mHealth Platform Research Articles

A smartphone-based centrifugal mHealth platform implementing hollow daisy-shaped quick response chip for hematocrit measurement

Due to the ever-increasing challenge of emerging and reemerging infections on global health, the development of POCT tools has been propelled. However, conventional point-of-care testing methods suffer from several limitations, including cumbersome operation, long detection times, and low accuracy, which hamper their widespread application. Compared to traditional disease diagnostic equipment, mobile health platforms offer several advantages, including portability, ease of operation, and automated analysis of detection results through recognition algorithms. Consequently, they hold great promise for the future. Here, we developed a smartphone-based centrifugal mHealth platform implementing daisy-shaped quick response chip for hematocrit measurement. The centrifugal microfluidic chip is combined with a smartphone through a back-clip-on mobile phone adapter whose control circuit is designed with low power consumption to enable the platform to operate without requiring a high-power source that is inconvenient to carry, thereby achieving the goal of portability. Concurrently, we designed a quick response chip featuring a unique hollow daisy structure that is in line with the properties of hematocrit detection. The distinctive configuration of the chip enables adequate centrifugal force to be supplied for hematocrit detection. Additionally, our customized quick response code recognition algorithm is able to recognize this chip, facilitating non-experts in performing hematocrit intelligent recognition with their smartphones.

Scoping Literature Review Study of Short Message Services (SMS) and Mobile App-Based Technology as an mHealth tool for Active Participant Centered (MAPC) Adverse Events Following Immunisations (AEFIs) Surveillance using a Low Middle-Income Country (LMIC) lens

INTRODUCTION Mobile technology is rapidly expanding globally. Uptake of such technologies to improve Adverse Events Following Immunisation (AEFIs) surveillance in most Low Middle-Income Countries (LMICs) settings is limited. There is limited evidence on the feasibility of such mHealth Active Participant Centered (MAPC) AEFI surveillance systems in LMICs. This scoping literature review study therefore focused at assessing the value and feasibility of mHealth active participant centered (MAPC) AEFI surveillance using SMS and /or mobile applications (apps) immunisation safety from the perspective of a LMIC. AIM The aim of the scoping literature review was to generate exploratory feasibility evidence of MAPC AEFI surveillance such as SMS response rates, AEFI reporting rates, cost implications, acceptability, and challenges from LMICs perspectives. METHODS Employing the Joanna Briggs Institute (JBI) approach for scoping reviews, we conducted literature review of MEDLINE via PubMed, Scopus, CINAHL and Africa -wide via EBSCOs, and the Cochrane Library for studies conducted from 1970 up to July 2022. Studies were assessed on type of mHealth platform, country of implementation, key findings of uptake, acceptability, response rates, cost and key challenges identified. Most studies 24/26(92%) were conducted in HICs from 2010 to July 2022, with evidence of MAPC AEFI surveillance improving consumer response rates and early AEFI reporting for most vaccines. The consumer vaccines SMS mean response rate was 71% for 23 studies using mixed digital technologies methods mostly conducted in HICs. These HICs have more well-resourced consumers, adequate immunisation AEFI surveillance programs and well-funded primary healthcare services. LMICs suffer from critical resource limitations to the extent that over 50 LMICs rely on donor funding for vaccine procurement. There was limited MAPC AEFI surveillance in LMICs of two published feasibility studies with no evidence of scale up. CONCLUSION MAPC AEFI surveillance is implemented mostly in HICs hence need for MAPC AEFI surveillance feasibility studies in LMICs taking advantage of increasing availability of mobile phone technology.

The NeoRoo mobile app: Initial design and prototyping of an Android-based digital health tool to support Kangaroo Mother Care in low/middle-income countries (LMICs).

