Assessing the Use of Mobile Health Technology by Patients: An Observational Study in Primary Care Clinics

Globally, governments and public health authorities are integrating Artificial Intelligence (AI) techniques in mobile apps to improve public health. For example, during the COVID-19 outbreak, AI-driven chatbots were deployed to provide immediate health information and advice. AI-based mobile apps are also used to support mental health or for preventive healthcare, such as personalized dietary recommendations. Moreover, the use of generative AI for public health purposes is rapidly increasing. In 2024, the WHO launched S.A.R.A.H - a generative AI chatbot designed to provide information on major health topics such as healthy lifestyles and mental health. By integrating AI, public institutions could potentially achieve better health outcomes, improve efficiency, and enhance access to healthcare. However, the rapid adoption of AI public health apps also raises significant ethical, legal, and regulatory challenges. The large amounts of sensitive personal data collected and processed by such apps may create issues for privacy, data protection, and cybersecurity. At the same time, the tendency of AI to exhibit biases may deepen existing health inequities. The new EU ‘digital’ legal framework does not directly address these challenges. This workshop aims to convene leading experts working on AI in health to address these issues. We bring together scholars from different disciplines (health law, health policy, bioethics, biosciences). The workshop objectives are twofold: (1) to critically assess the current landscape of AI in public health apps from a legal, ethical, and regulatory point of view, and (2) to lay the groundwork for policy recommendations on how to ensure the deployment of AI apps for public health in compliance with ethical principles and fundamental rights. First, the panel explores the differences in the data protection regulation of AI public health apps in the EU and the US (speaker: James Hazel). Second, it discusses how these apps are regulated under the new EU Artificial Intelligence Act (speaker: Hannah van Kolfschooten). Third, it investigates the consequences of the European Health Data Space regulation on how health data can be processed through public health apps (speaker: Mahsa Shabani). Finally, as the cross-border use of apps complicates regulatory efforts, it discusses the need for international cooperation in establishing and enforcing guidelines (speaker: Vasiliki Rahimzadeh). The workshop will be conducted as a round table discussion with 4 short presentations of 5 minutes each. Speakers first present a key challenge posed by AI in mobile health apps, and then suggest a potential regulatory solution. This will be followed by a dialogue between panelists and the audience to share best practices on how to regulate AI in mobile public health apps from a legal, ethical, and regulatory perspective. The input will be used to develop a submission for the Call for papers of BMC Bioinformatics. Key messages • As public institutions are increasingly integrating AI technologies into their mobile public health solutions, it is crucial to evaluate the ethical, legal, and regulatory implications. • In light of current gaps in the EU legal framework, we convene scholars from different disciplines and legal systems to design guidelines on the ethical use of AI mobile apps for public health. Speakers/Panelists James Hazel University of Amsterdam, Amsterdam, Netherlands Mahsa Shabani University of Amsterdam, Ghent University, Amsterdam, Netherlands Hannah van Kolfschooten University of Amsterdam, Amsterdam, Netherlands Vasiliki Rahimzadeh Baylor College of Medicine, Houston, USA Pramiti Parwani University of Amsterdam, Amsterdam, Netherlands

Cardiac arrest, acute myocardial infarction (AMI), and stroke affect millions of people in the United States annually.1 Despite significant advances in medical treatments for these conditions, they remain a major public health problem and a leading cause of morbidity and mortality.1 A critical common element in optimizing care and outcomes for these conditions is the timely recognition of symptoms and initiation of treatment. For example, rapid initiation of cardiopulmonary resuscitation (CPR) is associated with improved survival from cardiac arrest.2 Similarly, early recognition and presentation after onset of symptoms of AMI and ischemic stroke enable implementation of critical therapies such as primary angioplasty and thrombolysis, which are known to improve outcomes.1 Indeed, the “Chain of Survival” for emergency cardiovascular and cerebrovascular care (ECCC) starts with prompt identification of the condition and early activation of the healthcare system to rapidly initiate care.3 Unfortunately, despite national efforts that include public education initiatives and clinical practice guideline recommendations from entities such as the American Heart Association (AHA), major gaps remain in the timely identification of symptoms and initiation of ECCC.4–6 As one example, studies of out-of-hospital cardiac arrest (OHCA) have consistently noted delays in the initiation of bystander CPR.7 For AMI, there have been advances in the provision of timely primary angioplasty for ST-segment elevation myocardial infarction (STEMI), as reflected by significant improvements in door-to-balloon times.8 However, the time from patient symptom onset to seeking care for possible myocardial infarction has not improved significantly.9,10 Similarly, for stroke, there continue to be advances in door-to-needle times, but stroke symptom recognition and seeking of treatment by patients and their families remain a major barrier to timely stroke care.11–16 Public and clinician education efforts alone are not sufficient to reduce gaps …

