App Content Research Articles

Development of an mHealth app integrating pain-cognitive behavioral therapy and opioid support for patients with advanced cancer (STAMP+CBT).

418 Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients’ perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Methods: We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were >21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Results: Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients’ current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusions: MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app’s feasibility and acceptability in patients with advanced cancer.

Development of a Mobile-Based Self-care Application for Patients with Breast Cancer-Related Lymphedema in Iran.

Due to the chronic, progressive, and debilitating nature of breast cancer-related lymphedema (BCRL), it is necessary to observe and maintain self-care management accordingly. This study was conducted to develop a mobile application based on the Android operating system for self-care management of Iranian patients with BCRL. An applied developmental study was conducted in 2020. The users' information needs assessment as well as design, development, implementation, and evaluation of the mobile app for self-care management of patients with BCRL was done by searching the literature, reviewing the existing mobile applications, and surveying the users' needs. The mobile app was designed using the Android Studio environment and Java programming language in the Android operating system. The usability of the app was evaluated by 30 patients with BCRL using the questionnaire for user interface satisfaction-seventh version (QUIS 7). The mobile app for BCRL included demographic information, clinical information, lifestyle and system functions (drug use, nutrition, exercise, smoking cessation, communication, and test time reminder). User usability evaluation of the app content and functions confirmed that it was appropriate and satisfactory for the self-management of women with BCRL. The mobile app was appropriate in terms of the content, function, and quality for improving the patients' lifestyle and education and self-management of BCRL symptoms according to its usability evaluation from the end-users' (patients) perspective. It is suggested that studies should be performed to confirm the effectiveness and identify the clinical significance of the app.

Improve the cervical cancer prevention behaviors through mobile-based educational intervention based on I-CHANGE model: study protocol for a randomized controlled trial

BackgroundApplications of mobile technologies (mHealth) have the potential to reduce health inequalities, give patients more control over their health, and improve health care’s cost-effectiveness. The widespread use of mobile phones offers us a new way to prevent cervical cancer. The objective of the study was to design and develop a mobile phone application (app) that aims to conduct a behavioral intervention for women and to evaluate the efficacy of the app-based intervention.MethodsThis study involves 5 phases. In the first phase, understanding women’s perspectives will be identified using a qualitative approach based on the I-Change model. In phase 2, the results from the qualitative approach and requirement prioritization through providing experts’ perspectives will be done. The main outputs of this phase will be resulted in prioritizing the main measurable effective variables of the I-Change model. Phase 3 will be processed for the development and psychometric of an assessment tool regarding selected constructs. In phase 4, the App framework and content development will be performed. In phase 5, a three-armed, parallel-design randomized controlled trial will be conducted on women. Two hundred ten women will be randomly assigned to three groups including two intervention groups and one control group. The intervention groups included the following: (1) a mobile application and (2) a digital book. The data will be evaluated using tools designed and constructed in phase 3 of the study at baseline in 3-month follow-up assessments. The impact of the two interventions on cervical cancer prevention behaviors through mobile-based educational intervention will then be evaluated.DiscussionA theory-based health education program using a mobile app to improve cervical cancer-preventive behaviors will be implemented for the first time in Iran. With an effective health mobile-based educational design, it is very important to determine whether Iranian women will be motivated to adhere to preventive behavior related to CC.Trial registrationIranian Clinical Trial Register IRCT20181205041861N3. Registered V2.0 on 26 October 2021.

Co-design of a tablet app for communicating inpatient brain injury rehabilitation goals

The design of a tablet app for people with recent severe brain injuries is described, providing short videos outlining their current rehabilitation goals during inpatient rehabilitation. This research explored questions of desirability, functionality and usability. A co-design process was undertaken with clinicians and three current clients of such a brain injury service along with their family/whānau, iterating on a series of prototypes. Clinician, client and family participants responded positively to the concept and guided the design. Many design considerations reflected fairly universal principles—providing graphical/visual cues to complement text-based controls, and striving for a simple user interface and experience. The final design struck a balance between user control and a curated linear flow through app content. A sharp focus on the main objective was key—guiding rehabilitation goal setting best practice. The end result was an iPad app ready for clinical trial. Such tools may be able to contribute to rehabilitation processes through supporting client engagement, raising awareness of the purpose of rehabilitation, and thus potentially contributing to rehabilitation outcomes.

