mHealth System Research Articles

A System for the Promotion of Traceability and Ownership of Health Data Using Blockchain

The advent of wireless technologies and the development of more and better globally connected mobile devices, leverage real time health monitoring. Mobile health (m-health) promise to deliver health services anytime and anywhere, improving user convenience and enabling faster diagnoses without the need to travel to healthcare facilities. The use of m-health applications on mobile devices with the support of cloud computing is nowadays a technology trend that has many advantages, but also poses several challenges, especially on the data storage and privacy. Blockchain technology is an exponentially growing technology used in various research areas from finance, voting mechanisms, production chains, among others. This technology provides important characteristics such as immutability, non-repudiation, transparency, and reducing the need for intermediaries. Hence, this paper presents a novel approach for blockchain technology applied to m-health systems. This proposal allows an easy and fast integration with other health systems or applications allowing a patient-user to access his electronic health record in a more secure way. The data is traceable throughout the system, however maintaining the necessary anonymity. Hence, a prototype for a blockchain-based solution using <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Hyperledger Fabric</i> was developed. This implementation enables the creation of a chronologically organized and immutable health data record. To create an anonymous storage system, the proposed system uses two separate database components that maintain data traceability through sets of IDs stored in the blockchain. Furthermore, the development of the proposed system was evaluated in terms of performance and network configurations of the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Hyperledger Fabric</i> .

Differences in Park Walking, Comparing the Physically Inactive and Active Groups: Data from mHealth Monitoring System in Seoul.

Despite the overall increase in physical activities and park uses, the discrepancies between physically inactive and active people have increasing widened in recent times. This paper aims to empirically measure the differences in walking activity in urban parks between the physically inactive and active. As for the dataset, 22,744 peoples’ 550,234 walking bouts were collected from the mHealth system of the Seoul government, using the smartphone healthcare app, WalkOn, from September to November 2019, in Seocho-gu district, Seoul, Korea. We classified the physically inactive and active sample groups, based on their regular walking (≥150 min of moderate-to-vigorous walking activity a week), and analyzed their park walking activities. We found that while there was no significant difference in walking measures of non-park walking between the sample groups, the difference did exist in park walking. The park walking average in the physically active group had more steps (p = 0.021), longer time (p = 0.008), and higher intensity (p < 0.001) of walking than that in the inactive group. Each park also revealed differences in its on-site park walking quantity and quality, based on which we could draw the list of ‘well-walked parks’, which held more bouts and more moderate-to-vigorous physical activities (MVPAs) than other parks in Seocho-gu district. This paper addresses how park walking of physically inactive and active people is associated with multiple differences in everyday urban walking.

Mobile Health Upaya Peningkatan Kepatuhan Pengobatan Pasien Anak dengan Tuberkulosis : Tinjauan Literatur

&lt;p&gt;&lt;em&gt;&lt;strong&gt;&lt;em&gt;Background&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: Children are at risk for severe symptoms of tuberculosis. Most tuberculosis drug formulations have poor acceptance in children and require consistent adherence over a long period of time. The mobile-health application is a technology that can reach various levels of society, which is useful in the management of adherence to treatment of children with TB. &lt;strong&gt;Objective&lt;/strong&gt;: To provide an overview and ideas about the application of the m-health system in Indonesia, especially in the area of nursing children with tuberculosis. &lt;strong&gt;Method&lt;/strong&gt;: Literature review is a study conducted to analyze the literature that has been selected from various sources to become a conclusion of a new idea. &lt;strong&gt;Discussion&lt;/strong&gt;: The m-health application is effectively used for nursing services for children, especially children who are being treated for tuberculosis. In the development of m-health technology, regulations and legal policies are needed to enable the application and integration of m-health technology with health services. &lt;strong&gt;Recommendation&lt;/strong&gt;: It is hoped that further research can make m-health applications to improve medication adherence in children with tuberculosis and test its effectiveness&lt;/em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;br /&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Keywords: &lt;/strong&gt;&lt;em&gt;mobile health, medication adherence, TB in children&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;br /&gt;&lt;/em&gt;&lt;/p&gt;&lt;h1 align="left"&gt; &lt;/h1&gt;

