mHealth Platform Research Articles

Behavioral weight loss in emerging adults: Design and rationale for the Richmond Emerging Adults Choosing Health (REACH) randomized clinical trial

BackgroundIn the U.S., over 40% of 18–25 year olds meet criteria for overweight or obesity. Yet, no large-scale trials have targeted this age group for behavioral weight loss (BWL). Formative data revealed that existing BWL programs do not meet their unique needs and identified motivation as a fundamental barrier for weight management. The goal of the Richmond Emerging Adults Choosing Health (REACH) trial was to test the efficacy of two mHealth lifestyle interventions specifically focused on enhancing motivation, relative to adapted standard. MethodsParticipants (N = 381, 18–25 years, body mass index 25–45 kg/m2) will be randomized to 1) adapted BWL (aBWL), 2) aBWL + self-determination theory (aBWL+SDT), or 3) aBWL + behavioral economics (aBWL+BE). All arms will receive a 6-month intervention, delivered via one group session and one individual session, followed by an mHealth platform. Assessments will occur at baseline, 3-months, 6-months (post-treatment) and 12-months (following a no-contact period). The primary aim is to compare weight loss outcomes at 6 months. Secondary aims include changes at 6-months in physical and behavioral cardiometabolic risk factors, as well as psychosocial measures. We will also explore weight loss maintenance, change in hypothesized mediators, and moderators of treatment response. DiscussionREACH is the first large-scale BWL trial designed specifically for emerging adults. Further, it will be the first trial to compare a lifestyle intervention grounded in self-determination theory to one rooted in behavioral economics. If clinically significant reductions in adiposity are achieved, findings could inform a scalable treatment model to meet the needs of this vulnerable population.Trial Registration:NCT02736981

Antecedents of Intention to Adopt Mobile Health (mHealth) Application and Its Impact on Intention to Recommend: An Evidence from Indonesian Customers.

Introduction Mobile health (mHealth) applications gain popularity due to the increasing number of mobile phone usage and internet penetration, which might help some of Indonesia's medical issues. However, the uptake of mHealth applications is still low in Indonesia. This study is aimed at understanding the factors that drive individuals to adopt mHealth applications and their impact on the intention to recommend. Methods We applied a new model that combines three different theories with some other constructs: an extended unified theory of acceptance and use of technology, diffusion of innovation, and the internet customer trust model. The study used a cross-sectional study design with partial least squares causal modeling approach. Results There are 787 respondents in our study, with the majority of them being female, young adults. Our model could explain 53.2% of the variance of intention to adopt while explaining 48.3% of the variance of intention to recommend. Initial trust in mHealth platform (β = 0.373, p = <0.001), facilitating conditions (β = 0.131, p = <0.01), and performance expectancy (β = 0.099, p = <0.05) are the top three most important drivers of intention to adopt mHealth applications. Lastly, importance-performance map analysis (IPMA) showed that the mHealth application's initial trust is the most important construct with a high-performance score. Discussion. Mobile health developers and managers need to improve initial trust in the mHealth platform, facilitating conditions, and performance expectancy when developing the applications. With a medium Q2predict, these factors can be applied out of the research context with medium predictive power.

M♡THer, an mHealth System to Support Women with Gestational Diabetes Mellitus: Feasibility and Acceptability Study.

Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance first identified during pregnancy. Delays in diagnosis and challenges in management can lead to serious adverse outcomes for the mother and child. As rates of GDM diagnosis increase worldwide, health systems and maternity services have become increasingly strained, especially with new restrictions around in-person care due to the current COVID-19 pandemic. Mobile health (mHealth) has increasingly shown promise for management of chronic disease, driven by smartphone adoption and increased internet connectivity. The aim of this work was to evaluate the adoption and multidisciplinary care coordination of an mHealth platform called M♡THer in a cohort of women with first-time diagnosis of GDM.Methods: The mHealth platform for GDM management was developed incorporating a smartphone application, clinician portal, and secure cloud data storage. Forty participants with a first-time diagnosis of GDM were recruited to use the app during their pregnancy. User attitudes from clinicians and women were captured through post-hoc surveys, and app-usage metrics.Results: Clinicians and women indicated satisfaction and ease of use of the mHealth platform, with some technological challenges around wireless connectivity. Blood glucose reviews and antenatal contact were higher with use of the M♡THer app compared with a matched historical sample.Conclusion: The M♡THer mHealth platform is a new comprehensive tool for health care of women with GDM, and may provide an effective new avenue to enhance multidisciplinary care in the face of COVID-19 disruptions and challenges to traditional care pathways.

