mHealth Platform Research Articles

Abstract P372: Validation of a m-Health Platform for Blood Pressure Control and Reduction

Background: Self-measured blood pressure (BP) monitoring, has been proposed as a means of improving BP control. Lifestyle modifications are indicated in hypertension at any stage. AHA’s Life Simple 7 provides a straightforward call-to-action. mHealth services (mHs) may provide additional tools to effective BP control. Aim: We tested the reproducibility of the initial results of a mHs for remote BP monitoring and lifestyle counseling. The mHs in study is a cloud -based BP -recording, -interpretation and -trend evaluation service (BT) coupled with personalized lifestyle-change programs (LC). Initial results showed a significant reduction of BP at the end of the LC program. BT collects BPs, and after consistency-checks, feeds a proprietary CE-certified medical device algorithm to provide actual BP interpretation and BP trend assessment. Through a separate proprietary algorithm, LC provides a 3-month personalized lifestyle modification program for BP reduction, built on the AHA’s Life Simple 7 , after collecting detailed clinical and lifestyle data. BP changes were evaluated comparing BPs recorded at the beginning and at 3 months in both groups. We studied 2601 subjects (50±14 years old) that voluntarily and unsolicited joined LC+BT or BT-only, from June 2016 to April 2017, via App or website. Results: During the study period a total 60044 BP values were collected, subjects with discontinuous BP measurements were excluded from evaluation. We hence analyzed the data of 575 LC+BT subjects and 1653 BT-only subjects. We observed a significant BP reduction in LC+BT subjects at the end of the program for both systolic and diastolic BPs: 4.7±1.2 and 3.3±0.8 (mean + SEM, mmHg), p<0.0001, respectively. In BT-only subjects the reduction of BP values at 3-months was 2.5 ±0.9 and 1.7±1.0, p<0.001, respectively. The subjects of the LC+BT group with > 3 systolic BPs above normal values in the first 10 days, experienced a greater BP reduction: 7.9±1.4 and 4.2±1.1, p<0.0001, respectively. Conclusions: The data confirm that this mHealth service provides a strong and effective adjunctive tool for BP reduction. These results support the value of the combination of algorithm based remote BP monitoring and a personalized implementation of AHA’s Life Simple 7 recommendations.

Feasibility of a Secure Wireless Sensing Smartwatch Application for the Self-Management of Pediatric Asthma.

To address the need for asthma self-management in pediatrics, the authors present the feasibility of a mobile health (mHealth) platform built on their prior work in an asthmatic adult and child. Real-time asthma attack risk was assessed through physiological and environmental sensors. Data were sent to a cloud via a smartwatch application (app) using Health Insurance Portability and Accountability Act (HIPAA)-compliant cryptography and combined with online source data. A risk level (high, medium or low) was determined using a random forest classifier and then sent to the app to be visualized as animated dragon graphics for easy interpretation by children. The feasibility of the system was first tested on an adult with moderate asthma, then usability was examined on a child with mild asthma over several weeks. It was found during feasibility testing that the system is able to assess asthma risk with 80.10 ± 14.13% accuracy. During usability testing, it was able to continuously collect sensor data, and the child was able to wear, easily understand and enjoy the use of the system. If tested in more individuals, this system may lead to an effective self-management program that can reduce hospitalization in those who suffer from asthma.

PD_Manager: an mHealth platform for Parkinson's disease patient management.

PD_Manager is a mobile health platform designed to cover most of the aspects regarding the management of Parkinson's disease (PD) in a holistic approach. Patients are unobtrusively monitored using commercial wrist and insole sensors paired with a smartphone, to automatically estimate the severity of most of the PD motor symptoms. Besides motor symptoms monitoring, the patient's mobile application also provides various non-motor self-evaluation tests for assessing cognition, mood and nutrition to motivate them in becoming more active in managing their disease. All data from the mobile application and the sensors is transferred to a cloud infrastructure to allow easy access for clinicians and further processing. Clinicians can access this information using a separate mobile application that is specifically designed for their respective needs to provide faster and more accurate assessment of PD symptoms that facilitate patient evaluation. Machine learning techniques are used to estimate symptoms and disease progression trends to further enhance the provided information. The platform is also complemented with a decision support system (DSS) that notifies clinicians for the detection of new symptoms or the worsening of existing ones. As patient's symptoms are progressing, the DSS can also provide specific suggestions regarding appropriate medication changes.