A multi-method analytical approach to predicting young adults’ intention to invest in mHealth during the COVID-19 pandemic

Mobile-based health (mHealth) systems are proving to be a popular alternative to the traditional visits to healthcare providers. They can also be useful and effective in fighting the spread of infectious diseases, such as the COVID-19 pandemic. Even though young adults are the most prevalent mHealth user group, the relevant literature has overlooked their intention to invest in and use mHealth services. This study aims to investigate the predictors that influence young adults’ intention to invest in mHealth (IINmH), particularly during the COVID-19 crisis, by designing a research methodology that incorporates both the health belief model (HBM) and the expectation-confirmation model (ECM). As an expansion of the integrated HBM-ECM model, this study proposes two additional predictors: mobile Internet speed and mobile Internet cost. A multi-method analytical approach, including partial least squares structural equation modelling (PLS-SEM), fuzzy-set qualitative comparative analysis (fsQCA), and machine learning (ML), was utilised together with a sample dataset of 558 respondents. The dataset—about young adults in Bangladesh with an experience of using mHealth—was obtained through a structured questionnaire to examine the complex causal relationships of the integrated model. The findings from PLS-SEM indicate that value-for-money, mobile Internet cost, health motivation, and confirmation of services all have a substantial impact on young adults’ IINmH during the COVID-19 pandemic. At the same time, the fsQCA results indicate that a combination of predictors, instead of any individual predictor, had a significant impact on predicting IINmH. Among ML methods, the XGBoost classifier outperformed other classifiers in predicting the IINmH, which was then used to perform sensitivity analysis to determine the relevance of features. We expect this multi-method analytical approach to make a significant contribution to the mHealth domain as well as the broad information systems literature.

Enhancing System Acceptance through User-Centred Design: Integrating Patient Generated Wellness Data.

Gestational diabetes mellitus (GDM) is a condition that appears during pregnancy and is expected to be a temporary one. While patients are encouraged to manage it themselves, research findings indicate that GDM may negatively affect the foetus; in addition, there is an increased risk of women with GDM subsequently developing Type 2 diabetes. To alleviate the risks, women with GDM are advised to maintain a record of their diet and blood glucose levels and to attend regular clinical reviews. Rather than using a paper diary, women with GDM can maintain a record of their blood glucose level readings and other relevant data using a wellness mobile application (app). However, such apps are developed for general use and may not meet the specific needs of clinical staff (physicians, dietitians, obstetricians and midwives) involved in managing GDM; for example, an app may record glucose readings but not the details of a meal taken before or after the glucose reading. Second, the apps do not permanently store the data generated by the patient and do not support the transfer of these data to a clinical system or information portal. The mobile health (mHealth) system designed and developed in this research allows one to integrate different types of user generated wellness data into a centralised database. A user-centered design (UCD) approach informed by the technology acceptance model (TAM) was adopted. This paper investigates and evaluates the effectiveness of the approach with regard to facilitating system acceptance and future adoption through an early focus on enhancing system usefulness and ease of use. The functional system requirements of the proposed system were refined through a series of interviews with the perspective of clinical users; ease-of-use and usability issues were resolved through ‘think aloud’ sessions with clinicians and GDM patients.

The Use of mHealth in Orthopedic Surgery: A Scoping Review.

(1) Background: It is well known that the success of surgical procedures is related to optimal postoperative management and follow-up. In this regard, mHealth technologies could potentially improve perioperative care. Based on these considerations, the objective of this scoping review is to evaluate the current status and use of mHealth interventions designed to provide perioperative care in orthopedic surgery. (2) Methods: This scoping review was conducted in accordance with the PRISMA statement (Extension for Scoping Review) and follows the framework of Arskey and O’Malley. (3) Results: The use of mHealth in the surgical setting is mainly oriented towards the development of applications for monitoring post-operative pain and optimizing communication between the various health professionals involved in patient care. (4) Conclusions: The mHealth systems can have a positive impact both on patient participation in the therapeutic process and on the communication between health professionals, increasing the quality of care.

Mobile ELISA with a Transparent Incubator.

