App Content Research Articles

Feasibility of a Supportive Mobile Health App for Chimeric Antigen Receptor T-Cell Therapy

BACKGROUND: The operationalization of chimeric antigen receptor (CAR-T) therapy for hematologic malignancies can be complex for patients and their caregivers. In the weeks before CAR-T therapy, patients must process large amounts of information and coordinate logistics involving caregivers, lodging, and transportation. Immediately following CAR-T therapy, patients must be monitored closely for toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). In the months following CAR-T therapy, patients may be referred back to local oncologists without a clear plan for managing potential late effects such as hypogammaglobulinemia or neuropsychiatric complications (Chakraborty 2021).Mobile health (mHealth) apps may be able to improve the patient experience during CAR-T therapy by facilitating care coordination, home-based toxicity monitoring, and patient education (Banerjee 2021). By empowering patients and caregivers to better understand CAR-T therapy and actively participate in their care, mHealth tools may ultimately augment workflows for CAR-T clinics as well. However, the feasibility and acceptability of such supportive mHealth apps during CAR-T therapy have not been established.STUDY DESIGN: We have designed a “Companion for CAR-T” mHealth app to assist with care coordination, toxicity monitoring, and patient education during CAR-T therapy. Key components of the app are summarized in the Figure. In brief, pre-CAR-T components include educational videos and dynamic calendars to assist patients with coordinating logistics. Post-CAR-T components include app-based prompts to input body temperature daily, an electronic Immune Effector Cell-Associated Encephalopathy (eICE) screening tool for ICANS that can be administered by caregivers, and a patient-specific long-term survivorship care plan. Global app components include an ‘Appointment Companion’ to facilitate patient-provider discussions during appointments as well as a digital CAR-T wallet card to convey key health-related information to other healthcare providers.We plan to investigate the “Companion for CAR-T” app through a pilot study of 20 patients receiving commercially available CAR-T therapies for any hematologic malignancy at our institution. Co-primary endpoints include (1) app feasibility, defined as the percentage of patients who access all 5 core modules shown in the Figure at least once; and (2) app acceptability, defined as the percentage of patients who agree that the app was helpful during their experience with CAR-T therapy. Secondary endpoints include the incidence of fevers or eICE deficits recorded via the app. Exploratory endpoints include longitudinal trends in patient-reported outcomes such as emotional distress at each clinic visit.DISCUSSION: If feasibility and acceptability of the “Companion for CAR-T” app are demonstrated through this pilot study, we plan to launch a multicenter randomized Phase 2 study of this mHealth tool versus usual care to assess its effect on perceived stress and decisional conflict. Other important steps for our group include the translation of app content into different languages and the provision of tablet computing devices for patients who do not own smartphones. Once validated and expanded in these aforementioned ways, potential strengths of the “Companion for CAR-T” app include its ability to be personalized easily with information specific to individual CAR-T therapies, malignancies, and centers. [Display omitted] DisclosuresBanerjee: Sanofi: Consultancy; SparkCures: Consultancy; Pack Health: Research Funding. Sykes: Patient Discovery Solutions, Inc.: Current Employment. Shah: Amgen: Consultancy; Indapta Therapeutics: Consultancy; Sutro Biopharma: Research Funding; Sanofi: Consultancy; Teneobio: Research Funding; Precision Biosciences: Research Funding; Poseida: Research Funding; Karyopharm: Consultancy; Janssen: Research Funding; GSK: Consultancy; Kite: Consultancy; Nektar: Research Funding; Oncopeptides: Consultancy; CSL Behring: Consultancy; Bluebird Bio: Research Funding; BMS/Celgene: Research Funding; CareDx: Consultancy. Andreadis: Incyte: Honoraria; Roche: Current equity holder in publicly-traded company, Ended employment in the past 24 months; GenMAB: Research Funding; Merck: Research Funding; Novartis: Research Funding; Epizyme: Honoraria; Crispr Therapeutics: Research Funding; Atara: Consultancy, Honoraria; Karyopharm: Honoraria; TG Therapeutics: Honoraria; Kite: Honoraria; BMS/Celgene: Research Funding. Martin: Amgen: Research Funding; GlaxoSmithKline: Consultancy; Oncopeptides: Consultancy; Janssen: Research Funding; Sanofi: Research Funding. Shore: Patient Discovery Solutions, Inc.: Current Employment. Sodowick: Patient Discovery Solutions, Inc.: Current Employment. Wong: Amgen: Consultancy; Genentech: Research Funding; Fortis: Research Funding; Janssen: Research Funding; GloxoSmithKlein: Research Funding; Dren Biosciences: Consultancy; Caelum: Research Funding; BMS: Research Funding; Sanofi: Membership on an entity's Board of Directors or advisory committees.

