Use Of mHealth Research Articles

Use of mHealth in Atrial Fibrillation Telemonitoring: A Literature Review

Management of atrial fibrillation (AF) is limited to low detection, treatment non-adherence and several other considerations, resulting in the utilization of mobile health devices (mHealth) for comprehensive and continuous telemonitoring of atrial fibrillation. This study aims to identify the use of mHealth in atrial fibriullation telemonitoring. The reseach design is a literature review using the PRISMA method approach. Literature search used the keywords “mHealth” and “telemonitoring” and “atrial fibrillation” from the PubMed, Science Direct, Scopus and ProQuest databases, with inclusion criteria namely article on the use technology or mobile health-based applications in telemonitoring atrial fibrillation (AF), articles less than 5 years, fulltext and open access. The seven articles analyzed, six articles on the use of mHealth can be used for atrial fibrillation telemonitoring and one article shows the use of applications for educational media. Further development is needed in line with increasing needs, ease of use and technological developments in the health sector.

Differing Effects of Implementation Leadership Characteristics on Nurses' Use of mHealth Technologies in Clinical Practice: Cross-Sectional Survey Study.

Leadership has been consistently identified as an important factor in shaping the uptake and use of mobile health (mHealth) technologies in nursing; however, the nature and scope of leadership remain poorly delineated. This lack of detail about what leadership entails limits the practical actions that can be taken by leaders to optimize the implementation and use of mHealth technologies among nurses working clinically. This study aimed to examine the effects of first-level leaders' implementation leadership characteristics on nurses' intention to use and actual use of mHealth technologies in practice while controlling for nurses' individual characteristics and the voluntariness of use, perceived usefulness, and perceived ease of use of mHealth technologies. A cross-sectional exploratory correlational survey study of registered nurses in Canada (n=288) was conducted between January 1, 2018, and June 30, 2018. Nurses were eligible to participate if they provided direct care in any setting and used employer-provided mHealth technologies in clinical practice. Hierarchical multiple regression analyses were conducted for the 2 outcome variables: intention to use and actual use. The implementation leadership characteristics of first-level leaders influenced nurses' intention to use and actual use of mHealth technologies, with 2 moderating effects found. The final model for intention to use included the interaction term for implementation leadership characteristics and education, explaining 47% of the variance in nurses' intention to use mHealth in clinical practice (F10,228=20.14; P<.001). An examination of interaction plots found that implementation leadership characteristics had a greater influence on the intention to use mHealth technologies among nurses with a registered nurse diploma or a bachelor of nursing degree than among nurses with a graduate degree or other advanced education. For actual use, implementation leadership characteristics had a significant influence on the actual use of mHealth over and above the control variables (nurses' demographic characteristics, previous experience with mHealth, and voluntariness) and other known predictors (perceived usefulness and perceived ease of use) in the model without the implementation leadership × age interaction term (β=.22; P=.001) and in the final model that included the implementation leadership × age interaction term (β=-.53; P=.03). The final model explained 40% of the variance in nurses' actual use of mHealth in their work (F10,228=15.18; P<.001). An examination of interaction plots found that, for older nurses, implementation leadership characteristics had less of an influence on their actual use of mHealth technologies. Leaders responsible for the implementation of mHealth technologies need to assess and consider their implementation leadership behaviors because these play a role in influencing nurses' use of mHealth technologies. The education level and age of nurses may be important factors to consider because different groups may require different approaches to optimize their use of mHealth technologies in clinical practice.

The Management of Pediatric Asthma Using Telehealth: An Integrative Review.

Introduction: Asthma is one of the most chronic noncommunicable diseases of childhood, affecting 1 in 12 children in the United States. The use of telemedicine for the management of pediatric asthma has shown improved health outcomes; however, it is important to understand what can impact its acceptance. The purpose of this review was to identify the facilitators and barriers to pediatric asthma management, as viewed by stakeholders. Methods: An electronic literature search was performed using PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete. Articles included in the review contained perceptions of the use of telemedicine for the management of pediatric asthma, as viewed by stakeholders. The socioecological model was used as the theoretical framework to extract data based on its five levels. Results: After reviewing full texts of 143 articles, 118 were excluded, leaving 25 articles included in this review. A majority of included articles focused on mobile health (m-Health) studies for the management of pediatric asthma, with the remaining articles studying synchronous telemedicine or a combination of modalities. Common themes were identified; however, most were focused on the use of m-Health and few studies contained the viewpoints of the caregiver, children, or providers regarding synchronous telemedicine. Discussion: This integrative review identified a number of facilitators and barriers for the management of asthma using telemedicine. However, more qualitative studies are needed to evaluate the perceptions of caregivers, patients, and primary providers regarding synchronous telehealth. It was also recognized that telemedicine may increase instead of reduce health care disparities.

