transcribed, and analyzed using semistructured interview questions as a guide. Results: The positive findings indicated that the iPhones were accessible and portable at point of care with patients, enhanced communication in the workplace, particularly among the nurses, and that this technology would evolve and be embraced by all nurses in the future. The negatives were the small screen size when undertaking bedside education for the patient and the invasive nature of the device. Another issue was the perception of being viewed as unprofessional when using the device in real time with the patients and their family. Conclusions: The use of iPhones by nurses in acute care settings has the potential to enhance patient care, especially through more effective communication among nurses, and other health care professionals. To ensure that the benefits of this technology is woven into the everyday practice of the nurse, it is important that leaders in these organizations develop the agenda or policy to ensure that this occurs. %M 27246197 %R 10.2196/mhealth.5071 %U http://mhealth.jmir.org/2016/2/e43/ %U https://doi.org/10.2196/mhealth.5071 %U http://www.ncbi.nlm.nih.gov/pubmed/27246197 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 2 %N 1 %P e7 %T Assessment of Cancer Survivors’ Experiences of Using a Publicly Available Physical Activity Mobile Application %A Puszkiewicz,Patrycja %A Roberts,Anna L %A Smith,Lee %A Wardle,Jane %A Fisher,Abigail %+ Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 02076791723, anna.roberts.15@ucl.ac.uk %K cancer survivors %K mobile applications %K mHealth %K physical activity %K sleep %D 2016 %7 31.05.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective: This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors’ attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods: The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one’s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions: All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population. %M 28410168 %R 10.2196/cancer.5380 %U http://cancer.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/cancer.5380 %U http://www.ncbi.nlm.nih.gov/pubmed/28410168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 5 %P e121 %T Acceptability of Interventions Delivered Online and Through Mobile Phones for People Who Experience Severe Mental Health Problems: A Systematic Review %A Berry,Natalie %A Lobban,Fiona %A Emsley,Richard %A Bucci,Sandra %+ School of Psychological Sciences, Faculty of Medical and Human Sciences, University of Manchester, Room S42, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 44 16130 ext 60428, natalie.berry@manchester.ac.uk %K mHealth %K eHealth %K severe mental health %K psychosis %K bipolar disorder %K personality disorder %K severe mental health problems (SMI) %K acceptability %D 2016 %7 31.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological interventions are recommended for people with severe mental health problems (SMI). However, barriers exist in the provision of these services and access is limited. Therefore, researchers are beginning to develop and deliver interventions online and via mobile phones. Previous research has indicated that interventions delivered in this format are acceptable for people with SMI. However, a comprehensive systematic review is needed to investigate the acceptability of online and mobile phone-delivered interventions for SMI in depth. Objective: This systematic review aimed to 1) identify the hypothetical acceptability (acceptability prior to or without the delivery of an intervention) and actual acceptability (acceptability where an intervention was delivered) of online and mobile phone-delivered interventions for SMI, 2) investigate the impact of factors such as demographic and clinical characteristics on acceptability, and 3) identify common participant views in qualitative studies that pinpoint factors influencing acceptability. Methods: We conducted a systematic search of the databases PubMed, Embase, PsycINFO, CINAHL, and Web of Science in April 2015, which yielded a total of 8017 search results, with 49 studies meeting the full inclusion criteria. Studies were included if they measured acceptability through participant views, module completion rates, or intervention use. Studies delivering interventions were included if the delivery method was online or via mobile phones. Results: The hypothetical acceptability of online and mobile phone-delivered interventions for SMI was relatively low, while actual acceptability tended to be high. Hypothetical acceptability was higher for interventions delivered via text messages than by emails. The majority of studies that assessed the impact of demographic characteristics on acceptability reported no significant relationships between the two. Additionally, actual acceptability was higher when participants were provided remote online support. Common qualitative factors relating to acceptability were safety and privacy concerns, the importance of an engaging and appealing delivery format, the inclusion of peer support, computer and mobile phone literacy, technical issues, and concerns about the impact of psychological state on intervention use. Conclusions: This systematic review provides an in-depth focus on the acceptability of online and mobile phone-delivered interventions for SMI and identified the need for further research in this area. Based on the results from this review, we recommend that researchers measure both hypothetical and actual acceptability to identify whether initial perceptions of online and mobile phone-delivered interventions change after access. In addition, more focus is needed on the potential impact of demographic and clinical characteristics on acceptability. The review also identified issues with module completion rates and intervention use as measures of acceptability. We therefore advise researchers to obtain qualitative reports of acceptability throughout each phase of intervention development and testing. Further implications and opportunities for future research are discussed. %M 27245693 %R 10.2196/jmir.5250 %U http://www.jmir.org/2016/5/e121/ %U https://doi.org/10.2196/jmir.5250 %U http://www.ncbi.nlm.nih.gov/pubmed/27245693 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 2 %P e15 %T Facilitating Secure Sharing of Personal Health Data in the Cloud %A Thilakanathan,Danan %A Calvo,Rafael A %A Chen,Shiping %A Nepal,Surya %A Glozier,Nick %+ Software Engineering Lab, School of Electrical and Information Engineering, The University of Sydney, Level 5, Bldg J03 (Electrical Engineering Building), Maze Crescent, Sydney, 2006, Australia, 61 02 9351 8171, Danan.Thilakanathan@sydney.edu.au %K self care %K telemedicine %K privacy %K computer security %K information dissemination %D 2016 %7 27.05.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. Objective: This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. Methods: We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). Results: We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. Conclusions: We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors. %M 27234691 %R 10.2196/medinform.4756 %U http://medinform.jmir.org/2016/2/e15/ %U https://doi.org/10.2196/medinform.4756 %U http://www.ncbi.nlm.nih.gov/pubmed/27234691 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e65 %T Perceptions of the Feasibility and Practicalities of Text Messaging-Based Infectious Disease Surveillance: A Questionnaire Survey %A Dang,Linh Thuy %A Vu,Nguyen Cong %A Vu,Thiem Dinh %A James,Spencer L %A Katona,Peter %A Katona,Lindsay %A Rosen,Joseph M %A Nguyen,Cuong Kieu %+ Institute of Population, Health and Development, 18 Lane 132, Hoa Bang Street, Hanoi, 122667, Vietnam, 84 437822388 ext 822, cuong.kieu.nguyen@phad.org %K SMS %K SMS-based %K infectious diseases %K text messaging %K surveillance %K Vietnam %D 2016 %7 25.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In Vietnam, infectious disease surveillance data are collected via a paper-based system through four government tiers leading to a large delay. Meanwhile, mobile phones are abundant and very popular in the country, and known to be a useful tool in health care worldwide. Therefore, there is a great potential for the development of a timely disease surveillance system through the use of mobile phone short message service (SMS) text messages. Objective: This study aims to explore insights about the feasibility and practicalities of the utilization of SMS text messaging-based interventions in disease-reporting systems by identifying potential challenges and barriers in the text messaging process and looking at lessons learned. Methods: An SMS text messaging-based disease tracking system was set up in Vietnam with patient reports texted by clinic staff. Two 6-month trials utilizing this disease tracking system were designed and implemented in two northern provinces of Vietnam to report two infectious diseases: diarrhea and influenza-like illness. A structured self-reported questionnaire was developed to measure the feasibility and practicalities of the system from the participants. On the completion of the second trial in 2013, participating health staff from 40 commune health centers in the two pilot provinces were asked to complete the survey (N=80). Results: Most participants were female (61%, 49/80) and nearly half (44%, 35/80) were heads of a commune health center. Approximately two-thirds (63%, 50/80) of participants retained the basic structure of the SMS text message report and there was a strong influence (OR 28.2, 95% CI 5.3-151.2) of those people on the time they spent texting the information. The majority (88%, 70/80) felt the information conveyed in the SMS text message report was not difficult to understand. Most (86%, 69/80) believed that they could report all 28 infectious diseases asked for by the Ministry of Health by using SMS text messaging. Conclusions: From a health center staff perspective, a disease-reporting system utilizing text messaging technology is easy to use and has great potential to be implemented and expanded nationwide. The survey showed positive perceptions and feedback from the participants and contributed to a promising practical solution to improve the surveillance system of infectious disease in Vietnam. %M 27226418 %R 10.2196/mhealth.4509 %U http://mhealth.jmir.org/2016/2/e65/ %U https://doi.org/10.2196/mhealth.4509 %U http://www.ncbi.nlm.nih.gov/pubmed/27226418 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e47 %T User Preferences for Content, Features, and Style for an App to Reduce Harmful Drinking in Young Adults: Analysis of User Feedback in App Stores and Focus Group Interviews %A Milward,Joanna %A Khadjesari,Zarnie %A Fincham-Campbell,Stephanie %A Deluca,Paolo %A Watson,Rod %A Drummond,Colin %+ Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, ASB, 4 Windsor Walk, Denmark Hill, London, SE58BB, United Kingdom, 44 2078480717, joanna.milward@kcl.ac.uk %K alcohol %K drinking %K young adults %K mhealth %K brief intervention %K apps %K smartphone %K digital %K focus group %D 2016 %7 24.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Electronic screening and brief intervention (eSBI) is effective in reducing weekly alcohol consumption when delivered by a computer. Mobile phone apps demonstrate promise in delivering eSBI; however, few have been designed with an evidence-based and user-informed approach. Objective: This study aims to explore from a user perspective, preferences for content, appearance, and operational features to inform the design of a mobile phone app for reducing quantity and frequency of drinking in young adults engaged in harmful drinking (18-30 year olds). Methods: Phase 1 included a review of user reviews of available mobile phone apps that support a reduction in alcohol consumption. Apps were identified on iTunes and Google Play and were categorized into alcohol reduction support, entertainment, blood alcohol content measurement (BAC), or other. eSBI apps with ≥18 user reviews were subject to a content analysis, which coded praise, criticism, and recommendations for app content, functionality, and esthetics. Phase 2 included four focus groups with young adults drinking at harmful levels and residing in South London to explore their views on existing eSBI apps and preferences for future content, functionality, and appearance. Detailed thematic analysis of the data was undertaken. Results: In Phase 1, of the 1584 apps extracted, 201 were categorized as alcohol reduction, 154 as BAC calculators, 509 as entertainment, and 720 as other. We classified 32 apps as eSBI apps. Four apps had ≥18 user reviews: Change for Life Drinks Tracker, Drinksmeter, Drinkaware, and Alcohol Units Calculator. The highest proportion of content praises were for information and feedback provided in the apps (12/27, 44%), followed by praise for the monitoring features (5/27, 19%). Many (8/12, 67%) criticisms were for the drinking diary; all of these were related to difficulty entering drinks. Over half (18/32, 56%) of functionality criticisms were descriptions of software bugs, and over half of those (10/18, 56%) were for app crashing or freezing. Drinksmeter and Alcohol Units Calculator were the most highly praised apps overall (23/57 and 22/57; 39% of praise overall). In Phase 2, two main themes were identified. The meaningfulness theme reflected how young adults thought apps needed to be tailored to the interests and values of their age group, particularly emphasizing content and feedback around broader health and well-being factors such as exercise, diet, and image. The community theme suggested that young adults want to be able to engage with other app users, both in groups of friends and with online users for motivation and support. Conclusions: Targeted and relevant information and feedback, in addition to easy-to-use monitoring tools, were found to be important features of a mobile phone app to support a reduction in drinking. Future app development should consider tailoring all app aspects to the needs of young adults, considering broader well-being monitoring tools and online community functions. %M 27220371 %R 10.2196/mhealth.5242 %U http://mhealth.jmir.org/2016/2/e47/ %U https://doi.org/10.2196/mhealth.5242 %U http://www.ncbi.nlm.nih.gov/pubmed/27220371 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e13 %T Process and Effects Evaluation of a Digital Mental Health Intervention Targeted at Improving Occupational Well-Being: Lessons From an Intervention Study With Failed Adoption %A Muuraiskangas,Salla %A Harjumaa,Marja %A Kaipainen,Kirsikka %A Ermes,Miikka %+ VTT Technical Research Centre of Finland Ltd, Digital Health, Kaitoväylä 1, Oulu, 90590, Finland, 358 207222169, salla.muuraiskangas@vtt.fi %K acceptance and commitment therapy %K intervention studies %K mHealth %K cccupational health %K process assessment %K stress %K mindfulness %K attrition %K adoption %D 2016 %7 11.05.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Digital interventions have the potential to serve as cost-effective ways to manage occupational stress and well-being. However, little is known about the adoption of individual-level digital interventions at organizations. Objectives: The aim of this paper is to study the effects of an unguided digital mental health intervention in occupational well-being and the factors that influence the adoption of the intervention. Methods: The intervention was based on acceptance and commitment therapy (ACT) and its aim was to teach skills for stress management and mental well-being. It was delivered via a mobile and a Web-based app that were offered to employees of two information and communication technology (ICT) companies. The primary outcome measures were perceived stress and work engagement, measured by a 1-item stress questionnaire (Stress) and the Utrecht Work Engagement Scale (UWES-9). The intervention process was evaluated regarding the change mechanisms and intervention stages using mixed methods. The initial interviews were conducted face-to-face with human resource managers (n=2) of both companies in August 2013. The participants were recruited via information sessions and email invitations. The intervention period took place between November 2013 and March 2014. The participants were asked to complete online questionnaires at baseline, two months, and four months after the baseline measurement. The final phone interviews for the volunteer participants (n=17) and the human resource managers (n=2) were conducted in April to May 2014, five months after the baseline. Results: Of all the employees, only 27 (8.1%, 27/332) took the app into use, with a mean use of 4.8 (SD 4.7) different days. In the beginning, well-being was on good level in both companies and no significant changes in well-being were observed. The activities of the intervention process failed to integrate the intervention into everyday activities at the workplace. Those who took the app into use experienced many benefits such as relief in stressful situations. The app was perceived as a toolkit for personal well-being that gives concrete instructions on how mindfulness can be practiced. However, many barriers to participate in the intervention were identified at the individual level, such as lack of time, lack of perceived need, and lack of perceived benefits. Conclusions: The findings suggest that neither the setting nor the approach used in this study were successful in adopting new digital interventions at the target organizations. Barriers were faced at both the organizational as well as the individual level. At the organizational level, top management needs to be involved in the intervention planning for fitting into the organization policies, the existing technology infrastructure, and also targeting the organizational goals. At the individual level, concretizing the benefits of the preventive intervention and arranging time for app use at the workplace are likely to increase adoption. %M 27170553 %R 10.2196/mental.4465 %U http://mental.jmir.org/2016/2/e13/ %U https://doi.org/10.2196/mental.4465 %U http://www.ncbi.nlm.nih.gov/pubmed/27170553 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e30 %T Acceptability, Usability, and Views on Deployment of Peek, a Mobile Phone mHealth Intervention for Eye Care in Kenya: Qualitative Study %A Lodhia,Vaishali %A Karanja,Sarah %A Lees,Shelley %A Bastawrous,Andrew %+ London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 7796277602, vaishali.lodhia@gmail.com %K mobile phone %K mHealth %K qualitative %K ophthalmic testing %K acceptability %K usability %K Kenya %D 2016 %7 09.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The Portable Eye Examination Kit (Peek) is a mobile phone–based ophthalmic testing system that has been developed to perform comprehensive eye examinations. Shortages in ophthalmic personnel, the high cost, and the difficulty in transporting equipment have made it challenging to offer services, particularly in rural areas. Peek offers a solution for overcoming barriers of limited access to traditional ophthalmic testing methods and has been pilot tested on adults in Nakuru, Kenya, and compared with traditional eye examination tools. Objective: This qualitative study evaluated the acceptability and usability of Peek in addition to perceptions regarding its adoption and nationwide deployment. Methods: Semistructured interviews were conducted with patients and analyzed using a framework approach. This included analysis of interviews from 20 patients, 8 health care providers (HCPs), and 4 key decision makers in ophthalmic health care provision in Kenya. The participants were purposefully sampled. The coding structure involved predefined themes for assessing the following: (1) the context, that is, environment, user, task, and technology; (2) patient acceptability, that is, patients' perceived benefits, patient preference, and patient satisfaction; (3) usability, that is, efficiency, effectiveness, learnability, and flexibility and operability of Peek; and (4) the benefits of Peek in strengthening eye care provision, that is, capabilities enhancer, opportunity creator, social enabler, and knowledge generator. Emerging themes relating to the objectives were explored from the data using thematic analysis. Results: Patients found Peek to be acceptable because of its benefits in overcoming the barriers to accessing ophthalmic services. Most thought it to be fast, convenient, and able to reach a large population. All patients expressed being satisfied with Peek. The HCPs perceived it to satisfy the criteria for usability and found Peek to be acceptable based on the technology acceptance model. Peek was also found to have features required for strengthening ophthalmic delivery by aiding detection and diagnosis, provision of decision support, improving communication between provider and patient and among providers, linking patients to services, monitoring, and assisting in education and training. Some of the deployment-related issues included the need for government and community involvement, communication and awareness creation, data protection, infrastructure development including capacity creation, and training and maintenance support. Conclusions: According to all parties interviewed, Peek is an acceptable solution, as it provides a beneficial service, supports patients' needs, and fulfills HCPs' roles, overall contributing to strengthening eye health. %M 27160779 %R 10.2196/mhealth.4746 %U http://mhealth.jmir.org/2016/2/e30/ %U https://doi.org/10.2196/mhealth.4746 %U http://www.ncbi.nlm.nih.gov/pubmed/27160779 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e38 %T Community Engagement to Optimize the Use of Web-Based and Wearable Technology in a Cardiovascular Health and Needs Assessment Study: A Mixed Methods Approach %A Yingling,Leah R %A Brooks,Alyssa T %A Wallen,Gwenyth R %A Peters-Lawrence,Marlene %A McClurkin,Michael %A Cooper-McCann,Rebecca %A Wiley Jr,Kenneth L %A Mitchell,Valerie %A Saygbe,Johnetta N %A Johnson,Twanda D %A Curry,Rev. Kendrick E %A Johnson,Allan A %A Graham,Avis P %A Graham,Lennox A %A Powell-Wiley,Tiffany M %+ Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 10, 5-3330, 10 Center Drive, Bethesda, MD, 20892, United States, 1 301 594 3735, tiffany.powell@nih.gov %K mHealth %K physical activity %K community-based participatory research %K obesity %K African Americans %K activity monitoring %K qualitative research %K focus groups %K community %D 2016 %7 25.