Assessing mobile technology use and mHealth acceptance among HIV-positive men who have sex with men and transgender women in Malaysia.

BackgroundMobile health (mHealth) can be beneficial in monitoring the complex healthcare regimen for people with HIV that includes adhering to medication and refraining from risky practices such as unsafe sex and injection drug use. Not only is mHealth often implemented without appropriate feasibility and acceptability research, but there is limited mHealth research among key HIV-positive populations such as men who have sex with men (MSM) and transgender women (TGW).MethodsThis study assessed access to and use of mobile technology and acceptability of mHealth among 150 HIV-positive MSM and TGW who were prescribed antiretroviral therapy (ART) in Malaysia–an emerging economy with rapid telecommunications growth and societal stigma against these groups.ResultsFindings among the 114 MSM and 36 TGW reveal high levels of depression (42%), stigma (2.53/4.00) and risky sexual behavior (30%), and suboptimal ART adherence (22%). On the other hand, the sample had excellent access to smartphones (75.3%) and the internet (78%), and had high acceptance of mHealth especially for those with suboptimal ART adherence.ConclusionIn settings like Malaysia where homosexuality and cross-dressing are socially and legally stigmatized, HIV prevention and treatment strategies delivered using an mHealth platform have the potential to overcome in-person barriers.

MHealth to Improve Emergent Frailty after Lung Transplantation

Purpose Post-transplant frailty is a risk factor for poorer health-related quality of life, rehospitalization, and death. We aimed to evaluate the feasibility, safety, and efficacy of a remote mHealth-supported physical activity pilot intervention to treat frailty in lung transplant recipients following discharge from their index hospitalization. Methods We screened lung transplant recipients for frailty at the time of discharge at the University of Pennsylvania and UC San Francisco. Frailty was defined as a Short Physical Performance Battery (SPPB) score ≤7 and pre-frail as 8-9 (range 0-12, higher scores reflect less frailty). The primary intervention modality was Aidcube, a customizable app-based platform for home-based pulmonary rehabilitation providing personalized exercise prescriptions, for 8 weeks post-discharge. The primary aims included tolerability, feasibility, and acceptability of use of the mHealth platform. Additional outcome measures were changes in SPPB score and in scores of physical activity and disability measured using the DASI and LT-VLA. Results No adverse events were reported across the 18 study subjects throughout the 152 subject-week study time. Several themes emerged from weekly subject feedback. Subjects reported that the app was easy to use and that usability improved over time. Subjects also found that app use enhanced motivation to engage in post-transplant rehabilitation. Comments also highlighted the complexities of rehabilitation after lung transplant surgery, including level of functional decline, pain, tremor, and fatigue. At the end of the intervention, SPPB scores improved a median of 5 points (IQR 4, 7; p Conclusion Utilization of a personalized, app-based rehabilitation platform with participant-specific exercise prescriptions was safe and well received by post-lung transplant recipients. Remote rehabilitation was associated with improvements in frailty, physical activity and disability. Future studies should further evaluate mHealth treatment modalities in larger-scale randomized trials of lung transplant recipients.

EmERGE mHealth Platform: Implementation and Technical Evaluation of a Digital Supported Pathway of Care for Medically Stable HIV.