Premature birth and neonatal mortality are significant global health challenges, with 15 million premature births annually and an estimated 2.5 million neonatal deaths. Approximately 90% of preterm births occur in low/middle income countries, particularly within the global regions of sub-Saharan Africa and South Asia. Neonatal hypothermia is a common and significant cause of morbidity and mortality among premature and low birth weight infants, particularly in low/middle-income countries where rates of premature delivery are high, and access to health workers, medical commodities, and other resources is limited. Kangaroo Mother Care/Skin-to-Skin care has been shown to significantly reduce the incidence of neonatal hypothermia and improve survival rates among premature infants, but there are significant barriers to its implementation, especially in low/middle-income countries (LMICs). The paper proposes the use of a multidisciplinary approach to develop an integrated mHealth solution to overcome the barriers and challenges to the implementation of Kangaroo Mother Care/Skin-to-skin care (KMC/STS) in LMICs. The innovation is an integrated mHealth platform that features a wearable biomedical device (NeoWarm) and an Android-based mobile application (NeoRoo) with customized user interfaces that are targeted specifically to parents/family stakeholders and healthcare providers, respectively. This publication describes the iterative, human-centered design and participatory development of a high-fidelity prototype of the NeoRoo mobile application. The aim of this study was to design and develop an initial ("A") version of the Android-based NeoRoo mobile app specifically to support the use case of KMC/STS in health facilities in Kenya. Key functions and features are highlighted. The proposed solution leverages the promise of digital health to overcome identified barriers and challenges to the implementation of KMC/STS in LMICs and aims to equip parents and healthcare providers of prematurely born infants with the tools and resources needed to improve the care provided to premature and low birthweight babies. It is hoped that, when implemented and scaled as part of a thoughtful, strategic, cross-disciplinary approach to reduction of global rates of neonatal mortality, NeoRoo will prove to be a useful tool within the toolkit of parents, health workers, and program implementors.

An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study.

Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in people with T1D who use advanced diabetes technology. This study aims to develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in people with T1D who use advanced diabetes technology. We (a multidisciplinary team, including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program based on user-centered design principles. The following five iterative steps were taken: (1) conceptualization of hypoglycemia self-management processes and relevant interventions; (2) identification of text message themes and message content development; (3) message revision; (4) patient partner assessments for message readability, language acceptability, and trustworthiness; and (5) message finalization and integration with a CGM data-connected mHealth SMS text message delivery platform. An mHealth web-based SMS text message delivery platform that communicates with a CGM glucose information-sharing platform was also developed. The mHealth SMS text messaging hypoglycemia behavioral intervention program HypoPals, directed by patients' own CGM data, delivers personalized intervention messages to (1) improve hypoglycemia symptom detection and (2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to 4 times per day over a 10-week period. A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth SMS text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in advanced diabetes technology users with T1D. A clinical trial is needed to evaluate the program's efficacy for future clinical implementation.

Digitalising analogue policy targets! ‘Digital capabilities’ of older persons and policy digitalisation of social safety net programs in a developing country context

The optimization of the human-centeredness of technological innovations – policy digitalization - has exceedingly proliferated in most policy sectors. Yet, a few studies exist on the implications of digital policy tools in realizing social protection policies for older people, particularly in Africa. This paper discusses this issue. It examines data on the ‘digital capabilities’ of older persons and how digital technologies impact their usage and access to social safety net programs in Kenya, where digital policy tools like mHealth and e-Payment platforms are used to realize them. The data collection involved interviews with 81 respondents between 65-90 years of age (individuals targeted by social safety net programs and Social Protection officers). Findings show a need for more robust and policy target-sensitive efforts and budget allocation to overcome policy digitalization challenges, especially those arising from structural governance inequalities or older people’s capability deficits that underpin digital transformation pathways for different policy targets. Most older people in rural areas have negative attitudes and low user digital capabilities toward digital services. This is partly due to a range of challenges from infrastructural deficiencies, low access to internet resources to inadequate policy communication around digital tools. However, higher digital capabilities of policy targets and positive societal attitudes toward digital platforms could improve effective ‘public policy digitalization’ with more targeted investments and user-sensitive designs in place.