Development of 4to24, a Transition Application for Parents of Students With Visual Impairments

Introduction This article focuses on the development of 4to24, an informational app for parents of students with visual impairments, with emphasis on obtaining stakeholder input, developing content, and establishing content validity. The app provides information, resources, and activities to help students, ages 4–24 years, prepare for independence and employment as an adult. Method App design and content development involved multiple phases of iterative design and writing. Stakeholder input was obtained via an advisory board and user focus groups with parents and students. Experts reviewed and validated content with ratings and recommendations on accuracy, age-appropriateness, and relevance. Results Advisory board members identified important domains to address in 4to24 including social skills, technology, travel skills, health and fitness, independent living, career education, and self-determination. They recommended focusing on elevating parents’ expectations and confidence in supporting and teaching their children. Focus group participants recommended accessibility, ease of use, and relevant information to make the app appealing to users. The content validation process supported the content’s relevance, accuracy, and age-appropriateness and resulted in a final count of 410 informational modules. Discussion Parent involvement and expectations are critical to students’ preparation for future employment. 4to24 provides support for parents to collaborate with service providers and reinforce concepts and skills outside of school. Development of the app technology and its large volume of content required a full 5-year process. Implications for practitioners Lessons learned from this project can inform future resource development projects, including recommendations to start small and define goals early in the process. The 4to24 app is a new resource for parents of students with visual impairments that can supplement services provided by professionals.

Discussion Guide for the Petrinec Article

Discussion Guide for the Petrinec Article

Development and Demonstrational Instantiation of a Method for the Structured Content Analysis of Smartphone Apps

The publication discusses the adaptation of dedicated known methods for structured content analysis for the usage of smartphone apps, taking into account the specifics of these dynamic media types and resulting consequences for the procedure and content rating. The background is the increasing popularity of apps and the growing demand for precise analysis of the status quo regarding the content and functions of apps on the market, esp. within design-oriented business informatics. Within the literature, no uniform, comparable and systematic approach to this could be identified so far. Therefore, an existing standard for the evaluation of apps from the medical context has been adapted for general application to apps. This provides a helpful procedure for researchers, practitioners, and students and ensures consistency across studies. The feasibility of the proposed method and assessment standard were confirmed by a successful demonstrational instantiation based on an app review of energy information systems for private customers.

The Infusion Speech Skeleton Application (Apps) Concept as A Teaching Medium for Office Management & Technology (OMT) Students

This research aims to employ Apps in public speaking courses to facilitate OMT students’ learning process with simplified speech draft development versions. The Apps development was categorised into two divisions: (i) content and (ii) design and concept. Specifically, Apps content served to complement OMT students’ requirements while Apps design and concept encompassed interactive designs and waterfall models. Additionally, Analysis, Design, Development, Implementation, and Evaluation (ADDIE) and focus group discussion (FGD) were incorporated as research methodologies. Although App utilisation was presented in multiple educational courses, this study pioneered App development and implementation in the public speaking courses in line with non-communication (OMT ) student needs.