In this article, we described a new mobile-Health (mHealth) supported clinical pathway of care for people living with medically stable HIV in terms of platform acceptability, usability and technical feasibility. The EmERGE mHealth platform was codesigned with clinicians and the community, developed using Scrum agile methodology, integrated with hospital information systems and validated in a large prospective cohort study of 2251 participants. The evaluation of this new paradigm of care was conducted using a tailored Health Technology Assessment: the Model for Assessment of Telemedicine Applications. Usability and acceptability were assessed through the System Usability Score and a Patient Reported Experience Measure. The EmERGE platform was successfully deployed across diverse care settings in five European countries and used by 2251 patients and more than 20 clinicians for up to 30 months. Results from the formal evaluation demonstrated that the EmERGE platform is feasible and acceptable, with a high level of usability (median System Usability Score (SUS) 85.0%) and very positive patient-reported experiences (94.2% would recommend to a friend). The EmERGE platform is a secure and General Data Protection Regulation (GDPR)-compliant system with a complete set of functionalities that could be easily adapted to other clinical conditions, clinical sites and health systems thanks to its modular technical architecture.

Mobile-Health Technologies for a Child Neuropsychiatry Service: Development and Usability of the Assioma Digital Platform.

We developed an m-Health platform to support clinical pathways in a child and adolescent neuropsychiatry unit. The Assioma platform was created for tablets, smartphones and PCs, to support data collection and clinical workflow, to promote constant communication between patients, caregivers and clinicians, and to promote active family involvement in day hospital (DH) procedures. Through the Assioma application for tablets, caregivers filled out an anamnestic questionnaire and explored contents on the DH procedures and neurodevelopmental conditions. The application for smartphones included an agenda function for the DH pathways. Through the application for desktops, clinicians could export anamnestic information in text and Excel formats, send real-time notifications, and push relative contents to families’ account. We tested the usability and satisfaction of the Assioma platform in a group of children, caregivers (N = 24) and clinicians (N = 6). Both families and clinicians gave high scores to almost all usability items. The overall satisfaction reached the highest levels at 50% satisfied for families and at 33% for clinicians. Our results indicate that the Assioma platform has the potential to optimize clinical pathways, increasing compliance and clinical efficiency, and to reduce in-person contacts supporting social distancing for clinical pathways, a crucial need during the COVID-19 pandemic.

Mobile health technology to improve emergent frailty after lung transplantation.

We evaluated the feasibility, safety, and efficacy of a mHealth-supported physical rehabilitation intervention to treat frailty in a pilot study of 18 lung transplant recipients. Frail recipients were defined by a short physical performance battery (SPPB score ≤7). The primary intervention modality was Aidcube, a customizable rehabilitation mHealth platform. Our primary aims included tolerability, feasibility, and acceptability of use of the platform, and secondary outcomes were changes in SPPB and in scores of physical activity, and disability measured using the Duke Activity Status Index (DASI) and Lung Transplant-Value Life Activities (LT-VLA). Notably, no adverse events were reported. Subjects reported the app was easy to use, usability improved over time, and the app enhanced motivation to engage in rehabilitation. Comments highlighted the complexities of immediate post-transplant rehabilitation, including functional decline, pain, tremor, and fatigue. At the end of the intervention, SPPB scores improved a median of 5 points from a baseline of 4. Physical activity and patient-reported disability also improved. The DASI improved from 4.5 to 19.8 and LT-VLA score improved from 2 to 0.59 at closeout. Overall, utilization of a mHealth rehabilitation platform was safe and well received. Remote rehabilitation was associated with improvements in frailty, physical activity and disability. Future studies should evaluate mHealth treatment modalities in larger-scale randomized trials of lung transplant recipients.

Adapting an m-Health Intervention for Spanish-Speaking Latinx People Living with HIV in the Nonurban Southern United States.

