App Content Research Articles

Study protocol of the Health4Life initiative: a cluster randomised controlled trial of an eHealth school-based program targeting multiple lifestyle risk behaviours among young Australians

IntroductionLifestyle risk behaviours, including alcohol use, smoking, poor diet, physical inactivity, poor sleep (duration and/or quality) and sedentary recreational screen time (‘the Big 6’), are strong determinants of chronic disease....

Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study.

BackgroundChildhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies.ObjectiveThe goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity.MethodsAfter stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app.ResultsThree key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet.ConclusionsThe pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project.

Medical Mobile App Classification Using the National Institute for Health and Care Excellence Evidence Standards Framework for Digital Health Technologies: Interrater Reliability Study.

BackgroundClinical governance of medical mobile apps is challenging, and there is currently no standard method for assessing the quality of such apps. In 2018, the National Institute for Health and Care Excellence (NICE) developed a framework for assessing the required level of evidence for digital health technologies (DHTs), as determined by their clinical function. The framework can potentially be used to assess mobile apps, which are a subset of DHTs. To be used reliably in this context, the framework must allow unambiguous classification of an app’s clinical function.ObjectiveThe objective of this study was to determine whether mobile health apps could be reliably classified using the NICE evidence standards framework for DHTs.MethodsWe manually extracted app titles, screenshots, and content descriptions for all apps listed on the National Health Service (NHS) Apps Library website on July 12, 2019; none of the apps were downloaded. Using this information, 2 mobile health (mHealth) researchers independently classified each app to one of the 4 functional tiers (ie, 1, 2, 3a, and 3b) described in the NICE digital technologies evaluation framework. Coders also answered contextual questions from the framework to identify whether apps were deemed to be higher risk. Agreement between coders was assessed using Cohen κ statistic.ResultsIn total, we assessed 76 apps from the NHS Apps Library. There was classification agreement for 42 apps. Of these, 0 apps were unanimously classified into Tier 1; 24, into Tier 2; 15, into Tier 3a; and 3, into Tier 3b. There was disagreement between coders in 34/76 cases (45%); interrater agreement was poor (Cohen κ=0.32, 95% CI 0.16-0.47). Further investigation of disagreements highlighted 5 main explanatory themes: apps that did not correspond to any tier, apps that corresponded to multiple tiers, ambiguous tier descriptions, ambiguous app descriptions, and coder error.ConclusionsThe current iteration of the NICE evidence standards framework for DHTs did not allow mHealth researchers to consistently and unambiguously classify digital health mobile apps listed on the NHS app library according to their functional tier.

Content analysis of behavior change techniques in maternal and infant health apps.

Maternal and infant health (MIH) mobile applications (apps) are increasingly popular and frequently used for health education and decision making. Interventions grounded in theory-based behavior change techniques (BCTs) are shown to be effective in promoting healthy behavior changes. MIH apps have the potential to be useful tools, yet the extent to which they incorporate BCTs is still unknown. The objective of this study was to assess the presence of BCTs in popular MIH apps available in the Apple App and Google Play stores. Twenty-nine popular MIH apps were coded for the presence of 16 BCTs using the mHealth app taxonomy. Popular MIH apps whose purpose was to provide health education or decision-making support to pregnant women or parents/caregivers of infants were included in the final sample. On an average, the reviewed apps included seven BCTs (range 2-16). Techniques such as personalization, review of general or specific goals, macro tailoring, self-monitoring of goals, and health behavior linkages were most frequently present. No differences in the presence of BCTs between paid and free apps were observed. Popular MIH apps typically included only a minority of BCTs found to be useful for health promotion. However, apps developed by healthcare developers incorporated a higher number of BCTs within the app content. Therefore, app developers and policymakers may consider strategies to increase health expert involvement in app design and content delivery.