96 The pediatric health app landscape: Results of an environmental scan

Abstract Primary Subject area Technology Background Providing resources that aid in detection and identification of serious childhood illness helps parents feel better equipped to assess their child’s health and significantly changes parental health-seeking behaviours. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access health information about their child. Mobile health (mHealth) apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices. Objectives To systematically identify all Canadian and US child health apps for parents. Design/Methods We used an environmental scan approach – a review designed to summarize information for decision makers. The Android and Apple app marketplaces were used as search platforms. We built a list of search terms and used these platforms to search for apps targeted at parents, related to pediatric illnesses in US and Canada. Then once we determined that the app met the inclusion criteria, each included app was assessed using the Mobile App Rating Scale (MARS), a validated tool for assessing health apps. The MARS examines apps on five domains: engagement, functionality, aesthetics, information quality, and subjective quality. Results 650 unique apps were screened and 53 apps were included. On a scale of 1-5, the 53 apps assessed had an average Engagement score of 2.82/5 (θ = 0.86), Functionality of 3.98/5 (θ = 0.72), Aesthetics of 3.09/5 (θ = 0.87), Information quality of 2.73/5 (θ = 1.32), and Subjective quality of 2.2 (θ = 0.79). App scores ranged from 2.2/5 to 4.5/5 (µ= 3.2, θ =0.6).The top three apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top three apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces. In addition, published evidence of the included apps’ impact was poor: only 5/53 apps had an evidence base showing the app had been trialed. Conclusion There is a need for evidence-based apps of Canadian origin related to childhood illnesses. The results of this scan created a picture of the health app landscape by examining trends in apps related to pediatric health that are readily available to parents, and by identifying gaps in app design that can be addressed.

Can a meditation app help my sleep? A cross-sectional survey of Calm users.

Use of mindfulness mobile apps has become popular, however, there is little information about subscribers' perceptions of app content and its impact on sleep and mental health. The purpose of this study was to survey subscribers to Calm, a popular mindfulness meditation app, to explore perceived improvements in sleep and mental health, evaluate what components of the app were associated with improvements in sleep and mental health, and determine whether improvements differed based on sleep quality. Calm subscribers who had used a sleep-related component in the last 90 days completed a Web-based investigator-developed survey and the Pittsburgh Sleep Quality Index. The survey included questions about using Calm for sleep, sleep disturbances, mental health diagnoses (i.e., anxiety, depression, PTSD) and perceived impacts of the app. Participants reported on the extent to which they felt that using Calm had improved their sleep and mental health. Most participants reported sleep disturbance, and almost half reported a mental health diagnosis. The majority of participants reported that using Calm helped them fall asleep, stay asleep, and get restful sleep. All sleep components were associated with perceived improvements in sleep disturbance. Severity of sleep disturbance moderated relationships between using Calm components and reporting improved sleep. Among subscribers with mental health diagnoses, most reported that Calm helped improve symptoms. Perceived improvement in anxiety and depression was associated with using Calm's meditation components but not Sleep Stories or music/soundscapes. Severity of sleep disturbance did not moderate relationships between using Calm components and reporting mental health improvements. Given the accessibility of app-based meditation, research is needed to evaluate the efficacy of meditation apps to improve sleep disturbance. While some sleep content may be helpful for sleep, more research is needed to test what specific content affects mental health.

Digitally supported public health interventions through the lens of structural injustice: The case of mobile apps responding to violence against women and girls.

Mobile applications (apps) have gained significant popularity as a new intervention strategy responding to violence against women and girls. Despite their growing relevance, an assessment from the perspective of public health ethics is still lacking. Here, we base our discussion on the understanding of violence against women and girls as a multidimensional, global public health issue on structural, societal and individual levels and situate it within the theoretical framework of structural injustice, including epistemic injustice. Based on a systematic app review we previously conducted, we evaluate the content and functions of apps through the lens of structural injustice. We argue that technological solutions such as apps may be a useful tool in the fight against violence against women and girls but have to be situated within the broader frame of public health that considers the structural dimensions of such violence. Ultimately, the concerns raised by structural injustice are-alongside key concerns of safety, data privacy, importance of human supportive contact, and so forth-crucial dimensions in the ethical assessment of such apps. However, research on the role and relevance of apps as strategies to address the structural and epistemic dimensions of violence remains scarce. This article aims to provide a foundation for further discussion in this area and could be applicable to other areas in public health policy and practice.

Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan.

BackgroundProviding parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children’s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child’s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices. ObjectiveThe aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved.MethodsWe conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores.ResultsOverall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy.ConclusionsThere is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design.

A systematic review of smartphone apps for gastro-oesophageal reflux disease: the need for regulation and medical professional involvement.

