Mobile App Intervention Research Articles

A Community-Developed, Web-Based Mobile App Intervention Addressing Social Work and Legal Needs of Black Sexual Minority Men Living With HIV: Protocol for a Randomized Comparison Trial.

BackgroundBlack sexual minority men (BSMM) are disproportionately affected by HIV. Los Angeles County (LAC) carries a substantial burden of the HIV epidemic in California. Negative effects of both psychosocial and structural barriers highlight the timely need to increase HIV treatment among BSMM. Successful HIV interventions based on social media and mobile phone technology have been demonstrated. This protocol describes LINX LA, a study that tests LINX, a web-based mobile app that provides tailored social services, legal resources, and peer support for BSMM living with HIV (BSMM+) in LAC using a randomized comparison trial.ObjectiveDuring phase 1, the LINX LA study aims to engage in an iterative design process to develop the LINX App using qualitative data to inform and tailor the mobile app technology and its functionality. In phase 2 of LINX LA, we will test the efficacy of the LINX App compared with the LINX App Plus to improve HIV treatment outcomes (ie, antiretroviral therapy adherence, viral suppression) among BSMM+ in LAC by addressing social work and legal needs and developing a forum for peer support.MethodsIn this study funded by the California HIV/AIDS Research Program, we will recruit and enroll BSMM+ participants (aged ≥18 years) in LAC (N=400) to participate in a 12-month study that includes access to the LINX App, which provides a forum for peer support and tailored content aimed at improving the use of social and legal resources. All participants will also receive survey-based interviews at 3 time points (at baseline and 6- and 12-month intervals) and weekly text message surveys that assess medication and treatment adherence. Treatment adherence and viral suppression will be extracted from medical record data. Half of the participants will also be randomly assigned to receive 3 individualized coaching sessions (at 1-, 3-, and 6-month intervals) and the ability to directly message their coach via the LINX App. Over the course of the study, LINX App participants will receive a minimum of US $130 in cash and LINX App Plus participants will receive a minimum of US $190. We hypothesize that participants enrolled in LINX App Plus will demonstrate greater improvement in HIV outcomes compared with LINX App participants.ResultsThe LINX study will test the efficacy of a web-based mobile app intervention for BSMM+ in LAC (N=400). The LINX App seeks to increase participants’ knowledge of HIV; to facilitate access to necessary social and legal services, including information and referrals; and to increase social support across participants by providing a mediated forum for engagement.ConclusionsThe implementation of LINX LA aims to develop and test a culturally tailored approach to improve the HIV treatment outcomes of BSMM+.International Registered Report Identifier (IRRID)PRR1-10.2196/19770

A Mobile Social Networking App for Weight Management and Physical Activity Promotion: Results From an Experimental Mixed Methods Study.

