Health Apps Research Articles

Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study.

The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform "FitKnip" was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR €1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society. The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored. This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire-8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one's perceived level of stress by the 10-item Perceived Stress Scale (PSS-10). A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform. A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users' needs and preferences. This can help to increase uptake, engagement, and ultimately the platform's adoption and effectiveness.

Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews.

Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers. This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally. We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions. A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81%). The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research. PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77.

An Empirical Study on the Influencing Factors of Mobile Health Apps Acceptance Among Silver Generation in China: An Extended STAM

An Empirical Study on the Influencing Factors of Mobile Health Apps Acceptance Among Silver Generation in China: An Extended STAM

Effectiveness of a chatbot in improving the mental wellbeing of health workers in Malawi during the COVID-19 pandemic: A randomized, controlled trial.

We conducted a randomized, controlled trial (RCT) to investigate our hypothesis that the interactive chatbot, Vitalk, is more effective in improving mental wellbeing and resilience outcomes of health workers in Malawi than the passive use of Internet resources. For our 2-arm, 8-week, parallel RCT (ISRCTN Registry: trial ID ISRCTN16378480), we recruited participants from 8 professional cadres from public and private healthcare facilities. The treatment arm used Vitalk; the control arm received links to Internet resources. The research team was blinded to the assignment. Of 1,584 participants randomly assigned to the treatment and control arms, 215 participants in the treatment and 296 in the control group completed baseline and endline anxiety assessments. Six assessments provided outcome measures for: anxiety (GAD-7); depression (PHQ-9); burnout (OLBI); loneliness (ULCA); resilience (RS-14); and resilience-building activities. We analyzed effectiveness using mixed-effects linear models, effect size estimates, and reliable change in risk levels. Results support our hypothesis. Difference-in-differences estimators showed that Vitalk reduced: depression (-0.68 [95% CI -1.15 to -0.21]); anxiety (-0.44 [95% CI -0.88 to 0.01]); and burnout (-0.58 [95% CI -1.32 to 0.15]). Changes in resilience (1.47 [95% CI 0.05 to 2.88]) and resilience-building activities (1.22 [95% CI 0.56 to 1.87]) were significantly greater in the treatment group. Our RCT produced a medium effect size for the treatment and a small effect size for the control group. This is the first RCT of a mental health app for healthcare workers during the COVID-19 pandemic in Southern Africa combining multiple mental wellbeing outcomes and measuring resilience and resilience-building activities. A substantial number of participants could have benefited from mental health support (1 in 8 reported anxiety and depression; 3 in 4 suffered burnout; and 1 in 4 had low resilience). Such help is not readily available in Malawi. Vitalk has the potential to fill this gap.

Perception of middle-aged and older adults towards mHealth apps: A comparative factor analysis between Australia and Germany

ObjectiveAlthough evidence of the global effectiveness and usability of mobile health (mHealth) apps as non-drug interventions is growing, older adults often demonstrate low adoption rates of these apps. This study aims to identify the perspectives of older adults on introducing and adopting mHealth apps in Australia and Germany. Materials and MethodsWe conducted two online cross-sectional surveys to examine factors from contextual, technological and personal perspectives that influence older adults in mHealth app adoption. Using descriptive statistics, chi-square tests and exploratory factor analysis, we identified the differences and similarities between respondents’ perspectives across two countries. ResultsA total of 290 respondents (149, Australia; 141, Germany) completed the survey. Older adults’ ability to use a mHealth app, the user-friendliness of the app, their positive self-efficacy regarding their health and resource availability for using mHealth apps were related to intended adoption. Differences between Germany and Australia were found in issues concerned with data sharing and empowerment by the doctor, while similarities were related to trust in the doctor and their treatment approaches. Discussion and ConclusionThis study highlights participants’ perspectives and attitudes towards mHealth app use, unmet needs and barriers, and the facilitating influences in the two countries. These insights can be used to inform the development and implementation of mHealth apps and to construct tailored strategies to increase the adoption rates of mHealth apps among older adults and to maximise their potential benefits.