Expansion in smartphone use and mobile health (mHealth) apps has generated a large and unregulated sector. Gastro-oesophageal Reflux Disease (GORD) is a widely prevalent disease in the UK. The aim of this study is to evaluate the smartphone apps focused on GORD, available on major digital platforms, with particular emphasis on their recorded evidence base (EB) and the extent of medical professional involvement (MPI) in their constitution. Relevant apps were extracted using defined search terms and inclusion (using a wide array of search terms) and exclusion criteria (non-English language, duplicates) were applied. Data was collected from the overview provided by the developer in the app store and from the developer website for each app, and classified according to various variables. EB and professional involvement data was obtained from the application details provided in the app stores as well as information section of individual apps. A vast majority of the apps (97.3%) were developed targeting the general public. Of the 73 apps, 11 (15.1%) had a documented EB. Two apps stated if healthcare professionals were involved in the development, screening or assessment of the app content, meaning only 2.73% of the apps (2/73) stated their content had been contributed by medical professionals (individual, group or organisation of health providers). Thirty-four apps had recent updates in 2019 (47%, 34/73). Regulation and accreditation of mHealth apps related to GORD are needed.

Patient Acceptance of Educational Contents in Asma Droid for Learning Asthma Self-Management

Education on proper asthma self-management is important in the management of asthma. It is a strategy to improve the quality of life and clinical outcomes of asthmatics. In this modern era, almost all digital contents, including health promotion and patient education, can be simply carried out through a smartphone app. Unfortunately, not all patients accept this approach. A well-validated method, known as the Technology Acceptance Model, was adopted to ensure the acceptance of the contents by users, in this case, patients. This study aimed to determine the perceived usefulness and perceived ease of use in the patient acceptance of educational contents of an asthma self-management app, known as AsmaDroid. The design of this study was an explanatory model with a quantitative approach. The respondents were asthmatics with the following criteria: aged 19–22 years old, having a history of asthma, and having installed and used the AsmaDroid app for a month. The purposive sampling approach was adopted with 100 study respondents, and the instruments of the study were AsmaDroid and a TAM questionnaire. Additionally, a descriptive statistic was also adopted with the use of multiple linear regression to prove the study hypothesis. The results of this study showed that both perceived usefulness and perceived ease of use had a positive and significant effect on the user or patient acceptance, with a significant value of 0.00 and 0.02, respectively. This study concluded that asthma educational contents in AsmaDroid provided benefits and convenience for users. Therefore, the educational contents were accepted as an alternative medium to learn asthma self-management.

Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study.

BackgroundDespite the growing evidence indicating the efficacy of digital cognitive behavioral interventions (dCBIs) for behavioral health (BH) treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities.ObjectiveThis study assessed providers’ views on the feasibility and acceptability of delivering a cognitive behavioral therapy (CBT)-based mobile app in multiple care settings.MethodsParticipating providers included BH and physical health (PH) providers from a women’s health center, an outpatient BH clinic, and both rural/urban primary care settings. All participating providers cocreated workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, the providers referred adult patients experiencing anxiety or depression to a mobile app-based dCBI, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by the providers through the electronic medical record. To better understand facilitators of and challenges in integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach.ResultsA total of 19 provider interviews were conducted to discover motivators and barriers for referring RxWell. The providers benefited from a focused discussion on how to incorporate the referral process into their workflow, and knowing the app content was rooted in evidence. Although the providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress is needed. The providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone, or preference for in-person therapy. The providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, to have an extra treatment option that teaches BH exercises, and to have a CBT treatment option that overcomes barriers (eg, wait times, copays, travel) to traditional therapy modalities.ConclusionsDigital intervention success in health care settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet the mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse its use within their routine workflow.

Gambling Prevention Mobile Applications: Understanding the Inclusion and Use of Behaviour Change Techniques