BackgroundSmartphone apps, fitness trackers, and online social networks have shown promise in weight management and physical activity interventions. However, there are knowledge gaps in identifying the most effective and engaging interventions and intervention features preferred by their users.ObjectiveThis 6-month pilot study on a social networking mobile app connected to wireless weight and activity tracking devices has 2 main aims: to evaluate changes in BMI, weight, and physical activity levels in users from different BMI categories and to assess user perspectives on the intervention, particularly on social comparison and automated self-monitoring and feedback features.MethodsThis was a mixed methods study involving a one-arm, pre-post quasi-experimental pilot with postintervention interviews and focus groups. Healthy young adults used a social networking mobile app intervention integrated with wireless tracking devices (a weight scale and a physical activity tracker) for 6 months. Quantitative results were analyzed separately for 2 groups—underweight-normal and overweight-obese BMI—using t tests and Wilcoxon sum rank, Wilcoxon signed rank, and chi-square tests. Weekly BMI change in participants was explored using linear mixed effects analysis. Interviews and focus groups were analyzed inductively using thematic analysis.ResultsIn total, 55 participants were recruited (mean age of 23.6, SD 4.6 years; 28 women) and 45 returned for the final session (n=45, 82% retention rate). There were no differences in BMI from baseline to postintervention (6 months) and between the 2 BMI groups. However, at 4 weeks, participants’ BMI decreased by 0.34 kg/m2 (P<.001), with a loss of 0.86 kg/m2 in the overweight-obese group (P=.01). Participants in the overweight-obese group used the app significantly less compared with individuals in the underweight-normal BMI group, as they mentioned negative feelings and demotivation from social comparison, particularly from upward comparison with fitter people. Participants in the underweight-normal BMI group were avid users of the app’s self-monitoring and feedback (P=.02) and social (P=.04) features compared with those in the overweight-obese group, and they significantly increased their daily step count over the 6-month study duration by an average of 2292 steps (95% CI 898-3370; P<.001). Most participants mentioned a desire for a more personalized intervention.ConclusionsThis study shows the effects of different interventions on participants from higher and lower BMI groups and different perspectives regarding the intervention, particularly with respect to its social features. Participants in the overweight-obese group did not sustain a short-term decrease in their BMI and mentioned negative emotions from app use, while participants in the underweight-normal BMI group used the app more frequently and significantly increased their daily step count. These differences highlight the importance of intervention personalization. Future research should explore the role of personalized features to help overcome personal barriers and better match individual preferences and needs.

Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade.

BackgroundMobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release of the first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear.ObjectiveThis study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit drug use.MethodsThe review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile app study was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes.ResultsA total of 20 studies met eligibility criteria across a range of substances: alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1), and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizes ranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation to multicomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to 35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substance use at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reported significant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components.ConclusionsAlthough most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better than the comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcohol and illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk of bias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack of relevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventions are most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targeting problematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compare efficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substance use can be fulfilled.

Usability, Acceptability, and Adherence Rates of Mobile Application Interventions for Prevention or Treatment of Depression: A Systematic Review.

Mobile health applications (apps) have been growing as a new frontier in mental health care delivery. The objective of the current systematic review was to summarize the evidence regarding usability, acceptability, and adherence rates of mobile app interventions for prevention or treatment of depression. A literature search was conducted in relevant databases, including PubMed, PsycINFO, and Embase, for articles published between January 1, 2009, and August 1, 2019. Key terms used for searching included depression AND smartphone OR mobile AND application AND acceptability OR feasibility. Based on a full-text examination, seven studies were included for review. All studies were conducted in developed countries and five studies were developing a mobile app for depression treatment. The current study highlights the need for developers of mobile apps for individuals with mental health care needs to consider user acceptability and adherence rates. Innovation in designing a mobile app for individuals with depression is needed to improve the adherence rates of users. [Journal of Psychosocial Nursing and Mental Health Services, 59(2), 41-47.].

Weight loss before total joint arthroplasty using a remote dietitian and mobile app: study protocol for a multicenter randomized, controlled trial