BackgroundThe proliferation of mobile health apps has greatly changed the way society accesses the health care industry. However, despite the widespread use of mobile health apps by patients in China, there has been little research that evaluates the effect of mobile health apps on patient experience during hospital visits.ObjectiveThe purpose of our study was to examine whether the use of mobile health apps improves patient experience and to find out the difference in patient experience between users and nonusers and the characteristics associated with the users of these apps.MethodsWe used the Chinese Outpatient Experience Questionnaire to survey patient experience. A sample of 300 outpatients was randomly selected from 3 comprehensive public hospitals (3 tertiary hospitals) in Hubei province, China. Each hospital randomly selected 50 respondents from mobile health app users and 50 from nonusers. A chi-square test was employed to compare the different categorical characteristics between mobile health app users and nonusers. A t test was used to test the significance in continuous variables between user scores and nonuser scores. Multiple linear regression was conducted to determine whether the use of mobile health apps during hospital visits was associated with patient experience.ResultsThe users and nonusers differed in age (χ22=12.2, P=.002), education (χ23=9.3, P=.03), living place (χ21=7.7, P=.006), and the need for specialists (χ24=11.0, P=.03). Compared with nonusers, mobile health app users in China were younger, better educated, living in urban areas, and had higher demands for specialists. In addition, mobile health app users gave significantly higher scores than nonusers in total patient experience scores (t298=3.919, P<.001), the 18 items and the 5 dimensions of physician-patient communication (t298=2.93, P=.004), health information (t298=3.556, P<.001), medical service fees (t298=3.991, P<.001), short-term outcome (t298=4.533, P<.001), and general satisfaction (t298=4.304, P<.001). Multiple linear regression results showed that the use of mobile health apps during hospital visits influenced patient experience (t289=3.143, P=.002). After controlling for other factors, it was shown that the use of mobile health apps increased the outpatient experience scores by 17.7%. Additional results from the study found that the self-rated health status (t289=3.746, P<.001) and monthly income of patients (t289=2.416, P=.02) influenced the patient experience as well.ConclusionsThe use of mobile health apps could improve patient experience, especially with regard to accessing health information, making physician-patient communication more convenient, ensuring transparency in medical charge, and ameliorating short-term outcomes. All of these may contribute to positive health outcomes. Therefore, we should encourage the adoption of mobile health apps in health care settings so as to improve patient experience.

The integration of technology into health and wellness has been gaining momentum. Wearable technology and mobile health applications (Apps) have become increasingly popular for tracking health-related behaviors. This study explores the usage, perceived impact, and tracking capabilities of fitness trackers (FTs) and mobile health Apps among university students in Riyadh, Saudi Arabia, over a 4-month period in 2024. A cross-sectional, web-based study was conducted in the Riyadh, region of Saudi Arabia, between March and June 2024. The target population was undergraduate healthcare students enrolled in the faculties of nursing, pharmacy, and EMS at a public university in Riyadh for the academic year 2024. The questionnaires collected information on demographics and FT usage, perceptions. The other sections focused on Mobile Health App usage, reasons for not using, the most commonly utilized feature, source of FTs. The last section assessed the impact of mobile apps and FTs on health. A total of 523 healthcare students responded to the study by giving a response rate of 95.1%. However, the analysis included on 357 undergraduate students who used FTs and mobile health apps. The prevalence of use of FTs and mobile health apps was 68.3%, among those 40.1%(n = 143) of them were belongs to pharmacy, 30.3% (n = 108) of them were EMS and 29.7% (n = 106) of them were nursing. Among the users, the most popular FT was wristband 43.7% (n = 156) smart watches 35.9% (n = 128). In addition, 52.1% (n = 186) of the healthcare students reported using mobile health Apps. Healthcare students used FTs to increase physical activity 24.4%, improving workouts 21.6%, monitoring heart rate, and losing weight. In addition, 48.1% of the healthcare students agreed that FTs increases their physical activity. This study revealed fourth-year students were more likely to wear FTs every day compared to their peers, (p = 0.022; χ² =29.223), and athletes used FTs significantly more frequently than non-athletes (p = 0.022; χ² = 11.447) suggesting significant association between year of study and student’s athlete’s status and FTs use. Our findings emphasize the importance of technology in promoting health and wellness, especially through the use of FTs and mobile health apps. Significantly, the use of this technology was linked to higher levels of physical activity and increased confidence, illustrating the necessity for raising awareness among students and individuals regarding the advantages of FTs and mobile health apps. Additional research is needed to investigate the reasons behind utilizing technology for health enhancement, ultimately guiding efforts to maximize its benefits.

