%0 Journal Article %@ 2562-7600 %I JMIR Publications %V 9 %N %P e79188 %T The Relational Playbook Nurse Leadership Development Program Using the Whistle Systems Employee Recognition Platform: Feasibility Mixed Methods Study %A Daus,Marguerite %A Connelly,Brigid %A Carter,Drew %A Gilmartin,Heather M %K leadership %K nursing %K mobile app %K development %K workforce %D 2026 %7 2.2.2026 %9 %J JMIR Nursing %G English %X Background: Leadership development programs in health care often fail due to their lack of adaptability to the schedules of busy clinicians. This study addressed the need for scalable, flexible programs tailored to nurse leaders. Objective: This study evaluated the acceptability, appropriateness, and feasibility of the Relational Playbook, an evidence-based leadership development program developed in the Veterans Health Administration delivered through the Whistle Systems employee recognition web application and mobile app. Methods: A 1-year, single-team pilot was deployed using descriptive survey data and qualitative interview analysis. The Relational Playbook’s educational content and interventions were hosted on the Whistle platform, which integrates behavioral science and gamification strategies. Content was delivered weekly via app-based nudge notifications and email. Engagement metrics included activity completion rates. User experience data were collected through weekly reflection surveys (with Likert-scale responses and open-text options); monthly check-ins; and a postimplementation acceptability, appropriateness, and feasibility survey and interview. Descriptive statistics summarized engagement levels and trends, and qualitative data were analyzed using content analysis to identify recurring concepts. Quantitative and qualitative data were analyzed sequentially for comprehensive insights. Results: The section chief and 4 practicing cardiology nurse practitioners from a large academic medical center participated. The nurse practitioner section chief deemed the Whistle platform an acceptable, appropriate, and feasible technology for delivering the Relational Playbook content. They valued the weekly nudges, microlearning content, and flexibility of the web application and mobile app. The Relational Playbook content supported their personal growth and fostered positive shifts in attitudes toward work. Conclusions: Delivering leadership development content through the Whistle platform is an acceptable approach to support the growth and well-being of busy nurse leaders. The small sample and absence of a comparison group limit generalizability. %R 10.2196/79188 %U https://nursing.jmir.org/2026/1/e79188 %U https://doi.org/10.2196/79188 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 8 %N %P e68048 %T Determinants of Nurses’ Continuance Intention to Use Mobile Health Apps in Clinical Nursing Practice: Structural Equation Modeling to Extend the Expectation-Confirmation Model %A Mirabootalebi,Narjes %A Holl,Felix %A Meidani,Zahra %A Rangraz Jeddi,Fatemeh %A Tagharrobi,Zahra %A Akbari,Hossein %A Swoboda,Walter %K continuance intention %K expectation–confirmation model %K habits %K mobile health apps %K perceived usefulness %K user satisfaction %K technology anxiety %D 2025 %7 31.10.2025 %9 %J JMIR Nursing %G English %X Background: Mobile health (mHealth) apps enhance clinical nursing by improving access to resources and patient care. Further benefits include reduced errors, time savings, better communication, cost reduction, and training. Understanding factors driving nurses’ continued mHealth adoption is key to its sustained success. Objective: This study extends the expectation-confirmation model (ECM) to explore the determinants of Iranian nurses’ continuance intention to use mHealth apps in their daily clinical routines. Methods: A cross-sectional, descriptive-analytical study was conducted among 315 nurses from hospitals affiliated with Kashan University of Medical Sciences. The Nurses’ Mobile Health Device Acceptance Scale (NMHDA-Scale) was developed by the authors in 2022. The Intention to Continue Using Mobile Health Applications for Nurses questionnaire assesses nurses’ future willingness to use mHealth apps in their practice. This questionnaire was designed based on the ECM and the approach by Waltz et al. Its primary aim is to identify the factors that influence mHealth device acceptance, specifically among clinical nurses, as previous studies have not focused on this group and have shown inconsistent relationships between various factors. Participants completed structured questionnaires measuring perceived usefulness, perceived ease of use, social influence, habits, and technology anxiety. Data were analyzed using structural equation modeling in AMOS (version 26). The model tested relationships among confirmation, perceived usefulness, social influence, technology anxiety, and mHealth continuance behavior. Results: The analyzed sample (n=315) consisted primarily of female (252/315, 80%) and married (243/315, 77.1%) nurses, with a mean age of 35.67 (SD 1.24) years. The analysis revealed that perceived usefulness was significantly influenced by both confirmation (P<.001) and social influence (P<.001). Perceived ease of use was negatively impacted by new technology anxiety (P<.001), indicating that higher anxiety levels reduced perceived ease of use. Additionally, mHealth continuance behavior was positively associated with habits (P=.002), social influence (P<.001), and perceived security risks (P=.008). Contrary to expectations, perceived usefulness did not directly influence mHealth continuance (P=.15), suggesting that other factors, such as habits and social influence, play a more significant role in long-term use. Conclusions: Sustained mHealth app use by nurses hinges more on social influence and confirmed expectations than perceived usefulness. Although new technology anxiety remains a barrier, habits and social influence are key to long-term adoption. Hospital leaders should prioritize strategies that foster positive social reinforcement, minimize security concerns, and reduce anxiety through training and support when integrating mHealth into nursing workflows. These findings offer critical insights for improving digital health implementation, ultimately enhancing patient care and clinical efficiency. %R 10.2196/68048 %U https://nursing.jmir.org/2025/1/e68048 %U https://doi.org/10.2196/68048 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e67623 %T Exploring the Impact of Home-Based Serious Smartphone Resuscitation Gaming on Stress Among Nursing Students Practicing Simulated Adult Basic Life Support: Randomized Waitlist Controlled Trial %A Fijačko,Nino %A Abella,Benjamin S %A Metličar,Špela %A Kopitar,Leon %A Greif,Robert %A Štiglic,Gregor %A Skok,Pavel %A Strnad,Matej %K adult basic life support %K stress %K serious games %K gaming %K nursing student %K simulation %K randomized controlled trial %K RCT %K smartphone %D 2025 %7 29.8.2025 %9 %J JMIR Serious Games %G English %X Background: Simulation-based training is widely used in resuscitation education, yet limited research exists on how serious smartphone games—especially when used independently at home—impact stress levels during simulated adult basic life support (BLS). Understanding this relationship may offer new approaches to preparing health care students for high-stress clinical situations. Objective: This study aimed to evaluate the impact of a home-based serious resuscitation game, MOBICPR, on physiological stress markers among nursing students performing simulated adult BLS. Methods: In this single-center, randomized, waitlist controlled trial, 43 first-year nursing students were assigned to either an intervention group (IG) or a waitlist control group (WL-CG). Stress was measured at baseline and 2-week and 4-week follow-ups using electrodermal activity (EDA), blood volume pulse (BVP), heart rate (HR), and body temperature (BT) collected via the Empatica E4 wearable (Empatica Inc., USA). Each data collection point included 3 phases: mandala coloring before and after simulated adult BLS performance, and the adult BLS scenario itself. The MOBICPR game—a serious mobile game designed per the 2021 European Resuscitation Council adult BLS guidelines—was played at home over 2 weeks by IG (weeks 0‐2) and WL-CG (weeks 2‐4). A random forest classifier, trained on the AffectiveRoad dataset, predicted stress levels (none, moderate, and high) based on physiological signals. Results: Of 124 students invited, 43 