BackgroundThe months prior to elective surgery may present an opportunity for patients to initiate behavior changes that will simultaneously ready them for surgery and improve their overall health status. An upcoming elective total joint arthroplasty (TJA) may serve as motivation for patients with severe obesity (body mass index [BMI]> 40 kg/m2) to lose weight, as it may optimize clinical outcomes following TJA and help them become eligible for TJA since some surgeons use a BMI of 40 kg/m2 as a cut-off for offering surgery in an effort to optimize outcomes.MethodsThe purpose of this multicenter randomized, controlled trial is to assess the feasibility and efficacy of a 12-week remote dietitian (RD) supervised dietary and physical activity weight loss intervention and mobile app for 60 patients with severe obesity prior to undergoing TJA. Intervention participants will receive access to a smartphone app and connect with an RD who will contact these participants weekly or bi-weekly via video calls for up to nine video calls. Together, participants and RDs will set goals for lifestyle modifications, and RDs will check on progress towards achieving these goals using in-app tools such as food logs and text messages between video calls. All patients will be encouraged to lose at least 20 pounds with a goal BMI < 40 kg/m2 after 12 weeks. Individuals randomized to the control group will receive clinical standard of care, such as nutritionist and/or physical therapy referrals. Outcome and demographic data will be collected from blood serology, chart review, mobile app user data, pre- and postintervention surveys, and phone interviews. The primary outcome measure will be weight change from baseline. Secondary outcome measures will include percentage of patients eligible to undergo TJA, number of sessions completed with dietitians, self-reported global health status (PROMIS Global Health scale), self-reported joint-specific pain and function (Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS)), and serologies such as hemoglobin A1c, total lymphocyte count, albumin, and transferrin. Qualitative responses transcribed from phone interviews about the intervention will also be analyzed.DiscussionThis will be the first study to assess pre-operative weight loss in patients with severe obesity anticipating orthopaedic surgery using an RD and mobile app intervention aimed at helping patients become eligible for TJA.Trial registrationRegistered on 1 April 2020 at Clincialtrials.gov. Trial number is NCT04330391.

Effects of a six-week mobile app versus paper book intervention on quality of life, symptoms, and self-care in patients with fibromyalgia: a randomized parallel trial

BackgroundThe ProFibro application (app) was developed as a Mobile Health resource to promote self-care in fibromyalgia management. ObjectiveThis study aimed to assess the effects of the use of the ProFibro app for six weeks compared to the use of a traditional paper book of similar content to improve health-related quality of life, symptoms, and self-care agency in individuals with fibromyalgia. MethodsForty individuals with fibromyalgia were included in this randomized, single-blind, parallel trial. One group received intervention content using the ProFibro app on a smartphone while the other received similar information using a paper book. Participants were assessed at baseline and after six weeks. The primary outcome was the Revised Fibromyalgia Impact Questionnaire. Secondary outcomes were Widespread Pain Index, Pain Visual Analog Scale, Symptom Severity Scale, and Appraisal of Self-Care Agency Scale – Revised. ResultsNo differences in changes were found between groups at the end of the treatment for any outcome. Both groups showed improvements in symptom severity. ConclusionsThe use of the ProFibro app for six weeks was not more effective than the use of a traditional paper book with similar content for health-related quality of life, symptoms, or self-care agency in individuals with fibromyalgia. Both groups showed improvements from baseline on severity of symptoms, suggesting that the self-care program using a mobile app or a paper book may be beneficial for individuals with fibromyalgia.

Identifying user-centered content, design, and features for mobile health apps to support long-term assessment, behavioral intervention, and transitions of care in neurological rehabilitation: An exploratory study

Introduction The use of mobile health technology has the potential to increase healthcare accessibility, promote self-management, provide education materials, and support self-monitoring of biometrics. This may be of particular benefit to those living in the community with chronic neurological conditions. The purpose of this research was to characterize perspectives of individuals with brain injury or stroke, their care partners, and neuro-rehabilitation clinicians to inform the design of mobile health app-based interventions that address the need for ongoing community-based health-related professional support. Methods Individuals with stroke or traumatic brain injury, their care partners, and clinicians were recruited from a large university hospital with a specialized neuro-rehabilitation program. Data were collected via semi-structured focus groups and were examined using descriptive statistics and content analysis. Results Five consistent themes emerged: (a) all-in-one app with customized features; (b) communication with healthcare providers; (c) cognitive strategies; (d) app accessibility; and (e) user education. The clinician focus group reiterated these consumer focus group themes, with one additional theme: (f) logistics of clinician time and effort to provide effective app-based services to patients. Conclusions Results have directly informed the ongoing development of a community-based mobile health app intervention, and may also inform the content and design of future mHealth technological development in this population.