Feasibility of utilizing a novel mhealth platform to deliver an evidence-based exercise intervention among testicular cancer survivors (TCS).

e21608 Background: Cardiovascular disease results in significant morbidity among TCS. Exercise for Cancer Patients (EXCAP) is a self-directed, individually tailored intervention that improves cardiovascular fitness in cancer patients, yet this has not been tested in TCS. We conducted a randomized phase II feasibility study of a novel exercise intervention using a mHealth delivery platform for EXCAP. Methods: We developed mHealth-EXCAP, which integrates data from a wearable digital activity tracker (DAT) into a patient’s electronic medical record (EMR), allowing providers to monitor and adjust EXCAP prescriptions via a patient-centered virtual portal. We randomized TCS ( < 69 yr at diagnosis, any treatments, not in active or maintenance stage of exercise behavior) into 3 study arms: Arm 1 (mHealth-EXCAP), Arm 2 (EXCAP) and Arm 3 (usual care). TCS in both Arm 1 and 2 completed a 12 week EXCAP program with the goal of 12,000 daily steps and daily resistance exercises but Arm 1 used the mHealth platform. Arm 3 used a TCS care plan that promotes exercises. Results: 74 TCS were screened (32 ineligible; 23 declined), 19 consented and 14 (74%) completed study (3 withdrew; 2 lost to follow up) as of 1/31/17. Median age (yr) was 35 (Arm 1; n = 6), 48 (Arm 2; n = 4), and 48 (Arm 3; n = 4). In Arm 1, 83% TCS wore DAT and synced daily step data to EMR > 90% of days. EXCAP prescriptions were adjusted via EMR portal on average 5 times over 12 weeks for each TCS and their weekly daily step goals were met 73% of the time. The number of daily steps recorded by DAT and those synced from DAT to EMR differed by a mean of 1.5% steps (±1.8). Median baseline number of daily steps were 5,525 (Arm 1), 6,795 (Arm 2), and 5,904 (Arm 3) and increased by 5,236, 1,160, and 1,544 respective steps at 12 weeks, with only Arm 1 (50% TCS) achieving > 12,000 daily steps. At 3 months after intervention, 33% TCS in Arm 1 maintained > 12,000 daily steps. On average, TCS in Arm 1 performed resistance exercises 26 minutes a day/5 times a week vs. 28 minutes a day/4 times a week in Arm 2. Conclusions: mHealth-EXCAP is feasible to implement among TCS and may decrease sedentary behavior. Ongoing research will examine its effects on cardiovascular fitness and risk factors.

Periconception mHealth platform for prevention of placental-related outcomes and non-communicable diseases

Most placental-related pregnancy complications originate during the first trimester of pregnancy where gene-environmental interactions play a role. The environmental factors also include parental behaviors that can be positive, such as folic acid supplement use, or negative, e.g. poor lifestyle choices like smoking, and nutritional choices that contribute to obesity or micronutrient deficits. The overlapping risk factors associated with non-communicable disease are poor nutrition, smoking, and obesity. These modifiable factors differ between individuals, populations and high, middle and low income countries, but have in common that they are extremely difficult to change. Parents–to-be however are most motivated to change poor behaviors when they are aware of short-term health benefits of having a healthy baby. Therefore, these couples should be empowered to use evidence-based and personalized effective tools to improve poor behaviors. Moreover, these tools should be implemented to support healthcare professionals in delivering ‘nutrition and lifestyle care’ in routine patient care. From this background the usability and effectiveness of the mHealth coaching program www.SmarterPregnancy.co.uk (Dutch version www.SlimmerZwanger.nl) is presented as an opportunity to further customize this tool for specific target groups, healthcare professionals and low resource settings with the potential to prevent placental-related and non-communicable disease during the life course.

Evidence-based adaptation and scale-up of a mobile phone health information service.

