Health Technology Interventions Research Articles

Codesign of health technology interventions to support best-practice perioperative care and surgical waitlist management

ObjectivesThis project aimed to determine where health technology can support best-practice perioperative care for patients waiting for surgery.MethodsAn exploratory codesign process used personas and journey mapping in three interprofessional workshops...

The Role of Digital Health Technology Interventions in the Prevention of Type 2 Diabetes Mellitus: A Systematic Review.

Diabetes in the 21st century presents one of the greatest burdens of disease on the global population. Digitally mediated interventions have become imperative in alleviating this disease epidemic. We aimed to systematically review randomized controlled trials (RCTs) on different health technologies for preventing Type 2 diabetes mellitus, and their efficacy in decreasing diabetes risk-related outcomes in at-risk patients in comparison to standard care. Five electronic databases were searched between October 2021 and December 2022. Studies including digital health technology interventions used for preventing diabetes development by reducing diabetes risk-related outcomes in at-risk adults (⩾18 years) were identified. Data on glycemic levels, incidence of T2DM, weight, and intervention descriptions were extracted, and the risk of bias (ROB) was assessed. Nine studies met the inclusion criteria and 5 studies (56%) achieved clinically significant outcomes in at least one of the following: decreased weight (22%), glycemic levels (22%), or incidence of T2DM (11%). Two of the 3 (67%) computer-based interventions effectively reduced the HbA1c levels and mean weight of their study population, and 3 of 6 (50%) mobile based interventions (text messages, mobile app, and telehealth) decreased the incidence of T2DM and HbA1c levels. Four studies each had an overall low ROB and one had a high ROB due to attrition. Preliminary evidence identified in our review demonstrated that health technologies for diabetes prevention are effective for improving diabetes risk-related outcomes. Future research into digital technology protocol and studies of longer duration and more diverse populations are needed for clinical feasibility.

CHANGE IN USE OF REMOTE HEALTH TECHNOLOGIES AMONG OLDER AFRICAN AMERICAN MEN DURING THE COVID-19 PANDEMIC

Abstract It is well known that minority communities are disproportionately affected by disparities present within the US health care system. With the onset of COVID-19, these gaps in health quality continue to be exacerbated. Understanding health technology use differences pre-COVID and post-COVID among African American men is a necessary first step towards improving health outcomes that may be targeted via health technology interventions. The purpose of this study was to explicate and contextualize post-COVID health technology use among African American men in the United States for self-management of health. Of the 54 participants, all between the ages of 65-85, who completed a 30-item technology use questionnaire, a majority reported having type 1 diabetes and high blood pressure and that their current health was good or very good. For technology devices used pre-COVID, the highest reported devices owned were smartphones, desktop computer, laptop, and fitness tracker. Post-COVID, participants purchased fitness tracker CGM, glucose meter, and scale to check weight. As researchers and providers work towards addressing the prevalent health disparities disproportionately affecting members of our communities, these results provide an informative description of pre- and post-COVID.

EVALUATING MHEALTH APPLICATIONS FOR OLDER ADULTS WITH DIABETES: SYSTEMATIC META-ANALYSIS OF CLINICAL TRIALS

Abstract Diabetes is a common chronic condition among older adults and health technology interventions for diabetes management have the potential to support their self-management. However there is no systematic review and meta-analysis of the effects of mobile health applications (mHealth apps) for older adults. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effectiveness of mHealth apps for improving older adults’ diabetes outcomes. We searched the EBSCO, Clinical Trials, Cochrane Library, ProQuest, PubMed, ScienceDirect, Scopus, and Web of Science databases for relevant studies. We retrieved 4247 papers and two reviewers completed a full screen review of 257. We excluded papers if the study was not a RCT, did not examine the effect of mHealth apps, or was not conducted with older adults, resulting in 7 papers included in the final analysis. Our results indicate that mHealth apps can be effective for older adults managing diabetes, with significant reductions in glycated hemoglobin (HbA1C) (Hedge’s g: -0.40, 95% CI [-0.75 to -0.06]), and fasting blood sugar (FBS) levels (g: -0.29, 95% CI [-1.52 to 0.42]), as well as improvements in medication adherence (g: 0.93, 95% CI [0.53 to 1.28]). These effect sizes are comparable with other meta-analysis conducted across different aging groups. We describe each intervention and evaluate the risk of bias and the app components that could relate to effectiveness to inform the design of other diabetes management RCTs, and more broadly, the design of other mHealth tools for older adults. Pre-registration: http://doi.org/10.17605/OSF.IO/AWVCX

