mHealth Services Research Articles

What Predicts Patients' Adoption Intention Toward mHealth Services in China: Empirical Study.

BackgroundWith the increasing concerns about the health of individuals in China and the development of information technology, mHealth enables patients to access health information and interact with doctors anytime and anywhere. Examining patients’ willingness to use mHealth is considered critical because its success depends on the adoption of patients.ObjectiveThe objective of our study was to explore the determinants of mHealth service adoption among Chinese patients using an extended technology acceptance model (TAM) with trust and perceived risks.MethodsWe conducted a questionnaire-based survey in 3 large hospitals in China and analyzed the data using structural equation modeling.ResultsThe results corroborated that the proposed model fits well. Trust, perceived usefulness, and perceived ease of use positively correlated with mHealth service adoption. Privacy and performance risks negatively correlated with the patients’ trust and adoption intention toward mHealth services. In addition, patients’ age and chronic diseases can help predict their trust level and adoption intention toward mHealth, respectively.ConclusionsWe concluded that the TAM generally works in the context of mHealth adoption, although its significance has declined. In addition to technical factors, trust and perceived risks are critical for explaining mHealth service adoption among Chinese patients.

Exploring mHealth monitoring service acceptance from a service characteristics perspective

Abstract Undoubtedly, the mobile health (mHealth) service has rapidly gained ever-increasing research attention. However, few studies have focused on the impacts of service characteristics on mHealth interactions regarding use intentions and behaviour. To narrow this research gap, our study has developed a theoretical model to investigate the impacts of the factors related to service characteristics and the moderation effects of service relevance. The proposed research model and hypotheses were empirically tested through a survey. The results indicate the following key findings: (1) mHealth service matching and mHealth service competence positively and indirectly influence use intention through the cognitive and affective attitudes; (2) mHealth service relevance could moderate the relationship between attitude components and use intention; and (3) the moderating effects of mHealth service relevance on the cognitive attitude are regarded as positive, but are perceived as being negative for the affective attitude. Theoretical and practical implications are also included.

Utilization of mHealth Services in Dhamrai Upazila of Dhaka District, Bangladesh

Purpose: The adoption and use of mHealth is considered as an effective intervention to improve health sector performance in developing countries across the world. Yet mHealth is in the early stage of its implementation in many countries. This study aims to identify the patterns, extent, motivations, and problems of mHealth applications in Bangladesh. Methods: The study was done in Dhamrai Upazila of Dhaka district where 250 mobile-phone users were interviewed to identify their extent and reasons of using mHealth services. Based on literature review and focus group discussion in the study area, the research confined five dimensions or reasons for using mHealth services, six issues for motivational and discouraging factors each. Both descriptive and inferential statistics were used to analyze data using statistical software STATA. Findings: Calling doctor’s private office is top ranked mHealth application. In this connection, 38 percent respondents used at least four types of mHealth applications among five dimensions and 30 percent respondents used all types of mHealth applications. On an average, respondents used near about four types of application where the mean application is3.82 out of 5. Hypothesis testing result shows that male’s mHealth application is higher than that of female. Again, average mHealth application of extended family is higher than that of nuclear family. Both findings are statistically significant at 1 percent level. Regarding the motivational factor of using mHealth application, employed group has ranked time saving’ and unemployed group has ranked ‘accessibility from remote area’ as the most motivational factor. On the other hand, both groups have ranked ‘not reaching focal person timely’ as the most discouraging factor of adopting mHealth. Spearman’s rank correlation coefficient reports that, between employed and unemployed group, there exist77 percent resemblance in benefit rank and 94 percent resemblance in problem rank. Proper regulation is essential to have proper coordination among health service providers, seekers and telecommunication service providers.