Background: Latinx people in the United States are disproportionately diagnosed with HIV and are more likely to experience worse HIV-related health outcomes. Although m-health has demonstrated success in improving HIV care, a gap remains in the development of m-health platforms tailored to Latinx populations.Methods: We conducted formative study to guide the adaptation of an evidence-based m-health intervention, PositiveLinks (PL), for Spanish-speaking Latinx people living with HIV (PLWH). Spanish-speaking Latinx PLWH in the nonurban Southern United States completed semistructured interviews and viewed a demo version of the m-health intervention. Qualitative analysis was performed using a grounded theory approach. Emerging themes were identified in four topic areas: (1) prior experiences with technology, (2) desired m-health features, (3) experiences with prototype app, and (4) iteration of prototype.Results: All PLWH who participated (n = 22) were born outside the continental United States. Participants included 10 men, 10 women, and 2 transgender participants. Mean age was 41.1 years (standard deviation 11.6 years). Participants expressed concerns about privacy, a need for reliable information, and interest in practical m-health features such as appointment and medication reminders. After trialing the Spanish-language PL prototype, participants reported that peer support and positive reinforcement were strong motivators to use the app. The ability to individualize the app to meet one's own needs was also considered important.Conclusion: This formative study provides baseline attitudes about m-health among Latinx PLWH as well as desired m-health features. m-Health interventions are acceptable to Spanish-speaking PLWH and involving the target population in a user-centered formative process led to improvements in app accessibility and usability.

A Mobile Health Platform for Self-Management of Pediatric Cystic Fibrosis: Qualitative Study of Adaptation to Stakeholder Needs and Integration in Clinical Settings.

BackgroundCystic fibrosis (CF) is an inherited chronic condition that requires extensive daily care and quarterly clinic visits with a multidisciplinary care team. The limited exchange of information outside of the quarterly clinic visits impedes optimal disease self-management, patient engagement, and shared decision making.ObjectiveThe aim of this study is to adapt a mobile health (mHealth) app originally developed in Sweden to the needs of patients, families, and health care providers in a CF center in the United States and to test it as a platform for sharing patient-generated health data with the CF health care team.MethodsFocus groups with health care providers of patients with CF, adolescents with CF, and caregivers of children with CF were conducted to determine what modifications were necessary. Focus group data were analyzed using a thematic analysis, and emergent themes were ranked according to desirability and technical feasibility. The mHealth platform was then modified to meet the identified needs and preferences, and the flow of patient-generated health data to a secure Research Electronic Data Capture database was tested. Protocols for data management and clinical follow-up were also developed.ResultsA total of 5 focus groups with 21 participants were conducted. Recommended modifications pertained to all functionalities of the mHealth platform, including tracking of symptoms, treatments, and activities of daily care; creating and organizing medication lists and setting up reminders; generating reports for the health care team; language and presentation; sharing and privacy; and settings and accounts. Overall, health care providers recommended changes to align the mHealth platform with US standards of care, people with CF and their caregivers requested more tracking functionalities, and both groups suggested the inclusion of a mental health tracker as well as more detailed response options and precise language. Beta testers of the modified platform reported issues related to translatability to US environment and various bugs.ConclusionsThis study demonstrated the importance of identifying the needs and preferences of target users and stakeholders before adopting existing mHealth solutions. All relevant perspectives, including those of clinicians, patients, and caregivers, should be thoroughly considered to meet both end users’ needs and evidence-based practice recommendations.

Young People's Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study.

BackgroundDigital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people’s perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms.ObjectiveThe objective of this study was to explore young people’s experiences using an on-demand SRH mHealth platform in Kenya.MethodsWe used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International).ResultsRespondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received.ConclusionsThe importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience.

Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study.

BackgroundFamily-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the “mHealth DRIVE” program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers.ObjectiveThe objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it.MethodsStudy 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers.ResultsParental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children’s (N=10) BMI z-scores significantly decreased (mean –0.14, SD 0.17; P=.025). Over 90% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80% of providers reported that they and the families would benefit from digital tools to support child weight management.ConclusionsPediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers.Trial RegistrationClinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541.