Personalisation and Recommendation for Mental Health Apps: A Scoping Review

ABSTRACT Personalisation, which tailors to individual preferences, is considered a possible route for improving engagement with digital mental health (DMH) products. Despite claims about the presence and importance of personalised features, evidence about their extent and impact is limited. The study objective was to review evidence from published research to investigate and characterise the contribution of personalisation to engagement and effectiveness. Research papers were retrieved using keywords, with 139 papers being fully examined and 61 meeting our eligibility criteria. Most of the eligible articles reviewing DMH systems have weak to intermediate forms of personalisation (45). Only nine were coded as having strong, adaptive personalisation. Of the 40 articles which evaluated the personalisation effectiveness, 28 were qualitative indicating user preference for personalised features. The 16 controlled, quantitative designs lacked a non-personalised intervention, making it difficult to determine the added value. Effect sizes calculated from available data showed minimal differences in effectiveness compared to non-personalised apps. Our review indicates mixed evidence of personalisation’s performance in DMH interventions. Generally, there is a lack of good quality evidence to isolate specific contributions of personalisation. Opportunities were identified for improved evaluation, however caution is required when implementing more sophisticated methods of DMH personalisation.

Usability of novel beat-by-beat ECG annotation software portal for generating large-scale machine learning training datasets

Abstract Introduction Despite the availability of numerous large publicly available ECG datasets, there is a distinct absence of specialized software to enable the beat-by-beat annotation and labeling, limiting the ability to generate high-quality machine learning training datasets. This study analyzed the usability of such a novel software interface. Through a survey of several cardiologists and clinic staff, several metrics were gauged, including user satisfaction, system and app simplicity, user interface, and effectiveness. The survey results gleaned insight into the users’ experiences, providing an understanding of the software’s user-friendliness and potential in developing a large-scale machine learning annotated ECG training dataset to advance cardiac health research. Methods 3 cardiology physicians, and 9 cardiac telemetry unit staff were surveyed following use of the SafeBeat Annotation Software Platform to annotate a large publicly available dataset ECGs (n=10,646) beat-by-beat. The validated Post-Study System Usability Questionnaire (PSSUQ) and mobile Health App Usability Questionnaire (MAUQ) were used to assess the overall usability of the software interface. Results are reported as mean ± standard deviation. Results Users completed 10,646 ECG beat-by-beat annotations in 62 days, and averaged 164.0 ECGs per day. Physicians rated the software interface highly, with an overall mean PSSUQ of 6.4 ± 0.8 and MAUQ of 6.4 ± 0.7. Staff also rated the software interface highly, with an overall mean PSSUQ of 6.7 ± 0.6 and MAUQ of 6.8 ± 0.5. Overall 92% of the users reported that they strongly agreed they would use the application again and 83% strongly agreed that it was easy to learn how to use the system. Conclusion The usability analysis of this novel beat-by-beat ECG annotation software revealed that it was a highly effective tool for both cardiologists and clinic staff. Both the system and app were reported to be simple to learn, comfortable to use, and easily navigable. With most users responding that they could become productive quickly using this system, there is clear potential for it to be used to develop a large-scale machine learning dataset.Figure 1

Evaluating a New Digital App-Based Program for Heart Health: Feasibility and Acceptability Pilot Study.

Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)-powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample.

#703 Usability of a mobile health app for peritoneal dialysis patients: a pilot study

