Acceptability Of mHealth Research Articles

Consumer acceptability and validity of m-Health for the detection of adverse events following immunization – The Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) randomised control trial

IntroductionMonitoring for adverse events following immunisation (AEFI) is critical for vaccine pharmacovigilance. Given the global and expanding availability of mobile phones their utility for consumer-based vaccine safety surveillance is of interest but little is known about consumer acceptability. This study nested within the Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) randomised control trial sought to evaluate the acceptability of SMS for AEFI surveillance. MethodsThe primary STARSS study was a multi-centre RCT evaluating the efficacy of repeated SMS prompts for AEFI surveillance with participants being adult vaccinees or parents of children receiving any vaccine. This nested study enrolled primary RCT participants who completed a detailed computer assisted telephone interview to determine their attitudes towards SMS-based surveillance and ascertain their knowledge and attitudes toward vaccine safety, efficacy, data privacy and use of electronic health records. Attitudes to surveillance and related behaviour were used as measures of acceptability. Results20% (1200/6555) of the participants were enrolled and 1139 completed the full-length questionnaire. 96% indicated that SMS-based surveillance after immunisation to check the safety of the vaccine “should be done” but 62% of all respondents said it should be done but consent should be sought first. Neither vaccine safety attitudes nor attitudes toward privacy were associated with opposition to SMS-based surveillance. In terms of SMS related behaviour demographic rather than attitudinal factors were associated with non-compliance. ConclusionOverall, the attitude towards SMS-based surveillance was very favourable. Experiencing the SMS surveillance has the effect of reducing opposition to an SMS surveillance system, and at the same time increasing the likelihood of a preference for prior consent. Detection of a vaccine safety signal could be impeded in particular demographic groups who are non-compliant and we should undertake further research to understand why these groups are non-compliant and how this can be improved.

Do mobile health (mHealth) services ensure the quality of health life? An integrated approach from a developing country context

ABSTRACT Though the acceptance behavior of health technology has been investigated by several studies from different theoretical perspectives, a unified understanding is still lacking in the literature particularly addressing the Generation Y (Gen Y). Thus, the current study aims to explore the factors affecting the adoption of mHealth services among Gen Yers and how does mHealth adoption influence their quality of health life along with trust and satisfaction. With this intention, the conceptual framework was developed integrating UTAUT2 and D&M IS Success Models to predict the mHealth adoption and consequently trust, satisfaction, and quality of health life. Data were collected from existing mHealth users in Bangladesh. Results demonstrate that performance expectancy, effort expectancy, facilitating condition, social influence, hedonic motivation, system quality, and services quality had a significant impact on mHealth adoption which in turn leads to building trust, satisfaction, and improve quality of health life. Research implications are also provided for the mHealth services providers, top marketing communication managers, and policymakers in formulating and implementing effective marketing strategies to increase the acceptability of mHealth.

Acceptance of mHealth by Elderly Adults: A Path Analysis

Mobile health (mHealth) appears to be a promising assistive tool for the long-term health management of the elderly. However, mHealth adoption rates remain relatively low among the elderly. In this study, we surveyed 108 elderly adults to determine their perceptions of mHealth applications (apps) and conducted a path analysis with the aim of studying the factors that affected the acceptance of mHealth in this population. Notably, the intention to use health apps was positively affected by the perceived usefulness (PU) (β=0.32, p<0.001), perceived ease of use (PEOU) (β=0.24, p=0.003), mHealth literacy (β=0.21, p=0.004), smartphone screen size (β=0.15, p=0.02), and healthcare providers’ influence (β=0.17, p=0.02), but negatively affected by storage consumption (β=-0.18, p=0.03). PU was positively affected by PEOU (β=0.16, p=0.02), favorable features (β=0.40, p<0.001), and quality of information (β=0.26, p=0.003). Based on these findings, we suggest that high-quality information, a user-friendly interface, intriguing features, low storage consumption, a large display screen, and the involvement of healthcare professionals are needed to promote the acceptance of mHealth interventions among the elderly.