participated (22 in IG, 21 in WL-CG; 38/43, 88% female; mean age of 19, SD 0.6 years). EDA, BVP, and BT significantly changed across measurement phases in both groups (P<.05), while HR did not show consistent differences (P>.05). Stress classification showed a significant decrease in stress after simulated adult BLS in the IG at the 2-week follow-up (P=.04), but not in the WL-CG. After 2 weeks of gameplay, 12 of 22 participants in the IG had lower stress levels after performing simulated adult BLS compared to before, suggesting an adaptive stress response. No significant group-level stress reductions were observed over time. Conclusions: Short-term, home-based gameplay using a serious resuscitation game modestly influenced physiological indicators of stress during simulated adult BLS among nursing students. While overall group stress levels remained stable, individualized responses suggested improved coping for some. Incorporating serious games into curricula could offer learners safe, gamified environments to rehearse stressful clinical scenarios. Future research should explore optimal game frequency and content depth to maximize educational and emotional resilience outcomes. Trial Registration: ClinicalTrials.gov NCT05784675; https://clinicaltrials.gov/study/NCT05784675 %R 10.2196/67623 %U https://games.jmir.org/2025/1/e67623 %U https://doi.org/10.2196/67623 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e66262 %T Preliminary Efficacy of a Gamified Mobile App for Promoting Self-Health Management Among Nurses in the Post-COVID Era: Single-Group Pre-Post Study %A Hsu,Shao Huan %A Lu,Li Jung %A Chou,Pei Chin %+ College of Management, Institute of Healthcare Information Management, National Chung Cheng University, No. 168, Section 1, Daxue Road, Minxiong Township, Chiayi County, 621301, Taiwan, 886 +886 972091305, e4810.y0058@msa.hinet.net %K gamification %K mobile health %K nurse wellness %K self-health management %K post-COVID %K health care technology %K behavioral intervention %K digital health %K health promotion %K exercise adherence %D 2025 %7 3.7.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID-19 pandemic has significantly affected health care professionals, especially nurses, who have experienced elevated levels of stress, burnout, and physical health challenges. In the postpandemic era, supporting their well-being is crucial. Gamification, which is the application of game design elements in nongame contexts, has emerged as a promising strategy to promote engagement in health behaviors. This study explores the use of a gamified mobile app to support self-health management among nurses recovering from the COVID-19 experience. Objective: This study aimed to evaluate the preliminary efficacy of a gamified mobile app for promoting self-health management among nurses who experienced the COVID-19 pandemic. The study examined whether gamification could enhance engagement, improve physical health outcomes, and encourage sustainable behavior change. Methods: A single-arm pre-post intervention study was conducted using a user-centered design. The app was developed based on the Octalysis framework and goal-setting theory, incorporating personalized exercise prescriptions and health monitoring features. Nurses from a regional hospital in Hsinchu, Taiwan, participated in the 8-week intervention. Data were collected through interviews, pre- and postintervention surveys, and app usage analytics. Key outcomes included changes in step counts, BMI, and user engagement. Results: After the intervention, BMI classification improved significantly. The proportion of participants classified as obese decreased from 38.5% (90/234) to 13.7% (32/234), and the proportion of those classified as overweight increased from 24.8% (58/234) to 34.6% (81/234). Overall, the combined proportion of overweight or obese participants declined from 63.2% (148/234) to 48.3% (113/234), and that of participants with normal BMI increased from 18.4% (43/234) to 33.8% (79/234) (χ24=29.98; P<.001). Octalysis tool results showed strong motivational engagement, with the highest scores in development and accomplishment (mean 7.29), epic meaning and calling (mean 7.05), and empowerment of creativity and feedback (mean 6.55). Conclusions: The gamified mobile app demonstrated promising efficacy in enhancing self-health management among nurses in the post-COVID era by increasing physical activity and improving BMI. Gamification elements, such as achievement, purpose, and feedback, were effective in sustaining engagement. Further studies are recommended to assess long-term outcomes and broader applicability. %R 10.2196/66262 %U https://games.jmir.org/2025/1/e66262 %U https://doi.org/10.2196/66262 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 17 %N %P e69679 %T Proof of Concept for a Digital Framework to Support a Shared Agenda at Surgical Ward Rounds: Participatory Design Study %A Poulsen,Helle %A Clemensen,Jane %A Ammentorp,Jette %A Kofoed,Poul-Erik %A Wolderslund,Maiken %K surgical ward rounds %K structured interprofessional bedside rounds %K digital technologies %K logistics system %K patient participation %K family involvement %K mobile health app %D 2025 %7 19.6.2025 %9 %J J Particip Med %G English %X Background: Surgical ward rounds (SWRs) are often unstructured and deprioritized compared to traditional surgical tasks, leading to limited interdisciplinary collaboration, unprepared patients, and low family attendance. Objective: This study aims to co-design and develop a digital framework to facilitate a shared agenda for SWRs, ensuring all core participants can attend and participate effectively. Methods: Participatory design (PD) methodologies were used, using user-engaging activities within an iterative process. A multidisciplinary team, including patients, relatives, health care providers, technology designers, and researchers, collaborated in workshops and testing to translate user needs into prototypes of technologies consisting of the digital framework. Results: A logistics system was developed for nurses to prebook the SWRs in designated time slots, enabling them to prepare relevant data and partake in the dialogue with patients. In addition, a mobile health (mHealth) app displayed the schedule for patients and relatives, helping them to participate and prepare questions in advance. Multiple iterations ensured that the digital framework met user needs and was feasible for clinical practice. Conclusions: Our findings underscore the importance of collaboration between users and technology designers in developing digital health technologies. Engaging the users helped identify technical and organizational constraints that needed to be addressed to integrate the digital framework into clinical settings. %R 10.2196/69679 %U https://jopm.jmir.org/2025/1/e69679 %U https://doi.org/10.2196/69679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68173 %T The Norwegian Version of the Self-Efficacy in Clinical Performance Scale (SECP): Psychometric Validation Study %A Olaussen,Camilla %A Stojiljkovic,Marko %A Zlamal,Jaroslav %A Flølo,Tone Nygaard %A Nes,Andréa Aparecida Gonçalves %K clinical performance %K self-efficacy %K instrument validation %K nursing education %K psychometric analysis %K Norway %K psychometric %K validation study %K competence %K clinical practice %K translate %K translation %K cross-sectional study %K nursing student %K reliability %D 2025 %7 21.4.2025 %9 %J JMIR Form Res %G English %X Background: Previous research has demonstrated a correlation between nursing students’ self-efficacy and their clinical performance, competence, and behavior during clinical practice placements. Assessing students’ self-efficacy in clinical performance could be a valuable method for identifying areas that need reinforcement and for recognizing students who may require additional support during clinical practice placements. Objective: This study aimed to translate the Self-Efficacy in Clinical Performance Scale (SECP) from English into Norwegian and to evaluate the psychometric properties of the Norwegian version. Methods: A cross-sectional study design was used. The SECP was translated into Norwegian following a 6-step process: forward translation, forward translation synthesis, backward translation, backward translation synthesis, cognitive debriefing, and psychometric testing. The validity and reliability of the translated version were assessed using confirmatory factor analysis (CFA), Cronbach α, McDonald ω, and composite