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

IntroductionPrompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. MethodsIn-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants’ perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. ResultsStakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. ConclusionDespite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.

An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback.

HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks' efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. RR2-10.2196/37748.

Mobile Health-Supported Active Syndrome Surveillance for COVID-19 Early Case Finding in Addis Ababa, Ethiopia: Comparative Study.

Since most people in low-income countries do not have access to reliable laboratory services, early diagnosis of life-threatening diseases like COVID-19 remains challenging. Facilitating real-time assessment of the health status in a given population, mobile health (mHealth)-supported syndrome surveillance might help identify disease conditions earlier and save lives cost-effectively. This study aimed to evaluate the potential use of mHealth-supported active syndrome surveillance for COVID-19 early case finding in Addis Ababa, Ethiopia. A comparative cross-sectional study was conducted among adults randomly selected from the Ethio telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview for COVID-19 syndromic assessments, and their symptoms were scored and interpreted based on national guidelines. Participants who exhibited COVID-19 syndromes were advised to have COVID-19 diagnostic testing at nearby health care facilities and seek treatment accordingly. Participants were asked about their test results, and these were cross-checked against the actual facility-based data. Estimates of COVID-19 detection by mHealth-supported syndromic assessments and facility-based tests were compared using Cohen Kappa (κ), the receiver operating characteristic curve, sensitivity, and specificity analysis. A total of 2741 adults (n=1476, 53.8% men and n=1265, 46.2% women) were interviewed through the mHealth platform during the period from December 2021 to February 2022. Among them, 1371 (50%) had COVID-19 symptoms at least once and underwent facility-based COVID-19 diagnostic testing as self-reported, with 884 (64.5%) confirmed cases recorded in facility-based registries. The syndrome assessment model had an optimal likelihood cut-off point sensitivity of 46% (95% CI 38.4-54.6) and specificity of 98% (95% CI 96.7-98.9). The area under the receiver operating characteristic curve was 0.87 (95% CI 0.83-0.91). The level of agreement between the mHealth-supported syndrome assessment and the COVID-19 test results was moderate (κ=0.54, 95% CI 0.46-0.60). In this study, the level of agreement between the mHealth-supported syndromic assessment and the actual laboratory-confirmed results for COVID-19 was found to be reasonable, at 89%. The mHealth-supported syndromic assessment of COVID-19 represents a potential alternative method to the standard laboratory-based confirmatory diagnosis, enabling the early detection of COVID-19 cases in hard-to-reach communities, and informing patients about self-care and disease management in a cost-effective manner. These findings can guide future research efforts in developing and integrating digital health into continuous active surveillance of emerging infectious diseases.

An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study.

Chemsex-the use of psychoactive drugs to enhance the sexual experience-is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. In this study, we assessed the usability and acceptability of a mobile health (mHealth)-delivered safer chemsex package ("PartyPack") as a sexual harm reduction strategy among men who have sex with men in Malaysia-a setting where chemsex is becoming increasingly prevalent. This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted.

Exploring experiences of pharmacists and pharmacy students using mHealth apps: A qualitative study of user experience

ABSTRACT Purpose Pharmacists can enhance mHealth delivery by promoting the awareness and use of health apps, while pharmacy students and early career pharmacists allow broader perspective for further development. This study aimed to explore the experiences and attitudes of pharmacy students and pharmacists, on the use, advantages and possible improvement of available mHealth platforms in Serbia. Methods One-on-one interviews were conducted online in two phases, during March and April 2020 (n = 40) and during March 2021 (n = 20), using a published, validated interview guide which was adapted for this study. Interviews were transcribed ad verbatim, coded and thematically analysed. Results Although participants recognized room for optimization, most apps had satisfactory user experience. Participants used health apps as a source of updated information and tools in education and work, but also for self-development. During working hours, participants mostly used medication-related apps, however, it was shown that they use different health apps in order to provide the best possible care to patients. Conclusions Greater insight into usage, expectations, benefits and challenges of mHealth in pharmacy was obtained and can lead into better informed design of health apps to encourage students and pharmacists, both as professionals and individuals, on the path of their continuous improvement.