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Resource-limited communities in Washington, D.C. have high rates of obesity-related cardiovascular disease in addition to inadequate physical activity (PA) facilities and limited Internet access. Engaging community members in the design and implementation of studies to address these health disparities is essential to the success of community-based PA interventions. Objective: The objective of the study was to use qualitative and quantitative methods to evaluate the feasibility and acceptability of PA-monitoring wristbands and Web-based technology by predominantly African American, church-based populations in resource-limited Washington, D.C. neighborhoods. Methods: To address cardiovascular health in at-risk populations in Washington, D.C., we joined community leaders to establish a community advisory board, the D.C. Cardiovascular Health and Obesity Collaborative (D.C. CHOC). As their first initiative, the Washington, D.C. Cardiovascular Health and Needs Assessment intends to evaluate cardiovascular health, social determinants of health, and PA-monitoring technologies. At the recommendation of D.C. CHOC members, we conducted a focus group and piloted the proposed PA-monitoring system with community members representing churches that would be targeted by the Cardiovascular Health and Needs Assessment. Participants (n=8) agreed to wear a PA-monitoring wristband for two weeks and to log cardiovascular health factors on a secure Internet account. Wristbands collected accelerometer-based data that participants uploaded to a wireless hub at their church. Participants agreed to return after two weeks to participate in a moderated focus group to share experiences using this technology. Feasibility was measured by Internet account usage, wristband utilization, and objective PA data. Acceptability was evaluated through thematic analysis of verbatim focus group transcripts. Results: Study participants (5 males, 3 females) were African American and age 28-70 years. Participant wristbands recorded data on 10.1±1.6 days. Two participants logged cardiovascular health factors on the website. Focus group transcripts revealed that participants felt positively about incorporating the device into their church-based populations, given improvements were made to device training, hub accessibility, and device feedback. Conclusions: PA-monitoring wristbands for objectively measuring PA appear to be a feasible and acceptable technology in Washington, D.C., resource-limited communities. User preferences include immediate device feedback, hands-on device training, explicit instructions, improved central hub accessibility, and designation of a church member as a trained point-of-contact. When implementing technology-based interventions in resource-limited communities, engaging the targeted community may aid in early identification of issues, suggestions, and preferences. ClinicalTrial: Trial Registration: ClinicalTrials.gov NCT01927783; https://clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/6f8wL117u) %M 27113680 %R 10.2196/mhealth.4489 %U http://mhealth.jmir.org/2016/2/e38/ %U https://doi.org/10.2196/mhealth.4489 %U http://www.ncbi.nlm.nih.gov/pubmed/27113680 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e26 %T Young People’s Views and Experiences of a Mobile Phone Texting Intervention to Promote Safer Sex Behavior %A French,Rebecca Sophia %A McCarthy,Ona %A Baraitser,Paula %A Wellings,Kaye %A Bailey,Julia V %A Free,Caroline %+ London School of Hygiene & Tropical Medicine, Department of Social & Environmental Health Research, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 (0)20 7927 2047, Rebecca.French@lshtm.ac.uk %K text messaging %K young people %K sexual health %K intervention %K qualitative interviews %K sexual behavior %K behavior change %D 2016 %7 15.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The risk of poor sexual health, including unplanned pregnancy and sexually transmitted infections (STIs), is greatest amongst young people. Innovative and acceptable interventions to improve sexual health are required. Mobile phone text messaging (short message service, SMS) interventions have the potential to reach large numbers of people at relatively low cost, but greater understanding is needed on how these interventions should be developed and how they work. Objectives: The aim of this paper is to explore young people’s views of and experiences with a mobile phone text messaging intervention to promote safer sex behavior. Methods: We undertook qualitative interviews with young people aged 16 to 24 years as part of a pilot trial of a sexual health intervention delivered by text message in the United Kingdom. Study participants received sexual health promotion text messages based on behavior-change techniques. The message content, tailored by gender and STI status, included support for correct STI treatment and promotion of safer sex behaviors. Young people were eligible if they had received a positive chlamydia test or had more than one partner and at least one episode of unprotected sex in the last year. Telephone interviews were conducted 2 to 3 weeks after initiation of the intervention. A semi-structured topic guide was followed to explore participant experiences and a thematic analysis was conducted. Results: We conducted 16 telephone interviews with participants who had received the text intervention and an additional four interviews with those in the control group (13 women and 7 men). Intervention participants found text messages easy to understand and appearing to come from a friendly and trustworthy source. They considered the frequency and timing of messages to be appropriate, and delivery via mobile phones convenient. Receipt of support by text message allowed recipients to assimilate information at their own pace, and prompted reflection on and sharing of messages with friends, family members, and partners, thus providing opportunities for education and discussion. For some recipients, the messages had increased their knowledge of how to correctly use condoms. Some described how the messages had increased their confidence and reduced stigma, enabling them to disclose infection to a partner and/or to do so sooner and more calmly. Discussing the messages with a partner reportedly enabled some women to negotiate condom use. Conclusion: From the perspective of the recipients, the tone, frequency, and content of the text messaging-based sexual health intervention was acceptable and appropriate. Their accounts indicated that the intervention increased knowledge, confidence, and safer sex behaviors. A large-scale randomized controlled trial (RCT) is needed to assess effectiveness. %M 27083784 %R 10.2196/mhealth.4302 %U http://mhealth.jmir.org/2016/2/e26/ %U https://doi.org/10.2196/mhealth.4302 %U http://www.ncbi.nlm.nih.gov/pubmed/27083784 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e28 %T User Perceptions of ¡Protéjase!: An Intervention Designed to Increase Protective Equipment Use Among Mexican Immigrant and Mexican American Farmworkers %A Snipes,Shedra A %A Montiel-Ishino,Francisco A %A Smyth,Joshua M %A Murphy,Dennis J %A Miranda,Patricia Y %A Davis,Lisa A %+ Penn State University, Department of Biobehavioral Health, 125 Biobehavioral Health Building, University Park, PA, , United States, 1 814 865 4668, sas84@psu.edu %K mHealth %K Hispanic %K migrant worker %K intervention study %K pesticides %K occupational safety %D 2016 %7 11.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Farmworkers’ exposures to pesticides are reduced when they wear personal protective equipment (PPE), and mobile health (mHealth) platforms can potentially deliver information to farmworkers to help promote PPE use. However, little is known about the feasibility of using mHealth platforms to promote farmworkers’ use of PPE. Objective: The objective of the study was to describe the development and feasibility-testing of Protect Yourself! (¡Protéjase!), an intervention designed to increase PPE use. As the vast majority of farmworkers in the United States are from Mexico, we examined the intervention in a primarily Mexican-origin farmworker population. Methods: ¡Protéjase was developed in several steps. First, we performed ethnographic observations to understand what prevents PPE use. Next, we developed program components that met the challenges uncovered in the ethnographic observations, seeking direct feedback from farmworkers on each component. Feasibility was assessed using surveys and focus groups. Material was provided in Spanish or English at the preference of the participant. Finally, we pilot tested each component of the intervention, including: (1) PPE that was provided to each worker for their personal use during the intervention trial, and (2) delivery of an application-based tool that promoted the use of PPE through daily individualized messaging. Results: 55 farmworkers enrolled in the study, but only 41 of 55 (75%) completed the entire pilot intervention trial. Results focus on the evaluation of the intervention, and include only those who completed the entire trial. Among farmworkers who completed the entire intervention trial, all but two farmworkers were born in Mexico and were Spanish speaking. Still, all study participants self-identified as Mexican or Mexican-American. When asked what changes were needed in the intervention’s messaging or delivery to increase user satisfaction, 22 out of 41 participants (54%) felt that no changes were needed. However, 16 of 41 participants (39%) suggested small changes to messaging (eg, refer to long pants as pants only) to improve their understanding of the messages. Finally, a small number (3 of 41 participants, 7%) felt that messages were difficult to read, primarily due to low literacy. Conclusions: The ¡Protéjase! mHealth program demonstrated very good feasibility, satisfaction, and acceptance; potential improvements (eg, small modifications in messaging to increase farmworkers’ use) were noted. Overall, the PPE provided to workers as well as the mHealth platform were both perceived as useful for promoting PPE use. %M 27066727 %R 10.2196/mhealth.4455 %U http://mhealth.jmir.org/2016/2/e28/ %U https://doi.org/10.2196/mhealth.4455 %U http://www.ncbi.nlm.nih.gov/pubmed/27066727 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e33 %T Diet and Physical Activity Apps: Perceived Effectiveness by App Users %A Wang,Qing %A Egelandsdal,Bjørg %A Amdam,Gro V %A Almli,Valerie L %A Oostindjer,Marije %+ Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, 1430 Aas, Norway, 47 67 23 25 74, qing.wang@nmbu.no %K diet app %K physical activity app %K perceived effectiveness %K behavioral changes %D 2016 %7 07.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Diet and physical activity apps are two types of health apps that aim to promote healthy eating and energy expenditure through monitoring of dietary intake and physical activity. No clear evidence showing the effectiveness of using these apps to promote healthy eating and physical activity has been previously reported. Objective: This study aimed to identify how diet and physical activity (PA) apps affected their users. It also investigated if using apps was associated with changes in diet and PA. Methods: First, 3 semi-structured focus group discussions concerning app usability were conducted (15 app users and 8 nonusers; mean age 24.2 years, SD 6.4), including outcome measures such as motivations, experiences, opinions, and adherence. Results from the discussions were used to develop a questionnaire. The questionnaire, which contained questions about behavior changes, app usage, perceived effectiveness, and opinions of app usability, was answered by 500 Norwegians, with a mean age of 25.8 years (SD 5.1). Results: App users found diet and PA apps effective in promoting healthy eating and exercising. These apps affected their actions, health consciousness, and self-education about nutrition and PA; and were also a part of their social lives. Over half of the users perceived that apps were effective in assisting them to eat healthily and to exercise more. Diet apps were more effective when they were frequently used and over a long period of time, compared to infrequent or short-term use (P=.01 and P=.02, respectively). Users who used diet and PA apps, perceived apps as more effective than users who only used one type of app (all P<.05). App users were better at maintaining diet and PA behaviors than nonusers (all P<.05). Young adults found apps fun to use, but sometimes time consuming. They wanted apps to be designed to meet their personal expectations. Conclusions: App usage influenced action, consciousness, self-education about nutrition and PA, and social life. It facilitated maintaining a healthy diet and exercising more. Diet and PA apps of the future can be further strengthened by being tailored to meet personal needs. %M 27056639 %R 10.2196/mhealth.5114 %U http://mhealth.jmir.org/2016/2/e33/ %U https://doi.org/10.2196/mhealth.5114 %U http://www.ncbi.nlm.nih.gov/pubmed/27056639 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e15 %T Why do Patients Forget to Take Immunosuppression Medications and Miss Appointments: Can a Mobile Phone App Help? %A Israni,Ajay %A Dean,Carl %A Kasel,Brian %A Berndt,Lisa %A Wildebush,Winston %A Wang,C Jason %+ Hennepin County Medical Center, Department of Medicine, 701 Park Ave, Minneapolis, MN, 55415, United States, 1 612 873 6987, isran001@umn.edu %K adherence %K immunosuppressive medications %K appointments %K mobile phone %D 2016 %7 04.04.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Kidney transplant recipients must adhere to their immunosuppressive medication regimen. However, non-adherence remains a major problem. Objective: The aim of this paper is to determine how kidney transplant recipients remember to take their medications, and assess their perception and beliefs about adherence to immunosuppressive medications and barriers to medication adherence. In addition, we aim to assess perception and beliefs about willingness to use a hypothetical, mobile phone app to improve adherence. Methods: We conducted a qualitative study that included an average of three home or workplace visits of kidney transplant recipients (N=16) from a single urban transplant center. Results: The qualitative study revealed that transplant recipients understood the importance of taking their immunosuppressive medications and this motivated them to take their medications. The visits showed that most participants have incorporated medication use into their daily lives and that any minor deviation from daily routines could result in non-adherence. Participants also reported other barriers to adherence. All participants were interested in using an app to remind them to take their medication; however, they reported potential barriers to using the app. Conclusions: Although kidney transplant recipients understood the importance of medication adherence, there were significant barriers to maintaining adherence. Participants also reported interest in using a mobile phone app. %M 27227150 %R 10.2196/publichealth.5285 %U http://publichealth.jmir.org/2016/1/e15/ %U https://doi.org/10.2196/publichealth.5285 %U http://www.ncbi.nlm.nih.gov/pubmed/27227150 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e24 %T Development of a Weight Loss Mobile App Linked With an Accelerometer for Use in the Clinic: Usability, Acceptability, and Early Testing of its Impact on the Patient-Doctor Relationship %A Choo,Seryung %A Kim,Ju Young %A Jung,Se Young %A Kim,Sarah %A Kim,Jeong Eun %A Han,Jong Soo %A Kim,Sohye %A Kim,Jeong Hyun %A Kim,Jeehye %A Kim,Yongseok %A Kim,Dongouk %A Steinhubl,Steve %+ Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic Of Korea, 82 31 787 7796, kkamduri@snubh.org %K mobile apps %K electronic health record %K weight reduction programs %K physician-patient relations %D 2016 %7 31.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Although complications of obesity are well acknowledged and managed by clinicians, management of obesity itself is often difficult, which leads to its underdiagnosis and undertreatment in hospital settings. However, tools that could improve the management of obesity, including self-monitoring, engagement with a social network, and open channels of communication between the patient and doctor, are limited in a clinic-based setting. Objective: The objective of our study was to evaluate the usability and acceptability of a newly developed mobile app linked with an accelerometer and its early effects on patient-doctor relationships. Methods: From September 2013 to February 2014, we developed a mobile app linked with an accelerometer as a supportive tool for a clinic-based weight loss program. The app used information from electronic health records and delivered tailored educational material. Personal goal setting, as well as monitoring of weight changes and physical activity combined with feedback, are key features of the app. We also incorporated an interactive message board for patients and doctors. During the period of March 2014 to May 2014, we tested our mobile app for 1 month in participants in a hospital clinic setting. We assessed the app’s usability and acceptability, as well as the patient-doctor relationship, via questionnaires and analysis of app usage data. Results: We recruited 30 individuals (18 male and 12 female) for the study. The median number of log-ins per day was 1.21, with the most frequently requested item being setting goals, followed by track physical activities and view personal health status. Scales of the depth of the patient-doctor relationship decreased from 27.6 (SD 4.8) to 25.1 (SD 4.5) by a Wilcoxon signed rank test (P=.02). Conclusions: A mobile phone app linked with an accelerometer for a clinic-based weight loss program is useful and acceptable for weight management but exhibited less favorable early effects on patient-doctor relationships. %M 27032541 %R 10.2196/mhealth.4546 %U http://mhealth.jmir.org/2016/1/e24/ %U https://doi.org/10.2196/mhealth.4546 %U http://www.ncbi.nlm.nih.gov/pubmed/27032541 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e31 %T Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs %A Simons,Lucy %A Valentine,Althea Z %A Falconer,Caroline J %A Groom,Madeleine %A Daley,David %A Craven,Michael P %A Young,Zoe %A Hall,Charlotte %A Hollis,Chris %+ Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 +1158231294, chris.hollis@nottingham.ac.uk %K attention deficit hyperactivity disorder %K mHealth %K eMental Health %K remote monitoring technology %K mental health services %K qualitative methods %K feasibility testing %K user requirements %D 2016 %7 23.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Guidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT. Objective: To explore patients’, parents’, and health care professionals’ views and attitudes toward using digital technology for remote monitoring during titration for ADHD. Methods: This was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59). Results: All participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management. Conclusions: RMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required. %M 27009498 %R 10.2196/mhealth.5009 %U http://mhealth.jmir.org/2016/1/e31/ %U https://doi.org/10.2196/mhealth.5009 %U http://www.ncbi.nlm.nih.gov/pubmed/27009498 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e20 %T Design of a Tablet Computer App for Facilitation of a Molecular Blood Culture Test in Clinical Microbiology and Preliminary Usability Evaluation %A Samson,Lasse L %A Pape-Haugaard,Louise %A Meltzer,Michelle C %A Fuchs,Martin %A Schønheyder,Henrik C %A Hejlesen,Ole %+ Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 C1-223, Aalborg, 9220, Denmark, 45 99409940, lsamson@hst.aau.dk %K usability %K mobile applications %K tablet computers %K clinical simulation %K health information systems %K diagnostic test %K clinical microbiology %D 2016 %7 18.