Abstract C095: A quality review and content analysis of mobile applications for smoking cessation

Abstract Introduction: Mobile applications (apps) for smoking cessation promise to increase access to and uptake of smoking cessation services. However, limited information exists on the quality and content of available apps in this category. The purpose of this review was to evaluate the quality and content of free smoking-cessation mobile apps and examine whether they adhered to US Public Health Service Guideline for treating tobacco use and dependence. Methods: A purposive sample of 180 apps was downloaded from the App Store (Apple) and the Google Play Store in January 2018. The top-ranking 30 apps were retrieved for 3 smoking cessation-related search terms (“smoking cessation,” “quit smoking,” “stop smoking”) from the App Store and Google Play. Two reviewers independently coded each app. The technical quality of the included apps was rated using the Mobile Application Rating Scale (MARS), which includes five domains: Engagement (fun, interesting, customizable,), Functionality (easy to learn, navigation), Aesthetics (graphic design, overall visual appeal), and Information (e.g., text, feedback, measures, refences). Apps were also reviewed for other technical characteristics (e.g., allows sharing, app community, and password protection), behavioral change strategies (e.g., assessment, feedback) and whether they adhered to the US Public Health Service's 5As (i.e., Ask, Advise, Assess, Assist, and Arrange). Results: After removing duplicates and apps that were not free to download, 69 apps were identified for full review (41 from the App Store and 28 from the Google Play Store). Across these apps, the average score for MARS was 14.0/19, distributed as follows: Engagement (2.8/5), Functionality (4/5), Aesthetics (4/5), and Information (3/5). Among the 69 included apps, 45 allowed sharing, 15 allowed for an app community, and 6 required a password. The following features were included as follows: assessment (52), feedback (44), information/education (46), monitoring (52), and goal setting (28). The 5As features were included as follows: Ask (44), Advise (2), Assess (2), Assist (2), and Arrange (0). Conclusions: Given the growing availability of smoking-cessation apps as potential cessation aides, future efforts should focus on improving the technical quality of these apps and the adherence to evidence-based guidelines for treating tobacco use and dependence. Note: This abstract was not presented at the conference. Citation Format: Ifeoma Ibe, Antonio Laracuente, Samantha Joseph, Jinhai Huo, Ramzi Salloum. A quality review and content analysis of mobile applications for smoking cessation [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C095.

Limitations of Existing Dialysis Diet Apps in Promoting User Engagement and Patient Self-Management: Quantitative Content Analysis Study.

BackgroundWith the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable.ObjectiveThis study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients.MethodsThis study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: dialysis diet and diet for kidney disease. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as P<.05.ResultsA total of 22 out of 253 apps (8.7%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5% (1/22) of the apps offered relevant language options, and 46% (10/22) contained food databases. In addition, 54% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73%), free download (15/22, 68%), and usability (13/22, 59%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (r=.65, P=.001) and health-behavior theory constructs (r=.55, P=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download (β=.43, P=.03) and usability (β=.41, P=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality (β=.55, P=.008) and the engagement quality (β=.66, P=.001) of the apps, whereas the information quality domain could be determined by plan or orders (β=.48, P=.007) and knowledge (β=.45, P=.01).ConclusionsAlthough most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality.

632-P: Challenges and Opportunities for Patient-Centered DSME/S for Older Adults: Finding the Key to the Patient Portal

Mobile apps, patient portals, and EHRs are promising tools to enhance recommended behaviors for DM. This study reports whether these technologies could effectively deliver patient-centered DSME/S for older people with DM. We analyzed 179 of 1050 DM apps according to AADE7 self-care principles. Most DM apps included features of Monitoring (73%). Few apps supported Healthy Coping (9%), an essential principle for older adults with DM challenged with comorbid conditions. In addition, two focus groups (n=10, mean age=67) revealed a low usability score: 48/100. Participants had trouble using the apps due to poor navigation, visual and physical limitations. We also analyzed 200 visit notes randomly selected from 2634 notes of adults with DM from an EHR that provides access to clinic notes via a patient portal. Notes were written at Flesch Kincaid level 9.6. Using AADE7 principles, we conducted a thematic analysis to determine patterns of DSME/S information. Out of 3735 codes, Monitoring (48%) was addressed most frequently, possibly due to insurance requirements. Healthy Coping (2%) was addressed least frequently, possibly due to time constraints. Generalized linear mixed models revealed no significant associations between DSME/S delivered and patient demographic/DM control measures. Many patients shared data about glycemic control (88%) and had active patient accounts (50%) allowing access to clinical data. Our study shows that features and content of DM apps are not ideal for older adults. We found that patient notes in EHR were above NIH recommended readability levels (6th grade) and many older adults may not understand key points. We did find that older people have access to patient portals, and share information with providers. Patient portals are increasingly available through EHR. User-centered design process should be employed for patient-centered DSME/S to facilitate usability, readability, and information sharing through patient portals for older people with DM. Disclosure M. Kim: None. U.Z. Khan: None. S.A. Boren: None. Q. Ye: None. E.J. Simoes: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092950)