Studies of Fertility Smartphone Apps Reveal a Lack of Insight and Scientific Information

Background: Female reproductive health and fertility smartphone applications have grown rapidly into a 400 million dollar “femtech” industry. As such, there has been increased interest in their functions and benefits. Claims of app participation in research is a marketing tool for consumers, however there is little known about the current scope of reproductive health app research and specifically how it is performed and reported. Aim: This study aimed to determine the nature and extent of the peer-reviewed literature presented on fertility-based apps, to identify the reliability of the information within the apps, and to determine the ability of this information to educate users. Method: A systematic search of six databases was conducted in April 2020, returning a total of 21,158 records. After duplicate removal, title and abstract screening exclusionary steps, 27 records were reviewed and charted. Results: Fertility smartphone apps covered a variety of reproductive health themes including contraception, sexual health, and family planning, and used a range of research methodologies including prospective, retrospective and observational. A majority (63%) of the studies on apps specified ovulation windows as the sole information on fertility given to users. Around 52% of studies in the review based fertile window algorithms on stringent menstrual cycle length and variability requirements (typically 20-40 day length; <5 day variability). Furthermore, a third of studies in the scoping review contained authors that were affiliates or developers from an app company, and of these studies, 15% did not have co-authors independent to the app advisory board or employees. Conclusion: Female reproductive health apps have the potential to fulfil a range of reproductive health needs. However, they currently do so with severe limitations when it comes to the menstrual cycle variability, and they do not adequately succeed in multi-functional capabilities. Furthermore, the scope of information available in apps via the user interface is a major barrier to independent review for accuracy. Our findings support the recommendation for open source sharing of app contents. This would ensure developers are accountable to consumers, healthcare professionals and researchers. This study highlights lack of research evaluating the effectiveness of an app’s contents to translate to knowledge or behaviour change in participants.

Evaluation of the SUCCESS Health Literacy App for Australian Adults With Chronic Kidney Disease: Protocol for a Pragmatic Randomized Controlled Trial.

BackgroundWe developed a smartphone app—the SUCCESS (Supporting Culturally and Linguistically Diverse CKD Patients to Engage in Shared Decision-Making Successfully) app—to support Australian adults with kidney failure undertaking dialysis to actively participate in self-management and decision-making. The content of the SUCCESS app was informed by a theoretical model of health literacy that recognizes the importance of reducing the complexity of health information as well as providing skills necessary to access, understand, and act on this information.ObjectiveThe purpose of this study is to investigate the efficacy of the SUCCESS app intervention.MethodsWe designed a multicenter pragmatic randomized controlled trial to compare the SUCCESS app plus usual care (intervention) to usual care alone (control). A total of 384 participants receiving in-center or home-based hemodialysis or peritoneal dialysis will be recruited from six local health districts in the Greater Sydney region, New South Wales, Australia. To avoid intervention contamination, a pragmatic randomization approach will be used for participants undergoing in-center dialysis, in which randomization will be based on the days they receive hemodialysis and by center (ie, Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday). Participants undergoing home-based dialysis will be individually randomized centrally using simple randomization and two stratification factors: language spoken at home and research site. Consenting participants will be invited to use the SUCCESS app for 12 months. The primary endpoints, which will be assessed after 3, 6, and 12 months of app usage, are health literacy skills, evaluated using the Health Literacy Questionnaire; decision self-efficacy, evaluated using the Decision Self-Efficacy Scale; and rates of unscheduled health encounters. Secondary outcomes include patient-reported outcomes (ie, quality of life, evaluated with the 5-level EQ-5D; knowledge; confidence; health behavior; and self-management) and clinical outcomes (ie, symptom burden, evaluated with the Palliative care Outcome Scale–Renal; nutritional status, evaluated with the Patient-Generated Subjective Global Assessment; and intradialytic weight gain). App engagement will be determined via app analytics. All analyses will be undertaken using an intention-to-treat approach comparing the intervention and usual care arms.ResultsThe study has been approved by Nepean Blue Mountains Human Research Ethics Committee (2020/ETH00910) and recruitment has begun at nine sites. We expect to finalize data collection by 2023 and publish the manuscript by 2024.ConclusionsEnhancing health literacy skills for patients undergoing hemodialysis is an important endeavor, given the association between poor health literacy and poor health outcomes, especially among culturally diverse groups. The findings from this trial will be published in peer-reviewed journals and disseminated at conferences, and updates will be shared with partners, including participating local health districts, Kidney Health Australia, and consumers. The SUCCESS app will continue to be available to all participants following trial completion.Trial RegistrationAustralia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000235808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380754&isReview=trueInternational Registered Report Identifier (IRRID)DERR1-10.2196/39909

HIV patients' perceptions of a potential multi-component mindfulness-based smoking cessation smartphone application intervention.