Primary Care Pre-Visit Electronic Patient Questionnaire for Asthma: Uptake Analysis and Predictor Modeling.

BackgroundmHealth tablet-based interventions are increasingly being studied and deployed in various health care settings, yet little knowledge exists regarding patient uptake and acceptance or how patient demographics influence these important implementation metrics.ObjectiveTo determine which factors influence the uptake and successful completion of an mHealth tablet questionnaire by analyzing its implementation in a primary care setting.MethodsWe prospectively studied a patient-facing electronic touch-tablet asthma questionnaire deployed as part of the Electronic Asthma Management System. We describe tablet uptake and completion rates and corresponding predictor models for these behaviors.ResultsThe tablet was offered to and accepted by patients in 891/1715 (52.0%) visits. Patients refused the tablet in 33.0% (439/1330) visits in which it was successfully offered. Patients aged older than 65 years of age (odds ratio [OR] 2.30, 95% CI 1.33-3.95) and with concurrent chronic obstructive pulmonary disease (OR 2.22, 95% CI 1.05-4.67) were more likely to refuse the tablet, and those on an asthma medication (OR 0.55, 95% CI 0.30-0.99) were less likely to refuse it. Once accepted, the questionnaire was completed in 784/891 (88.0%) instances, with those on an asthma medication (OR 0.53, 95% CI 0.32-0.88) being less likely to leave it incomplete.ConclusionsOlder age predicted initial tablet refusal but not tablet questionnaire completion, suggesting that perceptions of mHealth among older adults may negatively impact uptake, independent of usability. The influence of being on an asthma medication suggests that disease severity may also mediate mHealth acceptance. Although use of mHealth questionnaires is growing rapidly across health care settings and diseases, few studies describe their real-world acceptance and its predictors. Our results should be complemented by qualitative methods to identify barriers and enablers to uptake and may inform technological and implementation strategies to drive successful usage.

Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic.

BackgroundDespite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide.ObjectiveThis study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs.MethodsParticipants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes.ResultsAll participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding.ConclusionsThere is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding.

The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study.

BackgroundIndigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment.ObjectiveThis study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population.MethodsThe Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth.ResultsLess than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services.ConclusionsWe observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.

Drivers of Mobile Health Acceptance and Use From the Patient Perspective: Survey Study and Quantitative Model Development.

BackgroundMobile health (mHealth) has potential to play a significant role in realizing a reversal of the current paradigm in health care toward a more patient-centric and more collaborative system to improve the outcomes obtained along with the quality and sustainability of health care systems.ObjectiveThe aim of this study was to explore and understand individual mHealth acceptance drivers between two groups of users: those with chronic health conditions and those without.MethodsThe extended unified theory of acceptance and usage of technology (UTAUT2) was enhanced with a new health-related framework: behavior intention to recommend and new mediation effects. We applied partial least squares (PLS) causal modeling to test the research model.ResultsWe obtained 322 valid responses through an online questionnaire. The drivers of behavior intention with statistical significance were performance expectancy (β=.29, P<.001), habit (β=.39, P<.001), and personal empowerment (β=.18, P=.01). The precursors of use behavior were habit (β= .47, P<.001) and personal empowerment (β=.17, P=.01). Behavior intention to recommend was significantly influenced by behavior intention (β=.58, P<.001) and personal empowerment (β=.26, P<.001). The model explained 66% of the total variance in behavior intention, 54% of the variance in use behavior, and 70% of the variance in behavior intention to recommend.ConclusionsOur study demonstrates a significant role of personal empowerment, as a second-order construct, in the mHealth acceptance context. The presence of a chronic health condition predicates an impact on acceptance of this technology.