Ontological MobiHealth System

<p>MobiHealth systems are tele-monitoring systems based on BAN (Body Area Network) and mobile health care (m-health) service platform utilizing next generation public wireless networks. Smart phone applications have self-monitoring and sensing capabilities and are used in health interventions and disease prevention. In this study, a prototype mobile sensing platform was introduced for m-Health and telemedicine applications, which medical sensors on patient body reports biological signals and environmental sensors send environment raw data to base station (smart phone). Then raw data were preprocessed and necessary features (situations) were extracted. In order to context computation and respond with adaptability, we have used ontology-based model. </p>

A framework for m-health service development and success evaluation

The emergence of mobile technology has influenced many service industries including health care. Mobile health (m-Health) applications have been used widely, and many services have been developed that have changed delivery systems and have improved effectiveness of health care services. Stakeholders of m-Health services have various resources and rights that lends to a complexity in service delivery. In addition, abundance of different m-Health services makes it difficult to choose an appropriate service for these stakeholders that include customers, patients, users or even providers. Moreover, a comprehensive framework is not yet provided in the literature that would help manage and evaluate m-health services, considering various stakeholder's benefits.In this paper, a comprehensive literature review has been done on famous frameworks and models in the field of Information Technology and electronic health with the aim of finding different aspects of developing and managing m-health services. Using the results of literature review and conducting a stakeholder analysis, we have proposed an m-health evaluation framework which evaluates the success of a given m-health service through a three-stage life cycle: (1) Service Requirement Analysis, (2) Service Development, and (3) Service Delivery. Key factors of m-health evaluation in each step are introduced in the proposed framework considering m-health key stakeholder's benefits. The proposed framework is validated via expert interviews, and key factors in each evaluation step is validated using PLS model. Results show that path coefficients are higher than their threshold which supports the validity of proposed framework.

Enhancing User Experience Through User Study: Design of an mHealth Tool for Self-Management and Care Engagement of Cardiovascular Disease Patients.

BackgroundAs patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the app can be used continuously.ObjectiveThe purpose of the study was to provide insightful information for developing mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors.MethodsTo drive the mobile functions and services needed to manage diseases in CVD patients, user research was conducted on patients and doctors at a tertiary general university hospital located in the Seoul metropolitan area of South Korea. Interviews and a survey were performed on patients (35 participants) and a focus group interview was conducted with doctors (5 participants). A mock-up mobile app was developed based on the user survey results, and a usability test was then conducted (8 participants) to identify factors that should be considered to improve usability.ResultsThe majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Functional features, such as communication with doctors, self-risk assessment, exercise, tailored education, blood pressure management, and health status recording had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were perceived to be useful to patients. The results of the mock-up usability test showed that inputting and visualizing blood pressure and other health conditions was required to be easier. The doctors requested a function that offered a comprehensive view of the patient’s daily health status by linking the mHealth app data with the hospital’s electronic health record system.ConclusionsInsights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel between patients and doctors, may be helpful to improve patient engagement in care.

MHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria

Objectives: Mobile health (mHealth) is gaining importance worldwide, changing and improving the way healthcare and services are provided, but its role is just emerging in Nigeria. This study aimed to assess the knowledge and use of mHealth among health workers and the provisions for its use in public secondary health-care facilities of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional study carried out among 65 doctors and 135 nurses selected using a two-staged sampling method. Data were collected with pretested self-administered questionnaires and analyzed with EpiInfo™ 7. Results: Majority (doctors 84.6%, nurses 91.1%) had not heard of the term “mHealth,” but most (doctors 96.9%, nurses 87.4%) were aware of the use of mobile phones in health-care delivery. Only three (27.3%) (health call centers/health-care telephone helpline, appointment reminders, and mobile telemedicine) out of 11 mHealth components listed were mostly known. Most doctors simply used patient monitoring/surveillance and mobile telemedicine, while nurses mainly used treatment compliance and appointment reminder services. Majority were willing to use more mHealth services if available in their hospital. All the doctors and 97% of nurses had mobile phones. However, only about one-quarter (27.5%) had smartphones with applications used for mHealth purposes. Conclusions: Knowledge, awareness, and use of mHealth services were low. Doctors and nurses should be enlightened and trained on ways to use mHealth services to improve health-care delivery, mHealth services should be made available in the hospitals, and use of smartphones encouraged as they portend better adaptability for mHealth use.