Electronic Supported Solutions to Scale-up Maternal New-born and Child Health Interventions Feasibility Assessment for Hoima District

Background: The application of mobile telecommunication technologies in the improvement of Maternal New-born and Child Health for developing countries including Uganda is one of the key innovations in improving health outcomes. One of the key models used in disseminating health messages to mothers is the timed and targeted counselling (ttC) model. This model is being implemented in Uganda and it utilizes the services of Village Health Teams (VHTs) to drive change through mHealth. Understanding the feasibility of electronic supported solutions in scaling up Maternal New-born and Child Health intervention is critical at inception to guide resource allocation, understand existing strength, weaknesses, opportunities and threats to successful implementation of a mobiles health solution. Methods: Across-sectional study to collect quantitative and qualitative data from 432 VHTs was used. A census of 43 Health facilities was also done in Hoima district. Secondary data was collected from the District Health Team, Ministry of Health (MoH) and other relevant actors. The study followed the mHealth Assessment and Planning for Scale (MAPS) Toolkit self-assessment and planning guide designed to offer improvement of project capacity to pursue strategies that increase potential for scaling up and long-term sustainability achievements. A semi structured questionnaire was used which assessed the mHealth feasibility basing on the 16 domains under the 6 axes for the assessment for scale-up of an mHealth platform. Data was analysed at different levels from CommCare, and the District Health Information System (DHIS2) using SPSS. Results. 95.8% of VHTs owned a mobile phone and majorly used them for text messaging (71.3%). The biggest portion of VHTS use MTN network for voice calls or data services with accessibility findings of 88.8% and 86.2% respectively. Most health facilities (55.8%) had personnel trained in computer skills but only 46.5% are proficient in basic computer skills. From the analysis of the 6 axes, the functionality of the mHealth in Hoima district was at 42.6% with Axis 1 on ground work planning and implementation scoring highest with 63.9% and Axis 3 that focuses on Financing the mHealth platform scoring the lowest of 30.0%. Conclusion. For successful application of telecommunication mobile technologies, partnership between different actors needs to be up scaled to reduce on costs and maximize benefits. A deeper stakeholder analysis needs to be done for different organisations to be engaged in different elements that support the mHealth project.

Technology-Enabled Health Care Collaboration in Pediatric Chronic Illness: Pre-Post Interventional Study for Feasibility, Acceptability, and Clinical Impact of an Electronic Health Record-Linked Platform for Patient-Clinician Partnership.

BackgroundMobile health (mHealth) technology has the potential to support the Chronic Care Model’s vision of closed feedback loops and patient-clinician partnerships.ObjectiveThis study aims to evaluate the feasibility, acceptability, and short-term impact of an electronic health record–linked mHealth platform (Orchestra) supporting patient and clinician collaboration through real-time, bidirectional data sharing.MethodsWe conducted a 6-month prospective, pre-post, proof-of-concept study of Orchestra among patients and parents in the Cincinnati Children’s Hospital inflammatory bowel disease (IBD) and cystic fibrosis (CF) clinics. Participants and clinicians used Orchestra during and between visits to complete and view patient-reported outcome (PRO) measures and previsit plans. Surveys completed at baseline and at 3- and 6-month follow-up visits plus data from the platform were used to assess outcomes including PRO completion rates, weekly platform use, disease self-efficacy, and impact on care. Analyses included descriptive statistics; pre-post comparisons; Pearson correlations; and, if applicable, effect sizes.ResultsWe enrolled 92 participants (CF: n=52 and IBD: n=40), and 73% (67/92) completed the study. Average PRO completion was 61%, and average weekly platform use was 80%. Participants reported improvement in self-efficacy from baseline to 6 months (7.90 to 8.44; P=.006). At 6 months, most participants reported that the platform was useful (36/40, 90%) and had a positive impact on their care, including improved visit quality (33/40, 83%), visit collaboration (35/40, 88%), and visit preparation (31/40, 78%). PRO completion was positively associated with multiple indicators of care impact at 3 and 6 months.ConclusionsUse of an mHealth tool to support closed feedback loops through real-time data sharing and patient-clinician collaboration is feasible and shows indications of acceptability and promise as a strategy for improving pediatric chronic illness management.