Operationalizing needs-focused palliative care for older adults in intensive care units: Design of and rationale for the PCplanner randomized clinical trial

IntroductionThe number of older adults who receive life support in an intensive care unit (ICU), now 2 million per year, is increasing while survival remains unchanged. Because the quality of ICU-based palliative care is highly variable, we developed a mobile app intervention that integrates into the electronic health records (EHR) system called PCplanner (Palliative Care planner) with the goal of improving collaborative primary and specialist palliative care delivery in ICU settings. ObjectiveTo describe the methods of a randomized clinical trial (RCT) being conducted to compare PCplanner vs. usual care. Methods and analysisThe goal of this two-arm, parallel group mixed methods RCT is to determine the clinical impact of the PCplanner intervention on outcomes of interest to patients, family members, clinicians, and policymakers over a 3-month follow up period. The primary outcome is change in unmet palliative care needs measured by the NEST instrument between baseline and 1 week post-randomization. Secondary outcomes include goal concordance of care, patient-centeredness of care, and quality of communication at 1 week post-randomization; length of stay; as well as symptoms of depression, anxiety, and post-traumatic stress disorder at 3 months post-randomization. We will use general linear models for repeated measures to compare outcomes across the main effects and interactions of the factors. We hypothesize that compared to usual care, PCplanner will have a greater impact on the quality of ICU-based palliative care delivery across domains of core palliative care needs, psychological distress, patient-centeredness, and healthcare resource utilization.

A Mobile App for Diabetes Management: Impact on Self-Efficacy Among Patients with Type 2 Diabetes at a Community Hospital.

BackgroundPatients with type 2 diabetes upload and review blood glucose data between clinic visits. Many mobile phone applications (apps) that receive data from a “connected” glucometer and that support pattern management are available and have the capacity to make data upload and review less burdensome.The objective of this study was to assess whether the diabetic management app could improve glycemic control and diabetes self-efficacy in a Chinese community hospital by a randomized controlled trial.Material/MethodsOne-hundred twenty patients with type 2 diabetes registered at the Community Health Service Center of Zhangjiawo Town, Xiqing District, Tianjin City, China were recruited and volunteered to participate in the project. They were randomly divided into the mobile app intervention group (n=60) and the control group (n=60) for a 6-month observation. The control group was given conventional diabetic treatment and the app group was given the mobile app and conventional care. Self-efficacy was measured by the Diabetes Self-Efficacy Scale questionnaire. The differences between the 2 groups in hemoglobin A1c (HbA1c) and diabetes self-efficacy were evaluated at the third and sixth months.ResultsAt the sixth month, patients in the app group showed better HbA1c control (6.71±1.06 vs. 7.22±1.02, P<0.05) and improved self-efficacy score (119.20±9.88 vs. 102.09±10.67, P<0.05).ConclusionsThe mobile app helped patients with type 2 diabetes in a community hospital improve therapeutic outcome and self-management behavior. It also provided experiences for prevention and management of other chronic diseases in community hospitals.

A Novel Mobile App Intervention to Reduce Dental Anxiety in Infant Patients.

Introduction: Anxiety and fear are feelings routinely associated with the dental experience, especially in childhood and adolescence. These have been prominent in the world for many years and are currently considered a public health issue. Since the young population is an assiduous user of virtual inputs, it was sought to develop a mobile application (app) with the function of reducing the levels of dental anxiety in children before dental treatment and evaluate its effectiveness. Materials and Methods: An app, entitled "Hello, Dentist!", containing dental anticipation videos, was developed by a multidisciplinary team and evaluated. This app was tested in two children groups (dental and school settings), aged 6-10 years. Children and caregivers answered sociodemographic questions. In addition, to measure children's dental anxiety, they completed the Children's Fear Survey Schedule before and after app utilization. Control groups were utilized. A total of 100 children were included in this study. Results: Anxiety levels were statistically lower in the groups using the app when compared with their control groups (p < 0.05). The effectiveness in reducing anxiety was greater when the initial anxiety values were higher, as seen in the dental environment group (p = 0.029). Dental procedures previously experienced, as well as the environment (dental or school) in which children were inserted, were factors that influenced their initial anxiety levels. Conclusions: The creation and utilization of an app to reduce dental anxiety are feasible and effective. The app developed decreased children's anxiety, especially in the dental setting, by anticipating dental situation.