Enzyme-linked immunosorbent assay (ELISA) is one of the most important technologies for biochemical testing critical for diagnosis and monitoring of many diseases. Traditional systems for ELISA incubation and reading are expensive and bulky, thus cannot be used at point-of-care or in the field. Here, we designed and demonstrated a new miniature mobile phone-based system for ELISA. This mHealth system can be used to complete all steps of the assay, including incubation and reading. It can be fabricated at low cost, it is portable, and can transfer test results via mobile phone. We have designed incubation chamber, imaging enclosure, and data processing algorithm. We demonstrate how mobile ELISA can be calibrated for accurate measurements of cortisol and show successful measurements with the calibrated system. We show that the results acquired with our prototype match well the results obtained with the gold standard.

A home-based pulmonary rehabilitation mHealth system to enhance the exercise capacity of patients with COPD: development and evaluation

BackgroundPatients with chronic obstructive pulmonary disease (COPD) experience deficits in exercise capacity and physical activity as their disease progresses. Pulmonary rehabilitation (PR) can enhance exercise capacity of patients and it is crucial for patients to maintain a lifestyle which is long-term physically active. This study aimed to develop a home-based rehabilitation mHealth system incorporating behavior change techniques (BCTs) for COPD patients, and evaluate its technology acceptance and feasibility.MethodsGuided by the medical research council (MRC) framework the process of this study was divided into four steps. In the first step, the prescription was constructed. The second step was to formulate specific intervention functions based on the behavior change wheel theory. Subsequently, in the third step we conducted iterative system development. And in the last step two pilot studies were performed, the first was for the improvement of system functions and the second was to explore potential clinical benefits and validate the acceptance and usability of the system.ResultsA total of 17 participants were enrolled, among them 12 COPD participants completed the 12-week study. For the clinical outcomes, Six-Minute Walk Test (6MWT) showed significant difference (P = .023) over time with an improvement exceeded the minimal clinically important difference (MCID). Change in respiratory symptom (CAT score) was statistically different (P = .031) with a greater decrease of − 3. The mMRC levels reduced overall and showed significant difference. The overall compliance of this study reached 82.20% (± 1.68%). The results of questionnaire and interviews indicated good technology acceptance and functional usability. The participants were satisfied with the mHealth-based intervention.ConclusionsThis study developed a home-based PR mHealth system for COPD patients. We showed that the home-based PR mHealth system incorporating BCTs is a feasible and acceptable intervention for COPD patients, and COPD patients can benefit from the intervention delivered by the system. The proposed system played an important auxiliary role in offering exercise prescription according to the characteristics of patients. It provided means and tools for further individuation of exercise prescription in the future.

Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development.

BackgroundThe proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development.ObjectiveDespite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems.MethodsTapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development.ResultsThe contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact.ConclusionsSystem designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research.

Mobile Health Systems Affordability in India: Perspectives of Stakeholders

Purpose: The purpose of this study were to identify stakeholder perspective for achieving affordable and cost-effective system outcomes and what describes success associated with mHealth systems in India. This study identifies stakeholder views on (a) fundamental conditions for initiating mobile health (mHealth) systems and (b) desirable outcomes regarding affordable and cost-effectiveness of successful mHealth systems. Design/Methodology/Approach: This qualitative study uses existing models of affordability and used an inductive approach to organise emerging codes as per a priori themes. Data were collected from direct observations and 17 in-depth interviews both online and offline involving stakeholder, namely healthcare professionals, technology entrepreneurs and software developers working on health information and mHealth systems. Findings: Findings illustrated people’s need and unwillingness, lack of application infrastructure, ecosystem development, governmental policies, and training and support as factors influencing successful mHealth systems in India. Originality/Value: Earlier studies were less adequate in explaining mHealth systems affordability and cost-effectiveness from the perspective of stakeholder. The current study attempts to provide fundamental conditions and desirable outcomes that are considered to be valuable for developing mHealth systems. This makes healthcare providers with information of what needs to be considered for developing mHealth systems.