Adapting the myPlan safety app to respond to intimate partner violence for women in low and middle income country settings: app tailoring and randomized controlled trial protocol

BackgroundIntimate partner violence (IPV) is a leading threat to women’s health and safety globally. Women in abusive relationships make critical decisions about safety and harm reduction while weighing multiple competing priorities, such as safety of children, housing and employment. In many low- and middle-income countries (LMIC), IPV prevention and response services are limited and women lack access to safety planning resources. In high-resource settings, an interactive safety decision aid app (myPlan) has been found valuable in reducing decisional conflict and empowering women to take action in accordance with their safety priorities. This paper describes 1) the community-participatory formative process used to adapt the myPlan app content, interface, and implementation for the Kenya context, and 2) the randomized clinical trial study protocol for efficacy evaluation of myPlan Kenya.MethodsA community-participatory formative process engaged service providers and stakeholders, as well as IPV survivors for adaptation, followed by an in-depth pilot and final refinements. A randomized clinical trial design will then be used to determine efficacy of the myPlan Kenya app compared to standard care among women reporting IPV or fear of partner and living in an urban settlement. myPlan Kenya app provides and solicits information on a) relationship health; b) safety priorities; and c) severity of relationship violence. Based on the woman’s inputs, the evidence-based algorithm developed for myPlan Kenya generates a tailored safety plan. Outcome measures are assessed at baseline, immediate post-intervention, and 3-month post-baseline. Difference-in-differences analysis compares primary (e.g. safety preparedness, safety behavior, IPV), and secondary outcomes (e.g. resilience, mental health, service utilization, self-blame) across timepoints by group.DiscussionFormative phase revealed high feasibility and acceptability of a technology-based intervention for safety planning in this LMIC setting. This phase generated essential refinements to myPlan Kenya app readability, content and implementation, including increased visualization of messaging, and implementation via community health volunteers (CHVs). The resulting trial will be the first to evaluate efficacy of a community-partnered technology-based IPV intervention in a LMIC. Our adaptation process and trial results will inform researchers and interventionists to integrate multiple data sources to adapt IPV intervention content and interface in settings where technology-based interventions for IPV are novel and literacy is limited.Trial registrationPan African Clinical Trial Registry approval received 25 April 2018 (PACTR201804003321122); retrospectively registered.

BabyByte: Formative Research to Inform the Development of an App to Improve Responsive Feeding Practices in Parents of Infants and Toddlers

Abstract Objectives Responsive feeding is associated with reduced risk of early childhood obesity. The objective of this qualitative study was to determine parents’ preferred content and features for a mHealth app designed to improve responsive feeding practices. Methods Parents of 0–2 year old children completed individual semi-structured interviews with a trained researcher. Interview questions were informed by the Technology Acceptance Model and parents provided feedback on preferred app content and features. An app prototype, BabyByte, was developed using the Marvel platform to discuss potential app features during the interview. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded by two researchers using a thematic analysis approach and major themes were summarized. Results Parents (n = 40) were, on average, 33.2 years old with the majority self-reporting as non-Hispanic white (53%), a bachelor's degree or higher education (62%), and low-income (53%). Half of the participants were fathers. Overall, the majority (85%) of parents indicated that they would be likely or very likely to use BabyByte. Themes revealed that parents were most interested in topics related to introducing new foods, feeding tips, example meals, recipes, and food allergy guidance. Features including personalized profile set-up, video content, goal setting, milestone tracking, ask an expert, discussion forum, and an app search box were noted as most important or helpful by parents. Convenient access, up-to-date content from a reputable and identifiable source, and incentives for completing modules were indicated as important benefits. Conclusions Findings of this study are important considerations for the development of future mHealth tools for parents of infants and toddlers to improve responsive feeding practices and prevent early childhood obesity. Usability testing of BabyByte is currently in progress. Funding Sources University of Florida CTSI.