MHealth-based peer mentoring for prevention of alcohol and substance abuse among first year university students: protocol for quasi-experimental intervention

ABSTRACT Objective: The use of psychoactive substances increases university students’ general morbidity and mortality. Universities run programs to prevent psychoactive substance use since they are associated with the risk of poor academic outcomes. The University of Nairobi (UoN) trains peer mentors who counsel students to prevent substance use. There is, however, inadequate feedback and no evaluation of the effectiveness of this method. This study will pilot mobile health (mHealth) based peer mentoring, evaluate and provide feedback about implementation. It will be based in two campuses of UoN, Nairobi, Kenya. Methods: Three phases study. In the first phase, a baseline survey determines students’ knowledge about, attitudes toward, and prevalence of substance use at baseline and the end of the intervention phase. Second phase, mHealth based intervention using a quasi-experimental design. Participants 100 mentors (50 intervention and 50 control groups). Intervention group using mHealth screens for substance use, provide structured brief intervention and treatment referral. A comparative control group, using a paper-based guide will deliver the same program. Phase three, mentors during focussed group discussions will share their experiences. Results: Data will be collected on implementation, acceptability and substance use patterns. Data analysis using descriptive, inferential statistics and thematic content analysis for qualitative data. Conclusions: The study will provide evidence on the implementation and acceptability of mHealth among university students. This will inform national and regional substance use prevention policy and practice. Abbreviations: ASSIST: Assessment of Smoking and Substance Involvement Test; AUDIT: Alcohol Use Disorder Identification Tool; KAP: Knowledge, Attitude, and Prevalence; mHealth: Mobile Health; RDSDQ: Researcher Designed Socio-Demographic Questionnaire; UNODC: United Nations Office on Drugs and Crime; USA: United States of America; WHO: World Health Organization

Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study.

BackgroundIn many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo’s database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines.ObjectiveThis study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services.MethodsWe conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development.ResultsWe conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor’s consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings.ConclusionsThese mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management.

To Use or Not to Use. Investigating M-health Acceptance by Citizens in Malawi Using UTAUT and Trust

To Use or Not to Use. Investigating M-health Acceptance by Citizens in Malawi Using UTAUT and Trust

Acceptance of mHealth among health professionals: a case study on anesthesia practitioners

BackgroundmHealth, the practice of medicine aided by mobile devices is a growing market. Although the offer on Anesthesia applications (Apps) is quite prolific, representative formal assessments on the views of anesthesia practitioners on its use and potential place in daily practice is lacking. This survey aimed thus to cross-assess the Belgian anesthesia population on the use of smartphone Apps and peripherals.MethodsThe survey was exclusively distributed as an online anonymous questionnaire. Sharing took place via hyperlink forwarding by the Belgian Society for Anesthesia and Reanimation (BSAR) and by the Belgian Association for Regional Anesthesia (BARA) to all registered members. The first answer took place on 5 September 2018, the last on 22 January 2019.ResultsThree hundred forty-nine answers were obtained (26.9% corresponding to trainees, 73.1% to specialists). Anesthesiologists were positively confident that Apps and peripherals could help improve anesthesia care (57.0 and 47.9%, respectively, scored 4 or 5, in a scale from 0 to 5). Trainees were significantly more confident than specialists on both mobile Apps (71.2% and 51.8%, respectively; p = 0.001) and peripherals (77.7% and 45.1%, respectively; p = 0.09).The usefulness of Apps and Peripherals was rated 1 or below (on a 0 to 5 scale), respectively, by 9.5 and 14.6% of the total surveyed population, being specialists proportionally less confident in Smartphone peripherals than trainees (p = 0.008). Mobile apps are actively used by a significantly higher proportional number of trainees (67.0% vs. 37.3%, respectively; p = 0.000001).The preferred category of mobile Apps was dose-calculating applications (39.15%), followed by digital books (21. 1%) and Apps for active perioperative monitoring (20.0%).ConclusionsBelgian Anesthesia practitioners show a global positive attitude towards smartphone Apps and Peripherals, with trainees trending to be more confident than specialists.Trial registrationClinicalTrials.gov database Identifier: NCT03750084. Retrospectively registered on 21 November 2018.