Online gambling is emerging as a significant health behaviour of concern at a population level. Mobile applications (apps) are a popular tool to target change in health behaviour. Behaviour change techniques (BCTs) can be included within such apps to change relevant psychological mechanisms along established pathways, yet the content of apps targeting gambling problems specifically is not currently known. The purpose of the review was to identify the BCTs included in gambling prevention apps. Apps were downloaded from the Apple App Store and Google Play Store in October 2020. Apps were included if they related to gambling problems, were freely downloadable, and available in English. Once downloaded, two researchers independently coded the apps in November 2020 using the behaviour change technique taxonomy version 1 (Michie et al., 2013). The screening led to forty apps meeting the inclusion criteria (12 Apple App Store, 28 Google Play). The analyses identified 32 BCTs (20 Apple apps, 28 Google Play apps), with apps including between 0 and 9 BCTs (mean = 2.82, median = 2). The BCTs included most frequently were “3.1. Social support (unspecified),” “2.3. Self-monitoring of behaviour,” and “7.4. Remove access to the reward.” The review provides important information on the BCTs used in apps developed to reduce gambling-related problems. A limited number of BCTs were adopted within apps. Developers of apps seeking to develop effective gambling reduction products should draw upon a greater variety of BCTs.

Effectiveness of a smartphone-based educational intervention to improve breastfeeding

BackgroundExclusive breastfeeding (EBF) is essential during the first six months of life and confers countless benefits to mothers and infants. This study aimed to assess the effectiveness of a smartphone-based educational intervention to improve new mothers’ breastfeeding for infants younger than six months of age in Urmia, Iran.MethodsA randomized controlled trial study was conducted from January to December 2019 with 40 new mothers and their first child aged < 3 months, assigned to the intervention (mobile app education + routine care) and control groups (routine care). The mean age of infants was 1.25 and 0.98 months for each group consequently. The designed app content categorized according to seven sections (the importance of breastfeeding, behavioral methods, complementary feeding and EBF, pumping and manual expression, managing common breast-related and breastfeeding problems, breastfeeding tips in special situations, and common queries) for educating the required knowledge to nursing mothers.ResultsForty mothers were assessed for primary outcomes in each group. At three months, the mothers’ knowledge, attitude, and practice (KAP) had meaningful differences in the intervention group compared to the control group. In the intervention group, the degree of changes in knowledge and attitude were 5.67 ± 0.94 and 8.75 ± 1.37 respectively more than the control group (p < 0.001, p < 0.001). However, this amount for the practice score was 0.8 ± 0.49 which is considered to be marginally significant (p = 0.063). During the study, the mothers’ breastfeeding self-efficacy showed significant progress in favor of the intervention group. The score enhancement was 26.85 ± 7.13 for the intervention group and only 0.40 ± 5.17 for the control group that was confirmed to be significant (p < 0.001).ConclusionThe smartphone-based app for educating new mothers on breastfeeding had a significantly positive effect on breastfeeding self-efficacy and maternal KAP. In future studies, the intervention can be tested in both prenatal and postpartum periods.

Feasibility of a Smoking Cessation Smartphone App (Quit with US) for Young Adult Smokers: A Single Arm, Pre-Post Study.

While smartphone applications (apps) have been shown to enhance success with smoking cessation, no study has been conducted among young adult smokers aged 18–24 years in Thailand. Quit with US was developed based on the 5 A’s model and self-efficacy theory. This single arm, pre-post study was conducted aiming to assess results after using Quit with US for 4 weeks. The primary outcome was a biochemically verified 7-day point prevalence of smoking abstinence. The secondary outcomes included smoking behaviors, knowledge and attitudes toward smoking and smoking cessation, and satisfaction and confidence in the smartphone app. A total number of 19 young adult smokers were included; most participants were males (68.4%) with the mean (SD) age of 20.42 (1.46) years. After 4 weeks of study, the primary outcome demonstrated a smoking cessation rate of 31.6%. All 19 participants expressed better smoking behaviors and better knowledge and attitudes toward smoking and smoking cessation. Further, they were satisfied with the smartphone app design and content and expressed confidence in using it. These findings provided preliminary evidence that Quit with US was found to be a potentially effective smoking cessation smartphone app for young adult smokers.