Designing a tablet-based prematurity education app for parents hospitalized for preterm birth

BackgroundAs technology has advanced over the last decade, handheld Mobile Health (mHealth) applications have increased in popularity. Pregnancy is one area of mHealth that has rapidly expanded, however very few pregnancy apps are developed in collaboration with health professionals. This creates an environment where the pregnancy information women are accessing may be inaccurate or even dangerous. Additionally, there are relatively few medical apps devoted to prematurity or targeted to women at risk for premature birth. To address the gap in premature birth education, we assembled a multidisciplinary team, including health care professionals, and developed the Preemie Prep for Parents (P3) app. MethodsOur team previously conducted 5 focus group meetings to assess the information needs of our target audience. Based on this information we developed a low fidelity P3 prototype. Our software development team transferred the low fidelity prototype into a high fidelity prototype which was hosted on Test Flight (a beta testing platform). We performed heuristic evaluation as well as user testing to improve the P3 app. ResultsUser testing of the high fidelity P3 prototype was performed with 13 diverse participants. 6 participants were parents of currently admitted Neonatal Intensive Care Unit (NICU) babies and 7 participants were women who had been or were currently pregnant. The native language of participants included English, Spanish, and Hmong and their educational level varied between completing high school and graduate degree. Participants provided feedback on the content of the P3 app, as well as its organization and aesthetics. The feedback led to 83 iterations of the P3 app prior to its deployment. Overall, participants noted that the information was “informative” and “reliable”. They also noted that the P3 app provided control over the information they could view and when they viewed it, stating “I could see info on my time”. Overall, participants felt that the P3 app was a valuable tool for mothers in preterm labor and it would help them ask questions. ConclusionsDevelopment of a mHealth app provides unique challenges regarding content, reliability of information, organization, and aesthetics. Creation of the P3 app to address the educational needs of women at risk for premature birth required assembling a multidisciplinary team, which included target users, and implementing an iterative design process. The efficacy of this app in improving user knowledge and decreasing anxiety is currently being tested in a randomized controlled trial.

Mobile health applications in oncology.

e14115 Background: Over 325,000 mobile health (mhealth) applications (apps) have been developed. There has been a substantial increase in mhealth investment, with over $8.1 billion invested in digital health startups in 2018. While apps have been studied within clinical oncology, we are aware of no comprehensive evaluation of the commercial footprint of oncology-specific apps. We sought to describe the state of oncology-specific apps and highlight notable areas of development. Methods: We conducted a systemic search for oncology apps in the Apple iOS and Google Play app stores in January 2020. Search terms included “cancer,” “oncology,” “radiotherapy,” and “chemotherapy.” All apps were manually reviewed and classified by English language support, date of last update, downloads, intended audience, intended purpose, and developer type. We also compared commercially available apps with those described in a recently conducted meta-analysis of oncology-app studies. We performed descriptive statistics using RStudio V1.2.335. Results: We identified 794 oncology-specific, English-language applications, but only 257 (32%) met basic quality standards and were considered evaluable. The primary reason for exclusion was lack of a recent update. Of included apps, almost half (47%) were found in the “Medical” Store Category and the majority were free (88%). The most common intended audience was healthcare professionals (45%), with 28% being geared towards the general public and 27% being intended for patients. The intended function was education for 37%, clinical decision support (CDS) for 19%, and patient support for 18%. Only 22% of education apps and 40% of CDS apps reported any formal app content review process. Web developers created 61% of apps, scientific societies created 10%, and hospitals/healthcare organizations created just 6% (Table). The most frequently downloaded apps tended to be geared toward educating/supporting the public. Of 54 studies that utilized mobile apps in oncology identified by a recent meta-analysis, only 2 could be matched to commercially available apps from our study, suggesting a substantial divide between investigation and product dissemination. Conclusions: Our analysis of oncology-related apps in the commercial marketplace found few high-quality, up-to-date apps, and a notable absence of key oncology stakeholders in app development. Future studies should explore barriers to developing and disseminating apps designed to advance oncology care delivery. [Table: see text]

A Systematic Review of Educational Mobile-Applications (Apps) for Surgery Residents: Simulation and Beyond