reliability. Results: A total of 399 nursing students completed the Norwegian version of the SECP. The CFA goodness-of-fit indices (χ2/df ratio=1.578, comparative fit index=0.98, Tucker-Lewis index=0.98, standardized root mean square residual=0.056, root mean square error of approximation=0.038) indicated an acceptable model fit. Reliability measures, including Cronbach ⍺, McDonald ω, and composite reliability, were high, with factor-level values ranging from 0.94 to 0.98. Conclusion: The Norwegian version of the SECP demonstrated strong potential as an instrument for assessing self-efficacy in both current and required competencies among nursing students in clinical practice within nursing education. Future research should aim to confirm the factor structure of the SECP and evaluate its test-retest reliability. %R 10.2196/68173 %U https://formative.jmir.org/2025/1/e68173 %U https://doi.org/10.2196/68173 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52644 %T Serious Game for the Nursing Assessment of Home-Dwelling Older Adults: Development and Validation Study %A Busca,Erica %A Caristia,Silvia %A Bidone,Sara Palmira %A Bolamperti,Alessia %A Campagna,Sara %A Cattaneo,Arianna %A Lea,Rosaria %A Montani,Doriana %A Scalogna,Antonio %A Piovesan,Francesca %A Bassi,Erika %A Dal Molin,Alberto %+ Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale, Piazza Sant’Eusebio 5, Vercelli, 13100, Italy, 39 +393287472630, silvia.caristia@uniupo.it %K nursing education %K serious game %K simulation training %K validation study %K home-dwelling older adults %K continuing education %K nursing students %K Family and Community Nursing %K validity %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: The use of serious games (SGs) in nursing education is increasing, with the COVID-19 pandemic significantly accelerating their development. A key feature of SGs is their flexibility, allowing students to train at any place and time as needed. Recently, there has been a shift from developing disease-specific SGs to games focused on broader health issues. However, there has been a lack of proposals to enhance nursing interventions in home and frail care settings. The REACtion project developed a SG to improve students’ understanding and clinical reasoning in caring for home-dwelling older adults. Objective: This study aims to describe the development of “REACtion Game” (RG) and explore its validity as an educational tool. A multidisciplinary team created a SG that simulates the assessment process of older adults in home settings by nurses. It features web-based scenarios, clickable objects, and a menu with tools, and medical records to enhance nursing students’ knowledge and clinical reasoning skills. Methods: A prospective, observational study was conducted using the Dutch Society for Simulation in Healthcare’s framework to validate the game. Further, 5 experts in home health care nursing evaluated content validity, while 30 students assessed construct validity, face validity, concurrent validity (by comparing game scores with those from the Nursing Clinical Reasoning Scale), game quality, and usability. Data were collected through self-administered web-based questionnaires and the debriefings of each match played. The students were enrolled in 2 postgraduate nursing programs: a master of science in nursing degree and a first-level continuing education in family and community nursing. Results: Experts rated the content validity highly after revisions (universal agreement calculation method of scale-level content validity index=0.97). The sample consisted of 30 students, predominantly women (n=20, 67%) and aged younger than 45 years (n=23, 77%) with no prior experience in SG. Almost all students had a positive impression of RG as an attractive and useful method for learning new knowledge. Participants found the cases, scenarios, and dialogues realistic (face validity) and of high quality, though usability aspects such as instructions clarity and intelligibility of game progression were less favored. Construct validity showed general agreement on the game’s educational value, with family and community nursing students reporting more consistent alignment with educational goals. Overall, RG scores correlated positively with time spent playing but showed limited correlation with Nursing Clinical Reasoning Scale scores. Conclusions: This study developed and validated a nursing education game, especially valuable as simulation is underused in some curricula. Created during the pandemic, it offered a digital learning environment. Although the game shows potential, further testing is needed for usability, concurrent validity, and functional improvements. Future research should involve larger samples to fully validate the game and assess its impact on academic achievement. %R 10.2196/52644 %U https://games.jmir.org/2024/1/e52644 %U https://doi.org/10.2196/52644 %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 %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46954 %T Experiences of Electronic Health Records’ and Client Information Systems’ Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study %A Paatela,Satu %A Kyytsönen,Maiju %A Saranto,Kaija %A Kinnunen,Ulla-Mari %A Vehko,Tuulikki %+ Health and Social Service System Research, Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland, 358 29 524 77 22, satu.paatela@thl.fi %K practical nurse %K information and communication technology %K electronic health record %K client information system %K documentation %K mobile technology %D 2024 %7 29.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today’s era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients’ homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities. Objective: This study aims to analyze practical nurses’ experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device. Methods: A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings. Results: The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses’ office (OR 2.33, 95% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not. Conclusions: To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use. %M 38809583 %R 10.2196/46954 %U https://www.jmir.org/2024/1/e46954 %U https://doi.org/10.2196/46954 %U http://www.ncbi.nlm.nih.gov/pubmed/38809583 %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 %@ 2562-7600 %I JMIR Publications %V 7 %N %P e54561 %T mHealth Gratitude Exercise Mindfulness App for Resiliency Among Neonatal Intensive Care Unit Staff: Three-Arm Pretest-Posttest Interventional Study %A Peterson,Neil E %A Thomas,Michael %A Hunsaker,Stacie %A Stewart,Tevin %A Collett,Claire J %+ College of Nursing, Brigham Young University, 500 Spencer West Kimball Tower (KMBL), Provo, UT, 84602, United States, 1 8014224893, neil-peterson@byu.edu %K burnout %K compassion fatigue %K compassion satisfaction %K secondary trauma %K trauma %K satisfaction %K compassion %K gratitude %K resilience %K quality of life %K QoL %K mindfulness %K meditation %K exercise %K happiness %K mHealth %K mobile health %K app %K apps %K applications %K neonatal intensive care unit %K NICU %K intensive care unit %K ICU %K intensive care %K nurse %K nurses %K nursing %K health care worker %K health care workers %K provider %K providers %K phone app %K physical activity %K resiliency %K mobile phone %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Nursing %G English %X Background: Health care is highly complex and can be both emotionally and physically challenging. This can lead health care workers to develop compassion fatigue and burnout (BO), which can negatively affect their well-being and patient care. Higher levels of resilience can potentially prevent compassion fatigue and BO. Strategies that enhance resilience include gratitude, exercise, and mindfulness. Objective: The purpose of this study was to determine if a 3-week daily resiliency practice, prompted via a gratitude, exercise, and mindfulness smartphone app, impacted the professional quality of life, physical activity, and happiness level of health care workers in a newborn intensive care unit setting. Methods: In total, 65 participants from a level III newborn intensive care unit at a regional hospital in the western United States completed this study. The Professional Quality of Life Scale, Physical Activity Vital Sign, and Subjective Happiness Score instruments were used to evaluate the effects of the mobile health (mHealth) intervention. Further, 2-tailed dependent paired t tests were used to evaluate participant pre- and postintervention instrument scores. Multiple imputation was used to predict scores of participants who practiced an intervention but did not complete the 3 instruments post intervention. Results: Dependent t tests using the original data showed that participants, as a whole, significantly improved in BO (t35=2.30, P=.03), secondary trauma stress (STS; t35=2.11, P=.04), and happiness (t35=–3.72, P<.001) scores. Compassion satisfaction (CS; t35=–1.94, P=.06) and exercise (t35=–1.71, P=.10) were trending toward, but did not reach, significance. Using the original data, only the gratitude intervention group experienced significant improvements (CS, BO, and happiness), likely due to the higher number of participants in this group. Analysis using imputed data showed that participants, as a whole, had significant improvements in all areas: CS (t64=–4.08, P<.001), BO (t64=3.39, P=.001), STS (t64=4.08, P<.001), exercise (t64=–3.19, P=.002), and happiness (t64=–3.99, P<.001). Looking at the intervention groups separately using imputed data, the gratitude group had significant improvements in CS, BO, STS, and happiness; the exercise group had significant improvements in STS and exercise; and the mindfulness group had significant improvements in CS and happiness. Conclusions: Phone app delivery of resilience-enhancing interventions is a potentially effective intervention model for health care workers. Potential barriers to mHealth strategies are the technical issues that can occur with this type of intervention. Additional longitudinal and experimental studies with larger sample sizes need to be completed to better evaluate this modality. %M 38363595 %R 10.2196/54561 %U https://nursing.jmir.org/2024/1/e54561 %U https://doi.org/10.2196/54561 %U http://www.ncbi.nlm.nih.gov/pubmed/38363595 %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 %@ 2562-7600 %I JMIR Publications %V 6 %N %P e50991 %T Personal Health Tracking: A Paradigm Shift in the Self-Care Models in Nursing %A Choi,Soyoung %+ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 272 Freer Hall, 906 S. Goodwin Ave, Urbana, IL, 61801, United States, 1 2173332573, soyoung@illinois.edu %K personal health data %K personal informatics %K self-care %K self-tracking %K mobile health technology %K human-technology %K human-computer %K human computer interaction %K health tracking %K framework %K frameworks %K model %K models %K mHealth %K mobile health %K informatics %D 2023 %7 20.9.2023 %9 Viewpoint %J JMIR Nursing %G English %X The rapidly evolving digital health landscape necessitates updates to existing self-care models in nursing. This viewpoint paper revisits and evaluates prevalent models, recognizing their comprehensive exploration of self-care concepts while also identifying a gap in the incorporation of personal informatics. It underscores the missing link of human-technology interplay, an essential aspect in understanding self-care practices within digital generations. The author delineates the role of personal health tracking in self-care and the achievement of desired health outcomes. Based on these insights, the author proposes a refined, digitized self-care model that incorporates mobile health (mHealth) technologies and self-tracking behaviors. The paper concludes by advocating the application of this model for future mHealth nursing interventions, providing a framework for facilitating patient self-care and improving health and well-being in the era of digital health. %M 37728970 %R 10.2196/50991 %U https://nursing.jmir.org/2023/1/e50991 %U https://doi.org/10.2196/50991 %U http://www.ncbi.nlm.nih.gov/pubmed/37728970 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e44435 %T Differing Effects of Implementation Leadership Characteristics on Nurses’ Use of mHealth Technologies in Clinical Practice: Cross-Sectional Survey Study %A Ronquillo,Charlene Esteban %A Dahinten,V Susan %A Bungay,Vicky %A Currie,Leanne M %+ School of Nursing, The University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 250 807 8332, charlene.ronquillo@ubc.ca %K mobile health %K mHealth applications %K nursing %K leadership %K implementation science %K nursing informatics %D 2023 %7 25.8.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: Leadership has been consistently identified as an important factor in shaping the uptake and use of mobile health (mHealth) technologies in nursing; however, the nature and scope of leadership remain poorly delineated. This lack of detail about what leadership entails limits the practical actions that can be taken by leaders to optimize the implementation and use of mHealth technologies among nurses working clinically. Objective: This study aimed to examine the effects of first-level leaders’ implementation leadership characteristics on nurses’ intention to use and actual use of mHealth technologies in practice while controlling for nurses’ individual characteristics and the voluntariness of use, perceived usefulness, and perceived ease of use of mHealth technologies. Methods: A cross-sectional exploratory correlational survey study of registered nurses in Canada (n=288) was conducted between January 1, 2018, and June 30, 2018. Nurses were eligible to participate if they provided direct care in any setting and used employer-provided mHealth technologies in clinical practice. Hierarchical multiple regression analyses were conducted for the 2 outcome variables: intention to use and actual use. Results: The implementation leadership characteristics of first-level leaders influenced nurses’ intention to use and actual use of mHealth technologies, with 2 moderating effects found. The final model for intention to use included the interaction term for implementation leadership characteristics and education, explaining 47% of the variance in nurses’ intention to use mHealth in clinical practice (F10,228=20.14; P<.001). An examination of interaction plots found that implementation leadership characteristics had a greater influence on the intention to use mHealth technologies among nurses with a registered nurse diploma or a bachelor of nursing degree than among nurses with a graduate degree or other advanced education. For actual use, implementation leadership characteristics had a significant influence on the actual use of mHealth over and above the control variables (nurses’ demographic characteristics, previous experience with mHealth, and voluntariness) and other known predictors (perceived usefulness and perceived ease of use) in the model without the implementation leadership × age interaction term (β=.22; P=.001) and in the final model that included the implementation leadership × age interaction term (β=−.53; P=.03). The final model explained 40% of the variance in nurses’ actual use of mHealth in their work (F10,228=15.18; P<.001). An examination of interaction plots found that, for older nurses, implementation leadership characteristics had less of an influence on their actual use of mHealth technologies. Conclusions: Leaders responsible for the implementation of mHealth technologies need to assess and consider their implementation leadership behaviors because these play a role in influencing nurses’ use of mHealth technologies. The education level and age of nurses may be important factors to consider because different groups may require different approaches to optimize their use of mHealth technologies in clinical practice. %M 37624628 %R 10.2196/44435 %U https://nursing.jmir.org/2023/1/e44435 %U https://doi.org/10.2196/44435 %U http://www.ncbi.nlm.nih.gov/pubmed/37624628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39525 %T Patients’ Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis %A Madujibeya,Ifeanyi %A Lennie,Terry A %A Pelzel,Jamie %A Moser,Debra K %+ Research and Interventions for Cardiovascular Health Heart Program, College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, United States, 1 8593340561, ima232@uky.edu %K heart failure %K patients’ experiences %K experience %K satisfaction %K facilitator %K mobile health apps %K mobile app %K health app %K app feature %K mobile health %K cardiology %K cardiovascular %K patient care %K self-management %K patient %K heart %K mHealth %K self-care %K medication %K performance %K feedback %K personalized %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)–related self-care. However, there is a dearth of research on patients’ experiences using mHealth apps for self-care in real-world settings. Objective: The purpose of this