PROTOCOL: Impact of financial inclusion in low- and middle-income countries: a systematic review of reviews.

PROTOCOL: Impact of financial inclusion in low- and middle-income countries: a systematic review of reviews.

The willingness for using mobile phone for health education among women caregivers of under 5 children in an urban resettlement colony in Delhi, India

Background: The delivery of health education through mobile phones either through voice calls or text messages (mHealth) provide valuable opportunities for bridging gaps in maternal and child healthcare in resource constrained settings. Aims & Objectives: The objective of the present study was to assess willingness to receive m-Health services among women caregivers of under-5 children. Material & Methods: We conducted a cross sectional study in an urban resettlement colony of North East District of Delhi during the period from September’ 2016 to Feb’ 2017. We enrolled 201 adult women up to 35 years of age who were active caregiver of at-least one under 5 child in their familial household. Results: The mean age of the women was 26.4 and mean years of schooling was 10.1 years. Nearly three-fourth (73.2%) could read text messages (SMS) while more than a third (36.8%) were using mobile internet services. The willingness to receive mHealth services for health promotion was affirmed by 157 (78.2%) subjects but it was significantly lower in women with low educational attainment. Conclusion: There exists a strong unmet need for mHealth services among young women caregivers of under 5 children. However, bridging the digital divide is a key challenge towards advancing mHealth for all.

Promoting China's mHealth market: A policy perspective

BackgroundThe mobile health (mHealth) service is experiencing worldwide escalation due to the invaluable support it provides to a rapidly expanding elderly population and patients with chronic conditions. However, the mHealth market in China is aberrated in comparison with other countries in two major aspects: 1) the monitoring service is a minority market; and 2) the potential users (the elderly and patients with chronic conditions) lack the interest for using this service. MethodTo explain this understated condition, we examine the specific policies on the mHealth service and the current healthcare system in China, with suggestions for forming mHealth policies. ResultsBased on our policy analysis, this research proposes several political and practical suggestions for mHealth implementation in China. Along with the characteristics of the mHealth market, this research further develops a healthcare ecosystem connecting major stakeholders, including the government, the community, service providers, health professionals, drug manufacturers, and data-analysis organizations. Our suggestions will be beneficial to China's mHealth market in the business sense and provide insights for policymakers on how to regulate the market.

Feasibility of mHealth intervention to improve uptake of antenatal and postnatal care services in peri-urban areas of Karachi: a qualitative exploratory study

Background: In Pakistan, poor antenatal and postnatal coverage, has accounted for nearly 70% of preventable maternal deaths. Interventions implemented to improve uptake of antenatal and postnatal care (PNC) services have not shown significant improvements. Recent increase in cellphone penetration has brought forward mHealth as a potential strategy to enhance antenatal care (ANC) and PNC uptake. The objective of this study was to explore if mHealth technology is a feasible strategy to improve uptake of preventive maternal healthcare services in peri-urban areas of Karachi. Methods: The study employed an exploratory qualitative research design using focus group discussions (FGDs) and key-informant interviews. FGDs were conducted with pregnant women, women in the postnatal period and lady health workers (LHWs) whereas key-informant interviews were conducted with maternal neonatal and child health experts and mHealth experts. The study data was analyzed using NVivo version 11. Results: This research found that women, healthcare providers and technology experts consider mHealth strategy has high potential to address barriers related to provision and utilization of ANC and PNC services. Healthcare providers and women understand the term mHealth and knew the benefits of mHealth services. Few of the women and healthcare providers are currently using mHealth for providing and receiving ANC and PNC services. Women and healthcare provider seemed ready for mHealth use however expressed challenges such as, illiteracy, cultural restrictions, lack of trustworthiness and misuse of technology. Conclusions: This study informs that mHealth is operationally feasible, culturally acceptable and technologically appropriate strategy. For successful integration of mHealth technology in to existing maternal neonatal and child health service delivery structure, it is considered imperative to build a sustainable model of mHealth by involving government, local communities, telecommunication personnel, health care providers and mHealth and maternal neonatal and child health experts and through tailoring the design of the mHealth solutions in such a way that it benefits majority of women.