Study Assessing the All4Cure Health Technology Intervention on Patient Activation in Multiple Myeloma

BACKGROUND Over the past 2 decades, outcomes have improved markedly in patients with multiple myeloma, a result attributable to the development of highly effective agents such as immunomodulators, proteasome inhibitors, and anti-CD38 monoclonal antibodies. However, multiple myeloma remains incurable despite these advances. Furthermore, with each successive relapse, the disease becomes increasingly resistant to treatment. Therefore, patients need methods to best identify those regimens most likely to benefit them. All4Cure has built a myeloma-focused knowledge-sharing platform for patients, clinicians, and researchers. Patients register and sign HIPAA (Health Insurance Portability and Accountability Act) release forms allowing All4Cure to access all medical records from all institutions from which they have received care. A team of myeloma-dedicated medical data specialists then extracts information from the medical records and displays it on each patient's deidentified, personalized dashboard. Patient dashboards display results of monthly patient-reported outcome (PRO) surveys and feature a graph depicting all treatments and responses, from diagnosis to present. A summary is also provided, containing a narrative of the patient's relevant past medical history. This allows a community of >2000 participating patients, clinicians, and researchers to post comments, questions, or suggestions in a discussion panel. With >800 participating patients with multiple myeloma, All4Cure can help inform the treatment decisions of a patient and their oncologist by providing insight into the treatment choices and outcomes of hundreds of other patients. Patient activation levels predict a broad range of health-related behaviors and outcomes and can be assessed using the 13-item Patient Activation Measure (PAM-13) instrument. Here we report an ongoing prospective cohort study to evaluate the impact of All4Cure enrollment on patient activation levels. METHODS The trial is enrolling 200 adults aged ≥18 years with a diagnosis of multiple myeloma. Patients unable to engage with the platform or who have previously enrolled in All4Cure are excluded. After providing informed consent, patients will complete quarterly PAM-13 surveys, monthly PRO assessments, and surveys to assess their attitudes regarding All4Cure at baseline and on completion of the 12-month study. Oncologists also consent to answer surveys to assess their attitudes regarding All4Cure at baseline and on study completion. The primary objective of the trial is to assess the effect of All4Cure enrollment on patient activation as assessed using PAM-13. Secondary objectives include evaluation of the associations between patient activation and symptom burden and patient and physician expectations of the utility of the platform. The trial is registered at ClinicalTrials.gov (NCT05673083) and sponsored by the GSK Patient Empowerment Alliance, a program created to help test, measure, and validate tools that show potential to empower patients as core members of their oncology care team, with the goal of improving care outcomes.

Evaluation of Mobile Health Technology Interventions for the Postdischarge Management of Patients With Head and Neck Cancer: Scoping Review.