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: User mobility is an important aspect of the development of clinical information systems for health care professionals. Mobile phones and tablet computers have obtained widespread use by health care professionals, offering an opportunity for supporting the access to patient information through specialized applications (apps) while supporting the mobility of the users. The use of apps for mobile phones and tablet computers may support workflow of complex tasks, for example, molecular-based diagnostic tests in clinical microbiology. Multiplex Blood Culture Test (MuxBCT) is a molecular-based diagnostic test used for rapid identification of pathogens in positive blood cultures. To facilitate the workflow of the MuxBCT, a specialized tablet computer app was developed as an accessory to the diagnostic test. The app aims to reduce the complexity of the test by step-by-step guidance of microscopy and to assist users in reaching an exact bacterial or fungal diagnosis based on blood specimen observations and controls. Additionally, the app allows for entry of test results, and communication thereof to the laboratory information system (LIS). Objective: The objective of the study was to describe the design considerations of the MuxBCT app and the results of a preliminary usability evaluation. Methods: The MuxBCT tablet app was developed and set up for use in a clinical microbiology laboratory. A near-live simulation study was conducted in the clinical microbiology laboratory to evaluate the usability of the MuxBCT app. The study was designed to achieve a high degree of realism as participants carried out a scenario representing the context of use for the MuxBCT app. As the MuxBCT was under development, the scenario involved the use of molecular blood culture tests similar to the MuxBCT for identification of microorganisms from positive blood culture samples. The study participants were observed, and their interactions with the app were recorded. After the study, the participants were debriefed to clarify observations. Results: Four medical laboratory technicians, for example, representative of end users of the app, participated in the clinical simulation study. Using the MuxBCT app, the study participants successfully identified and reported all microorganisms from the positive blood cultures examined. Three of the four participants reported that they found the app useful, while one study participant reported that she would prefer to make notes on paper and later enter them into the LIS. Conclusions: The preliminary usability evaluation results indicate that use of the MuxBCT tablet app can facilitate the workflow of the MuxBCT diagnostic test. %M 26993432 %R 10.2196/mhealth.5041 %U http://mhealth.jmir.org/2016/1/e20/ %U https://doi.org/10.2196/mhealth.5041 %U http://www.ncbi.nlm.nih.gov/pubmed/26993432 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e65 %T Acceptability of Mental Health Apps for Aboriginal and Torres Strait Islander Australians: A Qualitative Study %A Povey,Josie %A Mills,Patj Patj Janama Robert %A Dingwall,Kylie Maree %A Lowell,Anne %A Singer,Judy %A Rotumah,Darlene %A Bennett-Levy,James %A Nagel,Tricia %+ Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 41096, Casuarina, 0811, Australia, 61 407399919, josie_povey@hotmail.com %K mobile apps %K mental health %K indigenous populations %K therapeutics %K cognitive behavioral therapy %K acceptance and commitment therapy %K culturally competent care %D 2016 %7 11.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. E-mental health tools offer an opportunity for accessible, effective, and acceptable treatment. The AIMhi Stay Strong app and the ibobbly suicide prevention app are treatment tools designed to combat the disproportionately high levels of mental illness and stress experienced within the Aboriginal and Torres Strait Islander community. Objective: This study aimed to explore Aboriginal and Torres Strait Islander community members’ experiences of using two culturally responsive e-mental health apps and identify factors that influence the acceptability of these approaches. Methods: Using qualitative methods aligned with a phenomenological approach, we explored the acceptability of two culturally responsive e-mental health apps through a series of three 3-hour focus groups with nine Aboriginal and Torres Strait Islander community members. Thematic analysis was conducted and coresearcher and member checking were used to verify findings. Results: Findings suggest strong support for the concept of e-mental health apps and optimism for their potential. Factors that influenced acceptability related to three key themes: personal factors (eg, motivation, severity and awareness of illness, technological competence, and literacy and language differences), environmental factors (eg, community awareness, stigma, and availability of support), and app characteristics (eg, ease of use, content, graphics, access, and security and information sharing). Specific adaptations, such as local production, culturally relevant content and graphics, a purposeful journey, clear navigation, meaningful language, options to assist people with language differences, offline use, and password protection may aid uptake. Conclusions: When designed to meet the needs of Aboriginal and Torres Strait Islander Australians, e-mental health tools add an important element to public health approaches for improving the well-being of Aboriginal and Torres Strait Islander people. %M 26969043 %R 10.2196/jmir.5314 %U http://www.jmir.org/2016/3/e65/ %U https://doi.org/10.2196/jmir.5314 %U http://www.ncbi.nlm.nih.gov/pubmed/26969043 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e16 %T The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda %A English,Lauren Lacey %A Dunsmuir,Dustin %A Kumbakumba,Elias %A Ansermino,John Mark %A Larson,Charles P %A Lester,Richard %A Barigye,Celestine %A Ndamira,Andrew %A Kabakyenga,Jerome %A Wiens,Matthew O %+ Division of Infectious Diseases, Department of Medicine, University of British Columbia, 2733 Heather Street, Vancouver, BC, , Canada, 1 604 997 7753, mowiens@outlook.com %K infectious disease %K postdischarge mortality %K mHealth %K prediction model %K risk assessment %K usability %K Africa %K resource-limited settings %D 2016 %7 15.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Postdischarge death in children is increasingly being recognized as a major contributor to overall child mortality. The PAediatric Risk Assessment (PARA) app is an mHealth tool developed to aid health care workers in resource-limited settings such as Sub-Saharan Africa to identify pediatric patients at high risk of both in-hospital and postdischarge mortality. The intended users of the PARA app are health care workers (ie, nurses, doctors, and clinical officers) with varying levels of education and technological exposure, making testing of this clinical tool critical to successful implementation. Objective: Our aim was to summarize the usability evaluation of the PARA app among target users, which consists of assessing the ease of use, functionality, and navigation of the interfaces and then iteratively improving the design of this clinical tool. Methods: Health care workers (N=30) were recruited to participate at Mbarara Regional Referral Hospital and Holy Innocents Children’s Hospital in Mbarara, Southwestern Uganda. This usability study was conducted in two phases to allow for iterative improvement and testing of the interfaces. The PARA app was evaluated using quantitative and qualitative measures, which were compared between Phases 1 and 2 of the study. Participants were given two patient scenarios that listed hypothetical information (ie, demographic, social, and clinical data) to be entered into the app and to determine the patient’s risk of in-hospital and postdischarge mortality. Time-to-completion and user errors were recorded for each participant while using the app. A modified computer system usability questionnaire was utilized at the end of each session to elicit user satisfaction with the PARA app and obtain suggestions for future improvements. Results: The average time to complete the PARA app decreased by 30% from Phase 1 to Phase 2, following user feedback and modifications. Participants spent the longest amount of time on the oxygen saturation interface, but modifications following Phase 1 cut this time by half. The average time-to-completion (during Phase 2) for doctors/medical students was 3 minutes 56 seconds. All participants agreed they would use the PARA app if available at their health facility. Given a high PARA risk score, participants suggested several interventions that would be appropriate for the sociocultural context in southwestern Uganda, which involved strengthening discharge and referral procedures within the current health care system. Conclusions: Through feedback and modifications made during this usability study, the PARA app was developed into a user-friendly app, encompassing user expectations and culturally intuitive interfaces for users with a range of technological exposure. Doctors and medical students had shorter task completion times, though all participants reported the usefulness of this tool to improve postdischarge outcomes. %M 26879041 %R 10.2196/mhealth.5167 %U http://mhealth.jmir.org/2016/1/e16/ %U https://doi.org/10.2196/mhealth.5167 %U http://www.ncbi.nlm.nih.gov/pubmed/26879041 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e17 %T Design Considerations for Smoking Cessation Apps: Feedback From Nicotine Dependence Treatment Providers and Smokers %A McClure,Jennifer B %A Hartzler,Andrea L %A Catz,Sheryl L %+ Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, , United States, 1 206 287 2737, McClure.J@ghc.org %K tobacco use cessation %K smoking %K mobile health %K smartphone %D 2016 %7 12.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Hundreds of smoking cessation apps are commercially available, but most are not theory-based or designed to take advantage of mobile technology in ways that could make them more engaging and possibly more effective. Considering input from both clinical experts (who understand best practice nicotine dependence treatment requirements) to inform appropriate content and from smokers (the end users) to express their preferences is important in designing these programs in the future. Objective: To assess and compare the opinions of nicotine dependence treatment providers and smokers regarding the design of future smoking cessation apps. Methods: We surveyed providers (n=264) and smokers who own smartphones (n=40) to assess their opinions on the importance of 21 app design features. Features represented 5 domains: cost, reputation, privacy and security, content and user experience, and communication. Domains were chosen to reflect best practice treatment, leverage mobile technology to support smoking cessation, and elicit important user preferences. Data were collected between June and July 2015. Results: Most providers agreed that mHealth apps hold promise for helping people quit smoking (203/264, 76.9%) and would recommend them to their clients/patients (201/264, 76.1%), especially if the app were empirically validated (236/264, 89.4%). Few providers believe effective cessation apps currently exist (112/264, 42.4%). Few smokers (5/40, 13%) had ever downloaded a smoking cessation app; of the ones who had not, most said they would consider doing so (29/35, 83%). Both respondent groups indicated the following features were very to extremely important to include in cessation apps: free or low cost, keeps information private, matches individual needs and interests, adapts as one’s needs and interests change, helps to manage nicotine withdrawal symptoms and medication side effects, and allows users to track their progress. Providers and smokers also indicated gaming and social media connectivity were less important than other features. Despite these similarities, the groups had significantly different opinions about the relative importance of various features. In particular, providers rated privacy as the most important feature, whereas smokers rated low cost and the ability to adaptively tailor content as the most important features. Conclusions: Smoking cessation apps hold great promise as intervention tools but only if they engage users and appropriately treat nicotine dependence. Intervention development should take into consideration the perspectives of both treatment experts and smokers. This paper highlights important perspectives from each of these groups to be considered when designing future app-based smoking cessation programs. %M 26872940 %R 10.2196/mhealth.5181 %U http://mhealth.jmir.org/2016/1/e17/ %U https://doi.org/10.2196/mhealth.5181 %U http://www.ncbi.nlm.nih.gov/pubmed/26872940 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 2 %N 1 %P e1 %T Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study %A Martin,Emily C %A Basen-Engquist,Karen %A Cox,Matthew G %A Lyons,Elizabeth J %A Carmack,Cindy L %A Blalock,Janice A %A Demark-Wahnefried,Wendy %+ University of Texas MD Anderson Cancer Center, Department of Behavioral Science, PO Box 301439, Unit 1330, Houston, TX, 77230-1439, United States, 1 713 745 0338, emilymar@gmail.com %K cancer survivor %K technology %K smartphone %K behavioral intervention %K physical activity %K diet %D 2016 %7 11.02.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors’ interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective: The aim of this study was to determine the factors that predict cancer survivors’ interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods: Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants’ demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results: In total, 1053 respondents to the survey (56.3% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9% very/extremely interested) and lowest for smartphone–based interventions (73/847, 8.6%), with interest in clinic-based (147/847, 17.3%) and telephone-delivered (143/847, 16.9%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone–based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions: This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors’ current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants’ demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. %M 28410164 %R 10.2196/cancer.5247 %U http://cancer.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/cancer.5247 %U http://www.ncbi.nlm.nih.gov/pubmed/28410164 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e7 %T Acceptance of Commercially Available Wearable Activity Trackers Among Adults Aged Over 50 and With Chronic Illness: A Mixed-Methods Evaluation %A Mercer,Kathryn %A Giangregorio,Lora %A Schneider,Eric %A Chilana,Parmit %A Li,Melissa %A Grindrod,Kelly %+ School of Pharmacy, Faculty of Science, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 21358, kgrindrod@uwaterloo.ca %K chronic disease %K physical activity %K sedentary lifestyle %K wearables %D 2016 %7 27.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Physical inactivity and sedentary behavior increase the risk of chronic illness and death. The newest generation of “wearable” activity trackers offers potential as a multifaceted intervention to help people become more active. Objective: To examine the usability and usefulness of wearable activity trackers for older adults living with chronic illness. Methods: We recruited a purposive sample of 32 participants over the age of 50, who had been previously diagnosed with a chronic illness, including vascular disease, diabetes, arthritis, and osteoporosis. Participants were between 52 and 84 years of age (mean 64); among the study participants, 23 (72%) were women and the mean body mass index was 31 kg/m2. Participants tested 5 trackers, including a simple pedometer (Sportline or Mio) followed by 4 wearable activity trackers (Fitbit Zip, Misfit Shine, Jawbone Up 24, and Withings Pulse) in random order. Selected devices represented the range of wearable products and features available on the Canadian market in 2014. Participants wore each device for at least 3 days and evaluated it using a questionnaire developed from the Technology Acceptance Model. We used focus groups to explore participant experiences and a thematic analysis approach to data collection and analysis. Results: Our study resulted in 4 themes: (1) adoption within a comfort zone; (2) self-awareness and goal setting; (3) purposes of data tracking; and (4) future of wearable activity trackers as health care devices. Prior to enrolling, few participants were aware of wearable activity trackers. Most also had been asked by a physician to exercise more and cited this as a motivation for testing the devices. None of the participants planned to purchase the simple pedometer after the study, citing poor accuracy and data loss, whereas 73% (N=32) planned to purchase a wearable activity tracker. Preferences varied but 50% felt they would buy a Fitbit and 42% felt they would buy a Misfit, Jawbone, or Withings. The simple pedometer had a mean acceptance score of 56/95 compared with 63 for the Withings, 65 for the Misfit and Jawbone, and 68 for the Fitbit. To improve usability, older users may benefit from devices that have better compatibility with personal computers or less-expensive Android mobile phones and tablets, and have comprehensive paper-based user manuals and apps that interpret user data. Conclusions: For older adults living with chronic illness, wearable activity trackers are perceived as useful and acceptable. New users may need support to both set up the device and learn how to interpret their data. %M 26818775 %R 10.2196/mhealth.4225 %U http://mhealth.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/mhealth.4225 %U http://www.ncbi.nlm.nih.gov/pubmed/26818775 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e5 %T Tracking Health Data Is Not Enough: A Qualitative Exploration of the Role of Healthcare Partnerships and mHealth Technology to Promote Physical Activity and to Sustain Behavior Change %A Miyamoto,Sheridan W %A Henderson,Stuart %A Young,Heather M %A Pande,Amit %A Han,Jay J %+ College of Nursing, The Pennsylvania State University, 201 Nursing Sciences Building, University Park, CA, 16801, United States, 1 814 863 4141, smiyamoto@psu.edu %K mHealth %K health behavior %K motivation %K goals %K physical activity %D 2016 %7 20.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite the recent explosion of the mobile health (mHealth) industry and consumer acquisition of mHealth tools such as wearable sensors and applications (apps), limited information is known about how this technology can sustain health behavior change and be integrated into health care. Objective: The objective of the study was to understand potential users’ views of mHealth technology, the role this technology may have in promoting individual activity goals aimed at improving health, and the value of integrating mHealth technology with traditional health care. Methods: Four focus groups were conducted with adults interested in sharing their views on how mHealth technology could support wellness programs and improve health. Participants (n=30) were enrolled from an employee population at an academic health institution. Qualitative thematic analysis was used to code transcripts and identify overarching themes. Results: Our findings suggest that tracking health data alone may result in heightened awareness of daily activity, yet may not be sufficient to sustain use of mHealth technology and apps, which often have low reuse rates. Participants suggested that context, meaning, and health care partnerships need to be incorporated to engage and retain users. In addition to these findings, drivers for mHealth technology previously identified in the literature, including integration and control of health data were confirmed in this study. Conclusions: This study explores ways that mHealth technologies may be used to not only track data, but to encourage sustained engagement to achieve individual health goals. Implications of these findings include recommendations for mHealth technology design and health care partnership models to sustain motivation and engagement, allowing individuals to achieve meaningful behavior change. %M 26792225 %R 10.2196/mhealth.4814 %U http://mhealth.jmir.org/2016/1/e5/ %U https://doi.org/10.2196/mhealth.4814 %U http://www.ncbi.nlm.nih.gov/pubmed/26792225 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e97 %T Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study %A Sze,Yan Yan %A Daniel,Tinuke Oluyomi %A Kilanowski,Colleen K %A Collins,R Lorraine %A Epstein,Leonard H %+ Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Farber Hall, Room G56, 3435 Main Street, Building #26, Buffalo, NY, , United States, 1 716 829 3400, lhnet@buffalo.edu %K obesity %K ecological momentary intervention %K episodic future thinking %K Web-based %K health behavior %D 2015 %7 16.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. Objective: Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. Methods: We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m2. Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. Results: All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. Conclusions: We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions. %M 26678959 %R 10.2196/mhealth.4603 %U http://mhealth.jmir.org/2015/4/e97/ %U https://doi.org/10.2196/mhealth.4603 %U http://www.ncbi.nlm.nih.gov/pubmed/26678959 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e105 %T A Text-Messaging and Pedometer Program to Promote Physical Activity in People at High Risk of Type 2 Diabetes: The Development of the PROPELS Follow-On Support Program %A Morton,Katie %A Sutton,Stephen %A Hardeman,Wendy %A Troughton,Jacqui %A Yates,Tom %A Griffin,Simon %A Davies,Melanie %A Khunti,Kamlesh %A Eborall,Helen %+ Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, , United Kingdom, 44 116 252 5400, hce3@le.ac.uk %K physical activity %K mHealth %K text messaging %K pedometer %K tailoring %K type 2 diabetes %K intervention development %D 2015 %7 15.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technologies for health (mHealth) represent a promising strategy for reducing type 2 diabetes (T2DM) risk. The PROPELS trial investigates whether structured group-based education alone or supplemented with a follow-on support program combining self-monitoring with pedometers and tailored text-messaging is effective in promoting and maintaining physical activity among people at high risk of T2DM. Objective: This paper describes the iterative development of the PROPELS follow-on support program and presents evidence on its acceptability and feasibility. Methods: We used a modified mHealth development framework with four phases: (1) conceptualization of the follow-on support program using theory and evidence, (2) formative research including focus groups (n=15, ages 39-79 years), (3) pre-testing focus groups using a think aloud protocol (n=20, ages 52-78 years), and (4) piloting (n=11). Analysis was informed by the constant comparative approach, with findings from each phase informing subsequent phases. Results: The first three phases informed the structure, nature, and content of the follow-on support program, including the frequency of text messages, the need for tailored content and two-way interaction, the importance of motivational messages based on encouragement and reinforcement of affective benefits (eg, enjoyment) with minimal messages about weight and T2DM risk, and the need for appropriate language. The refined program is personalized and tailored to the individual’s perceived confidence, previous activity levels, and physical activity goals. The pilot phase indicated that the program appeared to fit well with everyday routines and was easy to use by older adults. Conclusions: We developed a feasible and innovative text messaging and pedometer program based on evidence and behavior change theory and grounded in the experiences, views, and needs of people at high diabetes risk. A large scale trial is testing the effectiveness of this 4-year program over and above structured group education alone. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 83465245; http://www.controlled-trials.com/ISRCTN83465245/83465245 (Archived by WebCite at http://www.webcitation.org/6dfSmrVAe) %M 26678750 %R 10.2196/mhealth.5026 %U http://mhealth.jmir.org/2015/4/e105/ %U https://doi.org/10.2196/mhealth.5026 %U http://www.ncbi.nlm.nih.gov/pubmed/26678750 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 2 %P e15 %T Assessing the Usability of Six Data Entry Mobile Interfaces for Caregivers: A Randomized Trial %A Ehrler,Frederic %A Haller,Guy %A Sarrey,Evelyne %A Walesa,Magali %A Wipfli,Rolf %A Lovis,Christian %+ Division of Medical Information Sciences, Department of medical imaging and medical information sciences, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223728697, frederic.ehrler@hcuge.ch %K data collection %K mobile applications %K computers, handheld %K user-computer interface %K vital signs %K patient safety %D 2015 %7 15.12.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: There is an increased demand in hospitals for tools, such as dedicated mobile device apps, that enable the recording of clinical information in an electronic format at the patient’s bedside. Although the human-machine interface design on mobile devices strongly influences the accuracy and effectiveness of data recording, there is still a lack of evidence as to which interface design offers the best guarantee for ease of use and quality of recording. Therefore, interfaces need to be assessed both for usability and reliability because recording errors can seriously impact the overall level of quality of the data and affect the care provided. Objective: In this randomized crossover trial, we formally compared 6 handheld device interfaces for both speed of data entry and accuracy of recorded information. Three types of numerical data commonly recorded at the patient’s bedside were used to evaluate the interfaces. Methods: In total, 150 health care professionals from the University Hospitals of Geneva volunteered to record a series of randomly generated data on each of the 6 interfaces provided on a smartphone. The interfaces were presented in a randomized order as part of fully automated data entry scenarios. During the data entry process, accuracy and effectiveness were automatically recorded by the software. Results: Various types of errors occurred, which ranged from 0.7% for the most reliable design to 18.5% for the least reliable one. The length of time needed for data recording ranged from 2.81 sec to 14.68 sec, depending on the interface. The numeric keyboard interface delivered the best performance for pulse data entry with a mean time of 3.08 sec (SD 0.06) and an accuracy of 99.3%. Conclusions: Our study highlights the critical impact the choice of an interface can have on the quality of recorded data. Selecting an interface should be driven less by the needs of specific end-user groups or the necessity to facilitate the developer’s task (eg, by opting for default solutions provided by commercial platforms) than by the level of speed and accuracy an interface can provide for recording information. An important effort must be made to properly validate mobile device interfaces intended for use in the clinical setting. In this regard, our study identified the numeric keyboard, among the proposed designs, as the most accurate interface for entering specific numerical values. This is an important step toward providing clearer guidelines on which interface to choose for the appropriate use of handheld device interfaces in the health care setting. %M 27025648 %R 10.2196/humanfactors.4093 %U http://humanfactors.jmir.org/2015/2/e15/ %U https://doi.org/10.2196/humanfactors.4093 %U http://www.ncbi.nlm.nih.gov/pubmed/27025648 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e101 %T Health App Use Among US Mobile Phone Owners: A National Survey %A Krebs,Paul %A Duncan,Dustin T %+ New York University School of Medicine, Department of Population Health, 227 East 30th Street, 7th Floor, New York, NY, 10016, United States, 1 646 501 2637, Paul.Krebs@nyumc.org %K cell phones %K mobile apps %K telemedicine %D 2015 %7 04.11.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile phone health apps may now seem to be ubiquitous, yet much remains unknown with regard to their usage. Information is limited with regard to important metrics, including the percentage of the population that uses health apps, reasons for adoption/nonadoption, and reasons for noncontinuance of use. Objective: The purpose of this study was to examine health app use among mobile phone owners in the United States. Methods: We conducted a cross-sectional survey of 1604 mobile phone users throughout the United States. The 36-item survey assessed sociodemographic characteristics, history of and reasons for health app use/nonuse, perceived effectiveness of health apps, reasons for stopping use, and general health status. Results: A little over half (934/1604, 58.23%) of mobile phone users had downloaded a health-related mobile app. Fitness and nutrition were the most common categories of health apps used, with most respondents using them at least daily. Common reasons for not having downloaded apps were lack of interest, cost, and concern about apps collecting their data. Individuals more likely to use health apps tended to be younger, have higher incomes, be more educated, be Latino/Hispanic, and have a body mass index (BMI) in the obese range (all P<.05). Cost was a significant concern among respondents, with a large proportion indicating that they would not pay anything for a health app. Interestingly, among those who had downloaded health apps, trust in their accuracy and data safety was quite high, and most felt that the apps had improved their health. About half of the respondents (427/934, 45.7%) had stopped using some health apps, primarily due to high data entry burden, loss of interest, and hidden costs. Conclusions: These findings suggest that while many individuals use health apps, a substantial proportion of the population does not, and that even among those who use health apps, many stop using them. These data suggest that app developers need to better address consumer concerns, such as cost and high data entry burden, and that clinical trials are necessary to test the efficacy of health apps to broaden their appeal and adoption. %M 26537656 %R 10.2196/mhealth.4924 %U http://mhealth.jmir.org/2015/4/e101/ %U https://doi.org/10.2196/mhealth.4924 %U http://www.ncbi.nlm.nih.gov/pubmed/26537656 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e99 %T Views of Women and Health Professionals on mHealth Lifestyle Interventions in Pregnancy: A Qualitative Investigation %A Willcox,Jane C %A van der Pligt,Paige %A Ball,Kylie %A Wilkinson,Shelley A %A Lappas,Martha %A McCarthy,Elizabeth A %A Campbell,Karen J %+ Centre for Nutrition and Physical Activity Research, School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, , Australia, 61 92468733, jwillcox@deakin.edu.au %K pregnancy %K attitude %K qualitative research %K mHealth %D 2015 %7 28.10.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women’s and health professionals’ views of mHealth in antenatal care are limited. Objective: This study aimed to explore women’s and health professionals’ views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy. Methods: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed. Results: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed. Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women’s advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision. Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care. Conclusions: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care. %M 26510886 %R 10.2196/mhealth.4869 %U http://mhealth.jmir.org/2015/4/e99/ %U https://doi.org/10.2196/mhealth.4869 %U http://www.ncbi.nlm.nih.gov/pubmed/26510886 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e94 %T Basal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study %A Wark,John D %A Henningham,Lucy %A Gorelik,Alexandra %A Jayasinghe,Yasmin %A Hartley,Stefanie %A Garland,Suzanne Marie %+ University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, 3052, Australia, 61 3 9342 7109, jdwark@unimelb.edu.au %K basal body temperature %K young female health initiative %K BodyMedia SenseWear %K ovulation %K menstrual cycle, young women %D 2015 %7 05.10.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. Objective: We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. Methods: Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. Results: We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2°C, BMSW: 29.7-36.7°C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6°C (SD 1.2) versus 36.4°C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0% agreement for evidence of ovulation. Conclusions: This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women. %M 26441468 %R 10.2196/mhealth.4263 %U http://mhealth.jmir.org/2015/4/e94/ %U https://doi.org/10.2196/mhealth.4263 %U http://www.ncbi.nlm.nih.gov/pubmed/26441468 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e85 %T A New App for At-Home Cognitive Training: Description and Pilot Testing on Patients with Multiple Sclerosis %A Tacchino,Andrea %A Pedullà,Ludovico %A Bonzano,Laura %A Vassallo,Claudio %A Battaglia,Mario Alberto %A Mancardi,Gianluigi %A Bove,Marco %A Brichetto,Giampaolo %+ Italian Multiple Sclerosis Foundation, Scientific Research Area, Via Operai 40, Genoa, 16100, Italy, 39 010 2712832, giampaolo.brichetto@aism.it %K tablet %K mobile phone %K mobile device %K cognitive rehabilitation %K cognitive impairment %K working memory %K self-management %K adaptive working load algorithms %K usability %D 2015 %7 31.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Cognitive impairment is common in people with neurological diseases and severely affects their social and professional life. It has been shown that intensive and personalized cognitive rehabilitation (CR), based on working memory exercises, leads to improved cognitive status of healthy and cognitive-impaired subjects. New technologies would help to promote accessible, at-home, and self-managed CR interventions. Objective: The aim of this paper is to describe the design of Cognitive Training Kit (COGNI-TRAcK), an app for mobile devices, to self-administer an at-home, intensive, and personalized CR intervention based on working memory exercises, and test its disposability-to-use (usability, motivation to use, compliance to treatment) on cognitive-impaired patients with multiple sclerosis (MS). Methods: COGNI-TRAcK includes user-friendly interfaces for personal data input and management and for CR intervention configurations. Inner routines automatically implement adaptive working load algorithms and allow data processing and analysis. A dedicated team developed COGNI-TRAcK with C# programming language, by using the platform Xamarin Studio 4.0.10 for Android (API level 15 and following). Three exercises based on working memory are now available. To assess the disposability-to-use of the system, patients with MS were selected as likely users due to the young age of disease onset. Cognitive-impaired patients with MS (N=16) with a mean age of 49.06 years (SD 9.10) and a mean score of 3.75 (SD 1.92) on the Expanded Disability Status Scale (EDSS) were submitted to an 8-week at-home intervention administered by the app. The intervention consisted of 5 daily scheduled 30-minute sessions per week. Disposability-to-use of COGNI-TRAcK was investigated by means of a questionnaire administered to patients at the end of the training. Results: The adherence to the treatment was 84% (33.4/40). Of the patients with MS, 94% (15/16) understood the instructions given, 100% (16/16) felt independent to use COGNI-TRAcK at home, 75% (12/16) found the exercises interesting, and 81% (13/16) found the exercises useful and were motivated to use the app again. Moreover, during the exercises, patients with MS were highly motivated to perform well (mean score 3.19/4, SE 0.16), experienced rather low levels of stress (mean score 2.19/4, SE 0.26), were not bored (mean score 1.81/4, SE 0.30), and felt amusement (mean score 2.25/4, SE 0.23). Conclusions: As COGNI-TRAcK is highly usable, motivating, and well-accepted by patients with MS, its effectiveness can now be investigated. To improve COGNI-TRAcK, new releases should contain more working memory exercises, have enhanced perceived amusement, and promote Internet communication procedures for data transfer and fostering remote control of the intervention. %M 26323749 %R 10.2196/mhealth.4269 %U http://mhealth.jmir.org/2015/3/e85/ %U https://doi.org/10.2196/mhealth.4269 %U http://www.ncbi.nlm.nih.gov/pubmed/26323749 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e210 %T Apps for IMproving FITness and Increasing Physical Activity Among Young People: The AIMFIT Pragmatic Randomized Controlled Trial %A Direito,Artur %A Jiang,Yannan %A Whittaker,Robyn %A Maddison,Ralph %+ Faculty of Medical and Health Sciences, National Institute for Health Innovation, University of Auckland, National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 9 373 7599 ext 85285, a.direito@auckland.ac.nz %K physical fitness %K motor activity %K exercise %K physical activity %K adolescent %K health promotion %K telemedicine %K mHealth %K mobile applications %K smartphone %D 2015 %7 27.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the global prevalence of insufficient physical activity (PA), effective interventions that attenuate age-related decline in PA levels are needed. Mobile phone interventions that positively affect health (mHealth) show promise; however, their impact on PA levels and fitness in young people is unclear and little is known about what makes a good mHealth app. Objective: The aim was to determine the effects of two commercially available smartphone apps (Zombies, Run and Get Running) on cardiorespiratory fitness and PA levels in insufficiently active healthy young people. A second aim was to identify the features of the app design that may contribute to improved fitness and PA levels. Methods: Apps for IMproving FITness (AIMFIT) was a 3-arm, parallel, randomized controlled trial conducted in Auckland, New Zealand. Participants were recruited through advertisements in electronic mailing lists, local newspapers, flyers posted in community locations, and presentations at schools. Eligible young people aged 14-17 years were allocated at random to 1 of 3 conditions: (1) use of an immersive app (Zombies, Run), (2) use of a nonimmersive app (Get Running), or (3) usual behavior (control). Both smartphone apps consisted of a fully automated 8-week training program designed to improve fitness and ability to run 5 km; however, the immersive app featured a game-themed design and narrative. Intention-to-treat analysis was performed using data collected face-to-face at baseline and 8 weeks, and all regression models were adjusted for baseline outcome value and gender. The primary outcome was cardiorespiratory fitness, objectively assessed as time to complete the 1-mile run/walk test at 8 weeks. Secondary outcomes were PA levels (accelerometry and self-reported), enjoyment, psychological need satisfaction, self-efficacy, and acceptability and usability of the apps. Results: A total of 51 participants were randomized to the immersive app intervention (n=17), nonimmersive app intervention (n=16), or the control group (n=18). The mean age of participants was 15.7 (SD 1.2) years; participants were mostly NZ Europeans (61%, 31/51) and 57% (29/51) were female. Overall retention rate was 96% (49/51). There was no significant intervention effect on the primary outcome using either of the apps. Compared to the control, time to complete the fitness test was –28.4 seconds shorter (95% CI –66.5 to 9.82, P=.20) for the immersive app group and –24.7 seconds (95% CI –63.5 to 14.2, P=.32) for the nonimmersive app group. No significant intervention effects were found for secondary outcomes. Conclusions: Although apps have the ability to increase reach at a low cost, our pragmatic approach using readily available commercial apps as a stand-alone instrument did not have a significant effect on fitness. However, interest in future use of PA apps is promising and highlights a potentially important role of these tools in a multifaceted approach to increase fitness, promote PA, and consequently reduce the adverse health outcomes associated with insufficient activity. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12613001030763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613001030763 (Archived by WebCite at http://www.webcitation.org/6aasfJVTJ). %M 26316499 %R 10.2196/jmir.4568 %U http://www.jmir.org/2015/8/e210/ %U https://doi.org/10.2196/jmir.4568 %U http://www.ncbi.nlm.nih.gov/pubmed/26316499 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e74 %T My Interventional Drug-Eluting Stent Educational App (MyIDEA): Patient-Centered Design Methodology %A Boyd,Andrew Dallas %A Moores,Kaitlin %A Shah,Vicki %A Sadhu,Eugene %A Shroff,Adhir %A Groo,Vicki %A Dickens,Carolyn %A Field,Jerry %A Baumann,Matthew %A Welland,Betty %A Gutowski,Gerry %A Flores Jr,Jose D %A Zhao,Zhongsheng %A Bahroos,Neil %A Hynes,Denise M %A Wilkie,Diana J %+ Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, 1919 W Taylor (MC 530), Chicago, IL, 60612, United States, 1 312 9968339, boyda@uic.edu %K drug-eluting stents %K health informatics %K Kolb's learning theory %K mHealth %K patient-centered design %K patient education %D 2015 %7 02.07.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Patient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, “My Interventional Drug-Eluting Stent Educational App (MyIDEA).” This is an educational program designed to improve patient medication adherence. Objective: Our goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. Methods: Patient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers’ suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. Results: The MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. Conclusions: Including patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success. %M 26139587 %R 10.2196/mhealth.4021 %U http://mhealth.jmir.org/2015/3/e74/ %U https://doi.org/10.2196/mhealth.4021 %U http://www.ncbi.nlm.nih.gov/pubmed/26139587 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e71 %T Doctors and the Etiquette of Mobile Device Use in Trauma and Orthopedics %A Blocker,Oliver %A Hayden,Lydia %A Bullock,Alison %+ The Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University, Cardiff University School of Social Sciences, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT, United Kingdom, 44 2920870780, drblocker@gmail.com %K education, medical %K cell phones %K patient-physician relationship %D 2015 %7 26.6.