Mobile Health Research Articles

P0348 Ultrasound enterography with a novel ultrasound contrast agent for Crohn’s Disease

Abstract Background Gastrointestinal ultrasound (GIUS) is a method with both high sensitivity and specificity for evaluating disease activity in patients with Crohn’s disease. However, detecting and classifying stenosis and ulcerations can be challenging with GIUS. Developing an ultrasound method for detecting and categorising these findings would be of significant benefit to these patients. GIUS using an oral ultrasound contrast agent containing microbubbles is a new method with the potential to improve the intestinal ultrasound examination in patients with Crohn’s disease. The goal of this study is to investigate if intestinal ultrasound with oral contrast containing Sonazoid microbubbles in a PEG solution is a feasible and safe method in patients with Crohn’s disease. Methods 24 patients with Crohn’s disease in the terminal ileum (TI) was examined with ileocolonoscopy and intestinal ultrasound with oral contrast in a phase 2, single centre prospective cross-sectional drug trial. The ultrasound examination was done using Logiq E10 in contrast hybrid mode after ingestion of 1ml Sonazoid mixed with 500ml of PEG. The quality of the examination was graded 0-3 based on the amount of contrast in the lumen. In grade 3 the terminal ileum filled completely with contrast, and this was considered a successful examination. The contrast grade and transit time to TI after ingestion was documented along with symptoms, side effects and disease activity using "Mobile Health Index for Crohn’s Disease" before and after the study visit (1). Results All the included patients completed the ultrasound examination. The examination had a feasibility of 96 % as 23/24 patients achieved contrast effect grade 3 in TI with a clear separation of the intestinal wall and lumen. Average time from ingestion to grade 3 contrast effect in the TI was 20.8 min. Average duration of contrast effect grade 3 in the TI was 50.4 min. 50% of the patients had self-limiting diarrhea after the examination, however using paired samples T test there was no significant difference in average disease activity measured by MHICD before and after the examination (p=0.685). 96% of the patients agreed or completely agreed to undergo the examination again. Conclusion All except one patient achieved successful grade 3 contrast effect in the terminal ileum with a clear separation of the lumen and intestinal wall. Half of the patients had self-limiting diarrhea, but there was no increase in Crohn’s disease activity after the contrast examination. According to our study, ultrasound with oral contrast consisting of 1ml Sonazoid and 500ml PEG is a feasible and safe method to examine patients with Crohn’s disease.

Skeletal muscle disorders as risk factors for type 2 diabetes.

The incidence and prevalence of muscular disorders and of type 2 diabetes (T2D) is increasing and both represent highly significant healthcare problems, both economically and compromising quality of life. Interestingly, skeletal muscle dysfunction and T2D share some commonalities including dysregulated glucose homeostasis, increased oxidative stress, dyslipidemia, and cytokine alterations. Several lines of evidence have hinted to a relationship between skeletal muscle dysfunction and T2D. For instance, T2D affects skeletal muscle morphology, functionality, and overall health through altered protein metabolism, impaired mitochondrial function, and ultimately cell viability. Conversely, humans suffering from myopathies and their experimental models demonstrated increased incidence of T2D through altered muscle glucose disposal function due to abnormal calcium homeostasis, compromised mitochondrial function, dyslipidemia, increased inflammatory cytokines and fiber size alterations and disproportions. Lifestyle modifications are essential for improving and maintaining mobility and metabolic health in individuals suffering from myopathies along with T2D. In this review, we updated current literature evidence on clinical incidence of T2D in inflammatory, mitochondrial, metabolic myopathies, and muscular dystrophies and further discussed the molecular basis of these skeletal muscle disorders leading to T2D.

Behind the software: The impact of Unobtrusiveness, Goal Setting and persuasive features on BMI.

Studies have demonstrated that interventions targeting weight loss and body mass index (BMI) reduction can be successful, although the specific factors that influence their effectiveness are still unclear. Behavior change support systems (BCSS) are an approach that aims to help users in their efforts to modify their behavior. A useful tool for assessing BCSS is the Persuasive Systems Design model (PSD), where different features and postulates can be employed. However, it is unknown whether the grouping of software features and design principles, along with behavioral traits, provide a better combination to achieve effective BMI reduction. This study investigates the impact of PSD features, postulates behind the design, and behavioral traits on BMI reduction after six months of utilizing a mobile health behavior change support system (mHBCSS). We examined a subset of 96 individuals from a randomized controlled trial using a mHBCSS for a period of six months. Data was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). We found that 15.3% in the variance of BMI reduction was explained by the ability of setting goals. Furthermore, users who perceive a system as highly persuasive are more likely to establish goals (R2=0.207). Among PSD features, Dialogue Support and Primary Task Support explained 54.9% of the variance in Perceived Persuasiveness. In addition, both Dialogue Support and Credibility Support have a mutual effect on Primary Task Support (R2=0.685). Finally, the system's unobtrusiveness explained 41.1% of the variance in Dialogue Support. PSD framework and behavior change theories provide significant influence on BMI reduction. Setting a clear and organized objective assists individuals in successfully pursuing their intended results. The findings of this study can help developers and health professionals decide which PSD features and postulates to include to make mHBCSS interventions targeting BMI reduction more effective.