Cigarette smoking rates among people living with HIV (PLWH) in the US is triple that of the general population. PLWH smokers are a high-risk group for smoking-related health disparities and should be a prime focus for smoking cessation efforts. Our team has developed a novel evidence-based Mindfulness Training (MT) smoking cessation smartphone application (app), "Craving-to-Quit." Using qualitative focus groups among PLWH smokers, this study aims to tailor and optimize the app's content and design to PLWH's unique psychosocial profile and needs. We conducted 8 focus groups among PLWH smokers (n = 59; 47.5% females; ≥18 years) to gain insight into participants' perceptions about the app, MT, and the feasibility and acceptability of adding two additional strategies (CM: Contingency Management; self-monitoring of anti-retroviral therapies intake [ART]) to further optimize the app. Participants were asked to practice MTs and watch videos from the app presented on a screen in the conference room to discuss their experience. Sessions were audio-taped, transcribed verbatim, and analyzed thematically using NVivo. Most participants were non-Hispanic black (67.8%), on a federal health insurance program (61.0%). Participants considered it easy to learn the app and thought that MT is helpful in reducing stress and motivating quit attempts and were supportive of adding CM and recommended providing $20-$50 weekly cash incentives to help in quitting. Participants felt that adding self-monitoring of ART is helpful but were concerned about confidentiality in case they lost their phone. Participants recommended making the app cost-free and adding information about smoking cessation medications and the negative effects of smoking among PLWH. Findings will guide the development of a novel multi-component smoking cessation intervention app integrating MT, CM, and ART self-monitoring strategies. This intervention has the potential to address several barriers to quitting in PLWH. Further clinical research is needed to test this intervention.

Modification and Validation of an mHealth App Quality Assessment Methodology for International Use: Cross-sectional and eDelphi Studies.

BackgroundOver 325,000 mobile health (mHealth) apps are available to download across various app stores. However, quality assurance in this field of medicine remains relatively undefined. Globally, around 84% of the population have access to mobile broadband networks. Given the potential for mHealth app use in health promotion and disease prevention, their role in patient care worldwide is ever apparent. Quality assurance regulations both nationally and internationally will take time to develop. Frameworks such as the Mobile App Rating Scale and Enlight Suite have demonstrated potential for use in the interim. However, these frameworks require adaptation to be suitable for international use.ObjectiveThis study aims to modify the Enlight Suite, a comprehensive app quality assessment methodology, to improve its applicability internationally and to assess the preliminary validity and reliability of this modified tool in practice.MethodsA two-round Delphi study involving 7 international mHealth experts with varied backgrounds in health, technology, and clinical psychology was conducted to modify the Enlight Suite for international use and to improve its content validity. The Modified Enlight Suite (MES) was then used by 800 health care professionals and health care students in Ireland to assess a COVID-19 tracker app in an online survey. The reliability of the MES was assessed using Cronbach alpha, while the construct validity was evaluated using confirmatory factor analysis.ResultsThe final version of the MES has 7 sections with 32 evaluating items. Of these items, 5 were novel and based on consensus for inclusion by Delphi panel members. The MES has satisfactory reliability with a Cronbach alpha score of .925. The subscales also demonstrated acceptable internal consistency. Similarly, the confirmatory factor analysis demonstrated a positive and significant factor loading for all 32 items in the MES with a modestly acceptable model fit, thus indicating the construct validity of the MES.ConclusionsThe Enlight Suite was modified to improve its international relevance to app quality assessment by introducing new items relating to cultural appropriateness, accessibility, and readability of mHealth app content. This study indicates both the reliability and validity of the MES for assessing the quality of mHealth apps in a high-income country, with further studies being planned to extrapolate these findings to low- and middle-income countries.