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The etiquette surrounding the use of mobile devices, so-called "mobiquette," has been previously identified as a barrier to use in an educational context. Objective: To investigate the influence of mobile device use on patient and staff opinions in the trauma and orthopedics department at a teaching hospital in Wales. Methods: A survey of patients at the bedside and staff in their work environment was undertaken. Data included age, frequency of observed use, suspected main reason for use, and whether doctors’ use of a mobile device positively or negatively influenced participants' opinions of them as a professional and as a person. Results: A total of 59 patients and 35 staff responded. The modal age range was 40 to 54 years old. Most patients (78%) never see doctors using mobile devices in the workplace, compared with 3% of staff. The main reason for use was thought to be "communicating with colleagues" (48%) followed by "Internet use/applications for work reasons" (40%). Approximately 40% of patients' opinions of doctors were positively influenced by device use, compared with 82% of staff. This difference between patient and staff opinions was statistically significant for both professional (P<.001) and personal (P=.002) opinions. Conclusions: Patients are likely to have a negative opinion of doctors using mobile devices in the workplace. This can be balanced by the more positive opinions of colleagues. We advise doctors to remember "mobiquette" around patients. %M 26116061 %R 10.2196/mhealth.4122 %U http://mhealth.jmir.org/2015/2/e71/ %U https://doi.org/10.2196/mhealth.4122 %U http://www.ncbi.nlm.nih.gov/pubmed/26116061 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 1 %N 1 %P e3 %T Global Outreach of a Locally-Developed Mobile Phone App for Undergraduate Psychiatry Education %A Zhang,Melvyn WB %A Cheok,Christopher CS %A Ho,Roger CM %+ National Healthcare Group, Level 9, Department of Psychological Medicine, National University Healthcare Systems (NUHS) Tower Block 5 Lower Kent Ridge Road, Singapore, 119054, Singapore, 65 7725555, melvynzhangweibin@gmail.com %K psychiatry %K education %K eLearning %K mobile phone apps %K mobile phones %K feasibility %K proof of concept %D 2015 %7 08.06.2015 %9 Original Paper %J JMIR Medical Education %G English %X Background: Over the past decade, there have been massive developments in both Web-based and mobile phone technologies. Mobile phones are well accepted by students, trainees, and doctors. A review of the current literature has identified the following specialties that have used mobile phones in education: pediatrics, ophthalmology, nephrology, plastic surgery, orthopedics, pharmacology, and urology. However, to date, there are no published papers examining the application of the latest mobile phone technologies for psychiatry education internationally. Objectives: The main objectives of this study are (1) to determine the feasibility and receptiveness of a locally-developed psychiatry mobile phone app and user perspectives (both quantitative and qualitative) towards it, and (2) to determine the receptiveness of a locally-developed app for psychiatry education internationally. Methods: A Web-based app that contained textbook contents, videos, and quizzes was developed using HTML5 technologies in 2012. Native apps were subsequently developed in 2013. Information about the apps was disseminated locally to Singaporean medical students, but the respective native apps were made available on the app stores. A user perspective survey was conducted locally to determine student’s perception of the app. Results: From the inception of the app until the time of preparation of this manuscript, there have been a cumulative total of 28,500 unique visits of the responsive HTML5 Web-based mobile phone app. There have been a cumulative total of 2200 downloads of the Mastering Psychiatry app from the Apple app store and 7000 downloads of the same app from the Android app store. The initial user perspective survey conducted locally highlighted that approximately a total of 95.2% (177/186) of students felt that having a psychiatry mobile phone app was deemed to be useful. Further chi-squared analysis demonstrated that there was a significant difference between males and females in their perception of having textbook contents in the mobile phone app (χ24=12.9, P=.0012). Conclusions: To the best of our knowledge, this is the first study to demonstrate the feasibility and global acceptance of a local, self-designed educational app for psychiatry education. Whilst the current research has managed to demonstrate the feasibility and acceptance of such an app, future studies would be warranted to look, in-depth, into whether there are cultural differences in terms of perceptions towards having such an app in psychiatry and what contents different cultures and cohorts of students might want within an app. %M 27731838 %R 10.2196/mededu.4179 %U https://medinform.jmir.org/2015/1/e3/ %U https://doi.org/10.2196/mededu.4179 %U http://www.ncbi.nlm.nih.gov/pubmed/27731838 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e47 %T How Willing Are Adolescents to Record Their Dietary Intake? The Mobile Food Record %A Boushey,Carol Jo %A Harray,Amelia J %A Kerr,Deborah Anne %A Schap,TusaRebecca E %A Paterson,Stacey %A Aflague,Tanisha %A Bosch Ruiz,Marc %A Ahmad,Ziad %A Delp,Edward J %+ University of Hawaii Cancer Center, University of Hawaii, 701 Ilalo Street,, Room 525,, Honolulu, HI, 96813, United States, 1 808 564 5915, cjboushey@cc.hawaii.edu %K adolescents %K children %K dietary assessment %K mobile food record %K novel technology %D 2015 %7 29.05.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Accurately assessing the diets of children and adolescents can be problematic. Use of technologies, such as mobile apps designed to capture food and beverages consumed at eating occasions with images taken using device-embedded cameras, may address many of the barriers to gathering accurate dietary intake data from adolescents. Objective: The objectives of this study were to assess the willingness of adolescents to take images of food and beverages at their eating occasions using a novel mobile food record (mFR) and to evaluate the usability of the user confirmation component of the mFR app, referred to as the “review process.” Methods: Mixed methods combining quantitative and qualitative protocols were used in this study. Adolescents (11-15-year olds) attending a summer camp were recruited to participate in the study. First, the participants were asked to take images of foods and beverages consumed as meals and snacks for 2 consecutive days using the mFR app running on an iPhone and the number of images taken was noted. This was followed by focus group sessions to evaluate usability, which was analyzed by content and themes. After using the mFR, a think-aloud method was used to evaluate the usability of the mFR method for reviewing system-identified foods (ie, the review process). A usability questionnaire was administered at the end of all activities. Results: The mFR was accepted by the majority of the 24 boys and 17 girls (n=41) but varied according to gender and eating occasion. Girls were significantly more likely than boys to capture images of their eating occasions (Fisher exact test, P=.03). Participants were more likely to take images of their breakfasts (90%, 36/40) and lunches (90%, 72/80) and least likely to capture afternoon and evening snacks, 54% (43/80) and 40% (32/80), respectively. The major themes from the focus groups with regard to using the mFR were games, rewards, and the need to know more about why they were using the app. Results of the usability questionnaire indicated that including a game component would be important to increase willingness to use the mFR, and a high majority of the participants indicated a willingness to use the mFR for 7 days or more. The image review process was found to be easy to use except for some confusion with overlapping markers on the screen. Conclusions: The adolescents’ experiences with and feedback about the mFR highlighted the importance of increased training, reminders, entertainment (eg, games), and training with practice in using the device to capture complete dietary intake as part of their active lifestyles. %M 26024996 %R 10.2196/mhealth.4087 %U http://mhealth.jmir.org/2015/2/e47/ %U https://doi.org/10.2196/mhealth.4087 %U http://www.ncbi.nlm.nih.gov/pubmed/26024996 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e37 %T Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage %A Lim,Joanne %A Cloete,Garth %A Dunsmuir,Dustin T %A Payne,Beth A %A Scheffer,Cornie %A von Dadelszen,Peter %A Dumont,Guy A %A Ansermino,J Mark %+ Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Clinical Support Building, 950 W. 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 604 875 2000 ext 6669, jlim2@cw.bc.ca %K pulse oximetry %K mHealth app %K predictive model %K usability analysis %K design methodology %D 2015 %7 17.04.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Pre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter. Objective: The aim of this study was to assess the usability of PotM (with mid-level health workers) for iteratively refining the system. Methods: Development of the PotM user interface involved usability testing with target end-users in South Africa. Users were asked to complete clinical scenario tasks, speaking aloud to give feedback on the interface and then complete a questionnaire. The tool was then evaluated in a pilot clinical evaluation in Tygerberg Hospital, Cape Town. Results: After ethical approval and informed consent, 37 nurses and midwives evaluated the tool. During Study 1, major issues in the functionality of the touch-screen keyboard and date scroll wheels were identified (total errors n=212); during Study 2 major improvements in navigation of the app were suggested (total errors n=144). Overall, users felt the app was usable using the Computer Systems Usability Questionnaire; median (range) values for Study 1 = 2 (1-6) and Study 2 = 1 (1-7). To demonstrate feasibility, PotM was used by one research nurse for the pilot clinical study. In total, more than 500 evaluations were performed on more than 200 patients. The median (interquartile range) time to complete an evaluation was 4 min 55 sec (3 min 25 sec to 6 min 56 sec). Conclusions: By including target end-users in the design and evaluation of PotM, we have developed an app that can be easily integrated into health care settings in low- and middle-income countries. Usability problems were often related to mobile phone features (eg, scroll wheels, touch screen use). Larger scale evaluation of the clinical impact of this tool is underway. %M 25887292 %R 10.2196/mhealth.3942 %U http://mhealth.jmir.org/2015/2/e37/ %U https://doi.org/10.2196/mhealth.3942 %U http://www.ncbi.nlm.nih.gov/pubmed/25887292 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e35 %T Mobile Access to ClinicalConnect: A User Feedback Survey on Usability, Productivity, and Quality %A Eapen,Bell Raj %A Chapman,Barbara %+ HNHB eHealth Office, Suite 108, 293 Wellington Street North, Hamilton, ON, L8L8E7, Canada, 1 9058700577, eapenb@hhsc.ca %K mHealth %K health information exchange %K ClinicalConnect %D 2015 %7 14.04.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: ClinicalConnect, a federated clinical viewer for South West Ontario, Canada, launched a mobile interface in June 2012. Objective: The aim of the study was to assess usability of the mobile interface and the perceived impact on productivity of health care providers and quality of healthcare delivery. Methods: A survey was conducted using the System Usability Scale (SUS) and questionnaires designed to measure productivity and quality based on Canada Health Infoway's Benefits Evaluation framework. Results: The mean SUS score was 67 based on 77 responses. The mean scores for productivity and quality were 3.37 (N=74) and 3.62 (N=71), respectively, on a 5-point Likert scale where 3 was neutral. Conclusions: Users perceived the mobile interface of ClinicalConnect as useful but were neutral about the ease of use. %M 25877226 %R 10.2196/mhealth.4011 %U http://mhealth.jmir.org/2015/2/e35/ %U https://doi.org/10.2196/mhealth.4011 %U http://www.ncbi.nlm.nih.gov/pubmed/25877226 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e33 %T Patient Engagement With a Mobile Web-Based Telemonitoring System for Heart Failure Self-Management: A Pilot Study %A Zan,Shiyi %A Agboola,Stephen %A Moore,Stephanie A %A Parks,Kimberly A %A Kvedar,Joseph C %A Jethwani,Kamal %+ Center for Connected Health, Partners HealthCare, 25 New Chardon Street, Suite 300, Boston, MA, , United States, 1 617 724 3410, kjethwani@partners.org %K heart failure %K disease self-management %K remote monitoring %K telemonitoring %K interactive voice response system %K mobile health %K Web portal %K patient engagement %K quality of life %D 2015 %7 01.04.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Intensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost. Objective: The objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure. Methods: This was a single-arm prospective study in which 21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations. Results: There were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80% (72/90 days) weekly and overall engagement with the program, and 15% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30). Conclusions: This pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monitoring programs such as the iGetBetter system on clinical outcomes in heart failure. %M 25842282 %R 10.2196/mhealth.3789 %U http://mhealth.jmir.org/2015/2/e33/ %U https://doi.org/10.2196/mhealth.3789 %U http://www.ncbi.nlm.nih.gov/pubmed/25842282 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e30 %T A Mobile Phone Food Record App to Digitally Capture Dietary Intake for Adolescents in a Free-Living Environment: Usability Study %A Casperson,Shanon L %A Sieling,Jared %A Moon,Jon %A Johnson,LuAnn %A Roemmich,James N %A Whigham,Leah %+ Grand Forks Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, 2420 2nd Ave N., Grand Forks, ND, , United States, 1 701 795 8497, shanon.casperson@ars.usda.gov %K adolescents %K dietary food records %K smartphone app %K dietary assessment %K food record app %D 2015 %7 13.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technologies are emerging as valuable tools to collect and assess dietary intake. Adolescents readily accept and adopt new technologies; thus, a food record app (FRapp) may be a useful tool to better understand adolescents’ dietary intake and eating patterns. Objective: We sought to determine the amenability of adolescents, in a free-living environment with minimal parental input, to use the FRapp to record their dietary intake. Methods: Eighteen community-dwelling adolescents (11-14 years) received detailed instructions to record their dietary intake for 3-7 days using the FRapp. Participants were instructed to capture before and after images of all foods and beverages consumed and to include a fiducial marker in the image. Participants were also asked to provide text descriptors including amount and type of all foods and beverages consumed. Results: Eight of 18 participants were able to follow all instructions: included pre- and post-meal images, a fiducial marker, and a text descriptor and collected diet records on 2 weekdays and 1 weekend day. Dietary intake was recorded on average for 3.2 (SD 1.3 days; 68% weekdays and 32% weekend days) with an average of 2.2 (SD 1.1) eating events per day per participant. A total of 143 eating events were recorded, of which 109 had at least one associated image and 34 were recorded with text only. Of the 109 eating events with images, 66 included all foods, beverages and a fiducial marker and 44 included both a pre- and post-meal image. Text was included with 78 of the captured images. Of the meals recorded, 36, 33, 35, and 39 were breakfasts, lunches, dinners, and snacks, respectively. Conclusions: These data suggest that mobile devices equipped with an app to record dietary intake will be used by adolescents in a free-living environment; however, a minority of participants followed all directions. User-friendly mobile food record apps may increase participant amenability, increasing our understanding of adolescent dietary intake and eating patterns. To improve data collection, the FRapp should deliver prompts for tasks, such as capturing images before and after each eating event, including the fiducial marker in the image, providing complete and accurate text information, and ensuring all eating events are recorded and should be customizable to individuals and to different situations. Trial Registration: Clinicaltrials.gov NCT01803997. http://clinicaltrials.gov/ct2/show/NCT01803997 (Archived at: http://www.webcitation.org/6WiV1vxoR). %M 25775506 %R 10.2196/mhealth.3324 %U http://mhealth.jmir.org/2015/1/e30/ %U https://doi.org/10.2196/mhealth.3324 %U http://www.ncbi.nlm.nih.gov/pubmed/25775506 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 4 %N 1 %P e1 %T Acceptance Factors of Mobile Apps for Diabetes by Patients Aged 50 or Older: A Qualitative Study %A Scheibe,Madlen %A Reichelt,Julius %A Bellmann,Maike %A Kirch,Wilhelm %+ Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Research Association Public Health Saxony and Saxony-Anhalt, Fiedlerstraße 33, Dresden, 01307, Germany, 49 351 458 6499, Madlen.Scheibe@uniklinikum-dresden.de %K mobile apps %K mobile health %K elderly %K diabetes mellitus %K blood sugar self-monitoring %K patient acceptance of health care %K qualitative research %K guided interviews %D 2015 %7 02.03.2015 %9 Original Paper %J Med 2.0 %G English %X Background: Mobile apps for people with diabetes offer great potential to support therapy management, increase therapy adherence, and reduce the probability of the occurrence of accompanying and secondary diseases. However, they are rarely used by elderly patients due to a lack of acceptance. Objective: We investigated the question “Which factors influence the acceptance of diabetes apps among patients aged 50 or older?” Particular emphasis was placed on the current use of mobile devices/apps, acceptance-promoting/-inhibiting factors, features of a helpful diabetes app, and contact persons for technical questions. This qualitative study was the third of three substudies investigating factors influencing acceptance of diabetes apps among patients aged 50 or older. Methods: Guided interviews were chosen in order to get a comprehensive insight into the subjective perspective of elderly diabetes patients. At the end of each interview, the patients tested two existing diabetes apps to reveal obstacles in (first) use. Results: Altogether, 32 patients with diabetes were interviewed. The mean age was 68.8 years (SD 8.2). Of 32 participants, 15 (47%) knew apps, however only 2 (6%) had already used a diabetes app within their therapy. The reasons reported for being against the use of apps were a lack of additional benefits (4/8, 50%) compared to current therapy management, a lack of interoperability with other devices/apps (1/8, 12%), and no joy of use (1/8, 12%). The app test revealed the following main difficulties in use: nonintuitive understanding of the functionality of the apps (26/29, 90%), nonintuitive understanding of the menu navigation/labeling (19/29, 66%), font sizes and representations that were too small (14/29, 48%), and difficulties in recognizing and pressing touch-sensitive areas (14/29, 48%). Furthermore, the patients felt the apps lacked individually important functions (11/29, 38%), or felt the functions that were offered were unnecessary for their own therapy needs (10/29, 34%). The most important contents of a helpful diabetes app were reported as the ability to add remarks to measured values (9/28, 32%), the definition of thresholds for blood glucose values and highlighting deviating values (7/28, 25%), and a reminder feature for measurement/medication (7/28, 25%). The most important contact persons for technical questions were family members (19/31, 61%). Conclusions: A lack of additional benefits and ease of use emerged as the key factors for the acceptance of diabetes apps among patients aged 50 or older. Furthermore, it has been shown that the needs of the investigated target group are highly heterogeneous due to varying previous knowledge, age, type of diabetes, and therapy. Therefore, a helpful diabetes app should be individually adaptable. Personal contact persons, especially during the initial phase of use, are of utmost importance to reduce the fear of data loss or erroneous data input, and to raise acceptance among this target group. %R 10.2196/med20.3912 %U http://www.medicine20.com/2015/1/e1/ %U https://doi.org/10.2196/med20.3912 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e21 %T Qualitative Evaluation of a Text Messaging Intervention to Support Patients With Active Tuberculosis: Implementation Considerations %A Iribarren,Sarah J %A Sward,Katherine A %A Beck,Susan L %A Pearce,Patricia F %A Thurston,Diana %A Chirico,Cristina %+ School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, United States, 1 212 342 0689, si2277@cumc.columbia.edu %K mHealth %K tuberculosis %K sociotechnical evaluation %K text messaging %D 2015 %7 27.02.