The number of mobile-applications (Apps) increases daily. The regulation of App content is minimal yet surgical residents use these in daily educational practice. Surgical educators must be aware of the quality, efficacy, and validity of Apps available to effectively educate residents. The aim of this review was to determine the quality, efficacy, and validity evidence for educational Apps used by surgical residents. We searched PubMed, Embase, and ERIC for articles published before September 1, 2019. Controlled vocabulary and natural language describing Apps/surgical residents were used. Two reviewers evaluated abstracts for inclusion. studies measuring the quality, efficacy, or validity of educational Apps for surgical residents. Data was extracted from full text of included articles: study design, participants, App investigated, App development, evidence for efficacy, or validity of App. Initial search identified 278 articles. 64 articles were duplicates and 214 articles were screened. A further 156 were excluded with 58 full text articles assessed for eligibility. Forty-five were included in analysis. Simulation (9/45) and Feedback (15/45) Apps were the most commonly studied in surgical residents. These were the main Apps that provided validity evidence for their use in education. Surgical education is evolving as educational technology becomes more prevalent. To be effective as surgical educators we must understand and appropriately use available tools. Of the educational Apps studied (21 Apps in 8 categories), only 3 categories reported validity evidence. Future studies should take care to measure validity and efficacy of educational Apps for surgical education to ensure quality control.

P102 Identifying physical activity mobile applications for people with rheumatoid arthritis: a content analysis and quality appraisal

Abstract Background Physical activity and exercise (PA) are recommended for people with rheumatoid arthritis (RA), although adherence to PA tends to be low. Accessible, tailored interventions are needed to help people with RA change their behaviour to achieve public health PA recommendations and improve health outcomes. Use of smartphones and mobile applications (apps) is increasing and apps may assist people to reach PA recommendations. However, the availability, quality and content of evidence-based PA apps for people with RA is unknown. This study assessed the features, content and quality of apps targeting PA for adults with RA by i) systematically identifying apps ii) summarising their features and content iii) comparing their content to physical activity and exercise guidelines and iv) rating app quality. Methods A systematic search of the UK Apple AppStore and Google Play store was conducted to identify apps designed to facilitate PA in adults with RA between 19th-20th June 2019. Apps were excluded if they were i) not in English ii) for use by clinicians only or ii) solely focused on advertising a clinic/product. No fee restrictions were applied. Android and iOS apps were downloaded to smartphones, features/functionality described, content coded using Consensus on Exercise Reporting Template (CERT) and behaviour change technique taxonomy V1 (BCTTv1) and apps rated using the Mobile App Rating Scale (MARS range 0-5) by two independent reviewers. App features were compared with public health PA guidelines (150 minutes moderate PA/week or equivalent plus twice weekly resistance exercise) and American College of Sports Medicine recommendations for exercise prescription. Results Initially, 14,047 apps were identified. Following de-duplication, 2,737 apps were screened for eligibly and six apps were downloaded (two UK Apple AppStore, four Google Play store), yielding four unique apps. Only one app provided PA recommendations broadly aligned with public health PA guidelines and no apps aligned to ACSM exercise prescription guidelines or offered information on tailoring of PA to disease symptoms or health status. Apps included between 4-13 behaviour change techniques (BCTs) and three BCTs were common to all apps (demonstration of behaviour, instructions on how to perform behaviour, information about health consequences). Overall, MARS scores ranged between 2.25-4.17. Conclusion There is a lack of high-quality mobile apps which can be tailored to support PA for people with RA. Whilst all included apps incorporated some BCTs previously identified as effective for PA promotion, only one, high quality app provided PA recommendations which broadly aligned with public health PA guidelines but offered limited options for tailoring PA or exercise. Collaboration between adults with RA, clinicians, and app developers is needed to produce evidence informed apps, with embedded BCTs, which can be tailored to support people with RA achieve PA recommendations. Disclosures L. Bearne None. M. Sekhon None. R. Grainger None. A. La None. M. Shamali None. A. Amirova None. E. Godfrey None. C. White None.

Views of adolescents and their parents on mobile apps for epilepsy self-management

IntroductionNew technologies are ubiquitous in our everyday lives, and this is especially true for teenagers. Very few mobile apps have been designed for adolescents with epilepsy. In order to better understand their expectations as well as those of their parents, we conducted a survey on this topic. MethodsThe survey consisted of an anonymous self-administered questionnaire that was distributed to adolescents with epilepsy aged 10 to 18 years old and their parents. Questionnaires contained 15 questions including 8 multiple choice questions, 5 groups of multiple questions with a rating scale ranging from 1 to 6, and 2 open–ended questions covering the scope of the interest of epilepsy self-management apps, seizure and epilepsy management, antiseizure medications, and information on epilepsy. ResultsSurveys were answered by 17 teenagers and 19 parents. It showed that adolescents embrace new technologies. Parents' highest expectations regarding mobile apps contents were seizure management and emergency information, while adolescents were expecting contents on epilepsy daily life, as well as a tool that would improve antiseizure medication compliance. ConclusionParents and adolescents' expectations on the content of an epilepsy app were different.