College student veterans' experience with a mindfulness- and acceptance-based mobile app intervention for PTSD: A qualitative study

This study aimed to explore college student military veterans' experience with a mindfulness- and acceptance-based smartphone app intervention. Upon the 4-week participation in the intervention, 23 student veterans took part in semi-structured interviews. In the thematic analysis of the interview transcripts, three main themes emerged: (1) generating momentum of app use; (2) optimizing the functions and benefits of the app; and (3) resolving to deepen the practice of mindfulness and acceptance. Considering the low engagement rates of several previous app-based studies, our results provide a useful framework for incorporating human feedback and support in enhancing users' engagement with the app.

Effects of a Novel Contextual Just-In-Time Mobile App Intervention (LowSalt4Life) on Sodium Intake in Adults With Hypertension: Pilot Randomized Controlled Trial.

BackgroundHigh dietary sodium intake is a significant public health problem in the United States. High sodium consumption is associated with high blood pressure and high risk of cardiovascular disease.ObjectiveThe aim of this study was to evaluate the effect of a just-in-time adaptive mobile app intervention, namely, LowSalt4Life, on reducing sodium intake in adults with hypertension.MethodsIn this study, 50 participants aged ≥18 years who were under treatment for hypertension were randomized (1:1, stratified by gender) into 2 groups, namely, the App group (LowSalt4Life intervention) and the No App group (usual dietary advice) in a single-center, prospective, open-label randomized controlled trial for 8 weeks. The primary endpoint was the change in the 24-hour urinary sodium excretion estimated from spot urine by using the Kawasaki equation, which was analyzed using unpaired two-sided t tests. Secondary outcomes included the change in the sodium intake measured by the food frequency questionnaire (FFQ), the 24-hour urinary sodium excretion, blood pressure levels, and the self-reported confidence in following a low-sodium diet.ResultsFrom baseline to week 8, there was a significant reduction in the Kawasaki-estimated 24-hour urinary sodium excretion calculated from spot urine in the App group compared to that in the No App group (–462 [SD 1220] mg vs 381 [SD 1460] mg, respectively; P=.03). The change in the 24-hour urinary sodium excretion was –637 (SD 1524) mg in the App group and –322 (SD 1485) mg in the No App group (P=.47). The changes in the estimated sodium intake as measured by 24-hour dietary recall and by FFQ in the App group were –1537 (SD 2693) mg and –1553 (SD 1764) mg while those in the No App group were –233 (SD 2150) mg and –515 (SD 1081) mg, respectively (P=.07 and P=.01, respectively). The systolic blood pressure change from baseline to week 8 in the App group was –7.5 mmHg while that in the No App group was –0.7 mmHg (P=.12), but the self-confidence in following a low-sodium diet was not significantly different between the 2 groups.ConclusionsThis study shows that a contextual just-in-time mobile app intervention resulted in a greater reduction in the dietary sodium intake in adults with hypertension than that in the control group over a 8-week period, as measured by the estimated 24-hour urinary sodium excretion from spot urine and FFQ. The intervention group did not show a significant difference from the control group in the self-confidence in following a low sodium diet and in the 24-hour urinary sodium excretion or dietary intake of sodium as measured by the 24-hour dietary recall. A larger clinical trial is warranted to further elucidate the effects of the LowSalt4Life intervention on sodium intake and blood pressure levels in adults with hypertension.Trial RegistrationClinicalTrials.gov NCT03099343; https://clinicaltrials.gov/ct2/show/NCT03099343International Registered Report Identifier (IRRID)RR2-10.2196/11282

Effectiveness of a Mobile App Intervention for Anxiety and Depression Symptoms in University Students: Randomized Controlled Trial.