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive text-based intervention to promote adherence with TB medication, was pilot-tested in Argentina with results supporting the implementation of trials at a larger scale. Objective: The objective of this research was to understand issues encountered during pilot-testing in order to inform future implementation in a larger-scale trial. Methods: A descriptive, observational qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation over 115 days, text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human, technical, or sociotechnical considerations. Results: Issues related to the intervention included workflow issues (eg, human, training, security), technical challenges (eg, data errors, platform shortcomings), and message delivery issues (eg, unintentional sending of multiple messages, auto-confirmation problems). System/contextual issues included variable mobile network coverage, electrical and Internet outages, and medication shortages. Conclusions: Intervention challenges were largely manageable during pilot-testing, but need to be addressed systematically before proceeding with a larger-scale trial. Potential solutions are outlined. Findings may help others considering implementing an mHealth intervention to anticipate and mitigate certain challenges. Although some of the issues may be context dependent, other issues such as electrical/Internet outages and limited resources are not unique issues to our setting. Release of new software versions did not result in solutions for certain issues, as specific features used were removed. Therefore, other software options will need to be considered before expanding into a larger-scale endeavor. Improved automation of some features will be necessary, however, a goal will be to retain the intervention capability to be interactive, user friendly, and patient focused. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems. %M 25802968 %R 10.2196/mhealth.3971 %U http://mhealth.jmir.org/2015/1/e21/ %U https://doi.org/10.2196/mhealth.3971 %U http://www.ncbi.nlm.nih.gov/pubmed/25802968 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e33 %T Short-Term Trajectories of Use of a Caloric-Monitoring Mobile Phone App Among Patients With Type 2 Diabetes Mellitus in a Primary Care Setting %A Goh,Glenn %A Tan,Ngiap Chuan %A Malhotra,Rahul %A Padmanabhan,Uma %A Barbier,Sylvaine %A Allen Jr,John Carson %A Østbye,Truls %+ Duke Global Health Institute, 310 Trent Drive, Durham, NC, , United States, 1 919 660 0331, truls.ostbye@duke.edu %K type 2 diabetes mellitus %K self-management %K mobile phone %K mobile apps %K longitudinal studies %D 2015 %7 03.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-management plays an important role in maintaining good control of diabetes mellitus, and mobile phone interventions have been shown to improve such self-management. The Health Promotion Board of Singapore has created a caloric-monitoring mobile health app, the “interactive Diet and Activity Tracker” (iDAT). Objective: The objective was to identify and describe short-term (8-week) trajectories of use of the iDAT app among patients with type 2 diabetes mellitus in a primary care setting in Singapore, and identify patient characteristics associated with each trajectory. Methods: A total of 84 patients with type 2 diabetes mellitus from a public primary care clinic in Singapore who had not previously used the iDAT app were enrolled. The app was demonstrated and patients’ weekly use of the app was monitored over 8 weeks. Weekly use was defined as any record in terms of food entry or exercise workout entry in that week. Information on demographics, diet and exercise motivation, diabetes self-efficacy (Diabetes Empowerment Scale-Short Form), and clinical variables (body mass index, blood pressure, and glycosylated hemoglobin/HbA1c) were collected at baseline. iDAT app use trajectories were delineated using latent-class growth modeling (LCGM). Association of patient characteristics with the trajectories was ascertained using logistic regression analysis. Results: Three iDAT app use trajectories were observed: Minimal Users (66 out of 84 patients, 78.6%, with either no iDAT use at all or use only in the first 2 weeks), Intermittent-Waning Users (10 out of 84 patients, 11.9%, with occasional weekly use mainly in the first 4 weeks), and Consistent Users (8 out of 84 patients, 9.5%, with weekly use throughout all or most of the 8 weeks). The adjusted odds ratio of being a Consistent User, relative to a Minimal User, was significantly higher for females (OR 19.55, 95% CI 1.78-215.42) and for those with higher exercise motivation scores at baseline (OR 4.89, 95% CI 1.80-13.28). The adjusted odds ratio of being an Intermittent-Waning User relative to a Minimal User was also significantly higher for those with higher exercise motivation scores at baseline (OR 1.82, 95% CI 1.00-3.32). Conclusions: This study provides insight into the nature and extent of usage of a caloric-monitoring app among patients with type 2 diabetes and managed in primary care. The application of LCGM provides a useful framework for evaluating future app use in other patient populations. %M 25648130 %R 10.2196/jmir.3938 %U http://www.jmir.org/2015/2/e33/ %U https://doi.org/10.2196/jmir.3938 %U http://www.ncbi.nlm.nih.gov/pubmed/25648130 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e7 %T Diet App Use by Sports Dietitians: A Survey in Five Countries %A Jospe,Michelle R %A Fairbairn,Kirsty A %A Green,Peter %A Perry,Tracy L %+ Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, 9054, New Zealand, 64 3 479 7948, michelle.jospe@otago.ac.nz %K nutritional requirements %K nutrition assessment %K dietary self-monitoring %K mobile apps %K questionnaire %K telemedicine %K sports nutritional sciences %D 2015 %7 22.01.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite the hundreds of diet apps available for use on smartphones (mobile phones), no studies have examined their use as tools for dietary assessment and tracking in sports nutrition. Objective: The aim is to examine the prevalence and perceptions of using smartphone diet apps for dietary assessment and tracking among sports dietitians. Methods: A cross-sectional online survey to examine the use and perception of diet apps was developed and distributed to sports dietitians in Australia, Canada, New Zealand, the United Kingdom, and the United States (US). Results: The overall response rate from the 1709 sports dietitians invited to participate was 10.3% (n=180). diet apps were used by 32.4% (57/176) of sports dietitians to assess and track the dietary intake of athletes. Sports dietitians from the US were more likely to use smartphone diet apps than sports dietitians from other countries (OR=5.61, 95% CI 1.84-17.08, P=.002). Sports dietitians used 28 different diet apps, with 56% (32/57) choosing MyFitnessPal. Overall, sports dietitians held a positive perception of smartphone diet apps, with the majority of respondents viewing diet apps as “better” (25/53, 47%) or “equivalent” (22/53, 41%) when compared with traditional dietary assessment methods. Conclusions: Nearly one-third of sports dietitians used mobile phone diet apps in sports nutrition practice, and viewed them as useful in helping to assess and track the dietary intake of athletes. %M 25616274 %R 10.2196/mhealth.3345 %U http://mhealth.jmir.org/2015/1/e7/ %U https://doi.org/10.2196/mhealth.3345 %U http://www.ncbi.nlm.nih.gov/pubmed/25616274 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 1 %P e1 %T Development and Pilot Evaluation of an Online Relapse-Prevention Program Based on Acceptance and Commitment Therapy for Chronic Pain Patients %A Fledderus,Martine %A Schreurs,Karlein MG %A Bohlmeijer,Ernst T %A Vollenbroek-Hutten,Miriam MR %+ Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede, 7500 AH, Netherlands, 31 534894470, martinefledderus@gmail.com %K chronic pain %K eHealth %K acceptance and commitment therapy %K relapse prevention %K aftercare %D 2015 %7 05.01.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: A significant number of chronic pain patients experience a decline in therapeutic effects after rehabilitation. As face-to-face contacts with health care professionals are not always feasible after treatment, new, innovative, fully automated relapse-prevention programs are highly needed. Objective: In this study an online, automated relapse-prevention program based on acceptance and commitment therapy (ACT)—both as a website and as a mobile app—was developed and evaluated. At each step of the development, end users (ie, chronic pain patients) were consulted in order to fully address their needs. Methods: In a step-by-step process, a contextual inquiry, requirement specification, and design were executed with chronic pain patients by conducting, respectively, a focus group (n=10), interviews with rapid prototyping (n=28), and a user- and expert-based usability evaluation (n=14). Furthermore, a pilot evaluation was conducted with 14 chronic pain or fatigue patients who had received the online relapse-prevention program following a multidisciplinary ACT treatment. They were interviewed about their usage and the usefulness of the program in supporting them to maintain changed behaviors and prevent relapses in avoidance and pain control behaviors. Results: The three stages provided information about the expected needs of end users, comments about the usefulness of the proposed features, and feedback about the design and usability of the program. This resulted in a fully operational, online relapse-prevention program. Results from the pilot evaluation showed that 9 patients used the online program after treatment, 5 of whom indicated that the program supported them after treatment. Of all the patients, 4 of them indicated that the program did not support them because they wanted more social interaction with other users. Conclusions: This study showed that an innovative, automated, online program that is user friendly can be developed by involving the end users in each step. The program was evaluated positively by some participants. The evaluation showed that the online relapse-prevention program has the potential to support chronic pain patients in maintaining their changed behaviors and preventing relapses in avoidance and pain control behaviors. Trial Registration: Nederlands Trial Register (NTR) Number: NTR4177; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4177 (Archived by WebCite at http://www.webcitation.org/6Ur6EFD1D). %M 27025550 %R 10.2196/humanfactors.3302 %U http://humanfactors.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/humanfactors.3302 %U http://www.ncbi.nlm.nih.gov/pubmed/27025550 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e1 %T A Mobile App for Securely Capturing and Transferring Clinical Images to the Electronic Health Record: Description and Preliminary Usability Study %A Landman,Adam %A Emani,Srinivas %A Carlile,Narath %A Rosenthal,David I %A Semakov,Simon %A Pallin,Daniel J %A Poon,Eric G %+ Brigham and Women\'s Hospital, Department of Emergency Medicine, 75 Francis Street, Boston, MA, 02115, United States, 1 617 525 8497, alandman@partners.org %K mobile phone %K photographs %K electronic health records %K telemedicine %D 2015 %7 02.01.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Photographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking. Objective: The aim of this study is to describe the implementation of a secure application for capturing and storing clinical images in the electronic health record (EHR), and to describe initial user experiences. Methods: We developed CliniCam, a secure Apple iOS (iPhone, iPad) application that allows for user authentication, patient selection, image capture, image annotation, and storage of images as a Portable Document Format (PDF) file in the EHR. We leveraged our organization’s enterprise service-oriented architecture to transmit the image file from CliniCam to our enterprise clinical data repository. There is no permanent storage of protected health information on the mobile device. CliniCam also required connection to our organization’s secure WiFi network. Resident physicians from emergency medicine, internal medicine, and dermatology used CliniCam in clinical practice for one month. They were then asked to complete a survey on their experience. We analyzed the survey results using descriptive statistics. Results: Twenty-eight physicians participated and 19/28 (68%) completed the survey. Of the respondents who used CliniCam, 89% found it useful or very useful for clinical practice and easy to use, and wanted to continue using the app. Respondents provided constructive feedback on location of the photos in the EHR, preferring to have photos embedded in (or linked to) clinical notes instead of storing them as separate PDFs within the EHR. Some users experienced difficulty with WiFi connectivity which was addressed by enhancing CliniCam to check for connectivity on launch. Conclusions: CliniCam was implemented successfully and found to be easy to use and useful for clinical practice. CliniCam is now available to all clinical users in our hospital, providing a secure and efficient way to capture clinical images and to insert them into the EHR. Future clinical image apps should more closely link clinical images and clinical documentation and consider enabling secure transmission over public WiFi or cellular networks. %M 25565678 %R 10.2196/mhealth.3481 %U http://mhealth.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/mhealth.3481 %U http://www.ncbi.nlm.nih.gov/pubmed/25565678 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e44 %T User Preferences and Design Recommendations for an mHealth App to Promote Cystic Fibrosis Self-Management %A Hilliard,Marisa E %A Hahn,Amy %A Ridge,Alana K %A Eakin,Michelle N %A Riekert,Kristin A %+ Johns Hopkins University School of Medicine, Department of Medicine, 5501 Hopkins Bayview Circle, Asthma and Allergy Center 3B.37, Baltimore, MD, 21224, United States, 1 410 550 7755, kriekert@jhmi.edu %K cystic fibrosis %K qualitative research %K mobile health %D 2014 %7 24.10.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: mHealth apps hold potential to provide automated, tailored support for treatment adherence among individuals with chronic medical conditions. Yet relatively little empirical research has guided app development and end users are infrequently involved in designing the app features or functions that would best suit their needs. Self-management apps may be particularly useful for people with chronic conditions like cystic fibrosis (CF) that have complex, demanding regimens. Objective: The aim of this mixed-methods study was to involve individuals with CF in guiding the development of engaging, effective, user-friendly adherence promotion apps that meet their preferences and self-management needs. Methods: Adults with CF (n=16, aged 21-48 years, 50% male) provided quantitative data via a secure Web survey and qualitative data via semi-structured telephone interviews regarding previous experiences using apps in general and for health, and preferred and unwanted features of potential future apps to support CF self-management. Results: Participants were smartphone users who reported sending or receiving text messages (93%, 14/15) or emails (80%, 12/15) on their smartphone or device every day, and 87% (13/15) said it would be somewhat or very hard to give up their smartphone. Approximately one-half (53%, 8/15) reported having health apps, all diet/weight-related, yet many reported that existing nutrition apps were not well-suited for CF management. Participants wanted apps to support CF self-management with characteristics such as having multiple rather than single functions (eg, simple alarms), being specific to CF, and minimizing user burden. Common themes for desired CF app features were having information at one’s fingertips, automation of disease management activities such as pharmacy refills, integration with smartphones’ technological capabilities, enhancing communication with health care team, and facilitating socialization within the CF community. Opinions were mixed regarding gamification and earning rewards or prizes. Participants emphasized the need for customization options to meet individual preferences and disease management goals. Conclusions: Unique capabilities of emerging smartphone technologies (eg, social networking integration, movement and location detection, integrated sensors, or electronic monitors) make many of these requests possible. Involving end users in all stages of mHealth app development and collaborating with technology experts and the health care system may result in apps that maintain engagement, improve integration and automation, and ultimately impact self-management and health outcomes. %M 25344616 %R 10.2196/mhealth.3599 %U http://mhealth.jmir.org/2014/4/e44/ %U https://doi.org/10.2196/mhealth.3599 %U http://www.ncbi.nlm.nih.gov/pubmed/25344616 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 1 %N 1 %P e2 %T Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults %A Hong,Yan %A Goldberg,Daniel %A Dahlke,Deborah Vollmer %A Ory,Marcia G %A Cargill,Jessica S %A Coughlin,Rachel %A Hernandez,Edgar %A Kellstedt,Debra K %A Peres,S Camille %+ School of Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX, 77843, United States, 1 9798621700, yhong@sph.tamhsc.edu %K physical activity %K mobile health, older adults %K usability testing %K user experience %D 2014 %7 13.10.2014 %9 Original Paper %J JMIR Human Factors %G English %X Background: Most older Americans do not exercise regularly and many have chronic conditions. Among an increasing number of fitness mobile and Web apps, few are designed for older adults with chronic conditions despite high ownership rates of mobile tools and Internet access in this population. We designed a mobile-enabled Web app, iCanFit, to promote physical activity in this population. Objective: This study aimed to test the usability and acceptability of iCanFit among older adults in a community setting. Methods: A total of 33 older adults (aged 60 to 82 years) were recruited from communities to test iCanFit. Of these 33, 10 participants completed the usability testing in a computer room of a senior community center. A research assistant timed each Web application task and observed user navigation behavior using usability metrics. The other 23 participants used the website on their own devices at home and provided feedback after 2-3 weeks by completing a user-experience survey assessing ease of use, helpfulness, and satisfaction with iCanFit. Results: Participants completed all 15 tasks on the iCanFit site in an average of 31 (SD 6.9) minutes; some tasks required more time or needed assistance. Participants’ comments were addressed to improve the site’s senior friendliness and ease of use. In the user-experience survey, participants reported high levels of usefulness and satisfaction. More than 56% (13/23) of participants indicated they would continue using the program and recommend it to their families or friends. Conclusions: Testing usability and acceptability is a very important step in developing age-appropriate and user-friendly Web apps, especially for older adults. Testing usability and acceptability in a community setting can help reveal users’ experiences and feedback in a real-life setting. Our study suggested that older adults had a high degree of acceptance of iCanFit and could use it easily. The efficacy trial of iCanFit is currently underway. %M 27025254 %R 10.2196/humanfactors.3787 %U http://humanfactors.jmir.org/2014/1/e2/ %U https://doi.org/10.2196/humanfactors.3787 %U http://www.ncbi.nlm.nih.gov/pubmed/27025254 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e35 %T ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels %A Grindrod,Kelly Anne %A Gates,Allison %A Dolovich,Lisa %A Slavcev,Roderick %A Drimmie,Rob %A Aghaei,Behzad %A Poon,Calvin %A Khan,Shamrozé %A Leat,Susan J %+ School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada, 1 519 888 4567 ext 21358, kgrindrod@uwaterloo.ca %K low vision %K legibility %K prescription labelling %K medication labels %K usability %K cognitive impairment %K visual impairment %D 2014 %7 15.08.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels. Objective: The aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition. Methods: This pilot study enrolled adults (≥55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes. Results: The 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the “drag and drop” function. Conclusions: ClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow. %M 25131813 %R 10.2196/mhealth.3250 %U http://mhealth.jmir.org/2014/3/e35/ %U https://doi.org/10.2196/mhealth.3250 %U http://www.ncbi.nlm.nih.gov/pubmed/25131813 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e33 %T Supporting Cancer Patients in Illness Management: Usability Evaluation of a Mobile App %A Mirkovic,Jelena %A Kaufman,David R %A Ruland,Cornelia M %+ Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Forskningsveien 2b, Oslo, 0373, Norway, 47 46343869, Jelena.Mirkovic@rr-research.no %K mobile applications %K patients %K cell phone %K smartphone %K symptom assessment %K self-care %K user-computer interface %D 2014 %7 13.08.