There are more than 318,000 mobile health apps available worldwide and more than 200 new apps become available each day. Although most are general wellness apps, the number of those related to patient care and management of health conditions continues to increase and has reached 40 percent of all health apps on the market. In fact, there is at least one high-quality app (i.e., apps with such attributes as good patient ratings, frequent updates, and promising clinical evidence) available to support patients’ needs at each stage of the care continuum, from prevention to treatment. More than 570 studies on mobile apps have been published, providing a robust amount of clinical evidence on their quality and effectiveness.1 One survey identified that 75 percent of U.S. health consumers believe technology, including apps, is important for managing their health. Mobile health apps are being embraced by patients for a multitude of uses, including virtual care and tracking, recording, and sharing health data, such as blood pressure and heart rate.2 Top uses for virtual care have included after-hours and follow-up appointments and concern-specific discussions. The use of virtual care continues to increase; 25 percent of surveyed consumers indicated they used these services in 2018, which is up from 21 percent in 2017. The majority of 2018 respondents who used these services (74 percent) said they were satisfied with the virtual care they received; in fact, approximately 50 percent of all respondents reported they would prefer a faster virtual care appointment than a delayed in-person visit.2 Moreover, 79 percent of U.S. consumers reported in another survey that they are more likely to choose a health care provider who has methods in place to connect virtually instead of one who does not.3 Ninety percent of patients surveyed indicated they are willing to share their health data obtained from mobile apps and wearable devices with their health care team.2 For health care professionals, mobile apps are beneficial for a range of uses, including to access medical references for point-of-care decisions; assist with hospital information systems, such as the electronic health record; communicate with other clinicians; perform training; and remotely monitor patients. In one survey, approximately 30 to 50 percent of U.S. clinicians reported using apps to actively engage in patient care, including to collect patient information at the bedside and monitor medical device information.3 Approximately 66 percent of the 100 biggest U.S. hospitals provide mobile apps for patients; 40 percent of these developed the apps in house.4 Health apps have been proven to reduce use of acute care services for diabetes, asthma, and cardiac and pulmonary rehabilitation; the use of apps in just these categories has the potential to save $7 billion in health care costs annually in the United States.1 Mobile apps can augment care for both patients and health care providers at all stages of care. Surveys of U.S. health care consumers and professionals point to an increasing adoption of this technology, highlighting the importance of identifying ways to incorporate these tools into patients’ health maintenance and care. This month’s lead feature discusses the use of mobile apps to aid patients in their postoperative recovery, including for medication compliance, pain management, and follow-up care.