Current Status and Trends in mHealth-Based Research for Treatment and Intervention in Tinnitus: Bibliometric and Comparative Product Analysis.

As a global medical problem, tinnitus can seriously harm human health and is difficult to alleviate, ranking among the top 3 complex diseases in the otolaryngology field. Traditional cognitive behavioral therapy and sound therapy require offline face-to-face treatment with medical staff and have limited effectiveness. Mobile health (mHealth), which, in recent decades, has been greatly applied in the field of rehabilitation health care, improving access to health care resources and the quality of services, has potential research value in the adjunctive treatment of tinnitus. This study aimed to understand the research trends, product characteristics, problems, and research transformation of tinnitus treatment software by analyzing the research progress of mHealth for tinnitus treatment based on the literature and related marketed apps. Bibliometric methods were used to describe the characteristics of the relevant literature in terms of the number and topics of publications, authors, and institutions. We further compared the features and limitations of the currently available tinnitus treatment software. Data published until February 28, 2022, were collected. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standardized screening process, 75 papers were included. The country with the highest number of publications was Germany, followed by the United Kingdom and the United States, whereas China had only a single relevant study. The most frequently found journals were the American Journal of Audiology and the Journal of the American Academy of Audiology (18/75, 24%). With regard to publication topics, cognitive behavioral therapy started to become a hot topic in 2017, and research on mHealth apps has increased. In this study, 28 tinnitus treatment apps were obtained (n=24, 86% from product data and n=4, 14% from literature data); these apps were developed mainly in the United States (10/28, 36%) or China (9/28, 32%). The main treatment methods were sound therapy (10/28, 36%) and cognitive behavioral therapy (2/28, 7%). Of the 75 publications, 7 (9%) described apps in the market stage. Of the 28 apps, 22 (79%) lacked literature studies or evidence from professional bodies. We found that, as a whole, the use of mHealth for treatment and intervention in tinnitus was showing a rapid development, in which good progress had been made in studies around sound therapy and cognitive behavioral therapy, although most of the studies (50/75, 67%) focused on treatment effects. However, the field is poorly accepted in top medical journals, and the majority are in the research design phase, with a lack of translation of the literature results and clinical validation of the marketed apps. Furthermore, in the future, novel artificial intelligence techniques should be used to address the issue of staged monitoring of tinnitus.

Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study.

The use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD. In this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use. Semistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults' use of airway mHealth. Twenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults' use of asthma and COPD mHealth tools. Focusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts.

Self-care intervention using mobile apps for sexual and reproductive health in the WHO Eastern Mediterranean Region

ABSTRACTSexual and reproductive health (SRH) concerns physical, mental, and social well-being as related to sexual and reproductive systems. Self-care, which is the ability to promote health without the support of a health-care provider, can advance SRH, especially for fragile populations. Mobile health (mHealth) solutions can be used to raise awareness about SRH. We performed a structured literature review and analysis of mHealth-based approaches for delivering self-SRH services and interventions in the WHO Eastern Mediterranean Region (EMR). A fuzzy-based framework for assessing those mHealth apps was proposed. We identified 6 out of 737 papers, and 23 (5.7%) out of 400 mHealth apps retrieved from app-stores, describing mHealth use for self SRH with only 10 apps developed in EMR countries, namely Morocco, Pakistan, Egypt, Iran, and Jordan. Our fuzzy-based framework proposes guidelines regarding the implementation of self-care interventions to help project leaders promote their adoption in the SRH systems.

A Systematic Review of the Use of mHealth in Oral Health Education among Older Adults.