New‐old‐ways: where does innovation stand with technology in anatomy labs

At the Icahn School of Medicine at Mount Sinai (ISMMS), Structures is a very intensive course that encompasses and integrates the subjects of Anatomy, Histology and Embryology. In 2019, we have incorporated iPads into our course, Structures. We here report the insights and challenges we faced while planning and implementing the project. We also include the input from students and educators on the outcomes of this beta version, as well as their vision for the future. At the ISMMS, the first‐year class has 124 students, divided in 24 groups of 5 or 6 components. Each group performs a full cadaver dissection, supervised and supported by faculty, residents, surgeons, emergency attendants, clinical specialists, and teaching assistants (TAs). Our TAs take part in teaching, organize review sessions, and play a major role in Table Conferences—our in‐lab oral assessment on practical knowledge of Anatomy. The team involved in the iPad project was comprised by directors, faculty, TAs, physicians, members of the Medical Education Department, and members of the Information Technology Group: experts in software/hardware and specialists in design and content development. Our goal is to provide our students with the foundation to proceed into the second‐year, without losing sight of the step‐exams, and use the iPads to facilitate content integration. The use of technology in the anatomy lab is not a new paradigm, but our experience shows that that in the area of custom‐tailored content and purposeful selection of apps, innovation and creativity has plenty of room to grow and flourish.

Love My Body: Pilot Study to Understand Reproductive Health Vulnerabilities in Adolescent Girls.

BackgroundSexually transmitted infections (STIs) are on the rise in the United States, and adolescent girls (15-19 years old) are more susceptible to acquiring STIs than their male peers. The co-occurrence of alcohol use and sexual risk taking contribute significantly to STI acquisition. Mobile health (mHealth) interventions are ideally suited for our target population and have demonstrated increases in STI testing in young people, as well as reductions in alcohol use.ObjectiveThis pilot study used both qualitative and quantitative methods to explore the views of adolescent girls (age range 15-19 years old; 74.6%, 279/374 white) on the desired qualities and content of an mHealth app for sexual health.MethodsWe conducted nine 60-min in-depth interviews (IDIs) to gather information and identify themes of sexual health and alcohol use, and we tested the feasibility of using a two-week social media campaign to collect survey information regarding sexual health risk in adolescent girls.ResultsWe iteratively coded IDIs and identified major themes around pressure of alcohol use, lack of STI knowledge, male pressure to not use condoms, and pregnancy as a worse outcome than STIs. Results from the web-based survey on risky health behaviors, which was completed by 367 participants, support the use of a sexual health app designed for girls.ConclusionsFuture work will integrate these themes to inform the development of a culturally sensitive mHealth app to prevent STIs among adolescent girls.

THRIVE intervention development: using participatory action research principles to guide a mHealth app-based intervention to improve oncology care.

Background:Women with hormone receptor-positive, early-stage breast cancer who adhere to adjuvant endocrine therapy (AET) reduce the risk of cancer recurrence and mortality. AET, however, is associated with adverse symptoms that often result in poor adherence. We applied participatory action research (PAR) principles to conduct focus groups and interviews to refine and enhance a web-enabled app intervention that facilitates patient-provider communication about AET-related symptoms and other barriers to adherence.Methods:We conducted four focus groups with women with early-stage breast cancer on AET (N=28), stratified by race (Black and White) and length of time on AET (<6 months and >6 months), to determine preferences and refine the app-based intervention. A fifth mixed-race focus group was convened (N=6) to refine THRIVE app content using high-fidelity mock-ups and to develop new, tailored feedback messages. We also conducted interviews with oncology nurses (N=5) who participated in the THRIVE randomized controlled trial.Results:Participants reported preferences for weekly reminder messages to use the THRIVE app, a free-text option to write in AET-related symptoms, and app aesthetics. Other requested app features included: a body map for identifying pain, sleep and dental problems on the symptom list, a dashboard, tailored feedback messages, and information about social support resources. Participants also developed new intervention messages, decided which messages to keep, and edited language for appropriateness and sensitivity. They also discussed the type of electronic pill monitor and incentive plan to be used in the intervention. Nurses reported THRIVE alerts integrated seamlessly into their clinical workflow and increased patient-provider communication, facilitating quicker response to patients’ reported symptoms. Nurses reported no negative feedback or usability concerns with the app.Conclusions:THRIVE app content reflects researchers’ partnership with a racially diverse sample of breast cancer survivors and healthcare providers and adherence to participatory design by incorporating patient-requested app features, app aesthetics, and message content. The app has the potential to improve AET adherence and quality of life among breast cancer survivors and reduce disparities in mortality rates for Black women by facilitating communication with healthcare providers.