Knowledge, attitudes and intention regarding mHealth in generation Y: evidence from a population based cross sectional study in Chakaria, Bangladesh

Background and objectivesmHealth offers a new opportunity to ensure access to qualified healthcare providers. Therefore, to better understand its potential in Bangladesh, it is important to understand how young people...

Investigating Factors Affecting Elderly's Intention to Use m-Health Services: An Empirical Study.

m-Health as an important part of e-health has recently become one of the most influential initiative in healthcare sector all over the world. In developing countries healthcare service providers started to provide m-health services from the last few years. Despite the widespread acceptance of mobile phones, the adoption of m-health among elderly is significantly low in developing countries. However, little research has been conducted to explore factors influencing elderly's intention to use m-health services particularly in developing countries. The objective of this study is to identify the factors that influence the elderly's intention to use m-health services. To assess elderly's intention to use m-health services, this study applied the Unified Theory of Acceptance and Use of Technology (UTAUT). Data were collected from participants of age 60 years and above. The partial least square method based on structural equation modeling was used to analyze data. The study found that performance expectancy, effort expectancy, social influence, and perceived credibility (p < 0.05) had significant influence on elderly's intention to use m-health services. However, facilitating condition (p > 0.05) had no significant influence on elderly's intention to use m-health services. The findings of this study may become beneficial for the governments, policy makers, and healthcare service providers in developing countries.

Global mHealth policy arena: status check and future directions.

In this review, we examine an important piece of the mHealth puzzle that has received scant attention-health policy. The question is whether health policy ultimately will serve to unite nations in advancing global mHealth or, as Mars and Scott suggested in 2010, keep nations isolated and ultimately making their policy decisions in "eHealth silos". Such a non-collaborative approach seriously hampers the potential for using mobile health technologies to deliver health care across borders, assuring individuals access to affordable, convenient, and quality healthcare in underserved regions. From a global perspective, mHealth policy review is difficult as some important policies may be subsumed in comprehensive planning and strategy documents. Political, environmental, economic, organizational, and technology disparities across nations represent a significant impediment to developing mHealth products and services that can be deployed globally. To date, there is modest evidence that such challenges are being addressed. Even though payers can encourage adoption of mHealth with financial incentives for use, it appears that payment or reimbursement tends to be a roadblock for almost all nations, whether they are emerging or developed. If payment for mHealth services is not guaranteed, business models will not be sustainable and providers will have fewer opportunities for scalability. Furthermore, because mHealth policies typically are subject to some type of government scrutiny and oversight, many product developers and entrepreneurs may turn elsewhere for their investments. Global resource scarcity also challenges optimal mHealth deployment, and governments seek to ensure improved population health outcomes as return on their mHealth investments. Unfortunately, such justification is difficult as evaluation methods simply have not kept pace with mHealth technology capability. Requisite measurement tools are sorely lacking when it comes to evaluating efficacy of mHealth interventions, due in part to insufficient research to inform development of needed measurement tools. Because most robust mHealth research trials have been conducted in the developed world with its impressive technology infrastructure and not in developing nations where the health needs are greatest, evaluation of mobile technology intervention from a global perspective tends to be insufficient to inform policy decisions.

Medical Images are Safe - an Enhanced Chaotic Scrambling Approach.

The patient data confidentiality is one of the vital security aspects in e-Health and m-Health services. In particular, providing confidentiality to the patient's medical image is essential and the protection approaches have to be explored in-depth due to the rapid progress in the technologies of teleradiology and PACS. In this study, the pseudo random number generators (PRNGs), namely, the linear congruential generator (LCG) and XOR shift generator (XSG) are improved and combined with improved logistic 2D coupled chaotic map to provide enhanced chaos based encryption. The proposed scheme encrypts the Digital Imaging and Communication in Medicine (DICOM) images to protect the patient confidentiality during the storage and transfer in radiological information system (RIS). The cipher image was measured with various security analyses and tested with different test suites to prove its randomness.