Understanding the mobile healthcare applications continuance: The regulatory focus perspective

BackgroundAlthough mobile healthcare (mHealth) applications have proliferated and offer new opportunities for personal health management, many users exhibit discontinuance behavior. Various factors in mHealth applications can strongly impact users’ continuance behavior, but it is not yet fully understood how they interact with each other to yield maximized effects. This study highlights the importance of identifying the antecedents and moderators of continuance intention to broaden the demographic reach of mHealth applications and thus contribute to maintaining a sustainable healthcare system. ObjectiveThis research explores three dimensions of perceived values (hedonic, utilitarian, and social) in mHealth platforms that lead to user satisfaction and, ultimately, continuance intention. It further investigates the moderating effects of personal traits defined by regulatory focus on the relationship between perceived value and user satisfaction. MethodsData was collected from 259 respondents with experience using the Samsung Health application. The research tests the proposed model and hypotheses by implementing PLS-SEM and multi-group analyses. ResultsEach dimension of perceived values positively influences user satisfaction, with hedonic and utilitarian values exhibiting stronger relationships. Regarding moderating effects, promotion (versus prevention) focus has a stronger enhancing effect on the positive relationship between utilitarian value and user satisfaction. In contrast, prevention (versus promotion) focus more strongly enhances the positive relationship between hedonic value and user satisfaction. Regulatory focus does not yield a significant moderating effect on the relationship between social value and user satisfaction. User satisfaction exerts a strong positive influence on continuance intention in mHealth environments. ConclusionsThe moderating effect of individuals’ regulatory focus has been identified. Combined effects of antecedents and moderators on user satisfaction influence their continuance intention in mHealth ecologies. Considering individual users’ characteristics may guide mHealth application developers to design personalized platforms and establish enforced marketing strategies.

The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review.

The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies. This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs. This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features. Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents. Although features and techniques were referenced, only a few of the studies provided specific information related to behavior change theory (2/11, 18%), visual design (2/11, 18%), and the translation of parent-targeted interventions to mHealth platforms. Such information would be useful for the development of mHealth apps. Preliminary outcomes for youth and parents are encouraging, but future studies should consider conducting a meta-analysis as the body of studies grows to determine aggregate statistical findings.

Optimizing usability of a mobile health intervention for Spanish-speaking Latinx people with HIV through user-centered design: a post-implementation study.

Latinx people comprise 30% of all new human immunodeficiency virus (HIV) infections in the United States and face many challenges to accessing and engaging with HIV care. To bridge these gaps in care, a Spanish-language mobile health (mHealth) intervention known as ConexionesPositivas (CP) was adapted from an established English-language platform called PositiveLinks (PL) to help improve engagement in care and reduce viral nonsuppression among its users. We aimed to determine how CP can address the challenges that Latinx people with HIV (PWH) in the United States face. We conducted a post-implementation study of the CP mHealth platform, guided by principles of user-centered design. We enrolled 20 Spanish-speaking CP users in the study, who completed the previously validated System Usability Scale (SUS) and semistructured interviews. Interviews were transcribed and translated for analysis. We performed thematic coding of interview transcripts in Dedoose. The SUS composite score was 75, which is within the range of good usability. Four categories of themes were identified in the interviews: client context, strengths of CP, barriers to use and dislikes, and suggestions to improve CP. Positive impacts included encouraging self-monitoring of medication adherence, mood and stress, connection to professional care, and development of a support system for PWH. While CP is an effective and easy-to-use application, participants expressed a desire for improved personalization and interactivity, which will guide further iteration. This study highlights the importance of tailoring mHealth interventions to improve equity of access, especially for populations with limited English proficiency.

Development and Initial Use of an Evidence-Based Home Blood Pressure Monitoring mHealth Platform.

Home blood pressure monitoring (HBPM) has been shown to provide a more reliable assessment of blood pressure (BP) than in-office measurement and may lead to improved BP control. While many mHealth apps are available to help users track their blood pressure (BP), no apps incorporate the full set of evidence-based HBPM recommendations for ensuring accurate measurement at home. Through an agile development approach employing user stories, we translated an evidence-based standardized protocol for BP measurement and monitoring over a recommended 3-7day monitoring period into a mHealth app and corresponding clinician portal. We then pilot tested this platform to assess its feasibility for guiding users to measure BP over multiple days according to this protocol. During this pilot testing, one hundred and twenty five users created an app account; 75 (60.0%) of these users recorded at least one BP reading and 47 (37.6%) completed at least one monitoring period. Through this work, we have demonstrated how a series of guidelines can be systematically translated into a mHealth platform for HBPM. Such platforms may be accessible resources to facilitate standardized HBPM and sharing of readings with providers.

The Effectiveness of Face-To-Face Counseling and Telenursing on the Drug Adherence for Individuals Suffering From HIV/AIDS

This research compares the intervention effectiveness of face-to-face counseling and telenursing method on the Anti-Retroviral medicine consumption adherence for individuals suffering from HIV/AIDS. The method: researchers explored the data from EBSCOHost, science direct, Proquest, springer nature, and PubMed within the period of 2018 and 2022. The exploration found 1.521 journal articles plus their abstracts. Out of 1.521 journal articles, the researchers found 10 articles examining the effectiveness of counseling-based digital media for both computers and applications on mobile. Results:10 studies used the mHealth platform, virtual counseling, digital media, computer-based technology, and mobile. The assessments on the ARV medicine consumption adherence applied CD4 and viral load checkup. On the other hand, the researchers found the assessment of the ARV medicine consumption adherence applied Electronic Dose Monitoring, EDM, to examine the missing doses. The researchers found electronic pill monitoring or eCAP to examine ARV medicine consumption adherence. The other assessment was the Visual Analog Scale, VAS, to report the side effects. Then, the last assessment was an autonomous self-report to remind the medical visits via phone calls. Conclusion: face-to-face counseling allows counselors to examine the clients' responses, transmission risk, and ARV medication hindrances directly. The counselors could also find the solution to deal with the problems and observe the allergic reactions to the medication or other complaints due to immunosuppressive. The researchers also concluded that technology could facilitate the service distance, save time and cost, provide accessible health, provide nursing health care, provide immediate responses, and become the support system for the clients to consume the medicines. However, the roles of face-to-face counseling are irreplaceable. Keywords: [Counseling, telenursing, drug adherence, HIV/AIDS]

Feasibility of a New Model of Care for Allogeneic Stem Cell Transplantation Recipients Facilitated by eHealth: The MY-Medula Pilot Study

The use of allogeneic stem cell transplantation (allo-SCT) for the treatment of hematologic diseases is steadily increasing; however, allo-SCT has the downside of causing considerable treatment-related morbidity and mortality. Mobile technology applied to healthcare (mHealth) has proven to be a cost-effective strategy to improve care and offer new services to people with multimorbidity, but there are little data on its usefulness in allo-SCT recipients. Here we describe a new integrated healthcare model facilitated by an mHealth platform, EMMASalud-MY-Medula, and to report the results of a feasibility and usability pilot study. The MY-Medula platform was developed in 4 phases. First, patient and healthcare professional needs were identified, and technological development and pretesting tests were conducted (phases 1 to 3, January 2016 to March 2021). Then a nonrandomized, prospective, observational, single-center pilot study was conducted (October 2021 to January 2022) at the adult SCT unit of a tertiary university hospital. Twenty-eight volunteer allo-SCT recipients were included in the pilot study, of whom one-half were outpatients in the first-year post-SCT and one-half were affected by steroid-dependent graft-versus-host disease (SR-GVHD). All patients used the MY-Medula app during the 2-month follow-up period, with a median number of visits to the app of 143 (range, 6 to 477). A total of 2067 self-monitoring records were created, and 205 text messages were received, most of them related to symptoms description (47%) and doubts about medication (21%). In 3.4% of the cases, drug dosage was adjusted by the pharmacist because of dosing errors or interactions. At the end of the study, a 6-question Likert-type questionnaire for patients and a 22-question test for healthcare professionals showed a high degree of satisfaction (95% and 100%, respectively) with the new healthcare pathway. Reengineering the follow-up of allo-SCT recipients into an integrated, multidisciplinary model of care facilitated by mHealth tools is feasible and has been associated with high usability and a high degree of satisfaction by patients and healthcare professionals. A randomized trial aiming to determine the cost-effectiveness of MY-Medula-based follow-up post-SCT is currently enrolling participants.