Language counts when learning mathematics with interactive apps

AbstractWhen available in multiple languages, educational apps can deliver the same mathematics instruction in the child’s first language or different language of instruction. This pilot study examined the feasibility of a maths app intervention compared to standard mathematical practice with 61 children aged 5–6 years attending a bilingual immersion school in Brazil. The apps were delivered in either the child’s first (L1, Brazilian Portuguese) or second (L2, English) language, while app content, time on task, and school setting were consistent across the two treatment groups. Time on task in the comparison group was less. After 10 weeks, results showed children made significant mathematical learning gains with the apps, for both languages of instruction, compared to standard practice: the finding is discussed in relation to the threat of time spent on task. Children using the apps in Brazilian Portuguese (L1) completed more app topics than children using the apps in English (L2) and proficiency in language of instruction correlated positively with app progress. As children’s L1 was significantly stronger than their L2 proficiency, this suggests the apps were most effectively implemented in their L1. This study advances the conjoining of bilingual educational theories to educational apps in a controlled, real‐world, bilingual immersion setting and highlights important directions for improving app‐based mathematics instruction for bilingual children. Practitioner NotesWhat is already known about this topic Educational maths apps, available in multiple languages are increasingly popular. Emerging evidence demonstrates the benefits of maths apps for supporting children’s mathematical development. To understand “what works” in the use of maths apps we need to consider factors that may impact outcomes, including children’s proficiency in the language of instruction. What this paper adds When delivered in the child’s first or second language, maths apps can support the acquisition of basic maths skills. To maximise engagement and learning with maths apps, children should have a sufficient level of proficiency in the language of instruction. Implications for practice and/or policy When deciding to implement maths apps with young children, educational practitioners and parents should consider the individual child’s proficiency in the languages spoken.

Abstract WP451: “Development, Feasibility and Validation of “Stroke Home Care” Application in a Resource Limited Setting: A Proof of Concept Study”

Introduction: Stroke rehabilitation and caregivers training is central to improve post stroke care and reduce caregivers’ burden. Mobile applications(app) may provide a patient and caregiver centric modality to improve stroke care Aim: To develop and evaluate feasibility of a medical application for delivering post stroke care. Methods: A mobile app was developed on an android operating system following a preliminary assessment of post stroke complications to train caregivers. App consists of videos of home based care strategies for bedsore prevention, feeding, mouth care, ROM exercises, catheter care, psychological support to patients etc. App includes awareness videos on stroke, problems faced after stroke, follow up schedule, feedback option. App feasibility was assessed among 25 bedridden stroke survivors and their caregivers selected purposely. App validation was done by 16 stroke experts including neurologists, nurses, psychologists, physiotherapists using semi-structured-questionnaire for data collection. Following this, final "Stroke Home Care" app was developed. Results Feasibility: Mean age of patients and caregivers was 52.6±14.8 and 32.4±8.9years, respectively. 64% patients females, 75% caregivers males. 56% lived in rural. Median NIHSS 14 (IQR: 12-17). Complications were 56% Ryle’s tube, 72% Foley’s catheter, 12% bedsore. 64% caregivers were graduates. 52% sons. All caregivers responded that app contents, videos and language was understandable and appropriate. 92% preferred ‘Hindi’ language. All agreed to App enhancing their stroke knowledge. All were satisfied. Validation: Mean age of experts was 33.2±4years. 75% females. 56% nursing experts and postgraduates,19% MDs. 50% Nursing teachers, 19% Neurology fellows. None faced any app installation problem. 81.3% experts highly satisfied with app functions, its contents, voice clarity, video clarity and duration, contents’ sequence, understandability. Discussion/Conclusion: “Stroke Home Care” App is feasible, pragmatic and user-friendly for use by caregivers of stroke survivors in a resource limited setting/developing country. It should be tested by an RCT to evaluate its efficacy in reducing post stroke complications and reducing caregivers’ burden.

Smartphone Apps for Tinnitus Management

Smartphone Apps for Tinnitus Management