Abstract Background and Aims Technology has changed how people interact with the world, so health apps may be useful for patients with long term conditions, facilitating adherence and enabling remote monitoring. Usability is a critical factor when evaluating the quality of a mobile health app, as it indicates the ease with which a user can use it to achieve specific clinically orientated goals with effectiveness, efficiency, and satisfaction. Method The mHealth App Usability Questionnaire (MAUQ), a reliable and validated tool, was used to evaluate the MyPD® mobile health app's usability for adult peritoneal dialysis (PD) patients. The arm using the My PD app in a pilot randomized clinical study in six renal clinics in Colombia from September 2022 to August 2023 was evaluated. The MAUQ questionnaire includes 18 items assessing 3 domains related to ease of use (5 items), interface and satisfaction (7 items) and usefulness (6 items). Patients rated each item on a seven-point Likert scale, with one (1) strongly disagreeing and seven (7) strongly agreeing. The overall rating is the mean of eighteen items (standalone version); closer to seven (7), higher usability. The socio-demographic and clinical characteristics of all patients were summarized descriptively. Results MyPD app allows patients to collect and view their clinical information and dialysis treatment. Figure 1 shows a general overview of the different navigation windows. A total of 65 patients were included in this analysis; the mean age was 52.2 years, 44.6% were in CAPD, and 21.5 % achieved elementary school education or were illiterate (Table 1). The overall usability was 6.5 (SD 0.7), the maximum possible score is 7. The items related to satisfaction and interface have a mean of 6.8 (SD 0.5). Regarding ease of use, the mean was 6.6 (SD 0.8), a very high figure given the socio-cultural context of a middle-income country. In relation to usefulness, the mean was 6.1 (SD 1.5). Patients rated the overall satisfaction item with the app as 6.8 (SD 0.6). See details in Table 2. These results are better than those reported by other authors (Table 3). Conclusion The usability of the health app MyPD® was rated very high by patients, which will allow this application to be used widely as a tool that supports the outpatient care of PD patients.

Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review.

People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians. We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities. Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus. We identified 34 papers representing 25 individual studies, including 18 (53%) pilot and feasibility studies, 13 (38%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record. Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination.

Patients and Stakeholders' Perspectives Regarding the Privacy, Security, and Confidentiality of Data Collected via Mobile Health Apps in Saudi Arabia: Protocol for a Mixed Method Study.

There is data paucity regarding users' awareness of privacy concerns and the resulting impact on the acceptance of mobile health (mHealth) apps, especially in the Saudi context. Such information is pertinent in addressing users' needs in the Kingdom of Saudi Arabia (KSA). This article presents a study protocol for a mixed method study to assess the perspectives of patients and stakeholders regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA and the factors affecting the adoption of mHealth apps. A mixed method study design will be used. In the quantitative phase, patients and end users of mHealth apps will be randomly recruited from various provinces in Saudi Arabia with a high population of mHealth users. The research instrument will be developed based on the emerging themes and findings from the interview conducted among stakeholders, app developers, health care professionals, and users of mHealth apps (n=25). The survey will focus on (1) how to improve patients' awareness of data security, privacy, and confidentiality; (2) feedback on the current mHealth apps in terms of data security, privacy, and confidentiality; and (3) the features that might improve data security, privacy, and confidentiality of mHealth apps. Meanwhile, specific sections of the questionnaire will focus on patients' awareness, privacy concerns, confidentiality concerns, security concerns, perceived usefulness, perceived ease of use, and behavioral intention. Qualitative data will be analyzed thematically using NVivo version 12. Descriptive statistics, regression analysis, and structural equation modeling will be performed using SPSS and partial least squares structural equation modeling. The ethical approval for this research has been obtained from the Biomedical and Scientific Research Ethics Committee, University of Warwick, and the Medical Research and Ethics Committee Ministry of Health in the KSA. The qualitative phase is ongoing and 15 participants have been interviewed. The interviews for the remaining 10 participants will be completed by November 25, 2023. Preliminary thematic analysis is still ongoing. Meanwhile, the quantitative phase will commence by December 10, 2023, with 150 participants providing signed and informed consent to participate in the study. The mixed methods study will elucidate the antecedents of patients' awareness and concerns regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA. Furthermore, pertinent findings on the perspectives of stakeholders and health care professionals toward the aforementioned issues will be gleaned. The results will assist policy makers in developing strategies to improve Saudi users'/patients' adoption of mHealth apps and addressing the concerns raised to benefit significantly from these advanced health care modalities. DERR1-10.2196/54933.