BackgroundMobile phone use in Vietnam has become increasingly popular in recent years, with youth (people aged 15-24 years) being one of the groups with the heaviest use. Health-related apps on mobile phones (mobile health [mHealth] apps) appear to be a feasible approach for disease and health management, especially for self-management. However, there has been a scarcity of research on mobile phone usage for health care among youth and adolescents.ObjectiveThis study aims to identify the patterns of usage of mobile phone apps and the preferences for functionalities of mobile phone-based health-related apps among Vietnamese youth.MethodsAn online cross-sectional study was conducted in Vietnam in August to October 2015. Web-based respondent-driven sampling technique was adopted to recruit participants. The online questionnaire was developed and distributed using Google Forms. Chi square and Mann-Whitney tests were used to investigate the difference in attitude and preference for mobile phone apps between the two genders.ResultsAmong 356 youths (age from 15 to 25 years) sampled, low prevalence was found of using mHealth apps such as beauty counseling (6.5%, 23/356), nutrition counseling (7.9%, 28/356), disease prevention (9.8%, 35/356), and disease treatment (7.6%, 27/356). The majority of users found the app(s) they used to be useful (72.7%, 48/356) and reported satisfaction with these apps (61.9%, 39/356). No significant differences were found between the genders in their perception of the usefulness of apps and their satisfaction with mobile health apps. Most of the participants (68.2%, 238/356) preferred apps which are conceptualized and designed to run on a mobile phone compared to Web-based apps, and 50% (176/356) preferred visual materials. Approximately 53.9% (188/356) reported that it was integral for the mobile phone apps to have a sharing/social network functionality. Participants with a higher perceived stress score and EuroQol-5 Dimensions (EQ-5D) index were significantly less likely to use mHealth apps.ConclusionsThis study found a low proportion using mHealth-related mobile phone apps, but a high level of receptiveness and satisfaction among Vietnamese youth. Acceptance level and preferences toward mHealth apps as well as specifically preferred functionalities discovered in this study are essential not only in conceptualizing and developing appropriate mobile phone interventions targeting youth and adolescents, but also in the application of technically advanced solutions in disease prevention and health management.

Rheumatoid arthritis (RA) is a highly dynamic and individualized disease in terms of its patterns of symptomatic flare-ups and periods of remission. Patient-centered care (PCC) aligns patients' lifestyle goals with their preferences for managing symptoms and side effects through the selection of therapies appropriate for disease management. Mobile health (mHealth) apps have the potential to engage and activate patients in PCC. mHealth apps can provide features that increase disease knowledge, collect patient-generated health indicators and behavioral metrics, and highlight goals for disease management. However, little evidence-based guidance exists as to which apps contain functionality essential for supporting the delivery of PCC. The objective of this study was to evaluate the patient-centeredness of United States-based rheumatoid arthritis mobile apps in terms of patient engagement and activation. A search of mobile apps on 2 major United States app stores (Apple App Store and Google Play) was conducted from June 2020 to July 2021 to identify apps designed for use by patients with RA by adapting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines for mobile health app screening based on the literature. Reviewers conducted a content analysis of mobile app features to evaluate their functionality for patient engagement and activation. Engagement and activation were assessed using the Mobile Application Rating Scale (MARS) and social cognitive theory, respectively. Apps were ranked by their ability to facilitate PCC care along 2 dimensions: engagement and activation. A total of 202 mobile apps were initially identified, and 20 remained after screening. Two apps emerged with the greatest ability to facilitate PCC. Both apps were scored as having acceptable or good patient engagement according to the MARS. These 2 apps also had high patient activation according to social cognitive theory, with many features within those apps representing theoretical constructs such as knowledge, perceived self-efficacy, and expectations about outcomes that support behavioral management of RA. We found very few mobile apps available within the United States that have functionality that both engages and activates the patient to facilitate PCC. As the prevalence of mobile apps expands, the design of mobile apps needs to integrate patients to ensure that their functionality promotes engagement and activation. More research is needed to understand how mobile app use impacts patient engagement and activation, and ultimately, treatment decisions and disease trajectory.