Usability Testing of a mHealth System for Swallowing Therapy in Patients Following Stroke

Purpose The objective of this study was to evaluate the usability of a mobile health (mHealth) system designed for dysphagia exercise in persons with a history of stroke. Method Five participants with a history of stroke were recruited from a tertiary health center and assessed for their ability to use and interact with the system. After being introduced to the technology, participants were asked to independently complete five tasks, one at a time. Assistance was available when required or requested. Usability was evaluated with respect to effectiveness, efficiency, and user satisfaction when completing the prespecified goals. Results Four men and one woman between the ages of 50 and 83 years ( M = 65.4) completed the usability testing. Time from stroke onset varied from 1 month to 2.5 years. Additional poststroke challenges related to the usability of the mHealth system included reduced range of motion or mobility, vision, and short-term memory difficulties. Independent success (system effectiveness) varied in this user subgroup, and the research clinician or the family member was required to adjust the level and type of support they provided (system efficiency). All participants reported satisfaction with the use of the system. Conclusion Usability of and satisfaction with this mHealth system and others like it can be achieved in individuals who have had a stroke, either as an independent user or as a patient–caregiver dyad.

Sustainability of a mobile phone application-based data reporting system in Myanmar\u2019s malaria elimination program: a qualitative study

BackgroundStrengthening surveillance systems to collect near-real-time case-based data plays a fundamental role in achieving malaria elimination in the Greater Mekong Subregion (GMS). With the advanced and widespread use of digital technology, mHealth is increasingly taking a prominent role in malaria surveillance systems in GMS countries, including Myanmar. In Myanmar’s malaria elimination program, an mHealth system called Malaria Case-based Reporting (MCBR) has been applied for case-based reporting of malaria data by integrated community malaria volunteers (ICMVs). However, the sustainability of such mHealth systems in the context of existing malaria elimination programs in Myanmar is unknown.MethodsFocus group discussions were conducted with ICMVs and semi-structured in-depth interviews were conducted with malaria program stakeholders from Myanmar’s Ministry of Health and Sports and its malaria program implementing partners. Thematic (deductive followed by inductive) analysis was undertaken using a qualitative descriptive approach.ResultsTechnological and financial constraints such as inadequate internet access, software errors, and insufficient financial resources to support mobile phone-related costs have hampered users’ access to MCBR. Poor system integrity, unpredictable reporting outcomes, inadequate human resources for system management, and inefficient user support undermined the perceived quality of the system and user satisfaction, and hence its sustainability. Furthermore, multiple parallel systems with functions overlapping those of MCBR were in use.ConclusionsDespite its effectiveness and efficiency in malaria surveillance, the sustainability of nationwide implementation of MCBR is uncertain. To make it sustainable, stakeholders should deploy a dedicated human workforce with the necessary technical and technological capacities; secure sustainable, long-term funding for implementation of MCBR; find an alternative cost-effective plan for ensuring sustainable system access by ICMVs, such as using volunteer-owned mobile phones for reporting rather than supporting new mobile phones to them; and find a solution to the burden of multiple parallel systems.Trial registrationNot applicable.

Development of a conceptual framework for linking mHealth applications to eRecord systems in Botswana

BackgroundThe proliferation of mHealth solutions and eRecord systems is inevitable in developing countries, and ensuring their bi-directional interoperability is essential. Interoperability has been described as the ability for two or more systems or components to exchange information and use the information that has been exchanged. Given the importance of linking mHealth solutions to eRecord systems in the developing world, a suitable interoperability framework is required to provide an agreed approach to interoperability and specify common elements. Although eHealth interoperability frameworks exist in the literature, none meet all the requirements for linking mHealth solutions to eRecord systems in developing countries. The aim of this paper was to describe the design and development of a conceptual framework for linking mHealth solutions to eRecord systems in Botswana, as an exemplar.MethodsAn iterative and reflective process was adopted, supported by existing literature and research including consultations with eHealth experts, and guidance from existing frameworks. These collectively identified key elements, concepts, and standards relevant and essential for framework design and development.ResultsThe mHealth-eRecord Interoperability Framework (mHeRIF) was developed which highlights the need for: governance and regulation of mHealth and eRecord systems, a national health information exchange, and which interoperability levels to achieve. Each of these are supported by integral themes and concepts. It also addresses the need for regular review, accreditation, and alignment of framework concepts and themes with a National eHealth Strategy Interoperability Development Process. To demonstrate the framework’s applicability, a proposed architecture for the Kgonafalo mobile telemedicine programme is presented.ConclusionInteroperable mHealth solutions and eRecords systems have the potential to strengthen health systems. This paper reports the design and development of an evidence-based mHeRIF to align with, build upon, and expand National eHealth Strategies by guiding the linking of mHealth solutions to eRecord systems in Botswana and other developing countries facing similar circumstances.