BackgroundDepression and anxiety symptoms are common among university students, but many do not receive treatment. This is often because of lack of availability, reluctance to seek help, and not meeting the diagnostic criteria required to access services. Internet-based interventions, including smartphone apps, can overcome these issues. However, a large number of apps are available, each with little evidence of their effectiveness.ObjectiveThis study aims to evaluate for the first time the effectiveness of a self-guided mobile app, Feel Stress Free, for the treatment of depression and anxiety symptoms in students.MethodsA web-based randomized controlled trial compared a cognitive behavioral therapy (CBT)–based mobile app Feel Stress Free with a wait-list control. University students self-identified as experiencing symptoms of anxiety or depression and were randomized to 6 weeks of intervention (n=84) or control (n=84), unblinded. The app is self-guided and incorporates behavioral relaxation activities, mood tracking and thought challenging, and minigames. Participants completed the Hospital Anxiety and Depression Scale online at baseline and every fortnight.ResultsAt week 6, the primary end point, there was evidence that the Feel Stress Free app reduced depression symptoms (mean difference −1.56; 95% CI −2.67 to −0.44; P=.006) but only very weak evidence that it reduced anxiety symptoms (mean difference −1.36; 95% CI −2.93 to 0.21; P=.09). At week 4, there was evidence to support the effectiveness of the intervention for anxiety symptoms (mean difference −1.94; 95% CI −3.11 to −0.77; P=.001) and, though weaker, depression symptoms (mean difference −1.08; 95% CI −2.12 to −0.04; P=.04). At week 6, 83% (34/41) of participants indicated that they were using the app weekly or more frequently.ConclusionsThe Feel Stress Free app is a promising mobile intervention for treating symptoms of anxiety and depression in students and overcomes many of the barriers to traditional CBT. Further research is needed to establish its effectiveness at and beyond 6 weeks.Trial RegistrationClinicalTrials.gov NCT03032952; https://clinicaltrials.gov/ct2/show/NCT03032952

Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis.

BackgroundObesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking.ObjectiveThe main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults.MethodsPubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias.ResultsA total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (−1.07 kg, 95% CI −1.92 to −0.21, P=.01) and body mass index (−0.45 kg/m2, 95% CI −0.78 to −0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI −2.21 to 2.55, P=.88).ConclusionsThe findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples.

Recruiting breast cancer patients for mHealth research: Obstacles to clinic-based recruitment for a mobile phone app intervention study.

Nearly half of newly diagnosed breast cancer patients will report clinically significant symptoms of depression and/or anxiety within the first year of diagnosis. Research on the trajectory of distress in cancer patients suggests that targeting patients early in the diagnostic pathway could be particularly impactful. Given the recent rise of smartphone adoption, apps are a convenient and accessible platform from which to deliver mental health support; however, little research has examined their potential impact among newly diagnosed cancer patients. One reason is likely due to the obstacles associated with in-clinic recruitment of newly diagnosed cancer patients for mHealth pilot studies. This article draws from our experiences of a recently completed pilot study to test a suite of mental health apps in newly diagnosed breast cancer patients. Recruitment strategies included in-clinic pamphlets, flyers, and direct communication with clinicians. Surgical oncologists and research staff members approached eligible patients after a medical appointment. Research team members met with patients to provide informed consent and review the study schedule. Four domains of in-clinic recruitment challenges emerged: (a) coordination with clinic staff, (b) perceived burden among breast cancer patients, (c) limitations regarding the adoption and use of technology, and (d) availability of resources. Potential solutions are provided for each challenge. Recruitment of newly diagnosed cancer patients is a major challenge to conducting mobile intervention studies for researchers on a pilot-study budget. To realize the impact of mobile interventions for the most vulnerable cancer patient populations, health researchers must address barriers to in-clinic recruitment to provide vital preliminary data in proposals of large-scale research projects.