The research base recommending the use of mobile phone interventions for health improvement is growing at a rapid pace. The use of mobile phones to deliver health behavior change and maintenance interventions in particular is gaining a robust evidence base across geographies, populations, and health topics. However, research on best practices for successfully scaling mHealth interventions is not keeping pace, despite the availability of frameworks for adapting and scaling health programs. m4RH-Mobile for Reproductive Health-is an SMS, or text message-based, health information service that began in two countries and over a period of 7 years has been adapted and scaled to new population groups and new countries. Success can be attributed to following key principles for scaling up health programs, including continuous stakeholder engagement; ongoing monitoring, evaluation, and research including extensive content and usability testing with the target audience; strategic dissemination of results; and use of marketing and sustainability principles for social initiatives. This article investigates how these factors contributed to vertical, horizontal, and global scale-up of the m4RH program. Vertical scale of m4RH is demonstrated in Tanzania, where the early engagement of stakeholders including the Ministry of Health catalyzed expansion of m4RH content and national-level program reach. Ongoing data collection has provided real-time data for decision-making, information about the user base, and peer-reviewed publications, yielding government endorsement and partner hand-off for sustainability of the m4RH platform. Horizontal scale-up and adaptation of m4RH has occurred through expansion to new populations in Rwanda, Uganda, and Tanzania, where best practices for design and implementation of mHealth programs were followed to ensure the platform meets the needs of target populations. m4RH also has been modified and packaged for global scale-up through licensing and toolkit development, research into new business/distribution models, and serving as the foundation for derivative NGO and quasi-governmental mHealth platforms. The m4RH platform provides an excellent case study of how to apply best practices to successfully scale up mobile phone interventions for health improvement. Applying principles of scale can inform the successful scale-up, sustainability, and potential impact of mHealth programs across health topics and settings.

Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study.

BackgroundMedicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting.ObjectiveThe aim of our study was to investigate care coordinators’ perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI).MethodsInterviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement.ResultsThe interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients’ agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship.ConclusionsMessaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations.

Improved Medication Adherence and Frequency of Blood Glucose Self-Testing Using an m-Health Platform Versus Usual Care in a Multisite Randomized Clinical Trial Among People with Type 2 Diabetes in India.

In 2015, India had an estimated 69.2 million people with diabetes and a national prevalence of 8.7%. Evidence is mounting for the benefits of telemedicine in diabetes care, but remains limited on mobile-health (m-Health) interventions. This study assessed the impact of an m-Health diabetes platform on clinical outcomes, patient-reported outcomes, patient and provider satisfaction, and app usage. This open-label, two-arm parallel study enrolled 91 people at 3 sites in India, aged 18-65, with type 2 diabetes, and an A1c between 7.5% and 12.5% (58-113 mmol/mol). Participants were randomly assigned 1:1 to m-Health or usual care and observed for 6 months. All received free visits, laboratory tests, transportation fees, and strips and lancets. Intervention participants received the m-Health app and a mobile phone data stipend. A1c change was previously reported as statistically significant. Significantly more participants in intervention than control had improved medication adherence (39.0% vs. 12.8%; p = 0.03) and increased frequency of blood glucose (BG) self-testing (39.0% vs. 10.3%; p = 0.01) at 6 months from baseline. No other outcomes were significantly different. Among m-Health users, 75% of participants actively used the app at week 24. Participants entered 29,668 medications and 2,575 BG readings, sent 497 messages, and received 890 messages. Most participants (80%) were satisfied with all aspects of the app and all seven providers rated the software very acceptable. Participants assigned to m-Health had increased medication adherence and frequency of BG testing compared with usual care participants. This tool could be an effective way to expand access to quality chronic disease care and improve outcomes.

Scoping review and evaluation of SMS/text messaging platforms for mHealth projects or clinical interventions