Exploring the relationship between e-health literacy and online health information-seeking behaviour among pharmacy students in Indonesia

Background: Digital transformation has changed the health service system and how people search for health information. Digital health literacy provides basic knowledge that the prospective pharmacy workforce must have to provide comprehensive pharmacy service. Objective: This study aims to explore pharmacy students' eHealth literacy level and relate to their behaviour in accessing health information online. Methods: A cross-sectional survey was conducted on 314 pharmacy students at two pharmacy diploma schools in Jakarta and Bandung, Indonesia. A semi-structured questionnaire was administered to identify online health information-seeking behaviour and e-health literacy scores. Results: Out of 314 students, most were women (86.3%) and sophomores (43.3%). More than half have health applications installed on their smartphone and access health information online more than twice a week. There was a significant relationship between e-health literacy scores and student entry year (p = 0.000), the frequency of online health information-seeking practice (p = 0.001), and installed health apps on smartphones (p = 0.002). Conclusion: A future altered curriculum and the appropriate study materials on digital health must be implemented to equip pharmacy students with adequate skills before graduation.

Understanding the Mechanisms of Mobile Health Apps Acceptance Among Silver Generation in China: A Mediation and Moderation Analysis

Understanding the Mechanisms of Mobile Health Apps Acceptance Among Silver Generation in China: A Mediation and Moderation Analysis

An intervention development study of an mHealth app to manage women’s health and safety while on probation

PurposePreliminary studies have suggested that women are responsive to using technology to manage their health, due to its discreet, convenient, and cost-effective nature. Yet, there are limited mobile health (mHealth) apps specific to women’s needs, particularly those on probation. The purpose of this study was to explore features of 2 existing mHealth applications related to sexual health and safety, specific to interpersonal and sexual violence, to answer research questions related to the usability, barriers, and facilitators of mHealth app use for women on probation.SubjectsWe purposefully sampled from a local adult probation site and utilized snow-ball sampling to recruit 11 women who were on probation and owned iPhones.MethodsWe conducted an exploratory intervention development study using a qualitative design. Social Cognitive Theory was used for data synthesize and organization.FindingsThree themes emerged: (1) It made me take time for myself; (2) It helped me to be more respectful of my body; (3) The connectivity….that was helpful.Major implicationsParticipants expressed mHealth apps to be usable, feasible, accessible and promoted self-efficacy by allowing them track symptoms and patterns of behavior specific to health and safety in a discreet, convenient, and effective manner. This research suggests that a culturally tailored mHealth app may be an appropriate intervention to provide timely gender-responsive feedback, resources, and health care to women on probation.

The Influence of Social Information Processing and Perceived Usefulness in Building Customer Trust in Halodoc Users

The rapid development of digital technology has reshaped healthcare, with mobile apps such as Halodoc emerging as key tools for quick and efficient access to medical services and information. However, the success of such health apps depends on customer trust. This study investigated the relationship between social information processing (SIP) theory, perceived usefulness, and customer trust among Halodoc users in Surabaya City using quantitative methods. A total of 157 respondents were sampled, and data analysis was conducted using the SPSS application. The results showed that social information processing and perceived usefulness are simultaneously and partially significant in influencing the development of customer trust, where users assess Halodoc's information features and express satisfaction with its services, which then fosters trust. The findings highlight the importance of social information processing and perceived usefulness in building customer trust, offer insights for increasing trust in healthcare applications and inform marketing and product development strategies in the telemedicine industry.

Who uses connected health technologies after a cancer diagnosis? evidence from the US Health Information National Trends Survey.