Analysis of allergenic pollen data, focusing on a pollen load threshold statement

Airborne allergenic pollen affects a significant part of the population and the information on pollen load is a valuable tool for public health prevention. The messages should be provided in a form easily understandable for the population. The study provides new insight for the categorisation of pollen load by defining thresholds solely from aerobiological data. Using the long-term airborne pollen data of Corylus, Alnus, Betula, Poaceae, and Artemisia have been evaluated the regionality of pollen concentrations in Lithuania. SPIn and peak values of the main pollen season highlighted as regionality indicators. The largest differences between stations were found in the cases of Corylus and Artemisia.The principle enabling a group of pollen concentrations into levels has been analysed based on retrospective aerobiological data of five pollen types. Thresholds were determined by employing the lowest peak value of the pollen season and applying the 25% principle for selected pollen types. The results were verified by performing associations of defined thresholds with retrospective morbidity data of allergic rhinitis and allergic asthma in Lithuania. Determined pollen thresholds can be used in epidemiological studies requiring associations with pollen concentration. Thresholds could also complement air quality information by integrating pollen load data into public messages or contribute to the development of mHealth systems.

Use of mHealth Solutions for Improving Access to Adolescents' Sexual and Reproductive Health Services in Resource-Limited Settings: Lessons From Zimbabwe.

Background: Gaps still exist in reducing new HIV infections among adolescent girls and young women (AGYW) aged 10–24 years. High Internet coverage and mobile phone penetration rates present opportunities for the use of mobile health (mHealth) to support access to health services. We present results of an FHI 360 and Zimbabwe Health Interventions-implemented mHealth intervention for reproductive health (RH) and HIV testing service (HTS) referral among AGYW aged 10–19 years between October 2019 and September 2020.Methods: Adolescent girls and young women referred for RH and HTS under the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program had automatic reminders sent to their phones to facilitate access to services through short message service (SMS) and also using a paper-based system. These data were captured in a web-based District Health Information System (DHIS) database, which captured the referral completion status of the AGYW. Data for AGYW referred for RH and HTS for the period October 2018 to September 2019 for the paper-based system and October 2018 to September 2020 for the mHealth were extracted from District Health Information System version 2 (DHIS2) database and analyzed using SPSS to generate descriptive statistics. The Chi-square test was used to assess differences in referral completion rates by age-group; marital status, district, and type of service, as well as differences between mHealth and paper-based referral completion rates within each of the groups for the variables above.Results: A total of 8,800 AGYW referred for RH and HTS, where 4,355 and 4,445 were referred through the mHealth and paper-based systems, respectively. About 95.2% (4,148/4,355) and 87.8% (3,903/4,445) referred through mHealth and the paper-based system, respectively completed referrals. The median time for referral completion was 1 day (Range = 0–9 days) for mHealth and 11 days (Range = 0–28 days) for the paper-based system. AGYW referred through mHealth were 17.995 timesmore likely to complete the referral system than those referred through the paper-based system (OR =17.995; p <0.001).Conclusion: Compared to the paper-based referral system the mHealth solution resulted in a higher, service referral completion rates and shorter turnaround time. We recommend expansion of the mHealth solution to all DREAMS supported districts to increase uptake of RH and HTS among AGYW aged 10–19 years.