Patients with head and neck cancer (HNC) often experience various types and degrees of complications and functional impairment following surgery or radiotherapy. Consequently, these patients require extensive postdischarge rehabilitation, either at home or in the community. Numerous studies have shown the advantages of mobile Health (mHealth) technology in assisting patients with cancer with self-management and rehabilitation during the postdischarge period. However, few reviews have focused on the intervention, management, and evaluation of mHealth technology in postdischarge patients with HNC. This study aimed to conduct a scoping review of mHealth technology apps and interventions currently available to patients discharged from hospitals after receiving treatment for HNC. This study sought to identify and summarize the types and effectiveness of existing mHealth interventions as well as the differences in their outcome assessments. The PubMed, Embase, Web of Science, and CINAHL databases were used to identify studies with no publication time limits. The keywords "mobile health technology" and "head and neck cancer" were combined to address the main concepts of the research questions. Of the 1625 papers identified, 13 (0.8%) met the inclusion and exclusion criteria. Most studies (n=8, 61.5%) were randomized controlled trials (RCTs) and cohort studies. These studies were conducted in 6 countries. The main aims of the mHealth interventions in these studies are as follows: (1) symptom monitoring and assessment, (2) rehabilitation training, (3) access to medical health information, (4) telehealth advisers, (5) peer communication and support, and (6) follow-up/review reminders. The outcome evaluations of the 13 included studies were grouped into 4 categories: (1) technology usability and patient satisfaction, (2) self-management of symptoms and patient-reported outcome-related indicators, (3) adherence, and (4) health-related quality of life. A limited number of studies have investigated the use of mHealth technology in the postdischarge self-management of patients with HNC. The existing literature suggests that mHealth technology can effectively assist patients with HNC in self-management and postdischarge interventions. It plays an important role in addressing patients' health information needs, reducing both their somatic and psychological burdens, and improving their overall quality of life. Future research should prioritize conducting additional high-quality RCTs to evaluate the usability and analyze the cost-effectiveness of mHealth technology.

Health technology assessment implementation in WHO South-East Asia Region: a realist review protocol

Background: A robust Health Technology Assessment (HTA) mechanism is crucial to address the rising burden of healthcare costs and expenditures of patients. This research aims to describe the HTA methods and mechanisms for successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings. Methods: Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines. Conclusions: To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.

"It depends on the people!" - A qualitative analysis of contextual factors, prior to the implementation of digital health innovations for chronic condition management, in a German integrated care network.

Integrated care and digital health technology interventions are promising approaches to coordinate services for people living with chronic conditions, across different care settings and providers. The EU-funded ADLIFE project intends to provide digitally integrated personalized care to improve and maintain patients' health with advanced chronic conditions. This study conducted a qualitative assessment of contextual factors prior to the implementation of the ADLIFE digital health platforms at the German pilot site. The results of the assessment are then used to derive recommendations for action for the subsequent implementation, and for evaluation of the other pilot sites. Qualitative interviews with healthcare professionals and IT experts were conducted at the German pilot site. The interviews followed a semi-structured interview guideline, based on the HOT-fit framework, focusing on organizational, technological, and human factors. All interviews were audio recorded, transcribed, and subsequently analysed following qualitative content analysis. The results of the 18 interviews show the interviewees' high openness and motivation to use new innovative digital solutions, as well as an apparent willingness of cooperation between different healthcare professionals. Challenges include limited technical infrastructure and large variability of software to record health data, lacking standards and interfaces. Considering contextual factors on different levels is critical for the success of implementing innovations in healthcare and the transfer into other settings. In our study, the HOT-fit framework proved suitable for assessing contextual factors, when implementing IT innovations in healthcare. In a next step, the methodological approach will be transferred to the six other European pilot sites, participating in the project, for a cross-national assessment of contextual factors.

Care Frictions: A Critical Reframing of Patient Noncompliance in Health Technology Design

Patient work encompasses a challenging set of activities necessary for learning about and managing chronic conditions over time. Many patient-centered health technology interventions focus on supporting types of patient work, such as symptom tracking, medication adherence, and information sharing between patients and providers. However, people may not always follow, or may actively resist, the activities prescribed by their formal patient role. In this paper, we present three case studies about patients with different chronic conditions to critically reflect on the types of patient behavior commonly taken up in health technology design as acts of "noncompliance." Detailing conflicts that emerge when patients are caught between meeting their personal needs and following clinical best practices, we show how everyday life and health system goals are often misaligned in ways that can't be easily reconciled through current design approaches. As a way forward, we argue for alternative ways of understanding the tensions routinely shaping people's healthcare experiences. We introduce the term care frictions as a sensitizing concept useful for helping designers reframe "noncompliant" behaviors as legitimate forms of patient work. Our paper also offers design considerations-both on challenges and generative possibilities-for future CSCW research seeking to support a wider breadth of patient behavior. In this, we call attention to the value of designer and researcher reflexivity in making visible the problematic assumptions in health technology design that can lead to social and emotional patient harms.

Co-design application and consideration for health technology intervention in Vietnam

Objectives: Co-design or participatory design is an approach to design attempting to actively involve all stakeholders in the design process to help ensure the result meets their needs and is usable. Participatory design is an approach which is focused on processes and procedures of design and is not a design style. With the idea of redesigning healthcare processes from patients’ perspectives, co-design in health research provides end-users an even platform with researchers in leading service design. The application of co-design in healthcare aims to address the misalignment between researchers’ aims and end-users’ needs, which is the main reason of research waste. The purpose of this paper was to inform available co-design approaches in health care and discuss contextual factors affecting the application of codesign in consideration of the Vietnamese health context. Methods: The application of co-design approaches in health technology intervention was developed from the synthesis of existing literature and the comments from all stakeholders regarding the Vietnamese health context. Discussion: Co-design has been developed long time ago, however its application in health care has started recently. The involvement of ‘patient’, ‘stakeholder’, or ‘public’ in designing and redesigning healthcare services is the signature of co-design approaches. While it is hard to define the most effective co-design approach to use, healthcare providers, health researchers and health policymakers should prioritise services-users’ perspectives and needs as well as consider contextual factors in health care in Vietnam.

"It's Kind of Like Code-Switching": Black Older Adults' Experiences with a Voice Assistant for Health Information Seeking.

Black older adults from lower socioeconomic environments are often neglected in health technology interventions. Voice assistants have a potential to make healthcare more accessible to older adults, yet, little is known about their experiences with this type of health information seeking, especially Black older adults. Through a three-phase exploratory study, we explored health information seeking with 30 Black older adults in lower-income environments to understand how they ask health-related questions, and their perceptions of the Google Home being used for that purpose. Through our analysis, we identified the health information needs and common search topics, and discussed the communication breakdowns and types of repair performed. We contribute an understanding of cultural code-switching that has to be done by these older adults when interacting with voice assistants, and the importance of such phenomenon when designing for historically excluded groups.

The role of digital health technology in rural cancer care delivery: A systematic review.

Rural residents face higher cancer incidence rates and mortality rates, disparities that could be mitigated with health technology interventions, yet a digital divide is also apparent. This paper systematically and critically examines existing literature to understand how digital technologies have been used to support rural oncology care. PubMed, CINAHL Complete, PsycINFO, and Embase were searched using Medical Subject Headings terms and keywords. Studies were eligible if they presented empirical data investigating the use of technology in rural oncology and were published in English in a peer-reviewed journal within the last decade. The Mixed Methods Appraisal Tool was used to assess methodological quality. Digital health has been less extensively utilized in rural oncology compared with the general cancer population and other chronic diseases. We identified 54 studies that used technology in rural cancer care delivery, a comparatively small number, representing a significant gap in the literature. Studies were classified into 4 categories: Telemedicine (n = 32), phone calls (n = 11), Internet (n = 9), and mobile phone (n = 2). Of the 54 articles, 12 were RCTs, 17 were quasi-experimental, 3 were descriptive, 12 were mixed methods, and 10 were qualitative. Most of the studies involved patients only (n = 31) and were not specific to a cancer type (n = 41). Further implementation and expansion of telemedicine and phone-based strategies in rural cancer care delivery are warranted. Rural cancer survivors value digital approaches to their care. However, social and behavioral determinants of health and access to technology must be considered.

Effect of Mobile Health Technology on Weight Control in Adolescents and Preteens: A Systematic Review and Meta-Analysis.

Childhood obesity is a crucial public health concern. In recent years, numerous studies have employed mobile health technology applications for weight control in children but obtaining varying effects. We conducted a meta-analysis to discuss the effectiveness of mobile health technology in reducing the body mass index (BMI) of obese children. The standardized mean difference (SMD) in BMI between the intervention and control groups was employed to measure the effect of mobile health technology intervention on weight control. The Comprehensive Meta-Analysis Version 3 software was employed for meta-analysis, and the results are presented in a forest plot. This study included nine randomized control trials, which featured a total of 1,202 participants. The meta-analysis revealed that mobile health technology intervention did not have a significant weight loss effect on subjects with obesity. However, by using ethnicity as a moderating variable for subgroup analysis, we discovered that the BMI of ethnic Chinese groups who received mobile health technology intervention was significantly lower than that of the control group. This effect was not significant in the non-ethnic Chinese subgroup. Therefore, the use of mobile health technology intervention for weight control in ethnic Chinese children resulted in significantly lower BMI in these children; however, the use of mobile health technology intervention for weight control is unsuitable for non-ethnic Chinese children.

A TRIZ-driven conceptualisation of finger grip enhancer designs for the elderly

Background: Elderly people with severe finger weakness may need assistive health technology interventions. Finger weakness impedes the elderly in executing activities of daily living such as unbuttoning shirts and opening clothes pegs. While studies have related finger weakness with ageing effects, there appears to be no research that uses an algorithmic problem-solving approach such as the theory of inventive problem-solving (TRIZ) to recommend finger grip assistive technologies that resolve the issue of finger weakness among the elderly. Using TRIZ, this study aims to conceptualise finger grip enhancer designs for elderly people. Methods: Several TRIZ tools such as the cause-and-effect chain (CEC) analysis, engineering contradiction, physical contradiction, and substance-field analysis are used to conceptualise solutions that assist elderly people in their day-to-day pinching activities. Results: Based on the segmentation principle, a finger assistant concept powered by a miniature linear actuator is recommended. Specific product development processes are used to further conceptualise the actuation system. The study concluded that the chosen concept should use a DC motor to actuate fingers through tendon cables triggered by a push start button. Conclusions: Finger pinch degradation worsens the quality of life of the elderly. A finger grip enhancer that assists in day-to-day activities may be an effective option for elderly people, not only for their physical but also their mental well-being in society.

A TRIZ-driven conceptualisation of finger grip enhancer designs for the elderly.

Background: Elderly people with severe finger weakness may need assistive health technology interventions. Finger weakness impedes the elderly in executing activities of daily living such as unbuttoning shirts and opening clothes pegs. While studies have related finger weakness with ageing effects, there appears to be no research that uses an algorithmic problem-solving approach such as the theory of inventive problem-solving (TRIZ) to recommend finger grip assistive technologies that resolve the issue of finger weakness among the elderly. Using TRIZ, this study aims to conceptualise finger grip enhancer designs for elderly people. Methods: Several TRIZ tools such as the cause-and-effect chain (CEC) analysis, engineering contradiction, physical contradiction, and substance-field analysis are used to conceptualise solutions that assist elderly people in their day-to-day pinching activities. Results: Based on the segmentation principle, a finger assistant concept powered by a miniature linear actuator is recommended. Specific product development processes are used to further conceptualise the actuation system. The study concluded that the chosen concept should use a DC motor to actuate fingers through tendon cables triggered by a push start button. Conclusions: Finger pinch degradation worsens the quality of life of the elderly. A finger grip enhancer that assists in day-to-day activities may be an effective option for elderly people, not only for their physical but also their mental well-being in society.

Patient-centered mobile health technology intervention to improve self-care in patients with chronic heart failure: Protocol for a feasibility randomized controlled trial

This randomized controlled trial aims to determine the feasibility and preliminary efficacy of a patient-centered, mobile health technology intervention (iCardia4HF) in patients with chronic Heart Failure (HF). Participants (n = 92) are recruited and randomized 1:1 to the intervention or control group. The intervention group receives a commercial HF self-care app (Heart Failure Storylines), three connected health devices that interface with the app (Withings weight scale and blood pressure monitor, and Fitbit activity tracker), and a program of individually tailored text-messages targeting health beliefs, self-care self-efficacy, HF-knowledge, and physical activity. The control group receives the same connected health devices, but without the HF self-care app and text messages. Follow-up assessments occur at 30 days and 12 weeks. The main outcome of interest is adherence to HF self-care assessed objectively through time-stamped data from the electronic devices and also via patient self-reports. Primary measures of HF self-care include medication adherence and adherence to daily weight monitoring. Secondary measures of HF self-care include adherence to daily self-monitoring of HF symptoms and blood pressure, adherence to low-sodium diet, and engagement in physical activity. Self-reported HF self-care and health-related quality of life are assessed with the Self-care Heart Failure Index and the Kansas City Cardiomyopathy Questionnaire, respectively. Hospitalizations and emergency room visits are tracked in both groups over 12 weeks as part of our safety protocol. This study represents an important step in testing a scalable mHealth solution that has the potential to bring about a new paradigm in self-management of HF.

Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder.

Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention.

Mobile Health Technology Interventions for Suicide Prevention: Systematic Review.

BackgroundDigital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice.ObjectiveThis review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes.MethodsThe following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here.ResultsA total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review.ConclusionsFurther research is needed to evaluate the efficacy of stand-alone mHealth technology–based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice.Trial RegistrationPROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899International Registered Report Identifier (IRRID)RR2-10.2196/resprot.8635

PILOTING A NOVEL DEVICE FOR MONITORING MEDICATION ADHERENCE IN URBAN CHILDREN WITH ASTHMA

Introduction Asthma is the most common chronic disease of childhood. If poorly controlled can considerably lower the quality of life. Medication non-adherence is a major reason for asthma exacerbation. Recent mobile health technology interventions are valid tools that can improve care. We aimed to assess the efficacy of an innovative tracking system for asthma management in children. Methods 26 Patients between the ages of 6 and 17 with a diagnosis of asthma were enrolled for a period of 12 weeks. participants received an electronic monitoring device paired with an app to support adherence to controller inhaler. There were 2 phone call follow-ups at 4 and 8 weeks and a final visit at 12 weeks. Outcomes measured were changes in Asthma Control Test (ACT) score, caregiver satisfaction and medication adherence. Results Our participants were 62% male and 38% female with a mean age of 9.1. Based on ACT scores, 48% of participants with uncontrolled asthma at baseline became controlled at final visit. This improvement was observed at 4 weeks follow up and remained improved until the end of the study. Non-adherence score increased from 1.1 at baseline to 1.9 at final visit (p-value of 0.10). 57% of participants reported no use of rescue medication at final visit vs 36% at baseline. 87% of caregivers reported they will recommend this device to friends. 78% found the device as an effective tool for asthma management. Conclusions This pilot study suggests that the use of an electronic monitoring device may have positive effects on asthma control in children.

Examination of the uses, needs, and preferences for health technology use in adolescents with asthma

Objective: To examine the health technology uses and preferences of adolescents with asthma using a qualitative descriptive individual interview approach. Methods: Twenty adolescents were recruited from regularly scheduled asthma clinic appointments from February to July 2016. Patients were interviewed about their technology use and ways in which health technology could improve their asthma management using an open-ended semi-structured interview format. Interviews were audio recorded, transcribed, and coded into themes. Results: Social media (e.g. Snapchat, Instagram) and general communication (e.g. messaging) were the most common uses of technology while medical reminders (e.g. appointment, refill, medication) were the most common use of health technology. Adolescents identified ways in which health technology could improve their asthma management including (1) tracking symptoms and medication, (2) medical reminders, and (3) asthma and self-management knowledge specifically related to medications and individual action plans. Other themes that emerged included a desire to customize health technology to fit with individual schedules and medical routines and use of health technology data with medical providers. Conclusions: Adolescents and parents experience a number of challenges related to managing asthma, and health technology interventions should focus on ways to improve adherence and self-management. Future research considerations and potential interventions including ways to integrate adolescent preferences with evidence-based interventions are discussed.