As the number of people living with and beyond cancer increases, connected health technologies offer promise to enhance access to care and support, while reducing costs. However, uptake of connected health technologies may vary depending on sociodemographic and health-related variables. This study aimed to investigate demographic and health predictors of connected health technology use among people living with and beyond cancer. Cross-sectional data from the US Health Information National Trends Survey Version 5 Cycle 4 (H5c4) was used. Regression analysis was used to examine associations between sociodemographic factors and the use of connected health technologies. The sample was restricted to individuals who self-reported a cancer diagnosis or history of cancer. In this cycle, 626 respondents self-reported a cancer diagnosis, with 41.1% using connected health technologies (health and wellness apps and/or wearable devices). Most were female (58.9%) and white (82.5%); 43.4% had graduated college or higher education. One third (33.6%) had a household income of $75,000 or more. Respondents who were younger, have higher education, were living as married, had higher incomes, had higher self-rated health and had higher health-related self-efficacy were significantly more likely to use connected health technologies. There were no significant associations between gender, race, stratum, time since diagnosis, history of anxiety or depression, and use of connected health technologies among people living with and beyond cancer. Connected health technology use among people living with and beyond cancer is associated with sociodemographic factors. Future research should examine these demographic disparities as the use of connected health technologies in healthcare continues to gather momentum. The study underscores a disparity in connected heath technology usage among people living with and beyond cancer. There is a pressing need for research into adoption barriers and interventions to ensure equitable digital healthcare integration among this population, especially with the heightened adoption of technology post COVID-19 pandemic.

Understanding Patient Perspectives on the Use of Gamification and Incentives in mHealth Apps to Improve Medication Adherence: Qualitative Study.

Medication nonadherence remains a significant health and economic burden in many high-income countries. Emerging smartphone interventions have started to use features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention. This qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mobile health (mHealth) apps for medication adherence in Australian patients taking medication for chronic conditions. A total of 19 participants were included in iterative semistructured web-based focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes. Three themes were identified: purpose-driven design, trust-based standards, and personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Major concerns relating to gamification and financial incentives were perceived trivialization and potential for medication abuse, respectively. The study's findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework.

Health Technology Access and Peer Support Among Digitally Engaged People Experiencing Homelessness: Qualitative Study.

Although the effects of digital health are receiving wide scientific attention, very little is known about the characteristics of digitally engaged people experiencing homelessness, especially in Central and Eastern Europe. Our previous research revealed a considerable level of internet use in the homeless population of Budapest, Hungary, for general purposes (350/662, 52.9%) and medical purposes (229/664, 34.6%). Moreover, a digitally engaged subgroup was identified (129/662, 19.5%). The aim of this exploratory study was to map out the resources, attitudes, and behaviors of digitally engaged homeless individuals in relation to digital technology to set the basis for potential health policy interventions, which will enable better access to health services through strengthening of the digital components of the existing health care system. Between August 18, 2022, and October 27, 2022, a total of 12 in-depth semistructured interviews were conducted in 4 homeless shelters in Budapest, Hungary. Upon analysis by 3 independent evaluators, 2 interviews were excluded. The interviewees were chosen based on purposive sampling with predefined inclusion criteria. Thematic analysis of the transcripts was conducted. In the thematic analysis, 4 main themes (attitude, access, usage patterns, and solutions for usage problems) emerged. Health-related technology use mostly appeared in health information-seeking behavior. Online search for prescribed medications (5 interviews), active ingredients of medications (4 interviews), medicinal herbs believed to replace certain pills (2 interviews) or foods, and natural materials (1 interview) were mentioned. Moreover, mobile health app use (3 interviews) was reported. The intention to circumvent or check on mainstream health care solutions was mainly associated with previous negative experiences in the health care system. Several gaps in the daily use of technology were identified by the interviewees; however, more than half of the interviewees (6/10) turned out to be contact points for their peers for digital problem-solving or basic digital literacy skill enhancement in the homeless shelters. Furthermore, a lack of institutional support or special programs targeting senior clients was noted. Digitally engaged homeless individuals might become mediators between their peers and comprehensive digital health programs. They have the trust of their peers, can recognize and harness the benefits of digital technology, and are able to provide meaningful help in technology- and usage-related issues through experience. Digital health services have great promise in community shelters for managing and preventing health issues, and digitally engaged individuals might be important for the success of such services.

Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial.

Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults' quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults' use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=&Enc=&userName=027977. DERR1-10.2196/53587.

A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study.

Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03),assessment of a patient's digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed "somewhat comfortable" on any of the above measures. Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum.