JMIR mHealth and uHealth

Smartphone Apps for Pulmonary Hypertension: Systematic Search and Content Evaluation

2024-10-30T20:45:07-04:00

Background: Pulmonary hypertension (PH), is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and healthcare professionals in monitoring and managing PH more effectively. Objective: This study aimed to identify and assess the quality of free smartphone apps for PH targeted at either patients or healthcare professionals. Methods: A systematic search was conducted on freely available apps for PH patients and healthcare professionals, accessed from a Spain IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analyzed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. Results: In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 7 updated since 2022. Twelve apps targeted patients/general population, while 9 targeted healthcare professionals; none involved patients in the development or design. Conversely, 13 apps involving healthcare professionals were identified. Ten apps received pharmaceutical industry funding. The app's primary goals for 81% were to disseminate general information about PH. The overall mean MARS quality was acceptable in 2022 and 2023, with mean ratings of 3.1 (SD =0.6) and 3.3 (SD =0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves however, two incorporated tools/algorithms derived from trials. The overall quality of iOS applications statistically outperformed that of Android applications in both years (p<0.05). Furthermore, the involvement of healthcare professionals in app development was associated with enhanced quality, a trend observed in both years (p<0.05). Conclusions: This review of mHealth apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of healthcare professionals in app development, contributing significantly to their quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over two years points to a need for continuous innovation and clinical validation for effective clinical integration. Conclusively, this research advocates for future app developers to engage with healthcare professionals actively, integrate patient insights, and mandate rigorous clinical validation for PH management.

Sensors for Smoking Detection in Epidemiological Research: Scoping Review

2024-10-30T16:00:35-04:00

Background: The use of wearable sensors is being explored as a challenging way to accurately identify smoking behaviors by measuring physiological and environmental factors in real-life settings. Although they hold potential benefits for aiding smoking cessation, no single wearable device currently achieves high accuracy in detecting smoking events. Furthermore, it is crucial to emphasize that this area of study is dynamic and requires ongoing updates. Objective: This scoping review aims to map the scientific literature for identifying the main sensors developed or used for tobacco smoke detection, with a specific focus on wearable sensors, as well as describe their key features and categorize them by type. Methods: According to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, an electronic search was conducted on the PubMed, MEDLINE, and Web of Science databases, using the following keywords: (“biosensors” OR “biosensor” OR “sensors” OR “sensor” OR “wearable”) AND (“smoking” OR “smoke”). Results: Among a total of 37 studies included in this scoping review published between 2012 and March 2024, 16 described sensors based on wearable bands, 15 described multisensory systems, and 6 described other strategies to detect tobacco smoke exposure. Included studies provided details about the design or application of wearable sensors based on an elastic band to detect different aspects of tobacco smoke exposure (eg, arm, wrist, and finger movements, and lighting events). Some studies proposed a system composed of different sensor modalities (eg, Personal Automatic Cigarette Tracker [PACT], PACT 2.0, and AutoSense). Conclusions: Our scoping review has revealed both the obstacles and opportunities linked to wearable devices, offering valuable insights for future research initiatives. Tackling the recognized challenges and delving into potential avenues for enhancement could elevate wearable devices into even more effective tools for aiding smoking cessation. In this context, continuous research is essential to fine-tune and optimize these devices, guaranteeing their practicality and reliability in real-world applications.

Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study

2024-10-29T16:01:46-04:00

Background: Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. Objective: This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers’ preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Methods: Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants’ app use was tracked and analyzed. The primary outcome measures were participants’ 7-day point prevalence abstinence at 6 and 12 weeks. Results: Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included “quit plan,” “tracking,” “reminders and notifications,” “MOtalks,” and “motivational quotes.” The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58% at 6 weeks and 52% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5% (odds ratio [OR] 1.05, 95% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95% CI 1.25-7.75) and 12 weeks (OR 4.65, 95% CI 1.83-11.76), compared with those who earned <5000 points. Conclusions: Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed.

Mobile-Based Platform With a Low-Calorie Dietary Intervention Involving Prepackaged Food for Weight Loss for People With Overweight and Obesity in China: Half-Year Follow-Up Results of a Randomized Controlled Trial

2024-10-28T21:00:08-04:00

Background: Obesity is a rapidly increasing health problem in China, causing massive economic and health losses annually. Many techniques have emerged to help people with obesity better adhere to intervention programs and achieve their weight loss goals, including food replacement and internet-delivered weight loss consultations. Most studies on weight loss interventions mainly focused on the change in body weight or body mass index; however, body fat, especially visceral fat mass, is considered the main pathogenic factor in obesity. In China, more reliable evidence is required on this topic. Moreover, it is unclear whether an integrated weight loss program combining food replacement products, mobile app-based platforms, and daily body composition monitoring using a wireless scale is useful and practical in China. Objective: In this two-arm, parallel-designed, randomized study, we explored the effectiveness and safety of the Metawell weight loss program in China, which combines prepackaged biscuits, a wireless scale, and a mobile app. Methods: Participants in the intervention group were guided to use food replacement products and a scale for weight loss and monitoring, whereas participants in the control group received printed material with a sample diet and face-to-face education on weight loss at enrollment. The intervention lasted for 3 months, and follow-up visits were conducted at months 3 and 6 after enrollment. Dual-energy X-ray absorptiometry and quantitative computed tomography were used to assess body fat. A multilevel model for repeated measurements was used to compare differences between the two groups. Results: Two hundred and twenty patients were randomly assigned to intervention (n=110) and control (n=110) groups. Participants in the intervention group had significantly greater decreases in body mass index, total body fat, visceral adipose area, and subcutaneous adipose area (all P<.001) than those in the control group. However, the rate of change in lean mass was not significantly different between the two groups (P=.62). Thirty-five participants in the intervention group reported adverse events. Constipation was the most frequently reported adverse event (11/110), followed by dizziness (6/110), hypoglycemia (4/110), fatigue (3/110), and gastritis (3/35). Conclusions: The Metawell program was effective for weight loss. After the intervention, participants in the intervention group lost more body weight and body fat while retaining muscle mass than those in the control group. Clinical Trial: Chinese Clinical Trial Registry ChiCTR1900021630; https://www.chictr.org.cn/showproj.html?proj=36183

French Version of the User Mobile Application Rating Scale: Adaptation and Validation Study

2024-10-24T20:30:13-04:00

Background: Effective management of non-communicable diseases requires ongoing coordination and monitoring, often facilitated by e-health technologies such as mobile health (mHealth) applications. The end-user Mobile Application Rating Scale (uMARS) is a valuable tool for assessing the quality of mHealth apps from a user perspective. However, the lack of a French version limits its use in French-speaking countries, where mHealth app evaluation and regulation remain insufficiently addressed although the growing number of applications and high interest in their role in healthcare. Objective: This study aims to translate, culturally adapt a French version of the uMARS (uMARS-F) and to test its overall and internal reliability. Methods: The uMars-F was evaluated as part through a cohort study using the French mHealth app “MonSherpa”. Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical challenges. One hundred sixty-seven participants assessed the app using the uMARS-F twice (T1 and T2) one week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test, and means, standard deviations and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using Intraclass Correlation Coefficients (ICCs) and internal reliability using Cronbach’s Alpha. Concordance between the 3 subscales (objective quality, subjective quality, and perceived Impact), 4 sections and 26 items at T1 and T2 was evaluated using the Paired t-test and Pearson correlation. Results: One hundred sixty-seven participants assessed the app both at both Time 1 and at Time 2 (100% compliance). Among them, 49.70% (n=83) were female and 50.30% (n=84) were male, with a median age of 43±16 years. The uMARS-F ICCs were excellent for objective quality (0.959), excellent for subjective quality (0.993) and moderate for perceived Impact (0.624). Cronbach’s alpha was good for objective quality (0.881), acceptable for subjective quality (0.701) and excellent for perceived impact (0.936). The paired t-tests demonstrated similar scores between the two assessments (P>0.05) and the Pearson Correlation coefficient indicated high consistency in each subscale, section and item (r>0.76 and P<0.001). Reliability and validity of the measures were similar to those found in the original English version, as well as in the Spanish, Japanese, Italian, Greek, and Turkish versions that have already been translated and validated. Conclusions: The uMARS-F is a valid tool for end-users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the MARS-F could now enable healthcare professionals and public health authorities to identify reliable, high quality and valid apps for the patients, and should be part of French healthcare education programs in the future.

Feasibility, Acceptability, Satisfaction, and Challenges of an mHealth App (e-ASCov) for Community-Based COVID-19 Screening by Community Health Workers in Rwanda: Mixed Methods Study

2024-10-14T16:30:20-04:00

Background: Background: Although at the base of the pyramid-shaped organization of the Rwandan health system, Community Health Workers (CHWs) are central to the community-based management of disease outbreaks. Objective: Objectives: This mixed-methods study explored the feasibility, acceptability, satisfaction and challenges of a mobile health (mHealth) tool for community-based COVID-19 screening in Rwanda. Methods: Methods: Two urban (Gasabo and Nyarugenge) and 2 rural (Rusizi and Kirehe) districts in Rwanda participated in the project (smartphone app for COVID-19 screening). A mixed-methods approach was used to inform the feasibility (awareness, expectation), acceptability (use, perceived benefits), satisfaction and challenges of the mHealth intervention. At the end of the project, CHWs were asked to complete a quantitative questionnaire on the use of and satisfaction with the app. Then, in-depth interviews and focus group discussions were organised with CHWs. Transcripts were content-analysed Results: Methods: Two urban (Gasabo and Nyarugenge) and 2 rural (Rusizi and Kirehe) districts in Rwanda participated in the project (smartphone app for COVID-19 screening). A mixed-methods approach was used to inform the feasibility (awareness, expectation), acceptability (use, perceived benefits), satisfaction and challenges of the mHealth intervention. At the end of the project, CHWs were asked to complete a quantitative questionnaire on the use of and satisfaction with the app. Then, in-depth interviews and focus group discussions were organised with CHWs. Transcripts were content-analysed Conclusions: Conclusion: In this proof-of-concept study, a smartphone app for screening COVID-19 was useful as an mHealth tool to be used by CHWs, with potential to increase health system efficiency in an epidemic context. The context should be analysed for generalisation on a country-wide scale, both in case of an epidemic and to take into account certain conditions at the community level. Information is needed on the conditions of generalisation and transferability of this type of app to other health conditions so that CHWs can be given their full place in a pyramidal health system.

Smartphone Screen Time Characteristics in People With Suicidal Thoughts: Retrospective Observational Data Analysis Study

2024-10-11T16:00:24-04:00

Background: Smartphone-based monitoring in natural settings provides opportunities to monitor mental health behaviors, including suicidal thoughts and behavior. Objective: To use passively collected smartphone state logs to estimate daily smartphone screen time characteristics in people with suicidal thinking, offering a more reliable method compared to traditional self-report surveys. Methods: Participants (n=126; median age 22 years) installed the Beiwe app on their smartphones, which passively collected phone state logs for up to 6 months after discharge from an inpatient psychiatric unit (adolescents) or emergency department visit (adults). We derived daily measures of screen-on time from these logs and compared those measures between the first four weeks and subsequent weeks. Additionally, we estimated the impact of a daylight time change on minute-level screen time using function-on-scalar generalized linear mixed-effects regression. Results: The median monitoring period was 169 days (range 42-169). For adolescents and adults, average daily screen-on time was 255.1 and 271.0 minutes, average daily screen-on bout duration was 4.2 and 5.0 minutes, and average daily screen-off bout duration was 25.4 and 26.9 minutes, respectively; there were no significant differences between smartphone operating systems. The daily measures were not significantly different for the first four weeks compared to the fifth week onwards. We observed a statistically significant effect of daylight time change on minute-level screen time. Conclusions: Passively collected phone logs offer an alternative to self-report measures for studying smartphone screen time characteristics in people with suicidal thinking. Our work demonstrates the feasibility of this approach, opening doors for further research on the associations between daily screen time, mental health, and other factors.

A Texting- and Internet-Based Self-Reporting System for Enhanced Vaccine Safety Surveillance With Insights From a Large Integrated Health Care System in the United States: Prospective Cohort Study

2024-10-11T14:00:32-04:00

Background: SMS text messaging- and internet-based self-reporting systems can supplement existing vaccine safety surveillance systems, but real-world participation patterns have not been assessed at scale. Objective: This study aimed to describe the participation rates of a new SMS text messaging- and internet-based self-reporting system called the Kaiser Permanente Side Effect Monitor (KPSEM) within a large integrated health care system. Methods: We conducted a prospective cohort study of Kaiser Permanente Southern California (KPSC) patients receiving a COVID-19 vaccination from April 23, 2021, to July 31, 2023. Patients received invitations through flyers, SMS text messages, emails, or patient health care portals. After consenting, patients received regular surveys to assess adverse events up to 5 weeks after each dose. Linkage with medical records provided demographic and clinical data. In this study, we describe KPSEM participation rates, defined as providing consent and completing at least 1 survey within 35 days of COVID-19 vaccination. Results: Approximately, 8% (164,636/2,091,975) of all vaccinated patients provided consent and completed at least 1 survey within 35 days. The lowest participation rates were observed for parents of children aged 12-17 years (1349/152,928, 0.9% participation rate), and the highest participation was observed among older adults aged 61-70 years (39,844/329,487, 12.1%). Persons of non-Hispanic White race were more likely to participate compared with other races and ethnicities (13.1% vs 3.9%-7.5%, respectively; P<.001). In addition, patients residing in areas with a higher neighborhood deprivation index were less likely to participate (5.1%, 16,503/323,122 vs 10.8%, 38,084/352,939 in the highest vs lowest deprivation quintiles, respectively; P<.001). Invitations through the individual's Kaiser Permanente health care portal account and by SMS text message were associated with the highest participation rate (19.2%, 70,248/366,377 and 10.5%, 96,169/914,793, respectively), followed by email (19,464/396,912, 4.9%) and then QR codes on flyers (25,882/2,091,975, 1.2%). SMS text messaging–based surveys demonstrated the highest sustained daily response rates compared with internet-based surveys. Conclusions: This real-world prospective study demonstrated that a novel digital vaccine safety self-reporting system implemented through an integrated health care system can achieve high participation rates. Linkage with participants’ electronic health records is another unique benefit of this surveillance system. We also identified lower participation among selected vulnerable populations, which may have implications when interpreting data collected from similar digital systems.