study was to explore patients’ experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. Methods: Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients’ responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). Results: Patients (median age 64, IQR 57-71 years; 17/23, 74% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). Conclusions: Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care. %M 37581912 %R 10.2196/39525 %U https://formative.jmir.org/2023/1/e39525 %U https://doi.org/10.2196/39525 %U http://www.ncbi.nlm.nih.gov/pubmed/37581912 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e38063 %T Understanding Whole-Person Health and Resilience During the COVID-19 Pandemic and Beyond: A Cross-sectional and Descriptive Correlation Study %A Rajamani,Sripriya %A Austin,Robin %A Geiger-Simpson,Elena %A Jantraporn,Ratchada %A Park,Suhyun %A Monsen,Karen A %+ University of Minnesota, 5-140 Weaver-Densford Hall; 308 Harvard St SE, Minneapolis, MN, 55455, United States, 1 6512787426, sripriya@umn.edu %K Omaha System %K whole-person health %K strengths %K resilience %K assessment %K app %K health information technology %K health informatics %K nursing %K health care %K mobile health %K health application %K mHealth %K health data %K health community %K digital health %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: The COVID-19 pandemic has prompted an interest in whole-person health and emotional well-being. Informatics solutions through user-friendly tools such as mobile health apps offer immense value. Prior research developed a consumer-facing app MyStrengths + MyHealth using Simplified Omaha System Terms (SOST) to assess whole-person health. The MyStrengths + MyHealth app assesses strengths, challenges, and needs (SCN) for 42 concepts across four domains (My Living, My Mind and Networks, My Body, My Self-care; eg, Income, Emotions, Pain, and Nutrition, respectively). Given that emotional well-being was a predominant concern during the COVID-19 pandemic, we sought to understand whole-person health for participants with/without Emotions challenges. Objective: This study aims to use visualization techniques and data from attendees at a Midwest state fair to examine SCN overall and by groups with/without Emotions challenges, and to explore the resilience of participants. Methods: This cross-sectional and descriptive correlational study surveyed adult attendees at a 2021 Midwest state fair. Data were visualized using Excel and analyzed using descriptive and inferential statistics using SPSS. Results: The study participants (N=182) were primarily female (n=123, 67.6%), aged ≥45 years (n=112, 61.5%), White (n=154, 84.6%), and non-Hispanic (n=177, 97.3%). Compared to those without Emotions challenges, those with Emotions challenges were aged 18-44 (P<.001) years, more often female (P=.02), and not married (P=.01). Overall, participants had more strengths (mean 28.6, SD 10.5) than challenges (mean 12, SD 7.5) and needs (mean 4.2, SD 7.5). The most frequent needs were in Emotions, Nutrition, Income, Sleeping, and Exercising. Compared to those without Emotions challenges, those with Emotions challenges had fewer strengths (P<.001), more challenges (P<.001), and more needs (P<.001), along with fewer strengths for Emotions (P<.001) and for the cluster of health-related behaviors domain concepts, Sleeping (P=.002), Nutrition (P<.001), and Exercising (P<.001). Resilience was operationalized as correlations among strengths for SOST concepts and visualized for participants with/without an Emotions challenge. Those without Emotions challenges had more positive strengths correlations across multiple concepts/domains. Conclusions: This survey study explored a large community-generated data set to understand whole-person health and showed between-group differences in SCN and resilience for participants with/without Emotions challenges. It contributes to the literature regarding an app-aided and data-driven approach to whole-person health and resilience. This research demonstrates the power of health informatics and provides researchers with a data-driven methodology for additional studies to build evidence on whole-person health and resilience. %M 35576563 %R 10.2196/38063 %U https://nursing.jmir.org/2022/1/e38063 %U https://doi.org/10.2196/38063 %U http://www.ncbi.nlm.nih.gov/pubmed/35576563 %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 %@ 2562-7600 %I JMIR Publications %V 4 %N 3 %P e28139 %T Experiences of Using a Self-management Mobile App Among Individuals With Heart Failure: Qualitative Study %A Schmaderer,Myra %A Miller,Jennifer N %A Mollard,Elizabeth %+ College of Nursing, University of Nebraska Medical Center, 550 N 19th HCCN, PO Box 880220, Lincoln, NE, 68588, United States, 1 402 472 7335, mschmade@unmc.edu %K mHealth %K eHealth %K mobile applications %K patient experiences %K patient perceptions %K self-management %K self-care %K heart failure %K congestive heart failure %K heart decompensation %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Nursing %G English %X Background: Interventions that focus on the self-management of heart failure are vital to promoting health in patients with heart failure. Mobile health (mHealth) apps are becoming more integrated into practice to promote self-management strategies for chronic diseases, optimize care delivery, and reduce health disparities. Objective: The purpose of this study was to explore the experience of using a self-management mHealth intervention in individuals with heart failure to inform a future mHealth intervention study. Methods: This study used a qualitative descriptive design. Participants were enrolled in the intervention groups of a larger parent study using a mobile app related to self-management of heart failure. The purposive, convenient, criterion-based sample for this qualitative analysis comprised 10 patients who responded to phone calls and were willing to be interviewed. Inclusion criteria for the parent study were adults who were hospitalized at Nebraska Medical Center with a primary diagnosis and an episode of acute decompensated heart failure; discharged to home without services such as home health care; had access to a mobile phone; and were able to speak, hear, and understand English. Results: Study participants were middle-aged (mean age 55.8, SD 12 years; range 36-73 years). They had completed a mean of 13.5 (SD 2.2) years (range 11-17 years) of education. Of the 10 participants, 6 (60%) were male. Half of them (5/10, 50%) were New York Heart Association Classification Class III patients and the other half were Class IV patients. The intervention revealed four self-management themes, including (1) I didn’t realize, and now I know; (2) It feels good to focus on my health; (3) I am the leader of my health care team; and (4) My health is improving. Conclusions: Participants who used a self-management mHealth app intervention for heart failure reported an overall positive experience. Their statements were organized into four major themes. The education provided during the study increased self-awareness and promoted self-management of their heart failure. The mHealth app supported patient empowerment, resulting in better heart failure management and improved quality of life. Participants advocated for themselves by becoming the leader of their health, especially when communicating with their health care team. Finally, the mHealth app was used by the participants as a self-management tool to assist in symptom management and improve their overall health. Future research should study symptom evaluation, medication tracking, and possibly serve as a health provider communication platform to empower individuals to be leaders in their chronic disease management. %M 34406966 %R 10.2196/28139 %U https://nursing.jmir.org/2021/3/e28139 %U https://doi.org/10.2196/28139 %U http://www.ncbi.nlm.nih.gov/pubmed/34406966 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 4 %N 3 %P e19709 %T Enabling Nurse-Patient Communication With a Mobile App: Controlled Pretest-Posttest Study With Nurses and Non–English-Speaking Patients %A Silvera-Tawil,David %A Pocock,Courtney %A Bradford,DanaKai %A Donnell,Andrea %A Freyne,Jill %A Harrap,Karen %A Brinkmann,Sally %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Cnr Vimiera and Pembroke Roads, Marsfield, 2121, Australia, 61 293724282, david.silvera-tawil@csiro.au %K nursing %K interpersonal communication %K mobile app %K information technology %K communication barrier %K diversity %K interpreters %K mHealth %K mobile phone %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Nursing %G English %X Background: There is growing concern regarding the implications of miscommunication in health care settings, the results of which can have serious detrimental impacts on patient safety and health outcomes. Effective communication between nurses and patients is integral in the delivery of timely, competent, and safe care. In a hospital environment where care is delivered 24 hours a day, interpreters are not always available. In 2014, we developed a communication app to support patients’ interactions with allied health clinicians when interpreters are not present. In 2017, we expanded this app to meet the needs of the nursing workforce. The app contains a fixed set of phrases translated into common languages, and communication is supported by text, images, audio content, and video content. Objective: This study aims to evaluate the efficacy of the communication app to support nursing staff during the provision of standard care to patients from non–English-speaking backgrounds when an interpreter is not available. Methods: This study used a one-group pretest-posttest sequential explanatory mixed methods research design, with quantitative data analyzed using inferential statistics and qualitative data analyzed via thematic content analysis. A total of 134 observation sessions (82 pretest and 52 posttest) of everyday nurse-patient interactions and 396 app use sessions were recorded. In addition, a total of 134 surveys (82 pretest and 52 posttest) with nursing staff, 7 interviews with patients, and 3 focus groups with a total of 9 nursing staff participants were held between January and November 2017. Results: In the absence of the app, baseline interactions with patients from English-speaking backgrounds were rated as more successful (t80=5.69; P<.001) than interactions with patients from non–English-speaking backgrounds. When staff used the app during the live trial, interactions with patients from non–English-speaking backgrounds were rated as more successful than interactions without the app (F2,119=8.17; P<.001; η2=0.37). In addition, the level of staff frustration was rated lower when the app was used to communicate (t80=2.71; P=.008; r=0.29). Most participants indicated that the app assisted them in communicating. Conclusions: Through the use of the app, a number of patients from non–English-speaking backgrounds experienced better provision of standard care, similar to their English-speaking peers. Thus, the app can be seen as contributing to the delivery of equitable health care. %M 34406964 %R 10.2196/19709 %U https://nursing.jmir.org/2021/3/e19709 %U https://doi.org/10.2196/19709 %U http://www.ncbi.nlm.nih.gov/pubmed/34406964 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e28729 %T The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study %A Heponiemi,Tarja %A Kaihlanen,Anu-Marja %A Gluschkoff,Kia %A Saranto,Kaija %A Nissinen,Sari %A Laukka,Elina %A Vehko,Tuulikki %+ Department of Public Health and Welfare, Finnish Institute for Health and Welfare, PO Box 30, Helsinki, 00271, Finland, 358 295247434, tarja.heponiemi@thl.fi %K stress related to information systems %K time pressure %K usability %K stress %K health and social care %D 2021 %7 6.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses’ workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses’ well-being. Objective: This study aimed to examine the association between using a mobile version of the EHR and nurses’ perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators. Methods: This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other). Results: Nurses who used the mobile version of their EHR had higher levels of time pressure (F1,3537=14.96, P<.001) and stress related to information systems (F1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F1,3581=14.93, P<.001), ease of use (F1,3577=10.16, P=.001), and technical quality (F1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs. Conclusions: According to our results, it seems that at present mobile device use is not beneficial for the nurses’ well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses’ workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses. %M 34255704 %R 10.2196/28729 %U https://medinform.jmir.org/2021/7/e28729 %U https://doi.org/10.2196/28729 %U http://www.ncbi.nlm.nih.gov/pubmed/34255704 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e22633 %T Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach %A Egilsdottir,H Ösp %A Heyn,Lena Günterberg %A Brembo,Espen Andreas %A Byermoen,Kirsten Røland %A Moen,Anne %A Eide,Hilde %+ Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Grønland 58, Drammen, 3045, Norway, 47 94886406, osp.egilsdottir@usn.no %K learning %K mobile phone %K mobile application %K education, nursing %K students, nursing %K education, clinical %K nursing skills %K physical examination %K computer simulation %K clinical competence %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor’s degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts. Objective: This study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context. Methods: We used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored. Results: The students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development. Conclusions: The co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students’ perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts. %M 33410756 %R 10.2196/22633 %U https://mhealth.jmir.org/2021/1/e22633 %U https://doi.org/10.2196/22633 %U http://www.ncbi.nlm.nih.gov/pubmed/33410756 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18774 %T Nurses’ Use of Personal Smartphone Technology in the Workplace: Scoping Review %A de Jong,Andrea %A Donelle,Lorie %A Kerr,Michael %+ Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, FNB Rm 2356 Faculty of Health Science Western Uni, 1115 Richmond St, London, ON, N6A 5B9, Canada, 1 5196612111 ext 86565, ldonelle@uwo.ca %K nurses %K digital health %K smartphone %K evidence-informed practice %D 2020 %7 26.11.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: There has been an increase in the technological infrastructures of many health care organizations to support the practice of health care providers. However, many nurses are using their personal digital devices, such as smartphones, while at work for personal and professional purposes. Despite the proliferation of smartphone use in the health care setting, there is limited research on the clinical use of these devices by nurses. It is unclear as to what extent and for what reasons nurses are using their personal smartphones to support their practice. Objective: This review aimed to understand the current breadth of research on nurses’ personal smartphone use in the workplace and to identify implications for research, practice, and education. Methods: A scoping review using Arksey and O’Malley’s methodological framework was conducted, and the following databases were used in the literature search: CINAHL, PubMed, ProQuest Dissertations and Theses, Embase, MEDLINE, Nursing and Allied Health Database, Scopus, Web of Science, and Cochrane Reviews. Search terms used were Nurs* AND (personal digital technology OR smartphone OR cellphone OR mobile phone OR cellular phone). Inclusion criteria included research focused on nurses’ use of their own digital technologies, reported in English, and published between January 2010 and January 2020. Exclusion criteria were if the device or app was implemented for research purposes, if it was provided by the organization, if it focused on infection control, and if it was focused on nursing students or nursing education. Results: A total of 22 out of 2606 articles met the inclusion criteria. Two main themes from the thematic analyses included personal smartphone use for patient care and implications of personal smartphone use. Nurses used their smartphones to locate information about medications, procedures, diagnoses, and laboratory tests. Downloaded apps were used by nurses to locate patient care–related information. Nurses reported improved communication among health team members and used their personal devices to communicate patient information via text messaging, calling, and picture and video functions. Nurses expressed insight into personal smartphone use and challenges related to distraction, information privacy, organizational policies, and patient