BackgroundDisasters are becoming more frequent due to the impact of extreme weather events attributed to climate change, causing loss of lives, property, and psychological trauma. Mental health response to disasters emphasizes prevention and mitigation, and mobile health (mHealth) apps have been used for mental health promotion and treatment. However, little is known about their use in the mental health components of disaster management.ObjectiveThis scoping review was conducted to explore the use of mobile phone apps for mental health responses to natural disasters and to identify gaps in the literature.MethodsWe identified relevant keywords and subject headings and conducted comprehensive searches in 6 electronic databases. Studies in which participants were exposed to a man-made disaster were included if the sample also included some participants exposed to a natural hazard. Only full-text studies published in English were included. The initial titles and abstracts of the unique papers were screened by 2 independent review authors. Full texts of the selected papers that met the inclusion criteria were reviewed by the 2 independent reviewers. Data were extracted from each selected full-text paper and synthesized using a narrative approach based on the outcome measures, duration, frequency of use of the mobile phone apps, and the outcomes. This scoping review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).ResultsOf the 1398 papers retrieved, 5 were included in this review. A total of 3 studies were conducted on participants exposed to psychological stress following a disaster while 2 were for disaster relief workers. The mobile phone apps for the interventions included Training for Life Skills, Sonoma Rises, Headspace, Psychological First Aid, and Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioural Health Disaster Response Apps. The different studies assessed the effectiveness or efficacy of the mobile app, feasibility, acceptability, and characteristics of app use or predictors of use. Different measures were used to assess the effectiveness of the apps’ use as either the primary or secondary outcome.ConclusionsA limited number of studies are exploring the use of mobile phone apps for mental health responses to disasters. The 5 studies included in this review showed promising results. Mobile apps have the potential to provide effective mental health support before, during, and after disasters. However, further research is needed to explore the potential of mobile phone apps in mental health responses to all hazards.

In this editorial, we discuss how mobile phone technology has the potential to move the field forward in terms of understanding suicide risk as well as laying foundations for the development of effective treatments/interventions. We have focused on mobile health technology given the rapid growth of mobile health approaches in suicide prevention (De Jaegere & Portzky, 2014; Mishara & Kerkhof, 2013) and psychological research more generally (Myin-Germeys et al., 2009; Nock, Prinstein, & Sterba, 2009; Palmier-Claus et al., 2011) and because mobile phone use is ubiquitous, with 75% of the world having access to a mobile phone (Kay, 2011). (aut. ref.)

Introduction: Family Caregivers play a significant role in healthcare by providing supplemental uncompensated care that delays or prevents the need for more expensive institutionalized care. Caregiver burden and stress is high as caregiving takes a physical and mental toll on the health and well-being of the caregiver. As family members and patients search for ways to help them better manage their healthcare, they are turning to mobile health (mHealth) applications. The VA created a suite of Mobile Health Apps designed to support Family Caregivers in their caregiving role. The objective of this research was twofold: First to assess the effectiveness of the Family Caregiver mHealth apps in reducing Caregiver burden levels and second to determine the characteristics of Family Caregivers and their care recipients that predict the use of these Apps. Methods: The effectiveness of the mobile health apps in reducing Caregiver burden was investigated using a quasi-experimental pre-posttest study design with a nonrandom control group. The intervention consisted of Mobile Health Apps created by the VA that were loaded on an iPad and distributed to 881 Family Caregivers in the VA’s Family Caregiver Program who volunteered to participate in the mobile health pilot. Family Caregivers enrolled in the program but who did not volunteer to participate in the mobile health pilot formed the control group (3620). The outcome variable assessed was the change in Pre and Post Zarit burden scores in the treatment group compared with the control after adjusting for the Pre Zarit burden score and other covariates. Pre and Posttest Zarit Burden scores were extracted from VA electronic notes and analyzed using a General Linear Model. The follow-up rate for the treatment group and control groups were 70% and 65% respectively. Predictor variables were extracted from VA operational databases. The characteristics of the Caregiver/Patient dyads that predict use of the mobile apps was studied in the treatment group receiving the iPads (881) and in a subset of the treatment participants (570) who completed a Caregiver characteristic survey. The outcome variable measured was the number of times the mobile health apps were used by the Caregiver/Patient dyads over a threemonth time period ending September 18, 2013. Predictor variables were extracted from VA operational databases and the Caregiver characteristic survey. Logistic and Negative Binomial regression models were constructed to predict outcomes. Results: A statistically significant difference was not found between the treatment and control groups in the mean change of their Zarit Burden scores. Statistically significant predictors of App Use varied by individual App but included: the relationship of Caregiver to care recipient, urban/rural living location, polytrauma care, diagnosis, age and the IADL – “Assistance Arranging Services”. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116479– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. Conclusion: This study has contributed to the mHealth evidence base by identifying user characteristics that predict the use of specific types of mobile health apps.