A "No-Code" App Design Platform for Mobile Health Research: Development and Usability Study.

BackgroundA challenge facing researchers conducting mobile health (mHealth) research is the amount of resources required to develop mobile apps. This can be a barrier to generating relevant knowledge in a timely manner. The recent rise of “no-code” software development platforms may overcome this challenge and enable researchers to decrease the cost and time required to develop mHealth research apps.ObjectiveWe aimed to describe the development process and the lessons learned to build Pathverse, a no-code mHealth app design platform.MethodsThe study took place between November 2019 and December 2021. We used a participatory research framework to develop the mHealth app design platform. In phase 1, we worked with researchers to gather key platform feature requirements and conducted an exploratory literature search to determine needs related to this platform. In phase 2, we used an agile software framework (Scrum) to develop the platform. Each development sprint cycle was 4 weeks in length. We created a minimum viable product at the end of 7 sprint cycles. In phase 3, we used a convenience sample of adults (n=5) to gather user feedback through usability and acceptability testing. In phase 4, we further developed the platform based on user feedback, following the V-model software development process.ResultsOur team consulted end users (ie, researchers) and utilized behavior change technique taxonomy and behavior change models (ie, the multi-process action control framework) to guide the development of features. The first version of the Pathverse platform included features that allowed researchers to (1) design customized multimedia app content (eg, interactive lessons), (2) set content delivery logic (eg, only show new lessons when completing the previous lesson), (3) implement customized participant surveys, (4) provide self-monitoring tools, (5) set personalized goals, and (6) customize app notifications. Usability and acceptability testing revealed that researchers found the platform easy to navigate and that the features were intuitive to use. Potential improvements include the ability to deliver adaptive interventions and add features such as community group chat.ConclusionsTo our knowledge, Pathverse is the first no-code mHealth app design platform for developing mHealth interventions for behavior. We successfully used behavior change models and the behavior change technique taxonomy to inform the feature requirements of Pathverse. Overall, the use of a participatory framework, combined with the agile and hybrid-agile software development process, enabled our team to successfully develop the Pathverse platform.

Apprentices' Attitudes Toward Using a Mental Health Mobile App to Support Healthy Coping: Mixed Methods Study.

BackgroundApprenticeships are a common pathway for young people transitioning into the workforce. Apprentices often face many employment-related challenges and have high levels of psychological distress, drug and alcohol use, and suicidal ideation. Little is known about the attitudes of apprentices toward using smartphone apps to support their mental health and the content that would engage them.ObjectiveThis study explored (1) apprentices’ interest in using an app to support their mental health and (2) the healthy coping strategies used to manage their mental well-being in the face of workplace challenges, in order to inform future app content.MethodsA mixed methods study was conducted with 54 apprentices (50/54 male, 93%) with a mean age of 22.7 (SD 5.7) years. Participants completed a survey on preferred ways of using an app to support mental health. Across 8 focus groups, participants were asked to describe healthy strategies they used to cope with occupational stressors.ResultsOnly 11% (6/54) of participants currently used a well-being app, but there was high interest in using an app to support their friends (47/54 participants, 87%) and develop self-help strategies to manage or prevent mental health issues (42/54 participants, 78%). Four major types of coping behaviors were identified: (1) social connection for disclosure, advice, and socializing; (2) pleasurable activities, such as engaging in hobbies, time-outs, and developing work-life separation; (3) cognitive approaches, including defusing from thoughts and cognitive reframing; and (4) self-care approaches, including exercise, a healthy diet, and getting adequate sleep.ConclusionsThere is interest among apprentices to use an app with a positive well-being focus that helps them to develop self-management skills and support their friends. Apprentices utilized a range of healthy behaviors to cope with workplace stressors that can be incorporated into mental health apps to improve uptake and engagement. However, many of the preferred coping strategies identified are not those focused on by currently available apps, indicating the need for more targeted digital interventions for this group.