Adherence to Dietary Regimen and Recommended Physical Activity: A missing Link in the Management of Diabetes in Low-Resource Settings of Eastern Cape South Africa

Background: Diabetes is a significant public health and socio-economic challenge. It is a complex health condition requiring medical therapy and modifications to dietary recommendations to attain treatment targets. Objective: To assess the level of adherence to recommended dietary regimen and physical activity and the factors responsible for non-adherence. Methods: This forms part of a larger multi-centre, two-arm, parallel, randomised-controlled trial designed to assess the effectiveness, feasibility and acceptability of mHealth as a tool to promote glycaemic control and adherence among low-income earning adults. Study was conducted among diabetic patients with uncontrolled glycaemic status in Eastern Cape Province of South Africa. A total of 216 participants were included in the study. A self-designed validated and reliable tool was used to collect information on dietary activity adherence as well as factors responsible for non-adherence. Descriptive statistics were carried out. Results: Over half of the patients have been taught about the recommended diet and only 10% follow the recommended diet always. The most cited reason for not adhering was perceived high cost of healthy diets. Only 13% adhere to recommended physical activity pattern and lack of time was the most cited reason. Even after a six months text messaging intervention, the condition persisted. Conclusion: There is a low rate of adherence to recommended diet and activity pattern among diabetic patients in this setting, partly due to their low socio-economic status. There is a need to organise interventions that prioritises the cultural beliefs and socio-economic status of patients to achieve the required modifications.

Health worker acceptability of an mHealth platform to facilitate the prevention of mother-to-child transmission of HIV in Tanzania.

ObjectivesHealth workers (HWs) are increasingly using mobile health (mHealth) technologies in low-resource settings. Understanding HW acceptability of mHealth is critical to increasing the scale of mHealth solutions. We examined pre- and post-pilot clinical knowledge and acceptability of a tablet-based platform, the Tanzania Health Information System (T-HIT), targeting HWs delivering prevention of mother-to-child transmission (PMTCT) of HIV services in seven health facilities in Misungwi District, Tanzania.MethodsWe developed a survey based on the diffusion of innovation theory and administered it to 27 HWs before and after a 3-month pilot of T-HIT. Using a Wilcoxon signed-rank test, we analyzed changes in acceptability defined as attitudes towards and self-efficacy for system use comparing pre- and post-test assessment scores and changes in knowledge of clinical care. Using analysis of variance, we explored these changes, stratifying health facilities by level of care and by distance from the district hospital.ResultsPost-pilot scores showed statistically significant improvement from pre-test for the total survey (Z = −2.67, p < 0.008) and for questions concerning system attitude (Z = −2.63, p < 0.008). HWs in hospitals and health centers exhibited a lower initial level of system acceptability in attitude than those in dispensaries and a significant improvement in overall mean acceptability over the pilot (95% CI 0.004–0.0187). HWs working more than 20 km from the hospital had a lower initial level of both system knowledge and acceptability than their less remote counterparts, but demonstrated larger improvements in knowledge and acceptability over time, although this change was not statistically significant.ConclusionsThe pilot demonstrates that HWs in PMTCT in Misungwi have a high acceptability of mHealth solutions. Using an mHealth solution can facilitate HW delivery of PMTCT care in rural and remote settings. Consideration of acceptability is important for fostering mHealth scale and program sustainability.

Assessing mobile health feasibility and acceptability among HIV-infected cocaine users and their healthcare providers: guidance for implementing an intervention.