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile phones and tablets currently represent a significant presence in people’s everyday lives. They enable access to different information and services independent of current place and time. Such widespread connectivity offers significant potential in different app areas including health care. Objective: Our goal was to evaluate the usability of the Connect Mobile app. The mobile app enables mobile access to the Connect system, an online system that supports cancer patients in managing health-related issues. Along with symptom management, the system promotes better patient-provider communication, collaboration, and shared decision making. The Connect Mobile app enables access to the Connect system over both mobile phones and tablets. Methods: The study consisted of usability tests of a high fidelity prototype with 7 cancer patients where the objectives were to identify existing design and functionality issues and to provide patients with a real look-and-feel of the mobile system. In addition, we conducted semistructured interviews to obtain participants’ feedback about app usefulness, identify the need for new system features and design requirements, and measure the acceptance of the mobile app and its features within everyday health management. Results: The study revealed a total of 27 design issues (13 for mobile apps and 14 for tablet apps), which were mapped to source events (ie, errors, requests for help, participants' concurrent feedback, and moderator observation). We also applied usability heuristics to identify violations of usability principles. The majority of violations were related to enabling ease of input, screen readability, and glanceability (15 issues), as well as supporting an appropriate match between systems and the real world (7 issues) and consistent mapping of system functions and interactions (4 issues). Feedback from participants also showed the cancer patients’ requirements for support systems and how these needs are influenced by different context-related factors, such as type of access terminal (eg, desktop computer, tablet, mobile phone) and phases of illness. Based on the observed results, we proposed design and functionality recommendations that can be used for the development of mobile apps for cancer patients to support their health management process. Conclusions: Understanding and addressing users’ requirements is one of the main prerequisites for developing useful and effective technology-based health interventions. The results of this study outline different user requirements related to the design of the mobile patient support app for cancer patients. The results will be used in the iterative development of the Connect Mobile app and can also inform other developers and researchers in development, integration, and evaluation of mobile health apps and services that support cancer patients in managing their health-related issues. %M 25119490 %R 10.2196/mhealth.3359 %U http://mhealth.jmir.org/2014/3/e33/ %U https://doi.org/10.2196/mhealth.3359 %U http://www.ncbi.nlm.nih.gov/pubmed/25119490 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e32 %T Attitudes and Preferences on the Use of Mobile Health Technology and Health Games for Self-Management: Interviews With Older Adults on Anticoagulation Therapy %A Lee,Jung-Ah %A Nguyen,Annie Lu %A Berg,Jill %A Amin,Alpesh %A Bachman,Mark %A Guo,Yuqing %A Evangelista,Lorraine %+ University of California, Irvine, Program in Nursing Science, Berk Hall 100A, Irvine, CA, 92697-3959, United States, 1 949 824 2855, jungahl@uci.edu %K anticoagulation therapy %K health apps %K health games %K mobile health technology %K self-management %D 2014 %7 23.07.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Older adults are at substantial risk for cardiovascular disorders that may require anticoagulation therapy. Those on warfarin therapy report dissatisfaction and reduced quality of life (QOL) resulting from the treatment. Advances in the area of mobile health (mHealth) technology have resulted in the design and development of new patient-centric models for the provision of personalized health care services to improve care delivery. However, there is a paucity of research examining the effectiveness of mHealth tools on knowledge, attitudes, and patient satisfaction with treatment, as well as self-management, adherence to therapy, and QOL in older adults with chronic illness conditions requiring long-term warfarin therapy. Objective: The objective of the study was to explore the attitudes and preferences of older adults on warfarin therapy regarding the use of mHealth technology and health games to gain skills for self-management. Methods: We conducted group and individual interviews with patients (60 years or older) on warfarin therapy at two anticoagulation clinics affiliated with an academic medical center. We held 4 group and 2 individual interviews, resulting in 11 patient participants and 2 family caregiver participants. We used structured questions on three topic areas including medication self-management strategies, mHealth technology use, and health games for exercise. We demonstrated some commercial health apps related to medication management, vitamin K content of food, and a videogame for balance exercise. Discussions were audiotaped and transcribed verbatim. Common themes were drawn using content analysis. Results: The participants reported awareness of the importance of staying on schedule with warfarin therapy. They also acknowledged that negative experiences of friends or family members who were taking warfarin influenced their desire to keep on schedule with warfarin therapy. In addition, the participants expressed that the use of mHealth technology may be helpful for medication management. They also expressed the need for family support in the use of health technology devices. Moreover, the participants discussed concerns and challenges to use health technology and health games, and provided suggestions on ways to make mHealth technology and health games elder-friendly. Conclusions: These findings indicate that our older adults on warfarin therapy are interested in mHealth technology specific to warfarin medication management and health games. Further research needs to be done to validate these findings. Elder-friendly designs, technology support, and physical safety using mHealth technology may be useful in this population. These findings can be used to inform a larger study to design and test an elder-centered mHealth technology in this target population. %M 25098413 %R 10.2196/mhealth.3196 %U http://mhealth.jmir.org/2014/3/e32/ %U https://doi.org/10.2196/mhealth.3196 %U http://www.ncbi.nlm.nih.gov/pubmed/25098413 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e29 %T Exploring the Usability of a Mobile App for Adolescent Obesity Management %A O'Malley,Grace %A Dowdall,Grainne %A Burls,Amanda %A Perry,Ivan J %A Curran,Noirin %+ Department of Physiotherapy, Temple Street Children’s University Hospital, Temple Street, Dublin, Ireland, 353 1 8921838, omalleyg@tcd.ie %K obesity %K mobile health %K usability testing %K adolescent %K participatory health care %D 2014 %7 27.06.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Obesity is a global epidemic. Behavioral change approaches towards improving nutrition, increasing physical activity level, improving sleep, and reducing sitting time are recommended as best practices in adolescent obesity management. However, access to evidence-based treatment is limited and portable technologies such as mobile apps may provide a useful platform to deliver such lifestyle interventions. No evidence-based validated app exists for obesity intervention; therefore, a novel mobile app (Reactivate) was developed for use in the Temple Street W82GO Healthy Lifestyles Program (W82GO). Objective: This study aimed to test the usability (technical effectiveness, efficiency, and user satisfaction) of the Reactivate mobile app in obese adolescents. Methods: Ten adolescents (7 males and 3 females, aged 12-17 years) who had been treated for obesity (>98th percentile for body mass index) at the Temple Street Children's University Hospital were recruited. Participants were given 8 tasks to complete in order to test the technical effectiveness of the app. A research assistant timed the user while completing each task in order to test the relative user efficiency of the app (time-on-task). The tasks fell into 5 categories and required the user to enter personal settings, find and answer surveys, create a message, use the goal setting feature, and enter details regarding their weight and height. In exploration of user satisfaction, each participant completed the standardized software usability measurement inventory (SUMI), which measures 5 aspects of user satisfaction: efficiency, effect, helpfulness, controllability, and learnability. Descriptive statistics were used to explore the mean relative user efficiency and SUMI scores. Results: Mean age was 14.26 (SD 1.58) years. All adolescents completed each of the tasks successfully. The mean relative user efficiency scores were two to three times that of an expert user. Users responded that they would use Reactivate to monitor their growth over time, for motivation, and for goal setting. All users described Reactivate as an important mobile app. Conclusions: Our study describes the usability of a mobile app used in adolescent obesity management. Adolescents found Reactivate easy to use and their SUMI results indicated that the app scored high on user satisfaction. Usability testing is an important step towards refining the development of the Reactivate app, which can be used in the treatment of obesity. The study on the clinical efficacy of the Reactivate app is currently underway. %M 25098237 %R 10.2196/mhealth.3262 %U http://mhealth.jmir.org/2014/2/e29/ %U https://doi.org/10.2196/mhealth.3262 %U http://www.ncbi.nlm.nih.gov/pubmed/25098237 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e30 %T Feasibility and User Perception of a Fully Automated Push-Based Multiple-Session Alcohol Intervention for University Students: Randomized Controlled Trial %A Bendtsen,Marcus %A Bendtsen,Preben %+ Medical Faculty, Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Linköping, 581 83, Sweden, 46 702324615, preben.bendtsen@liu.se %K alcohol intervention %K text messages %K SMS %K email %K students %K multiple-session intervention %K push-based intervention %D 2014 %7 23.06.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers. Objective: This study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email. Methods: A total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded. Results: No difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group. Conclusions: Based on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted. %M 25098296 %R 10.2196/mhealth.3233 %U http://mhealth.jmir.org/2014/2/e30/ %U https://doi.org/10.2196/mhealth.3233 %U http://www.ncbi.nlm.nih.gov/pubmed/25098296 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e27 %T The Development of an Automated Device for Asthma Monitoring for Adolescents: Methodologic Approach and User Acceptability %A Rhee,Hyekyun %A Miner,Sarah %A Sterling,Mark %A Halterman,Jill S %A Fairbanks,Eileen %+ University of Rochester Medical Center, School of Nursing, University of Rochester, 601 Elmwood Avenue, Box SON, Rochester, NY, 14542, United States, 1 585 276 3775, hyekyun_rhee@urmc.rochester.edu %K asthma %K adolescents %K symptom monitoring %K symptom algorithm %K mobile device %D 2014 %7 19.06.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Many adolescents suffer serious asthma related morbidity that can be prevented by adequate self-management of the disease. The accurate symptom monitoring by patients is the most fundamental antecedent to effective asthma management. Nonetheless, the adequacy and effectiveness of current methods of symptom self-monitoring have been challenged due to the individuals’ fallible symptom perception, poor adherence, and inadequate technique. Recognition of these limitations led to the development of an innovative device that can facilitate continuous and accurate monitoring of asthma symptoms with minimal disruption of daily routines, thus increasing acceptability to adolescents. Objective: The objectives of this study were to: (1) describe the development of a novel symptom monitoring device for teenagers (teens), and (2) assess their perspectives on the usability and acceptability of the device. Methods: Adolescents (13-17 years old) with and without asthma participated in the evolution of an automated device for asthma monitoring (ADAM), which comprised three phases, including development (Phase 1, n=37), validation/user acceptability (Phase 2, n=84), and post hoc validation (Phase 3, n=10). In Phase 1, symptom algorithms were identified based on the acoustic analysis of raw symptom sounds and programmed into a popular mobile system, the iPod. Phase 2 involved a 7 day trial of ADAM in vivo, and the evaluation of user acceptance using an acceptance survey and individual interviews. ADAM was further modified and enhanced in Phase 3. Results: Through ADAM, incoming audio data were digitized and processed in two steps involving the extraction of a sequence of descriptive feature vectors, and the processing of these sequences by a hidden Markov model-based Viterbi decoder to differentiate symptom sounds from background noise. The number and times of detected symptoms were stored and displayed in the device. The sensitivity (true positive) of the updated cough algorithm was 70% (21/30), and, on average, 2 coughs per hour were identified as false positive. ADAM also kept track of the their activity level throughout the day using the mobile system’s built in accelerometer function. Overall, the device was well received by participants who perceived it as attractive, convenient, and helpful. The participants recognized the potential benefits of the device in asthma care, and were eager to use it for their asthma management. Conclusions: ADAM can potentially automate daily symptom monitoring with minimal intrusiveness and maximal objectivity. The users’ acceptance of the device based on its recognized convenience, user-friendliness, and usefulness in increasing symptom awareness underscores ADAM’s potential to overcome the issues of symptom monitoring including poor adherence, inadequate technique, and poor symptom perception in adolescents. Further refinement of the algorithm is warranted to improve the accuracy of the device. Future study is also needed to assess the efficacy of the device in promoting self-management and asthma outcomes. %M 25100184 %R 10.2196/mhealth.3118 %U http://mhealth.jmir.org/2014/2/e27/ %U https://doi.org/10.2196/mhealth.3118 %U http://www.ncbi.nlm.nih.gov/pubmed/25100184 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e26 %T Efficiency and Usability of a Near Field Communication-Enabled Tablet for Medication Administration %A Landman,Adam %A Neri,Pamela M %A Robertson,Alexandra %A McEvoy,Dustin %A Dinsmore,Michael %A Sweet,Micheal %A Bane,Anne %A Takhar,Sukhjit S %A Miles,Stephen %+ Brigham and Women's Hospital, Department of Emergency Medicine, 75 Francis Street, Neville House, Boston, MA, 02115, United States, 1 617 525 8497, alandman@partners.org %K medication systems %K medication errors %K mobile applications %K automatic data processing %K nursing %D 2014 %7 02.06.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Barcode-based technology coupled with the electronic medication administration record (e-MAR) reduces medication errors and potential adverse drug events (ADEs). However, many current barcode-enabled medication administration (BCMA) systems are difficult to maneuver and often require multiple barcode scans. We developed a prototype, next generation near field communication-enabled medication administration (NFCMA) system using a tablet. Objective: We compared the efficiency and usability of the prototype NFCMA system with the traditional BCMA system. Methods: We used a mixed-methods design using a randomized observational cross-over study, a survey, and one-on-one interviews to compare the prototype NFCMA system with a traditional BCMA system. The study took place at an academic medical simulation center. Twenty nurses with BCMA experience participated in two simulated patient medication administration scenarios: one using the BCMA system, and the other using the prototype NFCMA system. We collected overall scenario completion time and number of medication scanning attempts per scenario, and compared those using paired t tests. We also collected participant feedback on the prototype NFCMA system using the modified International Business Machines (IBM) Post-Study System Usability Questionnaire (PSSUQ) and a semistructured interview. We performed descriptive statistics on participant characteristics and responses to the IBM PSSUQ. Interview data was analyzed using content analysis with a qualitative description approach to review and categorize feedback from participants. Results: Mean total time to complete the scenarios using the NFCMA and the BCMA systems was 202 seconds and 182 seconds, respectively (P=.09). Mean scan attempts with the NFCMA was 7.6 attempts compared with 6.5 attempts with the BCMA system (P=.12). In the usability survey, 95% (19/20) of participants agreed that the prototype NFCMA system was easy to use and easy to learn, with a pleasant interface. Participants expressed interest in using the NFCMA tablet in the hospital; suggestions focused on implementation issues, such as storage of the mobile devices and infection control methods. Conclusions: The NFCMA system had similar efficiency to the BCMA system in a simulated scenario. The prototype NFCMA system was well received by nurses and offers promise to improve nurse medication administration efficiency. %M 25100043 %R 10.2196/mhealth.3215 %U http://mhealth.jmir.org/2014/2/e26/ %U https://doi.org/10.2196/mhealth.3215 %U http://www.ncbi.nlm.nih.gov/pubmed/25100043 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e25 %T A Persuasive and Social mHealth Application for Physical Activity: A Usability and Feasibility Study %A Al Ayubi,Soleh U %A Parmanto,Bambang %A Branch,Robert %A Ding,Dan %+ Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, 6026 Forbes Tower, Pittsburgh, PA, , United States, 1 412 383 6649, parmanto@pitt.edu %K mobile applications %K mHealth %K self-management %K social support %K persuasion %K physical activity %K usability %K feasibility studies %K pedometer %D 2014 %7 22.05.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Advances in smartphones and the wide usage of social networking systems offer opportunities for the development of innovative interventions to promote physical activity. To that end, we developed a persuasive and social mHealth application designed to monitor and motivate users to walk more every day. Objective: The objectives of this project were to conduct a focused review on the fundamental characteristics of mHealth for physical activity promotion, to develop an mHealth application that meets such characteristics, and to conduct a feasibility study to deploy the application in everyday life. Methods: This project started as an analytical study to review the fundamental characteristics of the technologies used in physical activity monitoring and promotion. Then, it was followed by a technical development of the application. Next, a 4 week deployment was conducted where participants used the application as part of their daily life. A think-aloud method and in-depth semistructured interviews were conducted following the deployment. A qualitative description method was used to thematically analyze the interviews. Feasibility measures included, adherence to the program, user-system interactions, motivation to use, and experience with physical activity and online social interactions. Results: There were seven fundamental characteristics of physical activity monitoring and promotion that were identified, which were then used as a foundation to develop the application. There were fourteen participants that enrolled in the application evaluation. The age range was from 24 to 45; body mass index ranged from 18.5 to 42.98, with 4 of the subjects falling into the category “obese”. Half of them were experienced with smartphones, and all were familiar with a social network system. There were thirteen participants that completed the study; one was excluded. Overall, participants gave high scores to almost all of the usability factors examined, with averages of 4.52 out of a 5.00 maximum. Over 29 days, participants used the application for a total of 119,380 minutes (average=7.57 hours/day/participant; SD 1.56). Conclusions: Based on the fundamental characteristics, the application was successfully developed. The usability results suggest that the system is usable and user satisfaction was high. Deploying the application was shown to be feasible for the promotion of daily physical activity. %M 25099928 %R 10.2196/mhealth.2902 %U http://mhealth.jmir.org/2014/2/e25/ %U https://doi.org/10.2196/mhealth.2902 %U http://www.ncbi.nlm.nih.gov/pubmed/25099928 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e20 %T Investigating the Use of Smartphones for Learning Purposes by Australian Dental Students %A Rung,Andrea %A Warnke,Frauke %A Mattheos,Nikos %+ The University of Hong Kong, Faculty of Dentistry, 34 Hospital Road, 4/F Blk A, Sai Ying Pun, Hong Kong, 852 2859 0310, nikos@mattheos.net %K health care education %K smartphone %K mobile technology %K social media %K computer literacy %D 2014 %7 30.04.