User Retention and Engagement With a Mobile App Intervention to Support Self-Management in Australians With Type 1 or Type 2 Diabetes (My Care Hub): Mixed Methods Study.

BackgroundMobile health apps are commonly used to support diabetes self-management (DSM). However, there is limited research assessing whether such apps are able to meet the basic requirements of retaining and engaging users.ObjectiveThis study aimed to evaluate participants’ retention and engagement with My Care Hub, a mobile app for DSM.MethodsThe study employed an explanatory mixed methods design. Participants were people with type 1 or type 2 diabetes who used the health app intervention for 3 weeks. Retention was measured by completion of the postintervention survey. Engagement was measured using system log indices and interviews. Retention and system log indices were presented using descriptive statistics. Transcripts were analyzed using content analysis to develop themes interpreted according to the behavioral intervention technology theory.ResultsOf the 50 individuals enrolled, 42 (84%) adhered to the study protocol. System usage data showed multiple and frequent interactions with the app by most of the enrolled participants (42/50, 84%). Two-thirds of participants who inputted data during the first week returned to use the app after week 1 (36/42, 85%) and week 2 (30/42, 71%) of installation. Most daily used features were tracking of blood glucose (BG; 28/42, 68%) and accessing educational information (6/42, 13%). The interview results revealed the app’s potential as a behavior change intervention tool, particularly because it eased participants’ self-care efforts and improved their engagement with DSM activities such as BG monitoring, physical exercise, and healthy eating. Participants suggested additional functionalities such as extended access to historical analytic data, automated data transmission from the BG meter, and periodic update of meals and corresponding nutrients to further enhance engagement with the app.ConclusionsThe findings of this short-term intervention study suggested acceptable levels of participant retention and engagement with My Care Hub, indicating that it may be a promising tool for extending DSM support and education beyond the confines of a physical clinic.

Effects of a Chrononutrition-Based Mobile App Intervention on Meal Timings and Weight Changes in Adults

Abstract Objectives Evidence from nutrition studies that consider the circadian system (chrononutrition) has rapidly accumulated. The aim of this study is to evaluate the effects of a chrononutrition-based mobile application (app) on meal timings and weight changes in participants categorized as lean, normal weight, overweight, and obese. Methods A total of 3,816 adults aged 19–66 (mean age: 40.4 ± 9.8 years, male: 72.1%) were recruited. The app, named “Reborn Magic,” enabled self-monitoring through the use of process motivators including gamification. The primary outcome was weight changes after a 4-week intervention. Other outcomes include waking time; timing of eating breakfast, lunch, and dinner; and bedtime on weekends and holidays. Physical condition score including feeling refreshed after waking up, concentration in the afternoon, and vitality after work were measured. Results Of the 3,816 adults enrolled in the Reborn Magic study, 1,835 completed the pre-post assessment (48.1% retention rate). Age was negatively correlated with waking time and dinner timing but had no correlation with the timing of breakfast, lunch, and going to bed. The rates of inappropriate meal time were 32.9%, 34.2%, and 61%, respectively. The time lag improved after the intervention (80.6 ± 71.9→69.0 ± 70.3, 83.8 ± 59.9→72.7 ± 62.0, 26.8 ± 49.9→18.1 ± 44.6, and 8.7 ± 73.9→40.7 ± 55.0 min, respectively), although they did not improved except bed time on weekends. Physical condition scores (out of 10) were significantly increased (6.6 ± 2.3 to 8.2 ± 2.0 points). Significant weight loss was observed in participants with overweight and obesity (-0.33 ± 1.23 and –0.49 ± 1.39 kg, respectively), while in participants in the lean category, significant weight gain was observed (+0.37 ± 0.99 kg). However, there were no weight changes in participants with normal weight. Conclusions These results demonstrate the chrononutrition-based mobile app's efficacy with regard to adjusting weight through the improvement of circadian rhythm. Further studies, including randomized controlled trials, are required to confirm these results. Funding Sources JSPS KAKENHI

Developing Mental or Behavioral Health Mobile Apps for Pilot Studies by Leveraging Survey Platforms: A Do-it-Yourself Process.