Mobile health (mHealth) can provide innovative, cost-effective strategies to improve medication adherence and optimize HIV treatment outcomes. Very little, however, is known about the acceptability and feasibility of mHealth among people with HIV (PWH) who use drugs. Our study objective was to assess feasibility, acceptability, and barriers and facilitators of implementing an mHealth intervention among PWH who are cocaine users, a group for whom no pharmacological treatment to reduce cocaine use is available. Five focus groups (FGs) (N=20) were conducted with PWH who self-reported cocaine use in the past 30 days, with 3 groups (N=8) of healthcare providers. Topics included previous experience with smartphones; barriers and facilitators of mobile technology for health purposes; and attitudes toward receiving types of feedback about adherence. Patients preferred text reminders over phone calls for reasons of privacy, accessibility and economizing phone minutes. Direct communication via text messages and phone calls was considered more appropriate for social workers and case managers, who have greater frequency of communication and deeper relationships with patients, and less so for doctors, who see patients less regularly than community health workers. Patients seem particular about who has what information, and overall, they seem to prefer that their medical information, especially HIV-related, stay within the confines of patient-provider relationships. HIV still provokes stigma and makes health information particularly sensitive for both providers and patients. The rise of mobile technology and related applications such as mHealth, means that new norms have to be established for its use. Participants' suggestions and feedback informed the design of a subsequent mHealth pilot randomized control trial to improve medication adherence.

Exploring the Patterns of Use and Acceptability of Mobile Phones Among People Living With HIV to Improve Care and Treatment: Cross-Sectional Study in Three Francophone West African Countries.

BackgroundThe use of mobile technology in health care (mobile health [mHealth]) could be an innovative way to improve health care, especially for increasing retention in HIV care and adherence to treatment. However, there is a scarcity of studies on mHealth among people living with HIV (PLHIV) in West and Central Africa.ObjectiveThe aim of this study was to assess the acceptability of an mHealth intervention among PLHIV in three countries of West Africa.MethodsA cross-sectional study among PLHIV was conducted in 2017 in three francophone West African countries: Côte d’Ivoire, Burkina Faso, and Togo. PLHIV followed in the six preselected HIV treatment and care centers, completed a standardized questionnaire on mobile phone possession, acceptability of mobile phone for HIV care and treatment, preference of mobile phone services, and phone sharing. Descriptive statistics and logistic regression were used to describe variables and assess factors associated with mHealth acceptability.ResultsA total of 1131 PLHIV—643 from Côte d’Ivoire, 239 from Togo, and 249 from Burkina Faso—participated in the study. Median age was 44 years, and 76.1% were women (n=861). Almost all participants owned a mobile phone (n=1107, 97.9%), and 12.6% (n=140) shared phones with a third party. Acceptability of mHealth was 98.8%, with the majority indicating their preference for both phone calls and text messages. Factors associated with mHealth acceptability were having a primary school education or no education (adjusted odds ratio=7.15, 95% CI 5.05-10.12; P<.001) and waiting over one hour before meeting a medical doctor on appointment day (adjusted odds ratio=1.84, 95% CI 1.30-2.62; P=.01).ConclusionsThe use of mHealth in HIV treatment and care is highly acceptable among PLHIV and should be considered a viable tool to allow West and Central African countries to achieve the Joint United Nations Programme on HIV/AIDS 90-90-90 goals.

Effective Factors in Adoption of Mobile Health Applications between Medical Sciences Students Using the UTAUT Model.