BackgroundThe digital transformation has the potential to change health care toward more consumers’ involvement, for example, in the form of health-related apps which are already widely available through app stores. These could be useful in helping people understand their risk of chronic conditions and helping them to live more healthily.ObjectiveWith this study, we assessed mobile health app use among older Australians in general and among those who were at risk of cardiovascular disease or type 2 diabetes mellitus.MethodsIn this cross-sectional analysis, we used data from the second follow-up wave of the 45 and Up Study. It is a cohort study from New South Wales, Australia, with 267,153 participants aged 45 years and older that is based on a random sample from the Services Australia (formerly the Australian Government Department of Human Services) Medicare enrollment database. The 2019 follow-up questionnaire contained questions about technology and mobile health use. We further used data on prescribed drugs and hospitalizations to identify participants who already had cardiovascular disease or diabetes or who were at risk of these conditions. Our primary outcome measure was mobile health use, defined as having used a mobile health app before. We used descriptive statistics and multivariate logistic regression to answer the research questions.ResultsOverall, 31,946 individuals with a median age of 69 (IQR 63-76) years had completed the follow-up questionnaire in 2019. We classified half (16,422/31,946, 51.41%) of these as being at risk of cardiovascular disease or type 2 diabetes mellitus and 38.04% (12,152/31,946) as having cardiovascular disease or type 1 or type 2 diabetes mellitus. The proportion of mobile health app users among the at-risk group was 31.46% (5166/16,422) compared to 29.16% (9314/31,946) in the total sample. Those who used mobile health apps were more likely to be female, younger, without physical disability, and with a higher income. People at risk of cardiovascular disease or type 2 diabetes mellitus were not statistically significantly more likely to use mobile health than were people without risk (odds ratio 1.06, 95% CI 0.97-1.16; P=.18; adjusted for age, sex, income, and physical disability).ConclusionsPeople at risk of cardiovascular disease or type 2 diabetes mellitus were not more likely to use mobile health apps than were people without risk. Those who used mobile health apps were less likely to be male, older, with a physical disability, and with a lower income. From the results, we concluded that aspects of equity must be considered when implementing a mobile health intervention to reach all those that can potentially benefit from it.

Back to table of contents Previous article Next article ProfessionalFull AccessAPA’s App Panel Offers Guidance on Digital ToolsNathan Tatro, M.A.Nathan TatroSearch for more papers by this author, M.A.Published Online:21 Apr 2021https://doi.org/10.1176/appi.pn.2021.5.37AbstractA new series of articles will provide information from APA experts on the use of apps in psychiatry. Your questions are welcome!“Ask an App Advisor” is a new feature of Psychiatric News in which members of APA’s App Advisor Expert Panel discuss the general use of mental health apps and answer APA members’ questions. This group is composed of APA members and other subject matter experts in mental health from related professions (for example, social work, psychology, nurse practitioners, informaticists) and patients with lived experience. The purpose of this panel is to maintain APA’s App Evaluation Model and to provide resources for professionals and patients to give them tools they can use when deciding what app is appropriate. The articles will also explore clinical, research, and policy interests of the panelists around mHealth (mobile health).This month’s panelist is Julia Tartaglia, M.D. She began working with APA’s panel as its first medical student representative while attending Rutgers Robert Wood Johnson Medical School, where she earned her M.D. with distinction in medical innovation and entrepreneurship. She is now a psychiatry resident at Zucker Hillside Hospital at Northwell Health.Q. Did you use apps in medical school? If so, how were you introduced to them?A. At the time, I wasn’t introduced to them as a part of the curriculum. While my medical school was very forward thinking and introduced a new elective on telemedicine, we did not have any formal or informal exposure to mobile apps for patient care. In clinical practice I did not see any mental health mobile apps being used by physicians or patients. As medical students, there are barriers to introducing new technologies in practice as well. As we are under direct supervision of attendings, I didn’t feel comfortable making recommendations about mobile app usage, especially without any experience or training in doing so, but there is definitely a need for medical school curricula to address the use of apps in clinical care. Personally, I did make use of medical education apps and mobile app tools for medicine, such as flashcard and question bank apps, anatomy apps, medication apps, and calculators.Q. Do you have an interest in a specific type of app?A. In general, I’m very interested in mobile apps that can be used for remote symptom monitoring and for eCBT (digitally based cognitive-behavioral therapy). One of my interests has been burnout and mental illness in the medical community. In medical school, I started working on developing an app for medical students. Burnout and mental illness are occurring at high rates among medical students, with 1 in 3 students meeting the criteria for clinical depression. Yet, medical students are less likely to seek help for emotional and mental health issues than peers in other professions. Further, many schools report that mental health resources are limited and cannot keep up with demand, with students often having to wait a month or more to schedule appointments with school mental health counselors.In response to this, I’m developing a wellness app for medical students that addresses mental health through self-guided eCBT modules and virtual counseling by connecting students to mental health counselors. Our app format will increase access to mental health resources. It will provide a point-of-care solution for students combatting anxiety/depression who may hesitate to seek help via traditional models that schools provide, such as in-person counseling. Further, unlike existing depression/anxiety apps that offer generic advice and solutions, our eCBT modules will be custom designed to address common medical school stressors and cognitive biases, such as imposter syndrome and stress related to board exams and clinical rotations.Check out future issues of Psychiatric News for more conversations with members of APA’s App Advisor Expert Panel. You can also review APA’s sample app evaluations and learn more about our App Evaluation Model. If you have a question for the panel, send an email to [email protected]. ■APA’s App Advisor page can be accessed here.Also, APA has launched a series of webinars during which APA members can ask questions of APA’s App Advisor Panel. Register here.Nathan Tatro, M.A., is deputy director of digital health in APA’s Department of Practice Management and Delivery Systems Policy. ISSUES NewArchived