BackgroundBehavioral health researchers are increasingly recognizing the potential of mobile phone apps to deliver empirically supported treatments. However, current options for developing apps typically require large amounts of expertise or money.ObjectiveThis paper aims to describe a pragmatic do-it-yourself approach for researchers to create and pilot an Android mobile phone app using existing survey software (eg, Qualtrics survey platform).MethodsThis study was conducted at an academic research center in the United States focused on developing and evaluating behavioral health technologies. The process outlined in this paper was derived and condensed from the steps to building an existing app intervention, iCanThrive, which was developed to enhance mental well-being in women cancer survivors.ResultsThis paper describes an inexpensive, practical process that uses a widely available survey software, such as Qualtrics, to create and pilot a mobile phone intervention that is presented to participants as a Web viewer app that is downloaded from the Google Play store. Health researchers who are interested in using this process to pilot apps are encouraged to inquire about the survey platforms available to them, the level of security those survey platforms provide, and the regulatory guidelines set forth by their institution.ConclusionsAs app interventions continue to gain interest among researchers and consumers alike, it is important to find new ways to efficiently develop and pilot app interventions before committing a large amount of resources. Mobile phone app interventions are an important component to discovering new ways to reach and support individuals with behavioral or mental health disorders.

Effectiveness of a Mobile App Intervention to Prevent Dating Violence in Residential Child Care

This study focuses on the effectiveness of an app-based, monitored intervention using the Liad@s app in a residential youth-care setting. The aim of this intervention is to reduce maladaptive beliefs and attitudes linked to dating violence: distortions or myths about romantic love and hostile and benevolent dimensions of sexism. A quasi-experimental pre-post study with a control group was carried out. Participants were 71 adolescents from 9 group homes in Valencia (Spain). The outcomes measures were hostile and benevolent sexism (Ambivalent Sexism Inventory - ASI), ambivalence and prejudice towards men (Ambivalence toward Men Inventory - AMI), and myths about romantic love. The results of the intervention were assessed using multivariate analysis of variance (MANOVA). A post-intervention, statistically significant reduction with a medium-large effect size was observed in all dimensions for the treatment group, with eta-square of .25 for the sexism dimensions, .38 for myths, and .21 for ambivalence and prejudices. The experimental group demonstrated significantly more change than the control group on all measures. The benefits of the intervention did not vary by participants’ sex. These results may be helpful to professionals involved in child and youth care, who can profit from adolescents’ proclivity toward online communication.

Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta‐Analysis

This meta-analysis aimed to assess the effect of mobile application (app) interventions on weight loss in patients with type 2 diabetes. Electronic databases were searched for randomized controlled trials examining the use of mobile app interventions with outcomes on weight loss evaluated by body weight or other measures such as BMI or waist circumference. A random-effects model was applied to obtain weight mean differences and 95% CIs. Fourteen studies enrolling 2,129 patients with type 2 diabetes were included. Mobile app interventions could significantly reduce body weight (weight mean difference, -0.84 kg; 95% CI: -1.51 to -0.17 kg) and lower waist circumference (-1.35 cm; 95% CI: -2.16 to -0.55 cm) but may not decrease BMI (-0.08 kg/m2 ; 95% CI: -0.41 to 0.25 kg/m2 ). The reductions appeared to be more pronounced in patients with obesity or among studies using mobile app interventions combined with other behavior components. However, weight loss was not moderated by the functionalitiesof the mobile apps (all Pinteraction > 0.05) or by the intervention duration (all P > 0.87). Mobile app interventions lead to weight loss in patients with type 2 diabetes and are worth recommending for weight loss promotion.