Advancing Sustainable HIV Services Through Integration in Primary Healthcare in Sub-Saharan Africa: A Perspective on Practical Recommendations.

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, weak health systems, and sociocultural factors. With this perspective, we discuss strategies to address these challenges. A comprehensive, multi-faceted approach is necessary to overcome these barriers. Investing in human resources, improving infrastructure, and strengthening health information systems are essential for strengthening the health system. Implementing patient-centered care, integrated service delivery models, and community engagement can optimize service delivery. Utilizing digital health tools, such as mobile health applications and electronic health records, can enhance service delivery and data management. Mobilizing for an increase in domestic resources, aligning donor funding, and using cost-effective approaches are crucial for effective financing. Finally, robust monitoring and evaluation systems are necessary to track progress, identify challenges, and inform decision-making. With these strategies, among many others, sub-Saharan African countries can significantly improve the integration of HIV services into primary healthcare, leading to better health outcomes for people living with HIV and more sustainable HIV programs.

Life after loss: the causal effect of parental death on daughters’ fertility

Using Austrian administrative data, this study examines the causal effect of parental death on daughters’ fertility through a difference-in-differences approach. The findings indicate that parental death leads to quantitatively insignificant changes in the number of children and the probability of childlessness. Complementary analyses show no substantial effects on labor market participation, residential mobility, or long-term mental health. The evidence suggests that fertility decisions remain largely unaffected by the logistical and emotional challenges of parental loss, highlighting the resilience of reproductive choices to external life shocks.

Development and Evaluation of a Mindfulness-Based Mobile Intervention for Perinatal Mental Health: Randomized Controlled Trial.

Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted. This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women. Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated. A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant. A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health. Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r.

Association between mobility decline and health literacy in olderJapanese adults: Onjuku study.

Decline in mobility is a global issue that must be addressed in rapidly aging societies. We aimed to clarify the association between locomotive syndrome (LS), a condition of decreased mobility and health literacy (HL) in community-dwelling Japanese adults aged ≥ 40 years. A descriptive survey was conducted in Onjuku Town, Japan, between 2019 and 2023. The participants performed LS risk tests, including the two-step test, stand-up tests and 25-question geriatric locomotive function scale, to assess mobility. They completed the 14-item health literacy scale to quantify the total HL and functional, communicative and critical HL subscales. Other participant characteristics, such as chronic diseases, bodily pain and physical activity, were also surveyed. The association between LS and HL was assessed using univariate and multivariate logistic regression analyses, adjusted for participant characteristics. We analyzed 492 participants with a median age of 71 years. The total HL score decreased as the LS stage increased, with 56, 54 and 51 points in stages 0, 1 and ≥ 2, respectively (p = 0.004). In the logistic regression analysis, a high total HL score was significantly associated with reduced odds of stage ≥ 2 LS (adjusted odds ratio, 0.95; p < 0.001). Furthermore, functional HL score had an independent association with stage ≥ 2 LS (adjusted odds ratio, 0.88; p = 0.009). Our results suggest that clinicians should provide HL education in addition to known preventive measures, such as promoting physical activity, as a holistic approach to decreased mobility.

Intention to use mobile phone-based TB screening among HIV patients in Debre Tabor Town public health facilities, Northwest Ethiopia: a cross-sectional study

BackgroundTo ensure fair access to TB screening, early diagnosis of TB infections, and timely starting of appropriate treatment, mobile technology tools provide convenience and feasibility for communities with limited infrastructure. This study aimed to assess the intention to use mobile-based TB screening among HIV patients in Debre Tabor Town Public health facilities, in Ethiopia.MethodA facility-based cross-sectional study was conducted among 423 HIV patients. Data was collected from May 23 to July 11, 2022, through the use of an interviewer-administered questionnaire. Epi-data 4.6 was utilized for data entry, and analysis was performed using Stata 14. Binary logistic regression analysis was employed to assess factors associated with the outcome variable. A P-value of less than 0.05 was considered statistically significant.ResultAround 70.7% of HIV patients indicated their intention to use mobile phone-based TB screening services. being employed, (AOR = 2.93; 95% CI: 1.35–6.34), experience reading received text messages (AOR = 2.81; 95% CI: 1.05–7.49), perceived usefulness (AOR = 7.29; 95% CI: 4.00 -13.31), perceived ease of use (AOR = 2.15; 95% CI: 1.17–3.95) clients having clinical follow-ups at the hospital (AOR = 3.03; 95% CI: 1.63–5.62) are significantly associated with intention to use mobile phone-based TB screening.ConclusionIn conclusion, approximately 70.7% of HIV clients intend to use mobile phone-based TB screening services, which is higher compared to previous studies. Factors such as employment status, experience reading received text messages, perceived usefulness, perceived ease of use, and having clinical follow-ups at a hospital were found to be significantly associated with the intention to use mobile phone-based TB screening. Healthcare providers, mobile health developers, and policymakers should take into account these factors when developing and deploying mobile phone-based TB screening initiatives.