Digital Health Readiness: Making Digital Health Care More Inclusive

2024-10-09T15:31:23-04:00

This paper proposes an approach to assess digital health readiness in clinical settings to understand how prepared, experienced, and equipped individual people are to participate in digital health activities. Existing digital health literacy and telehealth prediction tools exist but do not assess technological aptitude for particular tasks or incorporate available electronic health record data to improve efficiency and efficacy. As such, we propose a multidomain digital health readiness assessment that incorporates a person’s stated goals and motivations for use of digital health, a focused digital health literacy assessment, passively collected data from the electronic health record, and a focused aptitude assessment for critical skills needed to achieve a person’s goals. This combination of elements should allow for easy integration into clinical workflows and make the assessment as actionable as possible for health care providers and in-clinic digital health navigators. Digital health readiness profiles could be used to match individuals with support interventions to promote the use of digital tools like telehealth, mobile apps, and remote monitoring, especially for those who are motivated but do not have adequate experience. Moreover, while effective and holistic digital health readiness assessments could contribute to increased use and greater equity in digital health engagement, they must also be designed with inclusivity in mind to avoid worsening known disparities in digital health care.

Nutrition-Related Mobile Apps in the Spanish App Stores: Quality and Content Analysis

2024-10-04T16:15:24-04:00

Background: Mobile apps represent accessible and cost-effective tools to improve nutrition and prevent chronic diseases. However, most of these apps have been characterized as having limited functionality, raising concerns about their effectiveness, acceptability, and efficacy. Objective: To assess the quality of popular nutrition-related app platforms in Spain and to describe their characteristics and functionalities. Methods: We screened apps providing information on dietary advice, food advice, and nutritional content in the Apple App Store and Google Play Store in Spain from March 2 to March 16, 2024. Apps with a star rating of ≥4 (of 5 stars), available in Spanish, free of charge, last updated after January 2022, with >500 reviews, and >500,000 downloads were included. The quality of apps was assessed using the user version of the Mobile App Rating Scale (uMARS). General characteristics, nutritional, health, and market-related functionalities of the nutrition-related apps were described. Correlations among total and uMARS sections, star ratings, and number of reviews and downloads were evaluated. Results: Among the 1,460 apps identified in the search, 42 apps met the criteria. The majority of these (20/42, 48%) aimed at recording and analyzing food intake, followed by those providing nutritional plans or diets (9/42, 21%), advising on healthy habits (7/42, 17%), and offering recipes (6/42, 14%). The most prevalent nutritional functionalities offered were recording and monitoring body measurements (30/42, 71%), food tracking (26/42, 62%), and dietary analysis (25/42, 60%), whereas nutrition education was less common (16/42, 38%). Among market-related functionalities, advertisements were the most common among the study apps (30/42, 71%), followed by the option of sharing on social media (29/42, 69%) and customizable reminders (26/42, 62%). Sharing the recorded information in the app with health professionals was infrequent (1/42, 2%). The mean (standard deviation [SD]) total uMARS score (maximum 5 points) was 3.78 (0.35), while 4.21 (0.38) was for functionality, 3.94 (0.54) for aesthetics, 3.51 (0.46) for engagement, and 3.48 (0.44) for information. Lower mean scores were observed for the subjective quality (2.65 [0.56] and perceived impact (3.06 [0.67]). Moderate to strong positive significant correlations were mostly observed between total uMARS and section-specific uMARS scores, while the correlations between the uMARS section scores were mostly moderate positive. Total uMARS scores were very weakly correlated with user rating, number of reviews, and downloads. Conclusions: The quality of popular nutrition-related app platforms in Spain was acceptable, observing remarkable differences between sections. The majority of the apps were appealing due to their user-friendly interfaces. Only a few apps, however, provided dietary structure analysis or nutritional education. Further research is needed to assess the long-term impact of these apps on users.