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&lt;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&lt;0.001, respectively. The subjects of the LC+BT group with &gt; 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&lt;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.

Mobile IT in health – the case of short messaging service in an HIV awareness program

ABSTRACTThis study aims to augment our understanding of user intention to use mobile IT in health. Experiential dispositions and technology perceptions around a mobile service that is currently in use to access other value-seeking services are integrated to present an enriched characterization of intention to use m-health. Primary data from a pressing health context in a developing economy are collected to validate the model. The results demonstrate that previous experience from value services received on a mobile service enhances user attention, which in turn positively impacts the perceived usefulness of an incoming m-health program, which then influences user intention to adopt m-health services delivered on that mobile service. Overall, the findings provide a comprehensive understanding of user intention to accept m-health. Additionally, our results provide insights toward the choice of mobile technology and indicate aspects of message framing that may ensure practicable deployment and successful implementation of m-health programs.

Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh

BackgroundTraditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh.MethodsWe interviewed 4915 randomly selected respondents aged 18 years and above. Associations between gender and knowledge of available mHealth services, use of existing mHealth services and intentions to use mHealth services in the future were examined by multivariate logistic regression analysis, controlling for the effect of categorised covariates.ResultsOf the 4915 respondents to the survey, 61.8% of men (1213/1964) and 34.4% of women (1015/2951) owned a mobile phone. For men, mobile phone ownership was highest among those aged 18–29 years (n = 663, 76.3%), and for women among those aged 30–39 years (n = 825, 44.7%). A higher proportion of men owned phones compared to women, irrespective of socioeconomic status (SES) as indicated by asset index (p < 0.001). Although mobile phone ownership on average was lower among women, they were more likely to share their mobile phone with their family members (19.7%) compared to men (11.6%, p < 0.001). Greater number of men were more likely to be aware of the use of mobile phones for healthcare compared to women (38.5% vs 26.5%, p < 0.001). Knowledge about available mHealth services was lower among women than men; however, intention to use mHealth services in the future was high for both genders, irrespective of age, education and socioeconomic status.ConclusionsCompared to men, women are less likely to own a mobile phone and less aware of available mHealth services, despite high intention to use mHealth among both genders. To optimise the use of mHealth services and to achieve equity of use, uptake strategies should target women, with a focus on the poorer and less educated groups.

Voter's Intention to Use Electronic Voting Systems

Although the need for comprehensive assessment of mobile health (mHealth) systems is critical, most existing research focuses solely on these systems' technical merits. The purpose of this study is to prioritize different aspects and indicators of assessing the quality of mHealth services and compare four popular Iranian mHealth systems using this framework. Statistical population of this research included experts who have more than three years of active experience in the field. Using Judgmental sampling method, statistical sample size included 28 persons who responded to questionnaires. Content validity was confirmed by an expert panel, and reliability was confirmed by an inconsistency rate of less than 0.1. The study findings show that results quality is the most important component of quality assessment for mHealth systems. It also shows that indicators of confidentiality, responsiveness and customer orientation are likewise important.

Mobile Healthcare Applications and Gamification for Sustained Health Maintenance

This paper examines how gamification affects user intention to use mobile healthcare applications (mHealth) and how the effect of gamification works differently according to health status, age, and gender. We use data from a mobile survey conducted by a Korean representative survey agency. We estimate the effect of gamification on user intention to use mobile healthcare applications based on a structural equation model and examine the moderating effects of self-reported health status, age, and gender. We find that gamification is effective in increasing user intention to use mHealth, especially in the healthy and younger groups. These findings suggest that mHealth, with the gamification factor, would encourage healthy (but lack exercise) people as well as unhealthy people to maintain their health status, and thus the mHealth developers need to consider the gamification factor when they develop mHealth services for healthy people.