Preparing a financial incentive program to improve retention in HIV care and viral suppression for scale: using an implementation science framework to evaluate an mHealth system in Tanzania

BackgroundViral suppression is key to ending the HIV epidemic, yet only 58% of people living with HIV (PLHIV) in sub-Saharan Africa are suppressed. Cash transfers are an effective strategy to improve retention in care, but little is known about optimization of implementation; for example, designing effective programs that integrate into existing clinic workflows. We studied implementation of an mHealth system to deliver cash transfers to support retention.MethodsWe conducted a mixed-methods study assessing implementation of an mHealth cash transfer study. This was part of a larger, hybrid implementation-effectiveness randomized controlled trial evaluating cash transfers conditional on visit attendance for viral suppression among Tanzanian PLHIV initiating ART. An mHealth system using fingerprint identification and mobile payments was used to automatically disburse mobile money to eligible PLHIV. We used Proctor’s framework, assessing implementation of the mHealth system from the perspectives of PLHIV and clinicians. We analyzed mHealth system data and conducted surveys (n = 530) and in-depth interviews (n = 25) with PLHIV, clinic and pharmacy staff (n = 10), and structured clinic observations (n = 2293 visits).ResultsOne thousand six hundred fifty-one cash transfers were delivered to 346 PLHIV in the cash arms, 78% through mobile money. Among those in the cash arms, 81% registered their mobile money account with the mHealth system by study end, signaling high adoption. While acceptability for fingerprinting and mobile payments was high among PLHIV, interviews revealed mixed views: some had privacy concerns while others felt the system was secure and accurate, and provided some legitimacy to the clinical visits. Pharmacists praised system efficiency, but concerns about duplicative recordkeeping and added work arose. Clinic staff voiced excitement for the system’s potential to bring the cash program to all patients and simplify workflows; yet concerns about multiple systems, staffing, and intermittent connectivity tempered enthusiasm, highlighting structural issues beyond program scope. Structured observations revealed a steep learning curve; repeat fingerprint scans and manual entry declined as the system improved.ConclusionsBiometric identification and mobile payments were acceptable to most patients and staff. Fingerprinting encountered some feasibility limitations in the first months of testing; however, mobile payments were highly successful. Biometric identification and mobile payments may provide a scalable mechanism to improve patient tracking and efficiently implement financial incentives in low-resource settings.Trial registrationName of the registry: clinicaltrials.govTrial registration number: NCT03351556Date of registration: 11/24/2017Checklists: StaRI (included with submission). Note CONSORT for cluster-randomized trials was used for the main trial but is not directly applicable to this manuscript.

930Development and feasibility of a mHealth supported Comprehensive Intervention Model (“CIMmH”) for esophageal cancer patients

Abstract Background Esophageal cancer patients often experience a clinically relevant deterioration of quality of life (QoL) after esophagectomy due to malnutrition, lack of physical exercise, and psychological problems. This study aims to evaluate the feasibility and efficacy of a comprehensive intervention model using the mHealth system (CIMmH) on the mobile platform that offers accessible nutritional, exercise, and psychosocial support to esophageal cancer patients after esophagectomy. Methods Twenty esophageal cancer patients were invited to join the CIMmH for 12 weeks. The CIMmH included an online component and an offline consultation component. The participants were assessed before surgery and at 1-month and 3-month intervals after esophagectomy. QoL, depressive symptoms, anxiety, stress, nutrition, and physical fitness were measured. Results Sixteen out of 20 (80%) completed the program. One month after esophagectomy, the global health scale significantly decreased while fatigue, pain, and dyspnea increased. At the 3-month follow-up, only pain, difficulty with eating, dry mouth and trouble with talking were significantly worse than the baseline. All other dimensions in the QoL returned to the preoperative level. Weight and BMI were reduced throughout the study and no significant changes were observed in physical fitness. Depressive symptoms significantly increased one month after surgery. Conclusions The CIMmH had good feasibility and demonstrated encouraging preliminary efficacy for enhancing recovery after surgery among esophageal cancer patients in China. Key messages Esophageal cancer, Quality of life, Nutrition, Physical exercise, Psychological support, Mobile Health (mHealth)

Adherence to Home-Based Swallowing Therapy Using a Mobile System in Head and Neck Cancer Survivors.