Consumer Perspectives on Maternal and Infant Health Apps: Qualitative Content Analysis

BackgroundDespite the popularity of maternal and infant health mobile apps, ongoing consumer engagement and sustained app use remain barriers. Few studies have examined user experiences or perceived benefits of maternal and infant health app use from consumer perspectives.ObjectiveThis study aims to assess users’ self-reported experiences with maternal and infant health apps, perceived benefits, and general feedback by analyzing publicly available user reviews on two popular app stores—Apple App Store and Google Play Store.MethodsWe conducted a qualitative assessment of publicly available user reviews (N=2422) sampled from 75 maternal and infant health apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. The reviews were coded and analyzed using a general inductive qualitative content analysis approach.ResultsThe three major themes included the following: app functionality, where users discussed app features and functions; technical aspects, where users talked about technology-based aspects of an app; and app content, where users specifically focused on the app content and the information it provides. The six minor themes included the following: patterns of use, where users highlighted the frequency and type of use; social support, where users talked about receiving social support from friends, family and community of other users; app cost, where users talked about the cost of an app within the context of being cost-effective or a potential waste of money; app comparisons, where users compared one app with others available in app stores; assistance in health care, where users specifically highlighted the role of an app in offering clinical assistance; and customer care support, where users specifically talked about their interaction with the app customer care support team.ConclusionsUsers generally tend to value apps that are of low cost and preferably free, with high-quality content, superior features, enhanced technical aspects, and user-friendly interfaces. Users also find app developer responsiveness to be integral, as it offers them an opportunity to engage in the app development and delivery process. These findings may be beneficial for app developers in designing better apps, as no best practice guidelines currently exist for the app environment.

Evaluation of free mobile health applications for pelvic organ prolapse and urinary incontinence

BackgroundTechnology is becoming increasingly integrated into healthcare, including the rapid development of mobile health (mHealth) applications (apps) for various medical conditions such as urinary incontinence and pelvic organ prolapse (POP). As patients turn to these sources more frequently, closer evaluation of the apps becomes more important. ObjectivesTo (1) evaluate free applications designed for POP and urinary incontinence using the Xcertia guidelines for medical app quality, (2) analyze user sentiment of the apps, and (3) evaluate app information for quality, understandability, and actionability with the DISCERN and the Patient Education Materials Assessment Tool (PEMAT) tools. MethodsMobile medical apps were identified on the Apple App Store or Google Play Store with keywords “pelvic organ prolapse,” “incontinence,” or “bladder.” Exclusion criteria included 1) not free, 2) not updated in past year, 3) required a product for use, 4) not in English. Apps were evaluated using the Xcertia Guidelines. Categories included Operability, Privacy, Security, Content, and Usability. Ratings and sentiment of reviews were assessed, and associations analyzed with one-sided Fisher's exact test. Apps with an informational component were evaluated for quality, usability and actionability using DISCERN and PEMAT criteria. ResultsOverall, a total of 73 apps were found and 28 were included. There was an average number of ratings of 2341 and an average score of 3.39 for all the apps included. The average number of reviews was 216.2, with the majority of reviews having positive sentiment. A high number of ratings was associated with a high rating score (p < 0.05) and a high number of reviews was associated with a high percentage of positive reviews (p < 0.05). Based on Xcertia Guidelines, all apps met the guidelines for privacy, security, and usability. Regarding content, 67.9 % of apps incorporated an informational component, but only 17.9 % delineated sources. The average DISCERN score for information quality indicated good quality information (>3). The average PEMAT scores for Understandability and Actionability were 90.6 % and 86.6 %, respectively, which are good scores (≥75 %). ConclusionsMost free apps were functional and well received by users, however quality of app content varied. Only some apps had an informational component, and even fewer had sources listed. Providers recommending health apps should consider those that meet Xcertia guidelines, have reliable information, and have good understandability and actionability.

Engagement with a digital therapeutic for smoking cessation designed for persons with psychiatric illness fully mediates smoking outcomes in a pilot randomized controlled trial.

Understanding the mechanisms of change of digital therapeutics is a critical step to improve digital health outcomes and optimize their development. Access to and engagement with digital content is arguably a core mechanism of change of these interventions. However, the mediational role of app engagement has been largely unexamined. To evaluate the mediational effect of engaging with a digital therapeutic for smoking cessation designed for adults with psychiatric disorders. Secondary analysis of a pilot clinical trial of 62 adults with serious mental illness who were randomized to receive either a tailored digital therapeutic (Learn to Quit) or a digital therapeutic for the general public (NCI QuitGuide). Engagement was captured using background analytics of app utilization, including (a) number of interactions with app content, (b) minutes/day of app use, and (c) number of days used. The main outcome was reductions in cigarettes per day from baseline to the four-month endpoint. Mediational analysis followed the Preacher and Hayes bootstrap method. Number of application interactions fully mediated reductions in cigarettes per day in the Learn to Quit application but not in QuitGuide (Average Causal Mediation Effect = .31, p = .02). Minutes/day of app use played an uncertain role, and number of days used was not a significant mediator. Results suggest that one of the mechanisms of action of the Learn to Quit device, engagement with theory-based content, functioned as intended. Future research of digital therapeutics should emphasize granular approaches to evaluating apps' mechanisms of action.