Students with complex health care services process face constant challenges with regard to health education. The mobile devices are an important tool that can install various applications for using information such as clinical guidelines, drug resources, clinical calculations, and the latest scientific evidence without any time and place limitations. And this happens only when students accept and use it. The purpose of this article is to identify the factors influencing students in their intention to use mobile health (mHealth) by using Unified Theory of Acceptance and Use of Technology (UTAUT) model. A standard questionnaire was used to collect the data from nearly 302 Lorestan University of medical science students including nutrition and public health, paramedicine, nursing and midwifery, pharmacy, dentistry, and medical schools. The data were processed using LISREL (Scientific Software International, Inc., Lincolnwood, Illinois) and SPSS (IBM Corp., Armonk, New York) softwares and the statistical analysis technique was based on structural equation modeling (SEM). A total of 300 questionnaires including valid responses were used in this study. The results showed that mediator of age did not affect the predictors of intention to use mHealth, and the level of education and gender directly affected the intention to use. In addition, effort expectancy, facilitating condition, and behavioral intention directly and indirectly have effect on use, whereas the result revealed no significant relationship between two important processes of performance expectancy and social influence with students' behavioral intention to use the mHealth. The present study provides valuable information on mobile health acceptance factors for widespread use of this device among students of universities of medical sciences as a base infrastructure for a variety of information about health services and learning. Review and comparison of results with other studies showed that mHealth acceptance factors were different from other end users (elderly, patients, and health professionals).

Empowering lung cancer survivors and family members to “breathe easier”: Adaptation and evaluation of a m-health intervention.

e23046 Background: Survivors of lung cancer often experience a myriad of symptoms that have devastating effects on their physical and psychological functioning such as dyspnea, fatigue, and stress. To combat these symptoms, the American College of Chest Physicians has recommended the use of complementary therapies. Mindfulness-based Cancer Recovery (MBCR) can empower survivors, and caregivers who often cope with their own health problems and the stress related to caring for a survivor. Our goal is to deliver a tailored, culturally sensitive, MBCR intervention to survivors and family members via a mHealth app. Methods: This research was comprised of four phases. Phase I was the development and testing of an 8-week in-person intervention called Breathe Easier with survivors and family members (dyads). Phase II adapted Breathe Easier into a mHealth app prototype utilizing user-centered design. Phase III was a focus-group evaluation of the usability and acceptance of the mHealth app prototype by survivors and family members. Phase IV was comprised of additional interviews with an African-American subset of survivors and family members to assess the cultural sensitivity of the mHealth app. Results: Findings from the in-person intervention (n = 62) showed that all agreed the intervention materials were acceptable, different levels of yoga, breathing exercises, and meditations helped them, and involving a family member was important. Preliminary analyses showed survivors had less dyspnea and perceived stress over time (T1 vs T2). Both groups had improved fatigue and sleep scores. Findings from the mHealth app design and acceptance evaluation were organized into two primary categories: usefulness and ease of use. User-friendly design recommendations included aesthetic appeal, navigation layout, and display of content. Furthermore, potential health outcomes, privacy concerns, and comparison to in-person interventions also influenced app usefulness and acceptance. Lastly, findings from our cultural sensitivity assessment demonstrated that the mHealth app was culturally sensitive for African-Americans, but some changes were recommended. Conclusions: MBCR interventions hold great promise for improving the lives of racially diverse survivors of lung cancer and family members. An mHealth app will increase accessibility. However, special consideration of app design is needed to ensure future acceptance and longer-term usage.

Perceptions and Acceptance of mHealth in Patients With Cardiovascular Diseases: A Cross-Sectional Study.