Abstract 17502: Using Patient-Centered Outcomes Research Principles to Develop and Implement a Mobile Heart Failure Self-Care Program

Introduction: Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life. Remote monitoring and mobile health (mHealth) technologies can help prevent hospitalization for community-dwelling patients. We aimed to develop a HF mHealth application to enhance self-care after HF hospitalization. Hypothesis: We hypothesized that 1) a mHealth platform could be designed to increase HF self-care after hospital discharge for a population at high risk for HF readmission and 2) our tool would be user friendly and feasibly deployed. Methods: Intervention development included input from the following stakeholders: patients, clinicians, information technology developers, patient education experts, and mHealth researchers. We recruited 32 inpatient adults with HF and randomized them 1:1 to the mHealth program plus usual HF care or usual care only. Patients discharged to a nursing home, with end-stage HF (e.g. awaiting transplant/ventricular assist device or on palliative inotropes), or without a smart phone were excluded. Feasibility was determined by ease of deployment, duration of participant recruitment, and participant attrition. We measured program usability by how often the application was opened and used by patients. Results: We developed an educational HF mHealth patient self-care tool consisting of daily videos and self-assessments. Of 202 patients screened: 13 were excluded due to discharge to nursing home; 28 were excluded for end-stage HF; 9 were excluded because they did not have a smart phone. We enrolled 32 patients, 14 of which were randomized to receive the program. Mean age was 60 years (range 22-85). There were 53% male and 81% White. Four of 14 (28.6%) did not fully complete the 90-day program. All survey respondents expressed satisfaction with the intervention. Conclusions: We conducted a pilot study of a HF self-care mHealth tool for adults at risk for HF readmission and have determined it to be both feasible and acceptable. Our intervention, although a research prototype, may serve as a novel approach to reduce hospital admission and improve patient ability to manage HF as an outpatient.

Abstract 15845: Heart Heroes: A Gamified Mhealth Platform to Measure Continuous Cardiac Health Data in the Outpatient Setting of Adolescent Patients With Known and Suspected Heart Disease

Introduction: Adolescents with heart disease report difficulty in communication about their health as a major inhibiting factor in their care. MHealth technologies collect health data in daily life and enable health data sharing between the provider and patient. The adolescent population has a high level of engagement with mobile devices and a willingness to use them for health-related activities. Hypothesis: We hypothesized that our novel gamified mHealth platform Heart Hero can engage adolescent patients in the collection of cardiac health data in their daily life. Methods: We designed the research app using ResearchKit to collect continuous physiological data from the Apple Watch and daily survey data on well-being, stress, medical adherence, and cardiac symptoms. Patients were provided the app, iPhone, and Apple Watch and enrolled for 27 days. A final in-app survey was provided to assess feedback. We enrolled 28 patients total who were scheduled for outpatient cardiopulmonary exercise testing. Results: Mean age was 14.3 years old (SD +/-3.08) with a 1:1 M:F ratio. 61% of patients were ≥ 15 years of age. 94% of patients completed the final survey. Subjects on average completed 64% (SEM +/-5) of the daily quizzes with an average daily adherence of over 50% wearing the watch. 100% reported they liked using the watch and app, and 89% would like to continue wearing the Apple Watch. 53% reported the study encouraged them to exercise more while 21% reported encouragement to walk more. Fig 1 demonstrates A) Apple Watch and b) daily survey data collected from a patient throughout the study. Conclusions: In conclusion, Heart Hero is a mHealth platform which can successfully be used to collect continuous health data from the adolescent population with high engagement characterized by adherence and positive patient feedback. Adherence to the app was notably superior to the initial 5 ResearchKit applications enrolling adult patients.

Leveraging mobile applications in humanitarian crisis to improve health: a case of Syrian women and children refugees in Turkey

The open-door policy of Turkey has made it an attractive destination for millions of Syrians to escape the war. In Turkey, refugees can utilize health services free of charge, as individuals under temporary protection. However, the low uptake of preventive services including prenatal visits and childhood immunizations is a critical threat to the health of Syrian refugees and Turkish citizens. We designed an open-sourced mobile health (mHealth) platform, (HERA App), for Syrian women and children refugees in Turkey, to increase uptake of available preventive health services. HERA App is uniquely designed to reduce demand-side barriers that refugees encounter in relation to healthcare access and improve outcomes related to vaccine-preventable diseases and maternal health. HERA App provides solutions for healthcare navigation, health education, and behavioral nudges, such as automated reminders to increase timely childhood immunizations and pregnancy related doctor visits. HERA App is the first mHealth solution that has been designed for Syrian refugees in Turkey and is currently still in the data collection phase. We discuss its design and implementation and analyze the enablers and barriers of adoption systems, health systems access, and cultural norms for implementing a demand-side mHealth intervention in this context.