Purpose A large knowledge gap related to dysphagia treatment adherence was identified by a recent systematic review: Few existing studies report on adherence, and current adherence tracking relies heavily on patient self-report. This study aimed to report weekly adherence and dysphagia-specific quality of life following home-based swallowing therapy in head and neck cancer (HNC). Method This was a quasi-experimental pretest-posttest design. Patients who were at least 3 months post-HNC treatment were enrolled in swallowing therapy using a mobile health (mHealth) swallowing system equipped with surface electromyography (sEMG) biofeedback. Participants completed a home dysphagia exercise program across 6 weeks, with a target of 72 swallows per day split between three different exercise types. Adherence was calculated as percent trials completed of trials prescribed. The M. D. Anderson Dysphagia Inventory (MDADI) was administered before and after therapy. Results Twenty participants (75% male), with an average age of 61.9 years (SD = 8.5), completed the study. The majority had surgery ± adjuvant (chemo)radiation therapy for oral (10%), oropharyngeal (80%), or other (10%) cancers. Using an intention-to-treat analysis, adherence to the exercise regimen remained high from 84% in Week 1 to 72% in Week 6. Radiation therapy, time since cancer treatment, medical difficulties, and technical difficulties were all found to be predictive of poorer adherence at Week 6. A statistically significant improvement was found for composite, emotional, and physical MDADI subscales. Conclusions When using an mHealth system with sEMG biofeedback, adherence rates to home-based swallowing exercise remained at or above 72% over a 6-week treatment period. Dysphagia-specific quality of life improved following this 6-week treatment program.

Impact of a Mobile Health System on the Suppression of Schistosoma haematobium in Chad

ABSTRACT.This study determined the contribution of a mobile health (M-health) system to the treatment of Schistosoma haematobium in a region of Chad where S. haematobium is endemic. M-health involves the use of a mobile phone for health care. The study compared the prevalence of schistosomiasis in an area with an M-health system, newly installed in 2014, with an area without an adequate health infrastructure. Data were gathered after the M-health system had been running for 3 years. We took urine samples from children age 1 to 15 years, for a total of 200 children in a village in the M-health area and 200 in a village in a non-M-health area. Urine was checked for urinary schistosomiasis by using dipsticks for microhematuria and, in cases of positive dipstick results, microscopy was used to detect eggs. Comparison between the areas allowed us to assess the effectiveness of the installed M-health system after 3 years of operation. Based on dipstick outcomes, the non-M-health area had an infection rate of 51.5% compared with 29% in the M-health area. Microscopy results in non-M-health and M-health were 27.5% and 21%, respectively. The dipstick result difference between M-health and non-M-health areas was statistically significant. Dipsticks were more reliable than microscopy for the detection of schistosomiasis, especially in areas without qualified personnel. Based on these results, M-health proved its ability to reduce the infection rate of urogenital schistosomiasis, and the implementation of M-health shows great promise in areas where this disease is endemic and where no mass drug administration is provided.

Feasibility of a Mobile-Based System for Unsupervised Monitoring in Parkinson’s Disease

Mobile health (mHealth) has emerged as a potential solution to providing valuable ecological information about the severity and burden of Parkinson’s disease (PD) symptoms in real-life conditions. Objective: The objective of our study was to explore the feasibility and usability of an mHealth system for continuous and objective real-life measures of patients’ health and functional mobility, in unsupervised settings. Methods: Patients with a clinical diagnosis of PD, who were able to walk unassisted, and had an Android smartphone were included. Patients were asked to answer a daily survey, to perform three weekly active tests, and to perform a monthly in-person clinical assessment. Feasibility and usability were explored as primary and secondary outcomes. An exploratory analysis was performed to investigate the correlation between data from the mKinetikos app and clinical assessments. Results: Seventeen participants (85%) completed the study. Sixteen participants (94.1%) showed a medium-to-high level of compliance with the mKinetikos system. A 6-point drop in the total score of the Post-Study System Usability Questionnaire was observed. Conclusions: Our results support the feasibility of the mKinetikos system for continuous and objective real-life measures of a patient’s health and functional mobility. The observed correlations of mKinetikos metrics with clinical data seem to suggest that this mHealth solution is a promising tool to support clinical decisions.