ObjectivesMobile technology supporting text messaging interventions (TMIs) continues to evolve, presenting challenges for researchers and healthcare professionals who need to choose software solutions to best meet their program needs. The objective of this review was to systematically identify and compare text messaging platforms and to summarize their advantages and disadvantages as described in peer-reviewed literature. MethodsA scoping review was conducted using four steps: 1) identify currently available platforms through online searches and in mHealth repositories; 2) expand evaluation criteria of an mHealth mobile messaging toolkit and integrate prior user experiences as researchers; 3) evaluate each platform’s functions and features based on the expanded criteria and a vendor survey; and 4) assess the documentation of platform use in the peer-review literature. Platforms meeting inclusion criteria were assessed independently by three reviewers and discussed until consensus was reached. The PRISMA guidelines were followed to report findings. ResultsOf the 1041 potentially relevant search results, 27 platforms met inclusion criteria. Most were excluded because they were not platforms (e.g., guides, toolkits, reports, or SMS gateways). Of the 27 platforms, only 12 were identified in existing mHealth repositories, 10 from Google searches, while five were found in both. The expanded evaluation criteria included 22 items. Results indicate no uniform presentation of platform features and functions, often making these difficult to discern. Fourteen of the platforms were reported as open source, 10 focused on health care and 16 were tailored to meet needs of low resource settings (not mutually exclusive). Fifteen platforms had do-it-yourself setup (programming not required) while the remainder required coding/programming skills or setups could be built to specification by the vendor. Frequently described features included data security and access to the platform via cloud-based systems. Pay structures and reported targeted end-users varied. Peer-reviewed publications listed only 6 of the 27 platforms across 21 publications. The majority of these articles reported the name of the platform used but did not describe advantages or disadvantages. ConclusionsSearching for and comparing mHealth platforms for TMIs remains a challenge. The results of this review can serve as a resource for researchers and healthcare professionals wanting to integrate TMIs into health interventions. Steps to identify, compare and assess advantages and disadvantages are outlined for consideration. Expanded evaluation criteria can be used by future researchers. Continued and more comprehensive platform tools should be integrated into mHealth repositories. Detailed descriptions of platform advantages and disadvantages are needed when mHealth researchers publish findings to expand the body of research on TMI tools for healthcare. Standardized descriptions and features are recommended for vendor sites.

Assessing the Quality, Feasibility, and Efficacy of Electronic Patient Platforms Designed to Support Adolescents and Young Adults With Cancer: A Systematic Review Protocol.

BackgroundA range of innovative websites, mobile technologies, eHealth and mHealth platforms have emerged to support adolescents and young adults (AYAs) with cancer. Previous reviews have identified these various applications and solutions, but no review has summarized the quality, feasibility, and efficacy of existing patient platforms (inclusive of websites, mobile technologies, mHealth and eHealth platforms) developed specifically for young people with cancer.ObjectiveThis paper describes the design of a protocol to conduct a review of published studies or reports which describe or report on an existing platform designed specifically for AYAs who have had a cancer diagnosis.MethodsA search string was developed using a variety of key words and Medical Subject Heading and applied to bibliographic databases. General data (sample characteristics, patient platform development, design and, if applicable, pilot testing outcomes) will be extracted from reports and studies. Drawing on a previously developed coding schematic, the identified patient platforms will be coded for mode of delivery into (1) automated functions, (2) communicative functions, and (3) use of supplementary modes. An adapted version of the Mobile App Rating Scale (MARS) will be used to assess the of quality of each identified patient platform. The methodological quality of included studies will be assessed using the Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (QualSyst). Both authors will independently screen eligible studies for final inclusion and will both be responsible for data extraction and appraisal. Data will be synthesized narratively to provide an overview of identified patient platforms.ResultsThe review began in October 2016 and is currently in progress. The review paper will be submitted for peer-review and publication in the summer of 2017.ConclusionsThis review will be unique in its focus on assessing, where possible, the quality and efficacy of patient platforms for adolescents and young adults diagnosed with cancer. Results generated from this review will provide an invaluable insight into the utility of modern technology in supporting young people with cancer.

Rationale and design of the Medication adherence Improvement Support App For Engagement—Blood Pressure (MedISAFE-BP) trial

Hypertension is a major contributor to the health and economic burden imposed by stroke, heart disease, and renal insufficiency. Antihypertensives can prevent many of the harmful effects of elevated blood pressure, but medication nonadherence is a known barrier to the effectiveness of these treatments. Smartphone-based applications that remind patients to take their medications, provide education, and allow for social interactions between individuals with similar health concerns have been widely advocated as a strategy to improve adherence but have not been subject to rigorous testing. The MedISAFE-BP study is a prospective, randomized control trial designed to evaluate the impact on blood pressure and medication adherence of an mhealth application (Medisafe). Four hundred thirteen patients with uncontrolled hypertension have been enrolled and randomized in a 1:1 fashion to usual care or to the use of the Medisafe mhealth platform. Patients will be followed up for 12 weeks and the trial's co-primary outcomes will be change in systolic blood pressure and self-reported medication adherence. The MedISAFE-BP trial is the first study to rigorously evaluate an mhealth application's effect on blood pressure and medication adherence. The results will inform the potential effectiveness of this simple system in improving cardiovascular disease risk factors and clinical outcomes.