Assessing the educational potential and language content of touchscreen apps for preschool children

Touchscreen apps have the potential to teach children important early skills including oral language. However, there is little empirical data assessing the educational potential of children's apps in the app market or how apps link to theories of cognitive development to support learning. We compared popular children's apps with a learning goal (N=18) and without (N=26) using systematic evaluation tools to assess the educational potential and app features that may support learning. We also transcribed all utterances in the apps that included language with a learning goal (N=18) and without (N=12) in order to compare a number of psycholinguistic measures relating to accessibility of the language. Apps with a learning goal had higher educational potential, more opportunities for feedback, a higher proportion of ostensive feedback, and age-appropriate language to support learning and language development. Thus, we argue that selecting children's apps based on the presence of a learning goal is a good first step for selecting an educational app for pre-school age children. Nevertheless, app developers could do more to promote exploratory app use, adjust content to a child's performance, and make use of social interactions with characters onscreen in their apps to enhance the educational potential. Children's apps could also make better use of feedback to ensure that it is specific, meaningful and constructive to better facilitate learning.

An interactive smartphone application for trainees in Radiation Oncology: "The Rad Onc Handbook"

1The app is well structured and easy to use. 2The app content is relevant to radiation oncology. 3The audio lessons enhanced my learning. 4The quizzes and cases enhanced my learning. 5My overall knowledge in radiation oncology has increased. 6I would recommend this application to a colleague. 25 participants completed the survey on the advanced learning module. 70% of all survey participants ""agree"" or ""strongly agree"" to the five statements listed below: 1The module was well structured. 2The module is relevant to radiation oncology. 3The module was an appropriate level of complexity. 4My overall knowledge about breast cancers has increased. 5I would recommend this module to a colleague. Overall, the application and advanced learning modules were well received and the trainees express a desire for other advanced learning modules in the free text responses. This free smartphone application provides an easily accessible resource for self-directed learning in radiation oncology. Initial feedback was very favourable and recommended use of this innovative learning resource among a wider group of trainees. In response to trainee feedback, future work will focus on the development of additional modules, incorporating interactive virtual patient cases, in other tumour sites. As web-based learning continues to become increasingly popular, this application can be a useful educational resource for medical trainees." Background Radiation oncology (RO) textbooks and primary references are often complex, technically advanced, and inaccessible to medical trainees. To address this, we designed a free, interactive smartphone application, to introduce trainees to the basics of RO. Methods We created and implemented an Apple iOS smartphone application with RO content, targeted for medical trainees. The beta version is free for download via the TestFlight application (https://testflight.apple.com/join/4A6qXjq2). The application incorporates both introductory topics relevant to radiation oncology and advanced, site-specific modules, that focus on the different tumour sites and their management. Content includes written text, audio lectures, interactive quizzes, and clinical cases. Two questionnaires were implemented to elicit feedback; one for application design and the other a knowledge-quiz for an advanced learning module on breast cancers. Both contain quantitative 5-point Likert-scale questions and one qualitative freeform text question seeking suggestions for improvement. Results There have been over 70 unique downloads of the application. 40 participants completed the survey on application design. Over 80% have selected ""agree"" or ""strongly agree"" to the six statements listed below: Radiation oncology (RO) textbooks and primary references are often complex, technically advanced, and inaccessible to medical trainees. To address this, we designed a free, interactive smartphone application, to introduce trainees to the basics of RO. We created and implemented an Apple iOS smartphone application with RO content, targeted for medical trainees. The beta version is free for download via the TestFlight application (https://testflight.apple.com/join/4A6qXjq2). The application incorporates both introductory topics relevant to radiation oncology and advanced, site-specific modules, that focus on the different tumour sites and their management. Content includes written text, audio lectures, interactive quizzes, and clinical cases. Two questionnaires were implemented to elicit feedback; one for application design and the other a knowledge-quiz for an advanced learning module on breast cancers. Both contain quantitative 5-point Likert-scale questions and one qualitative freeform text question seeking suggestions for improvement. There have been over 70 unique downloads of the application. 40 participants completed the survey on application design. Over 80% have selected ""agree"" or ""strongly agree"" to the six statements listed below:

MHealth Apps for Musculoskeletal Rehabilitation: Systematic Search in App Stores and Content Analysis.

BackgroundThe number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways.ObjectiveThe objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities.MethodsA cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction.ResultsA total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8%) or videos (n=97, 67.4%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8%), communication portal (n=32, 22.2%), patient-reported outcome capture (n=36, 25%), or direct feedback (n=57, 39.6%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34%) and safety advice or disclaimers (n=38, 26.4%).ConclusionsThe cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies.