Suicide Prevention Mobile Apps for Indian Users: An Overview.

Suicide is an issue of global concern. Mobile applications (apps), if found effective, could supplement suicide prevention efforts by addressing some of the barriers to help-seeking. This study aimed to review the nature of suicide prevention apps available for Indian users using the Android platform. Apps identified were broadly reviewed on general features, inclusion of educative elements, suicide risk assessment, and strategies to manage suicidal thoughts. The search terms “suicide,” “suicide prevention,” and “feeling suicidal” were used to search the Google Play Store from May to December 2020, and apps exclusively focusing on suicide prevention were identified and reviewed.The initial search resulted in 492 apps, of which 43 met inclusion criteria and were further assessed. Fewer than half the apps included supplementary information to users on scientific, evidence-based content (32.55%), and only a few apps were reported to be empirically validated (11.62%). Approximately one-third of the apps intended for people at suicidal risk had an initial screening aspect (16.12%), and one-third of the apps intended for support providers had a suicide risk assessment tool (25.92%). Most apps (81.39%) included a suicide helpline number specific to the region where they were developed, but only a few (23.25%) included motivational elements to call helplines. Common therapeutic strategies suggested to manage suicidal thoughts included distraction, means restriction, environment safety, perspective-shifting strategies, and calming or soothing strategies. Several apps (39.53%) included therapeutic strategies through safety plans.For apps to be used effectively for suicide prevention, they should include evidence-based content and motivational elements to call helplines, and and clinicians need to examine app features and content before recommending them for use by patients.

A Biofeedback App for Migraine: Development and Usability Study.

BackgroundBiofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine. However, widespread use of biofeedback is hampered by the need for a trained therapist and specialized equipment. Emerging digital health technology, including smartphones and wearables (mHealth), enables new ways of administering biofeedback. Currently, mHealth interventions for migraine appear feasible, but development processes and usability testing remain insufficient.ObjectiveThe objective of this study was to evaluate and improve the feasibility and usability of an mHealth biofeedback treatment app for adults with migraine.MethodsIn a prospective development and usability study, 18 adults with migraine completed a 4-week testing period of self-administered therapist-independent biofeedback treatment consisting of a smartphone app connected to wearable sensors (Cerebri, Nordic Brain Tech AS). The app included biofeedback training, instructions for self-delivery, and a headache diary. Two wearable sensors were used to measure surface electromyographic voltage at the trapezius muscle and peripheral skin temperature and heart rate at the right second fingertip. Participants were instructed to complete a daily headache diary entry and biofeedback session of 10 minutes duration. The testing period was preceded by a preusability expectation interview and succeeded by a postusability experience interview. In addition, an evaluation questionnaire was completed at weeks 2 and 4. Adherence was calculated as the proportion of 10-minute sessions completed within the first 28 days of treatment. Usability and feasibility were analyzed and summarized quantitatively and qualitatively.ResultsA total of 391 biofeedback sessions were completed with a median of 25 (IQR 17-28) per participant. The mean adherence rate was 0.76 (SD 0.26). The evaluation questionnaire revealed that functionality and design had the highest scores, whereas engagement and biofeedback were lower. Qualitative preexpectation analysis revealed that participants expected to become better familiar with physical signals and gain more understanding of their migraine attacks and noted that the app should be simple and understandable. Postusability analysis indicated that participants had an overall positive user experience with some suggestions for improvement regarding the design of the wearables and app content. The intervention was safe and tolerable. One case of prespecified adverse events was recorded in which a patient developed a skin rash from the sticky surface electromyography electrodes.ConclusionsThe app underwent a rigorous development process that indicated an overall positive user experience, good usability, and high adherence rate. This study highlights the value of usability testing in the development of mHealth apps.