Oral diseases are largely preventable. However, as the number of older adults is expected to increase, along with the high cost and various barriers to seeking continuous professional care, a sustainable approach is needed to assist older adults in maintaining their oral health. Mobile health (mHealth) technologies may facilitate oral disease prevention and management through oral health education. This review aims to provide an overview of existing evidence on using mHealth to promote oral health through education among older adults. A literature search was performed across five electronic databases. A total of five studies were identified, which provided low to moderate evidence to support using mHealth among older adults. The selected studies showed that mHealth could improve oral health management, oral health behavior, and oral health knowledge among older adults. However, more quality studies regarding using mHealth technologies in oral health management, oral health behavior, and oral health knowledge among older adults are needed.

Effectiveness of Mhealth on Immunization Target Tracking Which Affects Drop Out and Left Out Numbers in Rural and Urban Areas at The Public Health Center Level, Indonesia

Background: The M-KIA (Mobile-Tracking Immunization Target) has features aimed at reducing the number of DO (Drop Out) and LO (Left Out) children. The purpose of this study was to analyze the effectiveness of using the M-KIA application in urban and rural areas. Method: We conducted a quasi-experiment with control group non-equivalent. The population were all parents with children aged 0-36 months who are DO or LO in the working area of the Bantaeng Public Health Center (PHC), while the number of samples is 226 people. The sampling technique was multistage random sampling. Data were analyzed by the Fisher exact test using STATA. Results: There is a significant relationship between the use of M-KIA on DO targets in rural areas (p = 0.000&lt;0.05) and in urban areas (p = 0.002&lt;0.05). On the LO target, the use of M-KIA showed a significant relationship in rural areas (p = 0.015 &lt;0.05) while in urban areas the data was not significant (p = 0.612 &lt;0.05). Conclusion: This study shows that the use of mhealth can reduce the number of DO and LO. Further research is recommended to be conducted to assess the level of usability to assess retention of use with users and admins.

Effectiveness of m-health based self-management on self-efficacy in patients with cancer: A systematic review and meta-analysis

Introduction: M-health has been developed and tested through studies in various settings and found was useful for providing knowledge and experience for nurses in cancer care settings. However, none has synthesized the effectiveness of m-health on self-management of patients with cancer. To evaluate the effect of interventions using mobile-based application on patient’s self-management. Outcome measures were patients’ medical adherence, self-efficacy and self-management level and health literacy.&#x0D; Method: The review is reported in accordance with the guidelines of the PRISMA statement. A systematic was conducted in five databases. Randomized controlled trials and quasi-experimental trial were eligible for inclusion. &#x0D; Results: Eight studies were including. There was no significant effect on self-efficacy after interventions using mobile-based applications (SMD = 0.36, CI 95%, [ 0.16, 0.56 ], p &lt; 0.00006). Qualitative synthesis shows that the use of m-health can improve changes in health behavior, health literacy and physical activity.&#x0D; Conclusion: M-health app interventions may improve self-efficacy in cancer patients. Meanwhile, changes in health behavior in patients can be significantly improved using m-health based self-management. M-health can be integrated into health services for the management of patients with cancer.

Aplikasi mHEALTH dalam Manajemen Luka Diabetik

This study aims to determine the use of mHealth in diabetic wound management. The research method uses a literature review approach through content analysis with a search method using an electronic database consisting of ProQuest, PubMed, Science Direct, Scopus, Sage, and SpringerLink with the keywords "telemedicine," "telehealth," "mobile health," "diabetic ulcer.", and "diabetic wound" published year 2018-2022. The search results obtained 612 articles, and 12 papers were reviewed after filtering. The results showed that there were four essential components in using health for diabetic wound management, namely counseling/consultation, use of wearable devices, routine foot temperature checks, and recommendations for diabetic wound care. In conclusion, mHealth positively and effectively impacts diabetic wound management.&#x0D; Keywords: Diabetic Wounds, Management, mHealth, Telehealth, Telemedicine

MHealth Interventions to Improve the Breast Cancer Continuum of Care from Prevention to Survivorship of Hispanic Women: A Scoping Review.