perception. Conclusions: Nurses view personal smartphones as an efficient method to gather patient care information and to communicate with the health care team. This review highlights knowledge gaps regarding nurses’ personal device use and information safety, patient care outcomes, and communication practices. This scoping review facilitates critical reflection on patient care practices within the digital context. We infer that nurses’ use of their personal devices to communicate among the health care team may demonstrate a technological “work-around” meant to reconcile health system demands for cost-efficiency with efforts to provide quality patient care. The current breadth of research is focused on acute care, with little research focus in other practices settings. Research initiatives are needed to explore personal device use across the continuum of health care settings. %M 33242012 %R 10.2196/18774 %U https://mhealth.jmir.org/2020/11/e18774 %U https://doi.org/10.2196/18774 %U http://www.ncbi.nlm.nih.gov/pubmed/33242012 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e17040 %T Influence of Organizational Issues on Nurse Administrators’ Support to Staff Nurses’ Use of Smartphones for Work Purposes in the Philippines: Focus Group Study %A Bautista,John Robert %A Lin,Trisha T C %A Theng,Yin-Leng %+ School of Information, The University of Texas at Austin, 1616 Guadalupe St, Austin, TX, 78701, United States, 1 5124713821, jrbautista@utexas.edu %K BYOD %K IT consumerization %K nurse administrators %K organizational support %K Philippines %K smartphone %D 2020 %7 10.1.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Studies show that nurses use their own smartphones for work purposes, and there are several organizational issues related to this. However, it is unclear what these organizational issues are in the Philippines and the influence they have on nurse administrators’ (ie, superiors) support to staff nurses’ (ie, subordinates) use of smartphones for work purposes. Objective: Drawing from the Organizational Support Theory (OST), this study aimed to identify organizational issues that influence nurse administrators’ support to staff nurses’ use of smartphones for work purposes. Methods: Between June and July 2017, 9 focus groups with 43 nurse administrators (ie, head nurses, nurse supervisors, and nurse managers) were conducted in 9 tertiary-level general hospitals in Metro Manila, the Philippines. Drawing from OST, issues were classified as those that encouraged or inhibited nurse administrators to support nurses’ use of smartphones for work purposes. Results: Nurse administrators were encouraged to support nurses’ use of smartphones for work purposes when (1) personal smartphones are superior to workplace technologies, (2) personal smartphones resolve unit phone problems, and (3) policy is unrealistic to implement. Conversely, issues that inhibited nurse administrators to support nurses’ use of smartphones for work purposes include (1) smartphone use for nonwork purposes and (2) misinterpretation by patients. Conclusions: Nurse administrators in the Philippines faced several organizational issues that encouraged or inhibited support to staff nurses’ use of smartphones for work purposes. Following OST, the extent of their support can influence staff nurses’ perceived organizational support on the use of smartphones for work purposes, Overall, the findings highlight the role and implication of organizational support in the context of smartphone consumerization in hospital settings, especially in developing countries. %M 34345781 %R 10.2196/17040 %U https://nursing.jmir.org/2020/1/e17040 %U https://doi.org/10.2196/17040 %U http://www.ncbi.nlm.nih.gov/pubmed/34345781 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15195 %T Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study %A Mayer,Miguel Angel %A Rodríguez Blanco,Octavi %A Torrejon,Antonio %+ Col·legi Oficial d'Infermeres i Infermers de Barcelona, Pujades 350, Barcelona, 08019, Spain, 34 932128108, atorrejon@coib.cat %K nurse’s role %K smartphones %K mobile phone %K mobile apps %K mHealth %D 2019 %7 1.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the last few years, the number of mobile apps for health professionals has increased exponentially. Nevertheless, there is a lack of knowledge about the professional use, training requirements, and quality perception of these apps among health care professionals such as nurses. Considering that the nursing profession is the largest segment of health care workforce in many countries such as Spain, the impact of the use of health apps by these professionals can be critical to the future of modern health care. Objective: The main objective of this study was to determine if nurses were using health apps professionally and what types of apps they were using. The secondary objectives were (1) to find out if, among nurses, there is a need for training in the use of health apps and (2) to explore nurses’ perceptions of health professional apps, determining whether there is a need for a certification process for health apps and the type of institution or organization that should review and validate these apps for professional use. Methods: After an initial piloting survey, all registered nurses at the Nursing Association of Barcelona were invited to participate in a 34-item online survey. Eventually, 1293 nurses participated in the survey; however, 52 did not complete the survey properly, omitting both age or gender information, and they were excluded from the analysis. Results: About half of the respondents (600/1241, 48.35%) had health professional apps installed on their devices and were included for analysis. Most participants in the survey were women (474/600, 79.0%) and the remaining were men (126/600, 21.0%). The most popular types of apps used and installed among nurses were related to drug information, health calculators, and health guidelines. Overall, 97.0% (582/600) of nurses thought that the health apps should be certified, and 80.0% (480/600) agreed that the certification process should be carried out by professional or health institutions. Furthermore, 14.5% (87/600) of participants mentioned that they were asked by their patients to prescribe a health app and only 6.5% (28/430) recommended them often. Most nurses (354/433, 81.8%) who answered the question about the importance of receiving specific training on using and prescribing health apps considered this point a very relevant issue. Conclusions: About half of the nurses in Catalonia use health apps for professional purposes, and they believe that these types of tools should be validated and certified by health or professional institutions before using them in clinical environments. Although the prescription of health apps in clinical environments is infrequent among nurses, they would be willing to prescribe apps if they were certified by a health organization. Finally, among nurses, there is a need for training in using and prescribing health apps for health care purposes. %M 31682587 %R 10.2196/15195 %U https://mhealth.jmir.org/2019/11/e15195 %U https://doi.org/10.2196/15195 %U http://www.ncbi.nlm.nih.gov/pubmed/31682587 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 2 %N 1 %P e14633 %T Design of a Consumer Mobile Health App for Heart Failure: Findings From the Nurse-Led Co-Design of Care4myHeart %A Woods,Leanna %A Duff,Jed %A Roehrer,Erin %A Walker,Kim %A Cummings,Elizabeth %+ School of Nursing, University of Tasmania, 1 Leichhardt St, Darlinghurst, Australia, 61 0285727930, leannaj@utas.edu.au %K heart failure %K mobile health (mHealth) %K mobile apps %K self-management %K mobile phone %K patient involvement %D 2019 %7 23.9.2019 %9 Original Paper %J JMIR Nursing %G English %X Background: Consumer health care technology shows potential to improve outcomes for community-dwelling persons with chronic conditions, yet health app quality varies considerably. In partnership with patients and family caregivers, hospital clinicians developed Care4myHeart, a mobile health (mHealth) app for heart failure (HF) self-management. Objective: The aim of this paper was to report the outcomes of the nurse-led design process in the form of the features and functions of the developed app, Care4myHeart. Methods: Seven patients, four family caregivers, and seven multidisciplinary hospital clinicians collaborated in a design thinking process of innovation. The co-design process, involving interviews, design workshops, and prototype feedback