Effect of Performance Feedback on Community Health Workers' Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial.

BackgroundSmall-scale community health worker (CHW) programs provide basic health services and strengthen health systems in resource-poor settings. This paper focuses on improving CHW performance by providing individual feedback to CHWs working with an mHealth program to address malnutrition in children younger than 5 years.ObjectiveThe paper aims to evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance for CHWs working with an mHealth platform to reduce malnutrition in five districts of Madhya Pradesh, India. We expected a positive impact on CHW performance for the indicator they received feedback on. Performance on indicators the CHW did not receive feedback on was not expected to change.MethodsIn a randomized controlled trial, 60 CHWs were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator were analyzed with the other two treatments acting as the control. In total, 10 CHWs were lost to follow-up. There were three performance indicators: case activity, form submissions, and duration of counseling. Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to as well as any challenges or technical issues faced during the week for a 6-week period. Data were collected for a further 4 weeks to assess intertemporal sustained effects of the intervention.ResultsWe found positive and significant impacts on duration of counseling, whereas case activity and number of form submissions did not show significant improvements as a result of the intervention. We found a moderate to large effect (Glass’s delta=0.97, P=.004) of providing performance feedback on counseling times in the initial 6 weeks. These effects were sustained in the postintervention period (Glass’s delta=1.69, P<.001). The counseling times decreased slightly from the intervention to postintervention period by 2.14 minutes (P=.01). Case activity improved for all CHWs after the intervention. We also performed the analysis by replacing the CHWs lost to follow-up with those in their treatment groups with the closest ranks in baseline performance and found similar results.ConclusionsCalls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had a positive effect on performance in the case of duration of counseling. The results suggest that difficulty in achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation.

Integration of advances in social media and mHealth technology are pivotal to successful cancer prevention and control.

The successful prevention and treatment of cancer is dependent upon efficient and reliable communication between healthcare workers and patients. Advances in social media and mHealth platforms have provided new ways in which to enhance the sharing of cancer related information. Other benefits of embracing this technology include utilising its analytic capabilities which can process the vast quantity of information generated from genome exploration in a highly efficient manner. The aim of this review is to provide an overview of the rapidly evolving areas through which digital engagement is proving useful in the prevention and control of cancer.

Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring.

BackgroundSurgical patients are increasingly using mobile health (mHealth) platforms to monitor recovery and communicate with their providers in the postdischarge period. Despite widespread enthusiasm for mHealth, few studies evaluate the usability or user experience of these platforms.ObjectiveOur objectives were to (1) develop a novel image-based smartphone app for postdischarge surgical wound monitoring, and (2) rigorously user test it with a representative population of vascular and general surgery patients.MethodsA total of 9 vascular and general surgery inpatients undertook usability testing of an internally developed smartphone app that allows patients to take digital images of their wound and answer a survey about their recovery. We followed the International Organization for Standardization (ISO) 9241-11 guidelines, focusing on effectiveness, efficiency, and user satisfaction. An accompanying training module was developed by applying tenets of adult learning. Sessions were audio-recorded, and the smartphone screen was mirrored onto a study computer. Digital image quality was evaluated by a physician panel to determine usefulness for clinical decision making.ResultsThe mean length of time spent was 4.7 (2.1-12.8) minutes on the training session and 5.0 (1.4-16.6) minutes on app completion. 55.5% (5/9) of patients were able to complete the app independently with the most difficulty experienced in taking digital images of surgical wounds. Novice patients who were older, obese, or had groin wounds had the most difficulty. 81.8% of images were sufficient for diagnostic purposes. User satisfaction was high, with an average usability score of 83.3 out of 100.ConclusionSurgical patients can learn to use a smartphone app for postoperative wound monitoring with high user satisfaction. We identified design features and training approaches that can facilitate ease of use. This protocol illustrates an important, often overlooked, aspect of mHealth development to improve surgical care.

Acceptability of a team-based mobile health (mHealth) application for lifestyle self-management in individuals with chronic illnesses.