Development and Testing of a Web Application to Improve Entry-to-Practice Pediatric Nursing Competencies: A Proof-of-Concept Study

Nurse educators can design technology-enhanced learning supports to prepare graduates to meet entry-to-practice (ETP) competencies and pass licensure examinations. The purpose of this study was to develop and test a proof-of-concept web application (Web App) to facilitate understanding of ETP competencies, and to explore the Web App’s potential to improve performance on NCLEX readiness tests. We developed and evaluated the Web App in two stages. We focused on identifying important technical considerations involved in creating the Web App, developing learning content, and creating self-testing questions for learners in the Pilot phase. In the full-scale implementation phase, participants accessed the Web App content and self-testing questions and completed a study questionnaire and knowledge test; a subset of participants completed the NCLEX readiness test. Web App participants demonstrated a small-medium effect size on the knowledge test for overall score (d=0.39) and knowledge transfer (d=0.44) when compared with non-participants. There was no significant difference in performance on the NCLEX readiness test between participants and non-participants. This proof-of-concept study supported the development, implementation, and evaluation of a Web App to promote learning of ETP competencies. Future research directions include development and evaluation of technology-enhanced learning aids that align with nursing curricula and ETP competencies. Keywords: education technology, web application, competency-based education, entry-to-practice competencies

Hansenapp: Development of a mobile application to assist primary healthcare providers to control leprosy.

To describe the development and validation of a mobile application to assist health professionals in the management of patients with leprosy and surveillance of contacts in primary healthcare. A methodological and developmental study was conducted in three phases: integrative literature review, mobile application development and application validation by health professionals. The construction of the application was supported by the literature review, Nielsen's heuristics and expert validation. Five experts individually analysed the prototype draft and performed two rounds of iterations to refine their recommendations. The validation step was performed by consulting health professionals working in primary healthcare, who evaluated the application for relevance, clarity and usability using a questionnaire based on task-technology fit theory. The mobile app's content, navigation methods and interaction were refined based on the discussions with experts. Their recommendations were applied, and the mobile app was revised until the final version was approved. Content validity indexes of 0.94 (p= 0.007), 0.99 (p> 0.0001) and 0.93 (p= 0.01) were obtained. The developed application is a technological tool that could assist primary healthcare providers in dealing with leprosy patients and their contacts in terms of management, planning, monitoring, evaluation, treatment and follow-up, in addition to leprosy control actions.

Participant Observation to Apply an Empirical Method of Codesign with Children

Dental anxiety in children is a well-documented problem in the scientific literature. Tools mediated by Information Technology have been shown to positively influence children’s mood based on distraction as well as relaxing activities. We propose an empirical method of codesign with children to generate app content for reducing dental anxiety. The results are embedded in text through a thick description as an ethnographic technique. The method was applied to 163 children (6–8 years old) from a summer school and a primary school, obtaining multimedia products that were integrated into an app prototype. Finally, although this use case of the presented method is applied to the health field, it can be transferred to any other field of application of codesign to children by using material that is specific to new scenarios.

City Symphony

City Symphony

Acceptability of reducing sedentariness using a mobile-phone application based on 'if then' plans for people with psychosis: A focus-group study conducted in North West England, UK.

Objective:To understand the acceptability of (a) reducing sedentary-behaviour in people with psychosis using ‘if-then’ plans and (b) the proposed app content.Design:Qualitative acceptability study.Method:Three structured focus-groups and an interview were conducted with eight participants who had experience of a psychotic episode. They discussed sedentary-behaviour, being more active, critical situations in which they may be tempted to be sedentary and solutions to these (the if-then plans), and a mock-up of the mobile application. The Theoretical Framework of Acceptability (TFA) was used to analyse qualitatively the transcripts.Results:All TFA constructs were coded in each of the transcripts. The idea of reducing sedentary-behaviour was acceptable to people with psychosis, participants knew the importance of being more active, however it is not always their main priority. Likewise, the proposed content of the app was found to be acceptable, with participants already using some of the proposed solutions.Conclusion:This was the first study to use the TFA framework to assess the acceptability of an app that uses critical situations and solutions (‘if-then plans’) to help reduce sedentary behaviour for people with psychosis. In this sample (male, English speaking mainly white people), participants understood the benefits of being more active. However, reducing sedentary-behaviour is not the main priority of this population and being sedentary has benefits when their mental-health is bad.