HIV self-test reporting using mHealth platforms: A pilot study in Johannesburg, South Africa.

The main impediment to operational scale-up of HIV self-testing (HIVST) and counselling, is a dearth of information on utilisation, reporting, and linkage to care for HIV-positive individuals. To inform solutions to this issue, this study investigated the utility of self-testers reporting their results using a mobile-health (mHealth) platform, and whether seropositive users linked into care. Candidates who met the recruitment criteria across multiple sites within inner-city Johannesburg each received an HIVST kit. Using short message service (SMS) reminders (50% standard and 50% behavioural science), participants were prompted to self-report results on provided platforms. On the seventh day, users who did not make contact, were called, and surveyed via an interactive voice response system (IVRS). Multivariable regression was used in reporting by age and sex. Of the 9,505 participants, 2,467 (25.9%) participants answered any survey question, and of those, 1,933 (78.4%) were willing to self-report their HIV status. Men were more likely than women to make an inbound call (10.2% vs. 9.1%, p = 0.06) however, women were significantly more likely to self-report their test result (AOR = 1.12, 95%CI = 1.01-1.24, p = 0.025). Overall, self-reporting a test result was predicted by being younger and female. In addition, reporting HIV results was associated with age, 25-35 (AOR = 1.58, 95% CI = 1.24-2.02) and above 35 years (AOR = 2.12, 95% CI = 1.61-2.80). Out of 1,933 participants willing to report their HIV status, 314 reported a positive test, indicating a HIV prevalence of 16.2% (95% CI: 14.6%-18.0%) and of those 204 (65.0%) reported inclination to link to care. While self-reporting HIVST results via an IVRS system yielded a higher response rate, behavioural SMSs were ineffective in increasing self-reporting.

Associations of Country-Specific and Sociodemographic Factors With Self-Reported COVID-19-Related Symptoms: Multivariable Analysis of Data From the CoronaCheck Mobile Health Platform.

The COVID-19 symptom-monitoring apps provide direct feedback to users about the suspected risk of infection with SARS-CoV-2 and advice on how to proceed to prevent the spread of the virus. We have developed the CoronaCheck mobile health (mHealth) platform, the first free app that provides easy access to valid information about the risk of infection with SARS-CoV-2 in English and German. Previous studies have suggested that the clinical characteristics of individuals infected with SARS-CoV-2 vary by age, gender, and viral variant; however, potential differences between countries have not been adequately studied. The aim of this study is to describe the characteristics of the users of the CoronaCheck mHealth platform and to determine country-specific and sociodemographic associations of COVID-19-related symptoms and previous contacts with individuals infected with COVID-19. Between April 8, 2020, and February 3, 2022, data on sociodemographic characteristics, symptoms, and reports of previous close contacts with individuals infected with COVID-19 were collected from CoronaCheck users in different countries. Multivariable logistic regression analyses were performed to examine whether self-reports of COVID-19-related symptoms and recent contact with a person infected with COVID-19 differed between countries (Germany, India, South Africa), gender identities, age groups, education, and calendar year. Most app users (N=23,179) were from Germany (n=8116, 35.0%), India (n=6622, 28.6%), and South Africa (n=3705, 16.0%). Most data were collected in 2020 (n=19,723, 85.1%). In addition, 64% (n=14,842) of the users were male, 52.1% (n=12,077) were ≥30 years old, and 38.6% (n=8953) had an education level of more than 11 years of schooling. Headache, muscle pain, fever, loss of smell, loss of taste, and previous contacts with individuals infected with COVID-19 were reported more frequently by users in India (adjusted odds ratios [aORs] 1.3-8.3, 95% CI 1.2-9.2) and South Africa (aORs 1.1-2.6, 95% CI 1.0-3.0) than those in Germany. Cough, general weakness, sore throat, and shortness of breath were more frequently reported in India (aORs 1.3-2.6, 95% CI 1.2-2.9) compared to Germany. Gender-diverse users reported symptoms and contacts with confirmed COVID-19 cases more often compared to male users. Patterns of self-reported COVID-19-related symptoms and awareness of a previous contact with individuals infected with COVID-19 seemed to differ between India, South Africa, and Germany, as well as by gender identity in these countries. Viral symptom-collecting apps, such as the CoronaCheck mHealth platform, may be promising tools for pandemics to support appropriate assessments. Future mHealth research on country-specific differences during a pandemic should aim to recruit representative samples.