Agile Application of Digital Health Interventions during the COVID-19 Refugee Response.

The intersection of digital health platforms and refugee health in the context of the novel 2019 coronavirus disease (COVID-19) has not yet been explored. We discuss the ability of a novel mobile health (mhealth) platform to be effectively adapted to improve health access for vulnerable displaced populations. In a preliminary analysis of 200 Syrian refugee women, we found positive user feedback and uptake of an mhealth application to increase access to preventive maternal and child health services for Syrian refugees under temporary protection in Turkey. Rapid adaptation of this application was successfully implemented during a global pandemic state to perform symptomatic assessment, disseminate health education, and bolster national prevention efforts. We propose that mhealth interventions can provide an innovative, cost-effective, and user-friendly approach to access the dynamic needs of refugees and other displaced populations, particularly during an emerging infectious disease outbreak.

Patient Use of Cardiovascular Devices and Apps: Are We Getting Our Money's Worth?

The evolution of technology makes it likely that a large number of people will invest in and use health-related mobile applications and wearable devices. Yet the question remains: Do these technology-based interventions modify health behavior and improve health…and are we getting our money's worth? The vast majority of studies concerning health-related apps and wearable devices have small sample sizes and short time spans of 6 months or less, so it is not clear if these durations were determined by lack of consistent use over time. Furthermore, many of the most popular applications have not been subjected to randomized trials. Overall, the small demonstrated improvements in outcomes are often associated with professional involvement from clinicians, coaches, or diabetes educators provided in conjunction with use of mobile health (mHealth) platforms. This paper explores the use of mHealth technologies that address cardiovascular disease/prevention (eg, diabetes, diet, physical activity, and associated weight loss) and discusses the lack of adequate evidence to support even minimal patient investment in mobile applications or wearable devices at this time.

An Image-Based Mobile Health App for Postdrainage Monitoring: Usability Study.

BackgroundThe application of mobile health (mHealth) platforms to monitor recovery in the postdischarge period has increased in recent years. Despite widespread enthusiasm for mHealth, few studies have evaluated the usability and user experience of mHealth in patients with surgical drainage.ObjectiveOur objectives were to (1) develop an image-based smartphone app, SurgCare, for postdrainage monitoring and (2) determine the feasibility and clinical value of the use of SurgCare by patients with drainage.MethodsWe enrolled 80 patients with biliary or peritoneal drainage in this study. A total of 50 patients were assigned to the SurgCare group, who recorded drainage monitoring data with the smartphone app; and 30 patients who manually recorded the data were assigned to the conventional group. The patients continued to record data until drain removal. The primary aim was to validate feasibility for the user, which was defined as the proportion of patients using each element of the system. Moreover, the secondary aim was to evaluate the association of compliance with SurgCare and the occurrence of unexpected events.ResultsThe average submission duration was 14.98 days, and the overall daily submission rate was 84.2%. The average system usability scale was 83.7 (SD 3.5). This system met the definition of “definitely feasible” in 34 patients, “possibly feasible” in 10 patients, and “not feasible” in 3 patients. We found that the occurrence rates of complications in the SurgCare group and the conventional group were 6% and 26%, respectively, with statistically significant differences P=.03. The rate of unexpected hospital return was lower in the SurgCare group (6%) than in the conventional groups (26%) (P=.03).ConclusionsPatients can learn to use a smartphone app for postdischarge drainage monitoring with high levels of user satisfaction. We also identified a high degree of compliance with app-based drainage-recording design features, which is an aspect of mHealth that can improve surgical care.