Effectiveness Of mHealth Interventions Research Articles

Effect of m-Health-Based Interventions on Blood Pressure: An Updated Systematic Review with Meta-Analysis.

Background: In recent years, the integration of mobile health (m-Health) interventions has garnered increasing attention as a potential means to improve blood pressure (BP) management in adults. This updated systematic review with meta-analysis aimed to identify the effect of m-Health-based interventions on BP in adults and to evaluate the effect of m-Health on BP according to the characteristics of subjects, interventions, and countries. Methods: The search was carried out in PubMed, Embase, ResearchGate, and Cochrane databases in January 2022. Study selection and data extraction were performed by two independent reviewers. For analysis, random effects models were used with a confidence interval (CI) of 95% and p < 0.05. Results: Fifty studies were included in this review and in the meta-analysis. Interventions with m-Health reduced systolic BP in 3.5 mmHg (95% CI -4.3; -2.7; p < 0.001; I2 = 85.8%) and diastolic BP in 1.8 mmHg (95% CI -2.3; -1.4; p < 0.001; I2 = 78.9%) compared to usual care. The effects of m-Health interventions on BP were more evident in men and in older adults, in interventions lasting 6-8 weeks, with medication reminders, with the possibility of insertion of BP values (p < 0.05). Conclusion: The results of this study support the effectiveness of m-Health in reducing BP when compared to standard care. However, these effects are dependent on the characteristics of the subjects and interventions. Given the substantial heterogeneity among the results of this systematic review with meta-analysis, its interpretation should be cautious. Future research on this topic is warranted.

Using Mobile Health (mHealth) Applications to Improve Access to Healthcare in Afghanistan

This study investigates the utilization of mobile health (mHealth) applications to improve healthcare access in Afghanistan. The research employs a mixed-methods approach, combining qualitative interviews and quantitative surveys with healthcare providers, patients, technology experts, and health administrators at Sehat Hospital in Kabul. Through thematic analysis of interview data and descriptive and inferential analysis of survey responses, the study explores the current landscape of mHealth applications, including their availability, features, usage patterns, and perceived impact on healthcare delivery and patient outcomes. The findings reveal diverse perceptions among participants regarding the accessibility, relevance, and effectiveness of mHealth interventions in Afghanistan. Challenges related to security, cultural adaptation, and user awareness are identified, alongside opportunities for enhancing the design and implementation of mHealth solutions. The study contributes valuable insights into the potential of mHealth applications to address healthcare disparities and improve patient outcomes in resource-constrained settings like Afghanistan. Recommendations for policymakers, healthcare providers, and technology developers are provided to optimize the use of mHealth technologies and maximize their impact on healthcare delivery. Overall, this research underscores the importance of contextually relevant and user-centered approaches in leveraging technology to advance healthcare access and quality in Afghanistan.

The Effect of mHealth Interventions on Women's Health Outcomes: A Systematic Review of Randomized Controlled Trials

Introduction: Mobile health (mHealth) is an emerging technology with great potential for improving people's health. Due to its availability, this technology can create more motivation to improve women's health by providing safe, coordinated, and effective health care. Considering the importance of women's health, the present study was conducted to systematically investigate the impact of mHealth interventions on women's health outcomes. Method: The present study was conducted as a systematic review of clinical trial studies in English. PubMed, Scopus, Science Direct, the Cochrane Library, and ClinicalTrials.gov databases were reviewed according to the inclusion criteria from 2011 to 2021. Results : A total of 28 articles were included in the study. mHealth tools, such as applications, text messages, voice or video calls, and wearable devices, were found to have multiple functions in this study, including providing information, reminders, education, and practical recommendations to improve the lifestyles of pregnant women in various areas. The study results indicated that in 82% of the studies, mHealth tools were effective in improving health outcomes for pregnant women, while in 18% of the studies, the intervention results did not differ from the standard method. Conclusion: mHealth interventions can have a positive effect on improving the health of pregnant women, including their lifestyle, knowledge, and attitude regarding their own and their baby's health. However, in all these studies, high heterogeneity limits the certainty of the evidence for these findings. Therefore, future studies should identify the context in which mHealth can be more effective for women's health.

Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review.

Hypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. This review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? This review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. As per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. The evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. PRR1-10.2196/51792.

Efficacy of mHealth Interventions for Improving the Pain and Disability of Individuals With Chronic Low Back Pain: Systematic Review and Meta-Analysis.

Low back pain is one of the main causes of disability worldwide. Individuals with chronic conditions have been widely affected by the COVID-19 pandemic. In this context, mobile health (mHealth) has become popular, mostly due to the widespread use of smartphones. Despite the considerable number of apps for low back pain available in app stores, the effectiveness of these technologies is not established, and there is a lack of evidence regarding the effectiveness of the isolated use of mobile apps in the self-management of low back pain. We summarized the evidence on the effectiveness of mHealth interventions on pain and disability for individuals with chronic low back pain. We conducted a systematic review and meta-analysis comparing mHealth to usual care or no intervention. The search terms used were related to low back pain and mHealth. Only randomized controlled trials were included. The primary outcomes were pain intensity and disability, and the secondary outcome was quality of life. Searches were carried out in the following databases, without date or language restriction: PubMed, Scopus, Embase, Physiotherapy Evidence Database (PEDro), the Cochrane Library, and OpenGrey, in addition to article references. The risk of bias was analyzed using the PEDro scale. Data were summarized descriptively and through meta-analysis (pain intensity and disability). In the meta-analysis, eligible studies were combined while considering clinical and methodological homogeneity. The certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) criteria. A total of 5 randomized controlled trials were included, totaling 894 participants (447 allocated to the mHealth group and 445 to the usual care group), and they had similar methodological structure and interventions. Follow-up ranged from 6 weeks to 12 months. The studies did not demonstrate significant differences for pain intensity (mean difference -0.86, 95% CI -2.29 to 0.58; P=.15) and disability (standardized mean difference -0.24, 95% CI -0.69 to 0.20; P=.14) when comparing mHealth and usual care. All studies showed biases, with emphasis on nonconcealed allocation and nonblinding of the outcome evaluator. The certainty of evidence was rated as low for the analyzed outcomes. mHealth alone was no more effective than usual care or no treatment in improving pain intensity and disability in individuals with low back pain. Due to the biases found and the low certainty of evidence, the evidence remains inconclusive, and future quality clinical trials are needed.

Effectiveness of mHealth intervention on safe abortion knowledge and perceived barriers to safe abortion services among female sex workers in Vietnam.

Mobile health (mHealth) has been used to promote sexual and reproductive health (SRH) education and services; however, little is known about the use of mHealth to improve safe abortion knowledge and access to safe abortion services among female sex workers (FSWs). This study evaluated the feasibility and effectiveness of iConnect intervention through changes in knowledge on safe abortion and changes in perceived barriers to safe abortion services among FSWs in Vietnam. iConnect mobile app was developed as an interactive platform to deliver safe abortion education and referral to safe abortion services through short messaging services (SMS) enhanced by tele-counseling for 512 FSWs in Hanoi, Vietnam. A pretest-posttest evaluation was conducted using questionnaire-based phone interviews administered to 251 participants at baseline and 3 months following the intervention. Non-parametric tests evaluated the change in abortion knowledge, behaviors, and perceived barriers to safe abortion. There were significant improvements in the knowledge on safe abortion among the study participants. Specifically, FSWs' knowledge of correct gestational ages (≤22 weeks) for medical abortion increased from 78.9% at baseline to 96.8% (P=0.001). Knowledge of correct gestational ages for medical abortion at the private clinic increased from 45.3% to 63.1% (P=0.001). Knowledge on the consequences of unsafe abortion increased from 75.2% to 92.1% (P=0.001). In addition, perceived stigma and discrimination when seeking safe abortion decreased from 36.5% to 27.8% (P=0.036) and worry about the lack of confidentiality decreased from 23.3% to 15.5% (P=0.035). The evaluation results showed the initial effectiveness of a mobile app-based intervention in improving access to safe abortion information and services among FSWs. A future study is needed to establish the efficacy of the intervention for scaling up in Vietnam and elsewhere.

Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis.

Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important part of health care systems, including the innovative cardiac rehabilitation services through mobile phone and mobile health (mHealth) interventions. In this study, we aimed to determine the effectiveness of different kinds of mHealth programs in changing lifestyle behavior, promoting adherence to treatment, and controlling modifiable cardiovascular risk factors and psychosocial outcomes in patients who have experienced a coronary event. A systematic review of the literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, SciELO, CINAHL, Scopus, The Clinical Trial, and Cochrane. Articles that were randomized clinical trials that involved an intervention consisting of an mHealth program using a mobile app in patients after a coronary event were included. The articles analyzed some of the following variables as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool; the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool; and heterogeneity was measured using the I2 test. A total of 23 articles were included in the review, and 20 (87%) were included in the meta-analysis, with a total sample size of 4535 patients. Exercise capacity measured using the 6-minute walk test (mean difference=21.64, 95% CI 12.72-30.55; P<.001), physical activity (standardized mean difference [SMD]=0.42, 95% CI 0.04-0.81; P=.03), and adherence to treatment (risk difference=0.19, 95% CI 0.11-0.28; P<.001) were significantly superior in the mHealth group. Furthermore, both the physical and mental dimensions of quality of life were better in the mHealth group (SMD=0.26, 95% CI 0.09-0.44; P=.004 and SMD=0.27, 95% CI 0.06-0.47; P=.01, respectively). In addition, hospital readmissions for all causes and cardiovascular causes were statistically higher in the control group than in the mHealth group (SMD=-0.03, 95% CI -0.05 to -0.00; P=.04 vs SMD=-0.04, 95% CI -0.07 to -0.00; P=.05). mHealth technology has a positive effect on patients who have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, as well as readmissions for all causes and cardiovascular causes. PROSPERO (International Prospective Register of Systematic Reviews) CRD42022299931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299931.

Effect of mHealth interventions on psychological issues experienced by women undergoing chemotherapy for breast cancer: A systematic review and meta-analysis.

A range of psychological issues often accompany breast cancer chemotherapy. Due to their ubiquity, mobile phones have been used to deliver supportive interventions addressing these issues. However, we currently lack sufficient evidence to guide the design of such interventions. To analyse and synthesise available evidence on the effectiveness of mobile-phone-based (mHealth) interventions in alleviating the psychological issues experienced by women receiving chemotherapy for breast cancer. A systematic literature search was conducted from 14 relevant databases. Revman 5.4 was used to pool the quantitative results from comparable studies for statistical meta-analysis. For clinically heterogeneous studies where statistical pooling of results was not possible, a narrative summary was used to present the findings. The review included nine RCTs which covered 1457 patients. The meta-analysis results indicated a significant improvement in the quality of life (standardised mean difference [SMD]=0.32, 95% confidence interval [CI] [0.07, 0.58], p=.01, I2 =17%). No significant effects were found for anxiety (SMD=-0.01, 95% CI [-0.26, 0.25], p=.96, I2 = 53%) and depression (SMD=0.02, 95% CI [-0.17, 0.20], p=.87, I2 =0%). Individual studies suggest reduced symptom prevalence (p=.033, d=0.27), symptom distress (p=.004, d =0.34), symptom interference (p=.02, d =0.51), supportive care needs (p < .05, d =2.43); improved self-efficacy (p=.03, d =0.53), self-esteem (p < .001, d=0.87) and emotional functioning (p=.008, d =0.30). The methodological quality ranged from low to moderate. mHealth interventions might help address certain psychological issues experienced by this population, although the evidence is still being gathered and not yet conclusive. More rigorous trials are warranted to confirm the suitable duration while addressing the methodological flaws found in previous studies. CRD42021224307.

Effects of m-Health interventions on physical activity level and sedentary behavior in pre-hypertensive and hypertensive individuals: a systematic review

This study aims to identify the effects of m-Health interventions on physical activity (PA) level and sedentary behavior (SB) in pre-hypertensive and hypertensive adults. Therefore, a systematic literature search was conducted according to the guidelines defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), in the scientific databases Web Of Science, MEDLINE/PubMed, SciELO, Scopus, and ACM Digital Library. Eligibility criteria were: clinical trials; description of the functionalities of m-Health apps (reminders, goals, wearables); description of the intervention characteristics (i.e., duration, expertise of professionals involved in the supervision, and others) and blood pressure assessment. In the end, 1447 studies were identified, of which 147 were duplicates. Through the screening by titles and abstracts, 43 studies were classified as relevant. However, only 12 studies met the eligibility criteria and were included in this systematic review. Most studies presented favorable results with the use of m-Health apps to increase PA and reduce SB. In addition, increasing PA and reducing SB might be an important non-pharmacological therapy to decrease blood pressure in hypertensive patients, when they follow the minimum recommendations proposed by the PA guidelines of the World Health Organization (WHO). However, further studies are still needed to assess the relationship between SB, PA and the use of m-Health interventions.

MHealth Interventions for Contraceptive Behavior Change in the United States: A Systematic Review

ABSTRACT Ensuring people have access to their preferred method of contraception can be key for meeting their reproductive goals. A growing number of mHealth interventions show promise for improving access to contraception, but no literature review has identified the effects of mHealth interventions among both adolescents and adults in the United States. The purpose of this systematic review was to describe the format, theoretical basis, and impact of mHealth interventions for contraceptive behavior change (contraceptive initiation and continuation) among people of all ages in the US. A systematic review of the literature was conducted using six electronic databases guided by Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data on study design, frequency, duration, mHealth modality, contraceptive method, behavior change theory, and behavioral outcome were extracted to facilitate comparison. Eighteen studies met eligibility criteria. The majority (11; 61%) used SMS (short message service). Twelve studies focused on contraceptive initiation, most (n = 8) of which also measured continued use over time. The remaining six interventions focused on continuation alone, generally through appointment reminders. Very little contraceptive behavior change was identified across studies. Current mHealth interventions may hold promise for some health areas but there is little evidence that they change contraceptive behavior. Future mHealth interventions should focus on assessing person-centered outcomes, including satisfaction, side effects, and reasons for discontinuation, to best support people to use their preferred contraceptive method.

Promoting Physical Activity and Weight Loss With mHealth Interventions Among Workers: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BackgroundPhysical activity (PA) is a vital factor in promoting health in the workforce. Mobile health (mHealth) interventions have recently emerged in workplace health promotion as an effective strategy for inducing changes in health behaviors among workers; however, the effectiveness of mHealth interventions in promoting PA and weight loss for workers is unclear.ObjectiveThis study aims to provide a comprehensive analysis of current evidence on the effectiveness of mHealth interventions in promoting PA and weight loss among workers.MethodsWe searched relevant databases, including PubMed, Embase, CINAHL Complete, and the Cochrane Library, for publications on mHealth interventions in the English or Korean language from inception to December 2020. Randomized controlled trials that evaluated the effectiveness of mHealth in improving PA and weight loss were retrieved. A meta-analysis with a random effects model and subgroup analyses was performed on PA types and mHealth intervention characteristics.ResultsA total of 8 studies were included in this analysis. More than half of the studies (5/8, 63%) were identified as having a high risk of bias. The mHealth intervention group showed a significant improvement in PA (standardized mean difference [SMD] 0.22, 95% CI 0.03-0.41; P<.001; I2=78%). No significant difference in weight loss was observed when comparing the intervention group with the control groups (SMD 0.02, 95% CI –0.07 to 0.10; P=.48; I2=0%). A subgroup analysis was also performed; walking activity (SMD 0.70, 95% CI 0.21-1.19; P<.001; I2=83.3%), a multicomponent program (SMD 0.19, 95% CI 0.05-0.33; P=.03; I2=57.4%), objective measurement (SMD 0.58, 95% CI 0.05-1.10; P<.001; I2=87.3%), and 2 or more delivery modes (SMD 0.44, 95% CI 0.01-0.87; P<.001; I2=85.1%) were significantly associated with an enhancement in PA.ConclusionsThis study suggests that mHealth interventions are effective for improving PA among workers. Future studies that assess long-term efficacy with a larger population are recommended.