sessions, incorporated the lived experience of stakeholders and evidence-based literature in a design that would be relevant and developed with rigor. Results: The home screen displays the priority HF self-management components with a reminder summary, general information on the condition, and a settings tab. The health management section allows patients to list health care team member’s contact details, schedule medical appointments, and store documents. The My Plan section contains nine important self-management components with a combination of information and advice pages, graphical representation of patient data, feedback, and more. The greatest strength of the co-design process to achieve the design outcomes was the involvement of local patients, family caregivers, and clinicians. Moreover, incorporating the literature, guidelines, and current practices into the design strengthened the relevance of the app to the health care context. However, the strength of context specificity is also a limitation to portability, and the final design is limited to the stakeholders involved in its development. Conclusions: We recommend health app development teams strategically incorporate relevant stakeholders and literature to design mHealth solutions that are rigorously designed from a solid evidence base and are relevant to those who will use or recommend their use. %M 34345774 %R 10.2196/14633 %U https://nursing.jmir.org/2019/1/e14633 %U https://doi.org/10.2196/14633 %U http://www.ncbi.nlm.nih.gov/pubmed/34345774 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e11701 %T Addressing Depression Comorbid With Diabetes or Hypertension in Resource-Poor Settings: A Qualitative Study About User Perception of a Nurse-Supported Smartphone App in Peru %A Brandt,Lena R %A Hidalgo,Liliana %A Diez-Canseco,Francisco %A Araya,Ricardo %A Mohr,David C %A Menezes,Paulo R %A Miranda,J Jaime %+ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Avenida Armendariz 497, Miraflores, Lima, Peru, 51 12416978, fdiezcanseco@gmail.com %K mental health %K depression %K noncommunicable diseases %K mHealth %K smartphone %K developing countries %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Smartphone apps could constitute a cost-effective strategy to overcome health care system access barriers to mental health services for people in low- and middle-income countries. Objective: The aim of this paper was to explore the patients’ perspectives of CONEMO (Emotional Control, in Spanish: Control Emocional), a technology-driven, psychoeducational, and nurse-supported intervention delivered via a smartphone app aimed at reducing depressive symptoms in people with diabetes, hypertension or both who attend public health care centers, as well as the nurses’ feedback about their role and its feasibility to be scaled up. Methods: This study combines data from 2 pilot studies performed in Lima, Peru, between 2015 and 2016, to test the feasibility of CONEMO. Interviews were conducted with 29 patients with diabetes, hypertension or both with comorbid depressive symptoms who used CONEMO and 6 staff nurses who accompanied the intervention. Using a content analysis approach, interview notes from patient interviews were transferred to a digital format, coded, and categorized into 6 main domains: the perceived health benefit, usability, adherence, user satisfaction with the app, nurse’s support, and suggestions to improve the intervention. Interviews with nurses were analyzed by the same approach and categorized into 4 domains: general feedback, evaluation of training, evaluation of study activities, and feasibility of implementing this intervention within the existing structures of health system. Results: Patients perceived improvement in their emotional health because of CONEMO, whereas some also reported better physical health. Many encountered some difficulties with using CONEMO, but resolved them with time and practice. However, the interactive elements of the app, such as short message service, android notifications, and pop-up messages were mostly perceived as challenging. Satisfaction with CONEMO was high, as was the self-reported adherence. Overall, patients evaluated the nurse accompaniment positively, but they suggested improvements in the technological training and an increase in the amount of contact. Nurses reported some difficulties in completing their tasks and explained that the CONEMO intervention activities competed with their everyday work routine. Conclusions: Using a nurse-supported smartphone app to reduce depressive symptoms among people with chronic diseases is possible and mostly perceived beneficial by the patients, but it requires context-specific adaptations regarding the implementation of a task shifting approach within the public health care system. These results provide valuable information about user feedback for those building mobile health interventions for depression. %M 31215511 %R 10.2196/11701 %U https://mental.jmir.org/2019/6/e11701/ %U https://doi.org/10.2196/11701 %U http://www.ncbi.nlm.nih.gov/pubmed/31215511 %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 2 %P e11644 %T The MomConnect Nurses and Midwives Support Platform (NurseConnect): A Qualitative Process Evaluation %A Fischer,Alex Emilio %A Sebidi,Jane %A Barron,Peter %A Lalla-Edward,Samanta Tresha %+ Wits Reproductive Health and HIV Institute, University of Witwatersrand, Hillbrow Health Precinct, 22 Esselen Street, HIllbrow, Johannesburg, 2001, South Africa, 27 073 776 2705, afischer@wrhi.ac.za %K evaluation %K mHealth %K mobile phone %K MomConnect %K NurseConnect %K South Africa %D 2019 %7 13.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over the past decade, mobile health has steadily increased in low-income and middle-income countries. However, few platforms have been able to sustainably scale up like the MomConnect program in South Africa. NurseConnect was created as a capacity building component of MomConnect, aimed at supporting nurses and midwives in maternal and child health. The National Department of Health has committed to expanding NurseConnect to all nurses across the country, and an evaluation of the current user experience was conducted to inform a successful scale up. Objective: This study aims to evaluate the perception and use of NurseConnect by nurses and midwives to produce feedback that can be used to optimize the user experience as the platform continues to scale up. Methods: We conducted focus group discussions and in-depth interviews with 110 nurses and midwives from 18 randomly selected health care facilities across South Africa. Questions focused on mobile phone use, access to medical information and their experience with NurseConnect registration, as well as the content and different platforms. Results: All participants had mobile phones and communication through calls and messaging was the main use in both personal and work settings. Of 110 participants, 108 (98.2%) had data-enabled phones, and the internet, Google, and apps (South African National Department of Health Guidelines, iTriage, Drugs.com) were commonly used, especially to find information in the work setting. Of 110 participants, 62 (56.4%) were registered NurseConnect users and liked the message content, especially listeriosis and motivational messages, which created behavioral change in some instances. The mobisite and helpdesk, however, were underutilized because of a lack of information surrounding these platforms. Some participants did not trust medical information from websites and had more confidence in apps, while others associated a “helpdesk” with a call-in service, not a messaging one. Many of the unregistered participants had not heard of NurseConnect, and some cited data and time constraints as barriers to both registration and uptake. Conclusions: Mobile and smartphone penetration was very high, and participants often used their phone to find medical information. The NurseConnect messages were well-liked by all registered participants; however, the mobisite and helpdesk were underutilized owing to a lack of information and training around these platforms. Enhanced marketing and training initiatives that optimize existing social networks, as well as the provision of data and Wi-Fi, should be explored to ensure that registration improves, and that users are active across all platforms. %M 30758298 %R 10.2196/11644 %U http://mhealth.jmir.org/2019/2/e11644/ %U https://doi.org/10.2196/11644 %U http://www.ncbi.nlm.nih.gov/pubmed/30758298