Applying a User-Centric Design Approach to Develop a Mobile Application for Management and Treatment of Gestational Diabetes in Nepal

ObjectivesMobile apps can aid with the management of Gestational Diabetes Mellitus (GDM) by providing patient education, and reinforcing daily glucose monitoring and diet/lifestyle modification. Here we describe our process of applying a user-centered design approach in developing a culturally-appropriate app (GDM-DH) to support the management of GDM among patients in Dhulikhel Hospital, Nepal.MethodsA multidisciplinary team including experts in GDM, mHealth, and behavior and implementation sciences, as well as health providers and patients at Dhulikhel Hospital, contributed to the development of the GDM-DH app. After finalizing the app's content and features, we created the app's wireframe, which illustrated the app's proposed interface, navigation sequences, and features and functions. This was followed by key informant interviews with healthcare providers (n = 5), focus groups, and in-depth interviews with GDM patients (n = 12) in which they were asked to provide feedback on the features and functions of the wireframe. Incorporating their input, we built the minimum viable product, which was user-tested with 6 GDM patients, and further refined for the final version of the GDM-DH app.ResultsQualitative findings from the user research affirmed the potential utility and usability of our target app and provided insight into app features and design elements that needed to be added or modified. Consistent with the Social Cognitive Theory, the final version of the GDM-DH app supports GDM self-management by providing health education and allowing patients to record and self-monitor blood glucose levels, carbohydrate intake, physical activity, and gestational weight gain. The app uses innovative features to minimize the self-monitoring burden and uses automatic feedback and data visualizations. Healthcare providers can use the web-based admin portal of the GDM-DH app to enter/review glucose readings, track patient progress, and guide treatment and counseling accordingly.ConclusionsTo our knowledge, this is the first mHealth platform for GDM developed for a low-income country, and the first one containing a feature to aid with carbohydrate estimation in meals. A pilot clinical trial is currently underway to explore the clinical utility of the GDM-DH app.Funding SourcesNIH/FIC.

Mobile app in oncology: A pilot survey on Latina patients with gynecological cancers and their perception on utilizing a mobile app.

1571 Background: Mobile applications have changed the way that users access information and revolutionized healthcare by allowing patients to educate themselves regarding their diagnosis and treatment. Challenges in developing a mobile health application include patient satisfaction and usage over time. Barriers to usage include trust, personalization, and accessibility. Investigating the patient population’s preferences on app content and ease of use is imperative. The use of mobile applications specifically for Latina Gynecologic Oncology patients undergoing treatment has yet to be investigated. Methods: Fifty-six patients were recruited from the Gynecologic Oncology clinic at an urban academic health sciences center located on the Texas-Mexico border. Cross-sectional analyses were performed. Subjects were asked a series of 10-point Likert scale questions including how comfortable they would feel using medical applications on their smartphones. Linear regression models were fit with this scale score as the outcome. Results: The age of the 56 patients ranged from 28 to 77 years with a mean of 53.9 years (SD: 11.1). Spanish was the preferred language of 53.8% of the patients (28/52). Forty-four subjects were available for the regression analyses. Subjects were asked, “Would you feel comfortable using medical applications on your smartphone,” where 1 represented “not at all comfortable” and 10 represented “very comfortable”. The mean comfort scale score was 7.39 (SD: 2.85). Thirty of the 44 subjects (68.2%) replied “Multiple times per day” to the question about how frequently they use mobile apps on their phone. After controlling for the patient’s age in a regression model, patients who used mobile apps multiple times per day had an average comfort scale score that was 1.75 points higher than that of women who did not use mobile apps on their phone multiple times per day (p = 0.03). After adjusting for the frequency of mobile app use, there was a reduction of 0.11 points (p = 0.002) in the comfort scale score for every one year increase in the patient’s age. Conclusions: Our unique pilot study found a positive association between the frequency of current app use and anticipated comfort in using smartphone medical applications. Overall, patients demonstrated a considerable amount of comfort with the prospect of using a mobile app. These findings support the idea of creating a mobile app designed to monitor Latina Gynecologic Oncology patients in efforts to lessen patients’ postoperative burden, improve mortality and morbidity outcomes, and decrease health care system costs.[Table: see text]