Breast cancer is the leading cause of cancer mortality in Hispanic women in the USA. Current interventions to improve breast cancer care include the use of mHealth, but its application in Hispanic women is limited. This scoping review aimed to describe the extent of research literature on the use of mHealth throughout the breast cancer care continuum (prevention, early detection, and treatment) in Hispanic women. A scoping review guided by the Arksey and O'Malley methodological framework and the Joanna Briggs Institute scoping review reporting protocol. Literature search of peer-reviewed research articles from 2012 to 2022 in PubMed, Scopus, and CINAHL® was conducted in March and June 2022. Of the 10 articles selected, seven included Hispanic breast cancer survivors and three included Hispanic women at risk for developing breast cancer. Seven articles involved mobile applications and three articles used text messaging and/or cell phone voicemail. Overall, the use of mHealth for breast cancer care in Hispanics was favorable but generalizability was limited given the type of design and small samples. All interventions were tailored to Hispanic culture. Scarcity of research on mHealth in Hispanic breast cancer care highlights healthcare disparities in this population. Evidence from this review suggests the use of mHealth to be beneficial to improving breast cancer care in Hispanics, but more research is needed involving randomized clinical trials and larger samples.

Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review.

The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients' and service providers' perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery.

712-P: Social Support, eHealth Literacy, and mHealth Use in Older Adults with Diabetes—Moderated Mediating Effect of Perceived Importance of App Design

Mobile healthcare (mHealth) for older adults with diabetes could benefit diabetes self-management. However, limited research is available regarding the factors influencing mHealth use. This descriptive study aimed to identify the factors that influence mHealth use. Participants aged 65 years or older with diabetes living in South Korea were recruited online and offline to complete a structured self-report questionnaire. With 252 valid responses, the moderated mediating effect of eHealth literacy and the perceived importance of app design in the relationship between social support and mHealth use were tested using SPSS PROCESS Macro 4.0. The results show that social support had a positive relationship with mHealth use, and eHealth literacy and perceived importance of app aesthetics had a moderated mediating effect. Moreover, when patients’ perceived importance of app aesthetics was high, eHealth literacy more positively affected mHealth use. This study implies that it is necessary to enlist the help of family, friends, and neighbors to increase access to internet-based health information and encourage mHealth use among older adults with diabetes. Furthermore, this study suggests developers should consider user experience (UX), such as font size, color, and menu configuration when developing mHealth for older adults with diabetes. Disclosure M.Kim: None. B.Kim: None. S.Park: None.

717-P: Unmet Needs and Communication Preferences for mHealth Self-Management Solutions in People with Type 1 Diabetes and Insulin Resistance

Insulin resistance (IR) is prevalent within type 1 diabetes (T1D) and associated with increased morbidity and mortality. Mobile health (mHealth) applications are useful platforms for delivering health behaviour interventions, but technologies focusing on addressing IR in T1D are absent. The aim of this formative study was to identity salient unmet patient needs, communication preferences, and barriers for mHealth self-management solutions in people with T1D and IR. 70 adults with type 1 diabetes (male=57%; HbA1c 8.1±3.4%; 28±5years) completed an online survey evaluating skills gaps in self-management and priorities for diabetes mHealth apps. Survey responses were ranked using a 9-point scale and analysed using descriptive and inferential statistics. Qualitative write-in responses were subsequently coded and analysed using inductive thematic analysis. IR was assessed using estimated glucose disposal rate (eGDR). Among all respondents, 49% (n=34) identified glycemic control/variability as the principle unmet self-management need. Fewer than 5% (n=3) reported having no self-perceived skills gaps. 89% (n=62) identified paternalistic communication and weight stigmatization as barriers to mHealth use. Real-life/situational feedback for glucose control/variability was reported as the single largest facilitator of mHealth use (65%, n=46). Preferred communication strategies were empathy, concern, and compassion (81%, n=57), and informal, open, and direct (77%, n=54). Our results highlight that glucose control/variability is the principle unmet self-management need in T1D adults with IR. Several communication barriers negatively impact mHealth acceptability and efficacy in this group, particularly paternalistic and weight-stigmatizing language. mHealth solutions that target glycemic control/variability and are non-weight stigmatizing are urgently needed for people with T1D and IR. Disclosure A.R.Wilson: None. M.Farrar: None. M.D.Campbell: None.