Neighborhood disadvantage moderates the effect of a mobile health intervention on adolescent depression.

This study leverages data from a pilot randomized controlled trial to investigate whether the effectiveness of a text-delivered mHealth intervention targeting adolescent depression and anxiety differs according to residential- and activity space-based measures of exposure to community-level socioeconomic disadvantage. For depression, we find that intervention efficacy is significantly stronger for youth residing in more disadvantaged neighborhoods, even after controlling for individual level socioeconomic status, as well as marginal moderating effects of activity space-based neighborhood disadvantage on treatment efficacy. We do not find evidence of treatment efficacy moderation by neighborhood disadvantage regarding anxiety. While the generalizability of our findings is restricted to this sample and for this intervention, this research serves as a motivating example and initial evidence for how mHealth intervention efficacy can vary by characteristics of the environment, in particular community-level disadvantage. Future clinical research should investigate whether the effectiveness of mHealth interventions may be enhanced by personalization based on an individual's contextual environmental exposures.

The effects of mobile health on emergency care in low- and middle-income countries: A systematic review and narrative synthesis.

BackgroundIn resource-constrained settings, mobile health (mHealth) has varied applications. While there is strong evidence for its use in chronic disease management, the applications of mHealth for management of acute illness in low- and middle-income countries (LMICs) are not as well described. This review systematically explores current available evidence on the effectiveness of mHealth interventions at improving health outcomes in emergency care settings in LMICs.MethodsA systematic search of the literature was performed in accordance with PRISMA guidelines, utilizing seven electronic databases and manual searches to identify peer-reviewed literature containing each of three search elements: mHealth, emergency care (EC), and LMICs. Articles quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.ResultsAfter removing duplicates, 6498 studies met initial search criteria; 108 were eligible for full text review and 46 met criteria for inclusion. Thirty-six pertained to routine emergency care, and 10 involved complex humanitarian emergencies. Based on the GRADE criteria, 15 studies were rated as “Very Low” quality, 24 as “Low” quality, 6 as “Moderate” quality, and 1 as “High” quality. Eight studied data collection, 9 studied decision support, 15 studied direct patient care, and 14 studied health training. All 46 studies reported positive impacts of mHealth on EC in LMICs.ConclusionsMobile health interventions can be effective in improving provider-focused and patient-centered outcomes in both routine and complex EC settings. Future investigations focusing on patient-centered outcomes are needed to further validate these findings.

The PTSD help app in a Danish PTSD population: research protocol of a randomized controlled feasibility trial

BackgroundDue to an increase in PTSD patients seeking help in the Danish mental health sector and the addition of Complex PTSD to the ICD-11, there is a need to increase efficiency of existing treatments for PTSD. mHealth interventions have been shown to reduce PTSD symptoms. Therefore, the implementation of a mHealth intervention designed for psychiatric PTSD patients as a therapy add-on may improve treatment outcome. No study to date has explored the effects of mHealth interventions for PTSD in the Danish mental health sector, the feasibility and effect of this type of intervention needs testing.MethodsThe study is an investigator-initiated randomized controlled feasibility trial investigating the clinical mHealth tool PTSD help combined with care as usual (CAU) compared to CAU for adults with PTSD. Seventy patients will be recruited and receive either the mHealth intervention combined with CAU or CAU alone. The primary feasibility outcome is the proportion of eligible patients that participate in the study until the end assessment. Secondary outcome data consists of the fraction of compliant patients in the experimental group and exploratory data on PTSD help on PTSD symptom severity, level of psychological distress, sleep quality, dissociation symptoms, therapy readiness, quality of life, disability levels, and recovery.DiscussionThis study may help increase our knowledge of possible benefits of, as well as potential barriers to, the implementation of mHealth tools in the psychiatric sector. It may also provide a cost-efficient means to increase therapy outcomes and decrease the duration of suffering for PTSD patients in the psychiatric sector.Trial registrationThe trial is registered at ClinicalTrials.gov (ID: NCT03862703) https://clinicaltrials.gov/ct2/show/NCT03862703 on the 27 of February 2019 and has been approved by the Danish Data Protection Agency (journal number: VD-2018-200 ISuite number 6443). Referring to the committee law §2, the National Committee on Health Research Ethics (DNVK) [H-18024180] decided that the study could proceed without approval as the use of PTSD help did not constitute a health science intervention according to Danish health science legislation.

Mechanisms and Effects of a WeChat-Based Intervention on Suicide Among People Living With HIV and Depression: Path Model Analysis of a Randomized Controlled Trial.

BackgroundPeople living with HIV and depression have high rates of suicide. Studies of mobile health (mHealth) interventions have shown feasibility, acceptability, and efficacy in improving mental health in people living with HIV and depression. However, few studies have examined the mechanisms and effects of mHealth interventions on suicide.ObjectiveThis study was designed to examine the mechanisms and effects of a WeChat-based intervention, Run4Love, on suicide among people living with HIV and depression in China, while considering perceived stress and depressive symptoms as mediators.MethodsA sample of 300 People living with HIV and depression was recruited from the outpatient clinic of a large HIV or AIDS treatment hospital and was randomized to the Run4Love group or a control group. Data were collected at baseline, 3-, 6-, and 9-month follow-ups. Path analysis modeling, with longitudinal data, was used in data analyses.ResultsThe Run4Love mHealth intervention had a direct effect on reducing suicide rate at the 6-month follow-up (beta=−.18, P=.02) and indirect effect through reducing perceived stress and depressive symptoms at the 3-month follow-up (beta=−.09, P=.001). A partial mediating effect between perceived stress and depressive symptoms accounted for 33% (–0.09/–0.27) of the total effect.ConclusionsThrough path analyses, we understood the mechanisms and effects of an mHealth intervention on suicide prevention. The findings underscored the importance of stress reduction and depression treatment in such a program. We call for more effective suicide prevention, especially mHealth interventions targeting the vulnerable population of people living with HIV and depression.Trial RegistrationChinese Clinical Trial Registry ChiCTR-IPR-17012606; http://www.chictr.org.cn/showprojen.aspx?proj=21019

Personalized support for well-being at work: an overview of the SWELL project

Recent advances in wearable sensor technology and smartphones enable simple and affordable collection of personal analytics. This paper reflects on the lessons learned in the SWELL project that addressed the design of user-centered ICT applications for self-management of vitality in the domain of knowledge workers. These workers often have a sedentary lifestyle and are susceptible to mental health effects due to a high workload. We present the sense–reason–act framework that is the basis of the SWELL approach and we provide an overview of the individual studies carried out in SWELL. In this paper, we revisit our work on reasoning: interpreting raw heterogeneous sensor data, and acting: providing personalized feedback to support behavioural change. We conclude that simple affordable sensors can be used to classify user behaviour and heath status in a physically non-intrusive way. The interpreted data can be used to inform personalized feedback strategies. Further longitudinal studies can now be initiated to assess the effectiveness of m-Health interventions using the SWELL methods.

Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review.

BackgroundUnhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear.ObjectiveThis study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes.MethodsWe systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings “mHealth,” “text message,” “SMS,” “App,” “IVR,” “self-control,” “self-regulation,” “alcohol*,” and “intervention” were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies.ResultsIn total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants’ health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory.ConclusionsMost studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU.