With increased incidence of chronic illnesses arising due to unhealthy lifestyle habits, it is increasingly important to leverage technology applications to promote and sustain health behavior change. We developed a smartphone-based application, NutriWalking (NW), which recommends personalized daily exercise goals and promotes healthy nutritional habits in small peer teams. Here, we demonstrate an early study of usability and acceptability of this app in patients with type 2 Diabetes Mellitus and Depression. Our goal was to evaluate the potential of NW as a self-management support tool. Findings point to design considerations for team-based self-management tools delivered via mHealth platforms.

Continuum of Care Services for Maternal and Child Health using mobile technology - a health system strengthening strategy in low and middle income countries.

BackgroundMobile phone technology is utilized for better delivery of health services worldwide. In low-and-middle income countries mobile phones are now ubiquitous. Thus leveraging mHealth applications in health sector is becoming popular rapidly in these countries. To assess the effectiveness of the Continuum of Care Services (CCS) mHealth platform in terms of strengthening the delivery of maternal and child health (MCH) services in a district in Bihar, a resource-poor state in India.MethodsThe CommCare mHealth platform was customized to CCS as one of the innovations under a project funded by the Bill and Melinda Gates Foundation to improve the maternal and newborn health services in Bihar. The intervention was rolled out in one project district in Bihar, during July 2012. More than 550 frontline workers out of a total of 3000 including Accredited Social Health Activists, Anganwadi Workers, Auxilliary Nurse Midwives and Lady Health Supervisors were trained to use the mHealth platform. The service delivery components namely early registration of pregnant women, three antenatal visits, tetanus toxoid immunization of the mother, iron and folic acid tablet supply, institutional delivery, postnatal home visits and early initiation of breastfeeding were used as indicators for good quality services. The resultant coverage of these services in the implementation area was compared with rest of Bihar and previous year statistics of the same area. The time lag between delivery of a service and its record capture in the maternal and child tracking system (MCTS) database was computed in a random sample of 16,000 beneficiaries. The coverage of services among marginalized and non-marginalized castes was compared to indicate equity of service delivery. Health system strengthening was viewed from the angle of coverage, quality, equity and efficiency of services.ResultsThe implementation blocks had higher coverage of all the eight indicator services compared to rest of Bihar and the previous year. There was equity of services across castes for all the indicators. Timely capture of data was also ensured compared to paper-based reporting.ConclusionBy virtue of its impact on quality, efficiency and equity of service delivery, health care manpower efficiency and governance, the mHealth inclusion at service provision level can be one of the potential strategy to strengthen the health system.

15 The ability and safety of community-based health workers to initiate lifesaving therapies for pre-eclampsia in Ogun State, Nigeria: An analysis of 294 community treatments with MGSO4 and/or methyldopa

Introduction Pre-eclampsia and its associated complications are the leading cause of maternal death in Nigeria. Many of these deaths occur at home or in primary health centres. Nevertheless, management of pre-eclampsia is limited to secondary and tertiary facilities. In Nigeria, community-based health workers serve as a bridge between the community and health facilities; therefore, these providers may be key in reducing the incidence of adverse pregnancy outcomes by way of early detection and treatment. Objectives This study aimed to assess the ability of community-based health workers to safely administer methyldopa, magnesium sulphate, and complete referral to a higher level facility when indicated. Methods The Community Level Intervention for Pre-eclampsia (CLIP) study was implemented by community-based health workers in Ogun State, Nigeria. These providers (i.e., Community Health Extension Workers, Health Assistants, midwives and nurses) utilized a mHealth platform to guide antenatal and postnatal visits, pre-eclampsia treatment with oral methyldopa (one dose = 750 mg) and intramuscular magnesium sulphate (one dose = 10 mg) prior to referral, based on evidence-based practice and the miniPIERS (Pre-eclampsia Integrated Estimated of RiSk) model. Results Findings of this study indicate that community-based health workers in Nigeria safely administered 137 doses of magnesium sulphate; this resulted in no infections or hematomas. Fifty-one doses of magnesium sulphate were given by community health extension workers, while nurses administered sixty-four: the high rate of administration by nurses can be explained by turf protection as well as their seniority within the health system. In addition, there were 139 doses of methyldopa administered, and a total of 127 urgent referrals completed. No safety concerns were reported. Conclusion These findings confirm the ability of community-based health workers to safely administer magnesium sulphate for severe pre-eclampsia with appropriate training; this is a big step towards reducing the negative impact of pre-eclampsia in Nigeria. The use of task-sharing, therefore, could drastically reduce the three delays (triage, transport and treatment) associated with high maternal mortality and morbidity in rural communities in low and middle-income countries.

Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform.

BackgroundParticipation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on.ObjectiveWe aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location.MethodsAn iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support.ResultsThe REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients’ exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription.ConclusionsThe REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial.

A prospective observational study to assess the effectiveness of an electronic health (E-health) and mobile health (M-health) platform versus conventional care for the management of diabetes mellitus

We undertook a prospective observational study to evaluate the effectiveness of an electronic health (E-health)/mobile health (M-health) platform versus conventional care for the management of diabetes mellitus. One hundred nine patients with type 2 diabetes were recruited from a tertiary care hospital in India. Thirty-nine patients were enrolled in the Diabetes Care 24x7® (DC) arm, whilst 70 were enrolled in the control (conventional care) group. Primary endpoints included fasting blood sugars (FBS), post-prandial blood sugars (2hr PP) and HbA1c level. Secondary endpoints included knowledge of the disease and its impact on quality of life. Outcome measures were assessed at the initial and fifth month visit. Males/females ≥18 years, attending the diabetes clinic, met the inclusion criteria. Pregnant women were excluded. Eighty six patients completed the study (33 in DC and 53 in the control group). A statistically significant reduction was observed in HbA1c (8.8 ± 1.2 to 7.4 ± 1.3, p value = 0.001). FBS/2hr PP blood sugars showed a trend towards improvement in both arms, but intergroup correlation at study end did not reach statistical significance (p value = 0.5). Diabetes knowledge scores (19.9 ± 2.5 vs. 17.9 ± 3.98, p value = 0.005) and quality of life indices (88.5 ± 7.8 vs. 83.5 ± 10.7, p value = 0.015) showed a statistically significant improvement in the intervention arm. A multifaceted E-health/M-health platform has great potential to reach patients in remote corners of the globe and improve not only their disease parameters but their knowledge scores and quality of life indices. Further longitudinal studies are needed to assess the true potential of this technology to impact diabetes management in the twenty-first century.

Impact of an mHealth Platform for Pregnancy on Nutrition and Lifestyle of the Reproductive Population: A Survey.

BackgroundPoor nutrition and lifestyle behaviors exert detrimental effects on reproduction and health during the life course. Therefore, lifestyle interventions during the periconceptional period can improve fertility, pregnancy outcome, and health of subsequent generations.ObjectiveThis survey investigates the compliance, usability, and initial effectiveness of the Web-based mHealth platform, Smarter Pregnancy.MethodsA free subscription to the mHealth platform, Smarter Pregnancy, was provided to couples contemplating pregnancy (n=1275) or already pregnant (n=603). After baseline identification of inadequate nutrition and lifestyle behaviors, a personal online coaching program of 6 months was generated. Using multiple imputation and the generalized estimating equation model with independent correlations, we estimated the changes from inadequate to adequate nutrition and lifestyle behaviors over time. Subgroup analyses were performed for (1) overweight and obese women (body mass index [BMI] ≥25 kg/m2), (2) pregnant women at the start of the program, and (3) couples.ResultsA 64.86% (1218/1878) compliance rate was observed and 54.7% (range 39.2-73.4%) of participants rated the program usability as positive or very positive. Adequate nutrition and lifestyle behaviors at baseline were 21.57% (405/1878) for vegetable intake, 52.61% (988/1878) for fruit intake, 85.44% (1303/1525) for folic acid use, 86.79% (1630/1878) for no tobacco use, and 64.43% (1210/1878) for no alcohol consumption. After 6 months of coaching, these lifestyle behaviors improved by 26.3% (95% CI 23.0-29.9) for vegetable intake, 38.4% (95% CI 34.5-42.5) for fruit intake, 56.3% (95% CI 48.8-63.6) for folic acid use, 35.1% (95% CI 29.1-41.6) for no tobacco use, and 41.9% (95% CI 35.2-48.9) for no alcohol consumption. The program showed the strongest effectiveness for participating couples.ConclusionsThis novel Web-based mHealth platform shows high compliance and usability, and users demonstrate improvements in nutrition and lifestyle behaviors. The next step will be further validation in randomized controlled trials and implementation.