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile Internet devices and smartphones have at present a significant potential as learning tools and the development of educational interventions based on smartphones have attracted increasing attention. Objective: The objective of this study was to obtain a deeper insight in the nature of students’ use of smartphones, as well as their attitudes towards educational use of mobile devices in order to design successful teaching interventions. Method: A questionnaire was designed, aiming to investigate the actual daily habitual use, as well as the attitudes of dental students towards smartphones for their university education purposes. The survey was used to collect data from 232 dental students. Results: Of the 232 respondents, 204 (87.9%) owned a smartphone, and 191 (82.3%) had access to third generation (3G) mobile carriers. The most popular devices were the iPhone and Android. Most of the respondents had intermediate smartphone skills and used smartphones for a number of learning activities. Only 75/232 (32.3%) had specific educational applications installed, while 148/232 (63.7%) used smartphones to access to social media and found it valuable for their education (P<.05). Students accessing social media with their smartphones also showed significantly more advanced skills with smartphones than those who did not (P<.05). There was no significant association between age group, gender, origin, and smartphone skills. There was positive correlation between smartphone skills and students' attitudes toward improving access to learning material (r=.43, P<.05), helping to learn more independently (r=.44, P<.05), and use of smartphones by teaching staff (r=.45, P<.05). Conclusion: The results in this study suggest that students use smartphones and social media for their education even though this technology has not been formally included in the curriculum. This might present an opportunity for educators to design educational methods, activities, and material that are suitable for smartphones and allow students to use this technology, thereby accommodating students’ current diverse learning approaches. %M 25099261 %R 10.2196/mhealth.3120 %U http://mhealth.jmir.org/2014/2/e20/ %U https://doi.org/10.2196/mhealth.3120 %U http://www.ncbi.nlm.nih.gov/pubmed/25099261 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e11 %T Evaluating User Perceptions of Mobile Medication Management Applications With Older Adults: A Usability Study %A Grindrod,Kelly Anne %A Li,Melissa %A Gates,Allison %+ School of Pharmacy, Faculty of Science, University of Waterloo, 200 University Avenue, Waterloo, ON, N2L3G1, Canada, 1 519 888 4567 ext 21358, kgrindrod@uwaterloo.ca %K medication therapy management %K medication adherence %K mHealth %K mobile health %D 2014 %7 14.03.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medication nonadherence has a significant impact on the health and wellbeing of individuals with chronic disease. Several mobile medication management applications are available to help users track, remember, and read about their medication therapy. Objective: The objective of this study was to explore the usability and usefulness of existing medication management applications for older adults. Methods: We recruited 35 participants aged 50 and over to participate in a 2-hour usability session. The average age ranged from 52-78 years (mean 67 years) and 71% (25/35) of participants were female. Each participant was provided with an iPad loaded with four medication management applications: MyMedRec, DrugHub, Pillboxie, and PocketPharmacist. These applications were evaluated using the 10 item System Usability Scale (SUS) and visual analog scale. An investigator-moderated 30-minute discussion followed, and was recorded. We used a grounded theory (GT) approach to analyze qualitative data. Results: When assessing mobile medication management applications, participants struggled to think of a need for the applications in their own lives. Many were satisfied with their current management system and proposed future use only if cognition and health declined. Most participants felt capable of using the applications after a period of time and training, but were frustrated by their initial experiences with the applications. The early experiences of participants highlighted the benefits of linear navigation and clear wording (eg, “undo” vs “cancel”) when designing for older users. While there was no order effect, participants attributed their poor performance to the order in which they tried the applications. They also described being a part of a technology generation that did not encounter the computer until adulthood. Of the four applications, PocketPharmacist was found to be the least usable with a score of 42/100 (P<.0001) though it offered a drug interaction feature that was among the favorite features of participants. The usability scores for MyMedRec (56/100), DrugHub (57/100), and Pillboxie (52/100) were not significantly different and participants preferred MyMedRec and DrugHub for their simple, linear interfaces. Conclusions: With training, adults aged 50 and over can be capable and interested in using mHealth applications for their medication management. However, in order to adopt such technology, they must find a need that their current medication management system cannot fill. Interface diversity and multimodal reminder methods should be considered to increase usability for older adults. Lastly, regulation or the involvement of older adults in development may help to alleviate generation bias and mistrust for applications. %M 25099993 %R 10.2196/mhealth.3048 %U http://mhealth.jmir.org/2014/1/e11/ %U https://doi.org/10.2196/mhealth.3048 %U http://www.ncbi.nlm.nih.gov/pubmed/25099993 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e12 %T Ideas and Enhancements Related to Mobile Applications to Support Type 1 Diabetes %A Pulman,Andy %A Taylor,Jacqui %A Galvin,Kathleen %A Masding,Mike %+ The School of Health & Social Care, Bournemouth University, R109, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, United Kingdom, 44 1202 962749, apulman@bournemouth.ac.uk %K patient education %K type 1 diabetes %K mobile %K apps %K sociotechnical design %K lifeworld %K humanising healthcare %K patient voice %K empathy %K ideas %K enhancements %D 2013 %7 25.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. Research and policy related to the integration of health information and support with this technology do not effectively consider the viewpoint of a younger patient. Views of young people with type 1 diabetes are vital in developing quality services and improving their own health-related quality of life (HRQOL), yet research on their lifestyle and use of Web and mobile technology to support their condition and in non–health-related areas is sparse. Objective: To develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on HRQOL. This can be achieved by constructing an in-depth picture of their day-to-day experiences from qualitative interviewing and exploring how they make use of technology in their lives and in relation to their condition and treatment. The goal was then to build something to help them, using the researcher’s technical expertise and seeking users’ opinions during the design and build, utilizing sociotechnical design principles. Methods: Data were collected by semistructured, in-depth qualitative interviews (N=9) of young people with type 1 diabetes aged 18-21. Interviews were transcribed and loaded onto NVivo for theme identification. Data analysis was undertaken during initial interviews (n=4) to locate potential ideas and enhancements for technical development. Latter interviews (n=5) assisted in the iterative sociotechnical design process of the development and provided additional developmental ideas. Results: Six themes were identified providing an understanding of how participants lived with and experienced their condition and how they used technology. Four technological suggestions for improvement were taken forward for prototyping. One prototype was developed as a clinically approved app. A number of ideas for new mobile apps and enhancements to currently existing apps that did not satisfactorily cater to this age group’s requirements for use in terms of design and functionality were suggested by interviewees but were not prototyped. Conclusions: This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. It is vital to include and reflect on their suggestions as they have a radically different view of technology than either their parents or practitioners. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use. %M 25100684 %R 10.2196/mhealth.2567 %U http://mhealth.jmir.org/2013/2/e12/ %U https://doi.org/10.2196/mhealth.2567 %U http://www.ncbi.nlm.nih.gov/pubmed/25100684 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e10 %T iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions %A Parmanto,Bambang %A Pramana,Gede %A Yu,Daihua Xie %A Fairman,Andrea D %A Dicianno,Brad E %A McCue,Michael P %+ Department of Health Information Management, School of Health & Rehabilitation Sciences, University of Pittsburgh, 6026 Forbes Tower, University of Pittsburgh, Pittsburgh, PA, PA 15243, United States, 1 412 383 6649, parmanto@pitt.edu %K mobile health %K mhealth %K self-care %K clinician-directed self-care %K self-management %K telehealth %K telemedicine %K smartphone %K chronic disease management %K spina bifida %K patient-clinician communications %D 2013 %7 11.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population. Objective: The project’s goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians. Methods: We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery. Results: There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient’s self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients’ conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau. Conclusions: The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized. %M 25100682 %R 10.2196/mhealth.2391 %U http://mhealth.jmir.org/2013/2/e10/ %U https://doi.org/10.2196/mhealth.2391 %U http://www.ncbi.nlm.nih.gov/pubmed/25100682 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e11 %T Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study %A Ahtinen,Aino %A Mattila,Elina %A Välkkynen,Pasi %A Kaipainen,Kirsikka %A Vanhala,Toni %A Ermes,Miikka %A Sairanen,Essi %A Myllymäki,Tero %A Lappalainen,Raimo %+ VTT Technical Research Centre of Finland, Sinitaival 6, Tampere, 33720, Finland, 358 207223384, elina.m.mattila@vtt.fi %K stress %K mental health %K mobile phone %K acceptance and commitment therapy %K field studies %K user experience %K design %D 2013 %7 10.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. Objective: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. Methods: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week’s and one month’s use. In-depth user experience interviews were conducted after one month’s use to study the acceptance and user experiences of Oiva. Results: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. Conclusions: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection. %M 25100683 %R 10.2196/mhealth.2596 %U http://mhealth.jmir.org/2013/2/e11/ %U https://doi.org/10.2196/mhealth.2596 %U http://www.ncbi.nlm.nih.gov/pubmed/25100683 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e8 %T The Development of a Mobile Monitoring and Feedback Tool to Stimulate Physical Activity of People With a Chronic Disease in Primary Care: A User-Centered Design %A van der Weegen,Sanne %A Verwey,Renée %A Spreeuwenberg,Marieke %A Tange,Huibert %A van der Weijden,Trudy %A de Witte,Luc %+ CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433881479, s.vanderweegen@maastrichtuniversity.nl %K user-centered design %K self-management %K physical activity %K accelerometry %K remote sensing technology %K primary health care %D 2013 %7 02.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage. Objective: The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback. Methods: The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team. Results: The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient. Conclusions: This study demonstrates that a user-centered approach brings in valuable details (such as the requirements for feedback in activity minutes per day) to improve the fit between the user, technology, and the organization of care, which is important for the usability and acceptability of the tool. The tool embedded in primary care will be evaluated in a randomized controlled trial. %M 25099556 %R 10.2196/mhealth.2526 %U http://mhealth.jmir.org/2013/2/e8/ %U https://doi.org/10.2196/mhealth.2526 %U http://www.ncbi.nlm.nih.gov/pubmed/25099556 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 1 %P e2 %T User Perceptions of an mHealth Medicine Dosing Tool for Community Health Workers %A Palazuelos,Daniel %A Diallo,Assiatou B %A Palazuelos,Lindsay %A Carlile,Narath %A Payne,Jonathan D %A Franke,Molly F %+ Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, 75 Francis Street, Boston, MA, 02115, United States, 1 617 732 5500, dpalazuelos@pih.org %K community health worker %K cellular phone %K mobile health %K Mexico %K Guatemala %K decision support techniques %K medical order entry systems %D 2013 %7 04.04.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technologies provide many potential benefits to the delivery of health care. Medical decision support tools have shown particular promise in improving quality of care and provider workflow. Frontline health workers such as Community Health Workers (CHWs) have been shown to be effective in extending the reach of care, yet only a few medicine dosing tools are available to them. Objective: We developed an mHealth medicine dosing tool tailored to the skill level of CHWs to assist in the delivery of care. The mHealth tool was created for CHWs with primary school education working in rural Mexico and Guatemala. Perceptions and impressions of this tool were collected and compared to an existing paper-based medicine dosing tool. Methods: Seventeen Partners In Health CHWs in rural Mexico and Guatemala completed a one-day training in the mHealth medicine dosing tool. Following the training, a prescription dosing test was administered, and CHWs were given the choice to use the mHealth or paper-based tool to answer 7 questions. Subsequently, demographic and qualitative data was collected using a questionnaire and an in-person interview conducted in Spanish, then translated into English. The qualitative questions captured data on 4 categories: comfort, acceptability, preference, and accuracy. Qualitative responses were analyzed for major themes and quantitative variables were analyzed using SAS. Results: 82% of the 17 CHWs chose the mHealth tool for at least 1 of 7 questions compared to 53% (9/17) who chose to use the paper-based tool. 93% (13/14) rated the phone as being easy or very easy to use, and 56% (5/9) who used the paper-based tool rated it as easy or very easy. Dosing accuracy was generally higher among questions answered using the mHealth tool relative to questions answered using the paper-based tool. Analysis of major qualitative themes indicated that the mHealth tool was perceived as being quick, easy to use, and as having complete information. The mHealth tool was seen as an acceptable dosing tool to use and as a way for CHWs to gain credibility within the community. Conclusions: A tailored cell phone-based mHealth medicine dosing tool was found to be useful and acceptable by CHWs in rural Mexico and Guatemala. The streamlined workflow of the mHealth tool and benefits such as the speed and self-lighting were found to be particularly useful features. Well designed and positioned tools such as this may improve effective task shifting by reinforcing the tasks that different cadres of workers are asked to perform. Further studies can explore how to best implement this mHealth tool in real-world settings, including how to incorporate the best elements of the paper-based tool that were also found to be helpful. %M 25100670 %R 10.2196/mhealth.2459 %U http://mhealth.jmir.org/2013/1/e2/ %U https://doi.org/10.2196/mhealth.2459 %U http://www.ncbi.nlm.nih.gov/pubmed/25100670 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 1 %N 2 %P e23 %T Initial Evaluation of an Electronic Symptom Diary for Adolescents with Cancer %A Baggott,Christina %A Gibson,Faith %A Coll,Beatriz %A Kletter,Richard %A Zeltzer,Paul %A Miaskowski,Christine %+ University of California, San Francisco, Department of Physiological Nursing, 2 Koret Way Box 0610, San Francisco, CA, , United States, 1 415 476 4320, christina.baggott@ucsf.edu %K mHealth, eHealth, patient-reported outcomes, symptom assessment, adolescent, cancer %D 2012 %7 11.12.2012 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The delivery of optimal care depends on accurate communication between patients and clinicians regarding untoward symptoms. Documentation of patients’ symptoms necessitates reliance on memory, which is often imprecise. We developed an electronic diary (eDiary) for adolescents and young adults (AYAs) with cancer to record symptoms. Objective: The purpose of this paper is to describe the utility of an eDiary designed for AYAs with cancer, including dependability of the mobile application, the reasons for any missing recorded data, patients’ adherence rates to daily symptom queries, and patients’ perceptions of the usefulness and acceptability of symptom data collection via mobile phones. Methods: Our team developed an electronic symptom diary based on interviews conducted with AYAs with cancer and their clinicians. This diary included daily severity ratings of pain, nausea, vomiting, fatigue, and sleep. The occurrence of other selected physical sequelae was assessed daily. Additionally, patients selected descriptors of their mood. A 3-week trial of the eDiary was conducted with 10 AYA cancer patients. Mobile phones with service plans were loaned to patients who were instructed to report their symptoms daily. Patients completed a brief questionnaire and were interviewed to elicit their perceptions of the eDiary and any technical difficulties encountered. Results: Overall adherence to daily symptom reports exceeded 90%. Young people experienced few technical difficulties and reported benefit from daily symptom reports. Symptom occurrence rates were high and considerable inter- and intra-patient variability was noted in symptom and mood reports. Conclusions: We demonstrated the utility of an eDiary that may contribute insight into patients’ symptom patterns to promote effective symptom management. %M 23612521 %R 10.2196/resprot.2175 %U http://www.researchprotocols.org/2012/2/e23/ %U https://doi.org/10.2196/resprot.2175 %U http://www.ncbi.nlm.nih.gov/pubmed/23612521 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e58 %T Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents %A Daugherty,Bethany L %A Schap,TusaRebecca E %A Ettienne-Gittens,Reynolette %A Zhu,Fengqing M %A Bosch,Marc %A Delp,Edward J %A Ebert,David S %A Kerr,Deborah A %A Boushey,Carol J %+ Epidemiology Program, University of Hawaii Cancer Center, 1236 Lauhala Street, Honolulu, HI, 96813, United States, 1 808 564 5915, cjboushey@cc.hawaii.edu %K Mobile telephone food record %K dietary assessment %K technology %K image analysis %K volume estimation %D 2012 %7 13.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image. Objective: To evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record. Methods: We recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults. Results: Adults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38% vs 58%, P = .03) and after (25% vs 50%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001). Conclusions: A majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment. %M 22504018 %R 10.2196/jmir.1967 %U http://www.jmir.org/2012/2/e58/ %U https://doi.org/10.2196/jmir.1967 %U http://www.ncbi.nlm.nih.gov/pubmed/22504018 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e25 %T Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring %A Seto,Emily %A Leonard,Kevin J %A Cafazzo,Joseph A %A Barnsley,Jan %A Masino,Caterina %A Ross,Heather J %+ Centre for Global eHealth Innovation, University Health Network, TGH/RFE Bldg, 4th Fl., 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6409, emily.seto@uhn.on.ca %K heart failure %K telemonitoring %K mobile phone %K patient monitoring %K self-care %K qualitative research %D 2012 %7 10.02.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs. Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring. Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient’s mobile phone based on their physiological values. Alerts were also sent to a cardiologist’s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients’ heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system. Conclusions: The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions. Key Words: %M 22328237 %R 10.2196/jmir.1912 %U http://www.jmir.org/2012/1/e25/ %U https://doi.org/10.2196/jmir.1912 %U http://www.ncbi.nlm.nih.gov/pubmed/22328237