WATERFALL METHOD OF MEDICAL RECORD APPLICATION DEVELOPMENT USING PHP AND MYSQL PROGRAMMING LANGUAGE

The use of computer technology and involvement in people's lives are involved in many aspects of life. One of the applications of computer technology in the health sector is to assist in detecting health problems suffered by the community. Modern society whose daily activities move dynamically certainly needs devices that help in reminding health conditions. One solution to this problem is the use of mobile health applications or M-Health, which tends to increase every year. Based on estimates in the United States, the number of users using these devices is 4500 in 2018 and an estimated increase is at 50,000 users in 2025. Another problem is that most of the current public health history is still recorded manually or not at all. Recording of public health data still uses books and for a long time, of course, these archives can be lost or damaged. One of the uses of this mobile medical history recording application is that the data will always be there. If at any time the user wants to look back at his history, he can just search in this system without having to look in the book and can save time. Current health history as one of the most important conditions in people's lives will provide services. Designing an application is carried out in research based on this problem which can make it easier for users to get their own health information quickly and flexibly using a browser that can be accessed via mobile phones or PCs. As a result of this research, this application will be developed using the waterfall process model and the SDLC (System Development Life Cycle) methodology.

The French General Population's Perception of New Information and Communication Technologies for Medical Consultations: National Survey.

The development of telehealth and telemedicine, in the form of increased teleconsultation and medical telemonitoring, accelerated during the COVID-19 health crisis in France to ensure continued access to care for the population. Since these new information and communication technologies (ICTs) are diverse and likely to transform how the health care system is organized, there is a need better to understand public attitudes toward them and their relationship with peoples' current experience of health care. This study aimed to determine the French general population's perception of the usefulness of video recording/broadcasting (VRB) and mobile Health (mHealth) apps for medical consultations in France during the COVID-19 health crisis and the factors associated with this perception. Data were collected for 2003 people in 2 waves of an online survey alongside the Health Literacy Survey 2019 (1003 in May 2020 and 1000 in January 2021) based on quota sampling. The survey collected sociodemographic characteristics, health literacy levels, trust in political representatives, and perceived health status. The perceived usefulness of VRB in medical consultations was measured by combining 2 responses concerning this technology for consultations. The perceived usefulness of mHealth apps was measured by combining 2 responses concerning their usefulness for booking doctor appointments and for communicating patient-reported outcomes to doctors. The majority (1239/2003, 62%) of respondents considered the use of mHealth apps useful, while only 27.6% (551/2003) declared VRB useful. The factors associated with the perceived usefulness of both technologies were younger age (≤ 55 years), trust in political representatives (VRB: adjusted odds ratio [aOR] 1.68, 95% CI 1.31-2.17; mHealth apps: aOR 1.88, 95% CI 1.42-2.48), and higher (sufficient and excellent) health literacy. The period of the beginning of the COVID-19 epidemic, living in an urban area, and being limited in daily activities were also associated with perceiving VRB positively. The perceived usefulness of mHealth apps increased with the level of education. It was also higher in people who had 3 or more consultations with a medical specialist. There are important differences in attitudes toward new ICTs. Perceived usefulness was lower for VRB than for mHealth apps. Moreover, it decreased after the initial months of the COVID-19 pandemic. There is also the possibility of new inequalities. Hence, despite the potential benefits of VRB and mHealth apps, people with low health literacy considered them to be of little use for their health care, possibly increasing their difficulties in accessing health care in the future. As such, health care providers and policy makers need to consider those perceptions to guarantee that new ICTs are accessible and beneficial to all.

Modeling Consumer Acceptance and Usage Behaviors of m-Health: An Integrated Model of Self-Determination Theory, Task-Technology Fit, and the Technology Acceptance Model.

Although mobile health (m-health) has great potential to reduce the cost of medical care and improve its quality and efficiency, it is not widely accepted by consumers. In addition, there is still a lack of comprehensive insight into m-health acceptance, especially among consumers with different demographic characteristics. This study aimed to explore the factors affecting consumers' acceptance and usage behaviors of m-health and to examine whether their roles differ by demographic characteristics. A comprehensive m-health acceptance model was proposed by integrating factors from the Self-Determination Theory, Task-Technology Fit, and Technology Acceptance Model. Survey data were collected from 623 Chinese adults with at least 6 months of m-health usage experience and analyzed using structural equation modeling techniques. Multi-group analyses were performed to assess whether the model relationships were different across gender, age, and usage experience. The results indicated that relatedness and competence were significant motivational antecedents of perceived ease of use. Task-technology fit and the perceived ease of use significantly affected the perceived usefulness. The perceived ease of use and perceived usefulness were significant determinants of consumer usage behaviors of m-health and together explained 81% of its variance. Moreover, the relationships among autonomy, perceived usefulness, and usage behaviors of m-health were moderated by gender. Consumer usage behaviors of m-health were affected by factors such as self-motivation (i.e., relatedness and competence), technology perceptions (i.e., perceived ease of use and perceived usefulness), and task-technology fit. These findings provide a theoretical underpinning for future research on m-health acceptance and provide empirical evidence for practitioners to promote the better design and use of m-health for healthcare activities.