Mobile healthcare platforms' sustainability: The perspective of health information quality.

As an emerging form of medical organization, Chinese mobile healthcare (mHealth) platforms are inherently linked to the continuous use of users, which depends on the quality of the health information provided. However, improving the health information quality of mHealth platforms is still a problem that needs to be studied and solved in order to make the platforms sustainable. Based on the reputation mechanism, this study creates a behavioral evolutionary game model for health information providers (physicians) and managers (mHealth platforms), explores the evolution process and evolutionarily stable strategy of the behaviors in various situations, and uses numerical simulation technology to analyze mHealth platforms' constraints and the influencing factors of health information quality. This study presents three key findings. First, considering reputation, health information managers and mHealth platform providers should not unilaterally optimize health information. Instead, mHealth platforms should have active quality control, and physician groups should provide high-quality health information, which is the ideal evolution of the model. Second, the rewards that physicians receive from patients and mHealth platforms for providing quality health information, the reputation benefits, the penalties that physicians suffer for providing low-quality health information, and the increased probability and cost of rent-seeking behavior that physicians may choose can effectively promote the choice of physicians to provide high-quality health information. Third, the reputation gain of mHealth platforms, the probability of mHealth platforms being exposed, and increased losses suffered from exposure can effectively promote the choice of mHealth platforms to control the quality of health information. This study can provide a theoretical basis for mHealth platforms' health information quality control, which is conducive to the healthy and sustainable development of mHealth platforms and the improvement of user satisfaction.

Toward a Unified mHealth Platform: A Survey of Current User Challenges and Expectations

Mobile health (mHealth) applications have become ubiquitous and have enabled self-monitoring to help provide better health outcomes. However, the wide availability of mHealth apps introduces new challenges when users need to download and use several apps. While past app evaluations have highlighted many issues, the surrounding work is limited. This study aims to analyse the current user challenges and expectations from future mHealth apps. This information is important to inform and guide the design of better and more attractive mHealth platforms of the future. For our empirical investigation of user feedback, we designed an anonymous online survey using key dimensions from the Mobile Application Rating Scale (MARS), the Technology Acceptance Model (TAM) and the Value Proposition Canvas. Our survey was distributed via online channels such as Twitter and LinkedIn, and we received 70 valid responses that indicated challenges such as functional overlaps between different apps, unnecessary features, and poor customizability. Similarly, most respondents expressed their preference for a single platform to manage their health. These challenges suggest the need to design more capable unified mHealth platforms that can be tailored to a user’s needs. While the development of such platforms raise valid questions around the increase in software complexity and privacy concerns around user data, an open design can address these concerns and offer a better experience. Overall, these findings indicate the need for more research into mHealth app design strategies where the regular use of more than one app must be considered to create better, more engaging mHealth apps.