BackgroundRising criticism about the risks associated with the use of mobile health apps necessitates a critical perspective to assess the use of these apps. A cost-benefit approach involving several moderating factors can be used to detect technology effects and individual-level push and pull factors related to health attitudes, lifestyle, and health management behaviors.ObjectiveWe introduce a cost-benefit perspective to examine how health attitudes related to mobile health apps and health situational factors (health crises, health changes, and hospitalization) affect the likelihood of adopting lifestyle and health management behaviors among app users.MethodsThe analysis is based on individuals’ reported use of mobile health apps. The sample included 1495 US adults aged over 18 years who were contacted by landline or cellphone. A total of 50.96% (762/1495) of the participants were women. A set of logistic regression models was used to predict lifestyle and health management behaviors among users considering variations in the extent of use, health attitudes, health situation, and socioeconomic characteristics.ResultsThe findings indicate that the proposed models were reasonably adequate. In all, 88.76% (1327/1495) of the cases were correctly classified regarding lifestyle behaviors, but only 71.97% (1076/1495) of the cases were correctly classified regarding health management behaviors. Although a large percentage of individuals changed their attitudes following the use of mobile health apps, only a small proportion adopted health management behaviors. The use of mobile health apps affected up to 67.95% (1016/1495) of the users for consultation and 71.97% (1076/1495) of the users for decision making. The model was effective for 88.76% (1327/1495) of the cases regarding lifestyle behaviors but only 71.97% (1076/1495) regarding health management behaviors. The moderating effect of regular use of mobile health apps significantly affects lifestyle (Wald=61.795; B=2.099; P<.005) but not health management behaviors (Wald=12.532; B=0.513; P=.01). These results collectively indicate that the use of mobile health apps for health management is partially effective.ConclusionsThe use of mobile health apps is a main route to instigate the process of health empowerment and shape health attitudes. However, an accurate assessment of the effectiveness of mobile health apps necessitates distinguishing between lifestyle and health management behaviors and adopting a cost-benefit approach because individuals facing health concerns, such as a chronic disease, health emergency, health crisis, or health change, consider their affordances and situational effects. These moderators generate a push and pull framework in the decision-making process that balances the costs and benefits of use.

Rationalizing personal health management (PHM) policy: Identifying health IT use patterns via observations of daily living (ODLs) data

BackgroundAlthough the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored.ObjectiveThe purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app.MethodsData were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021.ResultsWe found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently.ConclusionsThe COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.