Enhancing Inclusive mHealth Design for People Living with Dementia: Examples from Literature.

The availability of mHealth technologies for older adults living with dementia is increasing. However, due to highly complex and varying clinical presentations of dementia, these technologies do not always meet their needs, wishes and capabilities. An exploratory literature review was performed to identify studies that applied evidence-based design principles or provide design choices that aim to improve mHealth design. These were categorized as a unique design choice to tackle barriers to mHealth use related to cognition, perception, physical ability, frame of mind, or speech- and language. Through thematic analysis, themes of design choices were summarized per category in the MOLDEM-US framework. Thirty-six studies were included for data extraction, leading to seventeen categories of design choices. This study pushes the need to further investigate and refine inclusive mHealth design solutions for populations with highly complex symptoms, such as those living with dementia.

The Laro Kwo Project: A train the trainer model combined with mobile health technology for community health workers in Northern Uganda.

Community Health Workers (CHWs) in low and middle income countries (LMICs) provide invaluable health resources to their community members. Best practices for developing and sustaining CHW training programs in LMICs have yet to be defined using rigorous standards and measures of effectiveness. With the expansion of digital health to LMICs, few studies have evaluated the role of participatory methodologies combined with the use of mobile health (mHealth) for CHW training program development. We completed a three-year prospective observational study aligned with the development of a community-based participatory CHW training program in Northern Uganda. Twenty-five CHWs were initially trained using a community participatory training methodology combined with mHealth and a train-the-trainer model. Medical skill competency exams were evaluated after the initial training and annually thereafter to assess retention with use of mHealth. After three years, CHWs who advanced to trainer status redeveloped all program materials using a mHealth application and trained a new cohort of 25 CHWs. Implementation of this methodology coupled with longitudinal mHealth training demonstrated an improvement in medical skills over three years among the original cohort of CHWs. Further, we found that the train-the-trainer model with mHealth was highly effective, as the new cohort of 25 CHWs trained by the original CHWs exhibited higher scores when tested on medical skill competencies. The combination of mHealth and participatory methodologies can facilitate the sustainability of CHW training programs in LMIC. Further investigations should focus on comparing specific mHealth modalities for training and clinical outcomes using similar combined methodologies.

Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Protocol for a Mixed Method Systematic Review.

Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa. This mixed method systematic review will explore the impact of mHealth use by CHWs on the use of the maternal health continuum of care (antenatal care, intrapartum care, and postnatal care [PNC]), as well as barriers and facilitators of mHealth use by CHWs when supporting maternal health services. We will include studies that report the impact of mHealth by CHWs on the use of antenatal care, facility-based births, and PNC visits in sub-Saharan Africa. We will search 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus), with additional articles identified from Google Scholar and manual screening of references of the included studies. The included studies will not be limited by language or year of publication. After study selection, 2 independent reviewers will perform title and abstract screening, followed by full-text screening to identify the final papers to be included. Data extraction and risk-of-bias assessment will be performed using Covidence software by 2 independent reviewers. We will use a Mixed Methods Appraisal Tool to perform risk-of-bias assessments on all included studies. Finally, we will perform a narrative synthesis of the outcomes, integrating information about the effect of mHealth on maternal health use and barriers and facilitators of mHealth use. This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. In September 2022, we conducted an initial search in the eligible databases. After removing duplicates, we identified 1111 studies that were eligible for the title and abstract screening. We will finalize the full-text assessment for eligibility, data extraction, assessment of methodological quality, and narrative synthesis by June 2023. This systematic review will present new and up-to-date evidence on the use of mHealth by CHWs along the pregnancy, childbirth, and PNC continuum of care. We anticipate the results will inform program implementation and policy by highlighting the potential impacts of mHealth and presenting contextual factors that should be addressed to ensure the success of the programs. PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364. DERR1-10.2196/44066.