Design, validation and testing of short text messages for an HIV mobile-health intervention to improve antiretroviral treatment adherence in Mexico

ABSTRACTMobile Health (mHealth) interventions have become effective strategies to increase adherence to antiretroviral treatment (ART) in people living with HIV (PLWH). mHealth interventions use phone calls, e-mails, smartphone apps or short text messages (SMS) as reminders of medical appointments or ART adherence. SMS are a highly accepted mHealth strategy. Systematized processes to validate SMS tailored to end-user preferences are required to increase the effectiveness of mHealth interventions. We describe a structured approach to develop a set of SMS tailored to Mexican HIV+ individuals, focused on improving ART adherence and healthcare appointments. The process included three sequential phases: SMS design by HIV-healthcare professionals, validation by expert referees, and testing by PLWH. A set of 108 SMS in four categories (motivational self-healthcare messages, ART-collection, medical and laboratory-appointment reminders) was designed. Expert referees assessed 94.5% of messages as adequate, 65.7% as useful. Seventy-one SMS were further tested by PLWH, who considered 100% of SMS to be understandable and 57.7% useful. SMS had adequate intra-judge agreement scores for clarity and acceptability (ICC-2 = .08–.49). Qualitative feedback from expert referees and PLWH was incorporated into SMS. A final set of 41 highest-rated SMS was obtained. Careful validation of SMS could increase the effectiveness of mHealth interventions.

Effectiveness of mHealth Interventions in Improving Medication Adherence Among People with Hypertension: a Systematic Review.

This study aims to systematically review existing evidence on the effectiveness of mobile health technology (mHealth) interventions in addressing medication adherence among people with hypertension. Twenty-one studies of mHealth interventions were included in the final review after systematic searching and screening of publications from 2000 to 2017 in PubMed, Web of Science, and Embase. Key features of the mHealth interventions include high intervention intensity, multifactorial components, and patient-centered approaches with tailored content and interaction. All studies found tendencies to improvement in medication adherence, but only 12 studies reported that the improvements were statistically significant in the intervention groups compared with the control groups. Twelve studies also found that mHealth interventions were beneficial for blood pressure control. None of the studies was conducted in a low-income country. Our systematic review found evidence that mHealth interventions improved medication adherence and blood pressure control among people with hypertension. However, most studies were small in sample size and short in study duration, and not all results were statistically significant. Future research should focus on investigating the sustainability and generalizability of mHealth interventions.

A smartphone application for treating depressive symptoms: study protocol for a randomised controlled trial

BackgroundDepression is a commonly occurring disorder linked to diminished role functioning and quality of life. The development of treatments that overcome barriers to accessing treatment remains an important area of clinical research as most people delay or do not receive treatment at an appropriate time. The workplace is an ideal setting to roll-out an intervention, particularly given the substantial psychological benefits associated with remaining in the workforce. Mobile health (mhealth) interventions utilising smartphone applications (apps) offer novel solutions to disseminating evidence based programs, however few apps have undergone rigorous testing. The present study aims to evaluate the effectiveness of a smartphone app designed to treat depressive symptoms in workers.MethodsThe present study is a multicentre randomised controlled trial (RCT), comparing the effectiveness of the intervention to that of an attention control. The primary outcome measured will be reduced depressive symptoms at 3 months. Secondary outcomes such as wellbeing and work performance will also be measured. Employees from a range of industries will be recruited via a mixture of targeted social media advertising and Industry partners. Participants will be included if they present with likely current depression at baseline. Following baseline assessment (administered within the app), participants will be randomised to receive one of two versions of the Headgear application: 1) Intervention (a 30-day mental health intervention focusing on behavioural activation and mindfulness), or 2) attention control app (mood monitoring for 30 days). Participants will be blinded to their allocation. Analyses will be conducted within an intention to treat framework using mixed modelling.DiscussionThe results of this trial will provide valuable information about the effectiveness of mhealth interventions in the treatment of depressive symptoms in a workplace context.Trial registrationThe current trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000547347, Registration date: 19/04/2017).