BackgroundMobile health (mHealth)—a method of assisting long-term care in patients with chronic cardiovascular diseases (CVDs)—is gaining popularity in China, mainly owing to the large number of patients and limited clinical resources. Patients of different ages have varying needs for CVD management. However, evidence regarding how age influences Chinese CVD patients’ use and perceptions of mHealth is limited.ObjectiveThis study aimed to explore age-related differences among Chinese patients with CVD regarding their use and perceptions of mHealth and to determine the factors that influence this population’s willingness to use mHealth technologies.MethodsWe conducted a cross-sectional study of patients with chronic CVDs in a tertiary hospital in Beijing using a new questionnaire designed by the investigators. Participants were sourced using nonproportional quota-sampling methods, being recruited consecutively in each sampling category (age 18-49, 50-64, 65-74, and ≥75 years, with at least 25 men and 25 women in each age group). The survey consisted of 5 parts, including sociodemographic profile and medical history; current disease management situation; self-evaluation of disease management; current usage of mobile and internet technology (IT); and willingness to use an mHealth solution to perform disease self-management. Responses were compared among the 4 age groups as well as between patients who were willing to use mHealth solutions and those who were not. Multivariate logistic regression model was used to identify predictors of willingness to use mHealth for self-management.ResultsOverall, 231 patients (124 men) completed the questionnaire; of these, 53 were aged 18-49 years, 66 were aged 50-64 years, 54 were aged 65-74 years, and 58 were aged ≥75 years. Patients in the older cohorts visited hospitals more often than did those in the younger cohorts (P<.001), and they also showed lower technology skills regarding the use of mobile or internet devices (P<.001) and searched for health-related information on the internet less often (P<.001). In addition, 68.0% (157/231) of the patients showed interest in using mHealth solution to manage their disease; of these, 40.8% (64/157) were aged ≥65 years. Patients who were more willing to use mHealth solution to manage their diseases were younger (P<.001), more educated (P<.001), still working (P=.001), possessed higher skill regarding mobile or internet device use (P<.001), and more frequently searched for health information on the internet (P<.001). Finally, multivariate logistic regression showed that IT skill was the single indicator (P=.003) of willingness to use mHealth, not age.ConclusionsAlthough age is associated with the use of mobile or internet devices, the sole indicator of mHealth use for self-management was participants’ IT skills. Education regarding the use of mobile devices and development of easy-to-use software might improve the acceptance of mHealth solutions among older patient populations.

Improving health equity for ethnic minority women in Thai Nguyen, Vietnam: qualitative results from an mHealth intervention targeting maternal and infant health service access.

BackgroundEthnic minority women (EMW) in Vietnam experience disproportionately high infant and maternal mortality rates due to low social status, poverty and remoteness from health centres. This project piloted and evaluated a low-cost mobile health (mHealth) intervention called mMom utilizing behaviour change communication (BCC) to improve access to maternal, newborn and child health (MNCH) services and health equity among EMW living in remote areas.MethodsThe mMom intervention built an integrated mHealth platform which sent timely MNCH information and BCC text messages to participants, and engaged health workers towards increasing their interaction and building demand for quality natal care. Mid-term and final qualitative evaluations were conducted to assess the intervention’s acceptability and impact.ResultsIn evaluations, all participants expressed satisfaction with the quality, timeliness and convenience of the messages, and health workers reported increased efficiency and quality of care. The use of BCC increased care-seeking from EMW and strengthened relationships with health providers.ConclusionThe mMom project demonstrated the acceptability of mHealth in a remote Vietnamese region with a high proportion of disadvantaged EMW. The messages promoted increased contact between participants and health providers, which holds potential to address the marginalization of EMW from the health system.

Physiotherapists' and Physiotherapy Students' Perspectives on the Use of Mobile or Wearable Technology in Their Practice.

Purpose: Although extensive research has been carried out on the determinants of mobile or wearable health care technology (mHealth), as well as on its acceptance by patients and other health care providers, very little research has been done on physiotherapists' perspectives on the use of mHealth in their current or future practice. The aims of this study were to (1) explore the attitudes of physiotherapists toward mHealth using a modified technology acceptance model questionnaire, (2) understand the applications and delivery paradigms that are most desirable, and (3) assess the content validity of the questionnaire. Method: The questionnaire was administered online. Participants (n=76) were recruited using snowball and convenience sampling. Data were analyzed using factor analysis and partial least-squares path modelling. Results: Results indicate that perceived usefulness and perceived ease of use were related to early adoptive behaviour among participants. We found no evidence that age, gender, experience, or practice setting influenced early adoptive behaviour. Participants demonstrated favourable attitudes toward mHealth tools in clinical practice. Conclusions: This article provides initial insights into factors that are likely to be significant determinants of adoption of mHealth among physiotherapists. Further work, including qualitative research, will help to identify personal and institutional factors that will improve the acceptance of mHealth.