Mobile health clinics in a rural setting: a cost analysis and time motion study of La Clínica in Oregon, United States

BackgroundMobile Health Clinics (MHCs) are an alternate form of healthcare delivery that may ameliorate current rural–urban health disparities in chronic diseases and have downstream impacts on the health system by reducing costs. Evaluations of providers’ time allocation on MHCs are scarce, hindering knowledge transfer related to MHC implementation strategies.MethodsRetrospective economic cost was assessed using business ledgers and expert assessments in 2023 US Dollar (USD) from 2022 to 2023. Time motion observational study assessed nurse practitioner (NP) and community health worker (CHW) time allocation and compared them between patients residing in isolated rural areas (hereafter isolated rural patients) and patients experiencing houselessness (PEH) sub-populations. Procedure codes were assessed retrospectively for each patient encounter (n = 1,981) over one year (April 2022 to April 2023). We used statistical significance tests (chi-square and Fisher’s Exact) to evaluate difference across sub-populations.ResultsIntervention start-up and operational costs totaled 275,000USD and 308,000USD, respectively, with the largest allocations to the modified recreational vehicle (RV) unit and labor. NP attributed 32% of time on direct care (mean = 153.00 min (SD = 37.80 min)), 38% on indirect care (186.0 (53.40)), and 21% on MHC tasks (104.00 (23.94)). CHW spent 47% of time on MHC tasks (182.00 (29.46)), 22% on medical care tasks (85.01 (SD 81.97)), and 22% on social needs tasks (87.70 (86.71 min)). NP time allocation did not differ significantly between isolated rural patients and PEH (p > 0.01), but CHW time did (p < 0.01). Of all procedures, 31.3% were vaccinations (N = 438), 27.0% were Covid-19 related (N = 377), 12.8% were outside referrals (N = 179), and 11.8% were point of care testing. Healthcare utilization varied between patient sub-populations, with Isolated Rural patient use dominated by Covid-19 and Influenza vaccines whereas PEH use was dominated by point of care testing (p < 0.01).ConclusionPatient sub-populations require varying provider time in different tasks and variable economic resources for interventions. As local policy makers balance resources and community health needs, a complete understanding of the resources required to operate an MHC and use of provider time is essential for informed decision making and successful implementation in underserved communities.

Effectiveness of Mobile Health Intervention in Medication Adherence: a Systematic Review and Meta-Analysis.

Low medication adherence poses a great risk of poor treatment outcomes among patients with chronic diseases. Recently, mobile applications (apps) have been recognized as effective interventions, enabling patients to adhere to their prescriptions. This study aimed to establish the effectiveness of mobile app interventions for medication adherence, affecting features, and dropout rates by focusing on previous randomized controlled trials (RCTs). This study conducted a systematic review and meta-analysis of mobile app interventions targeting medication adherence in patients with chronic diseases. Electronic searches of eight databases were conducted on April 21, 2023, for studies published between 2013 and 2023. Comprehensive meta-analysis software was used to estimate the standardized mean difference (SMD) of pooled outcomes, odds ratios (ORs), and confidence intervals (CIs). Subgroup analysis was applied to investigate and compare the effectiveness of the interventional strategies and their features. The risk of bias of the included RCTs was evaluated by applying the risk of bias tool. Publication bias was examined using the fail-safe N method. Twenty-six studies with 5,174 participants were included (experimental group 2603, control group 2571). The meta-analysis findings showed a positive impact of mobile apps on improving medication adherence (OR = 2.371, SMD = 0.279). The subgroup analysis results revealed greater effectiveness of interventions using interactive strategies (OR = 2.652, SMD = 0.283), advanced reminders (OR = 1.849, SMD = 0.455), data-sharing (OR = 2.404, SMD = 0.346), and pill dispensers (OR = 2.453). The current study found that mobile interventions had significant effects on improving medication adherence. Subgroup analysis showed that the roles of stakeholders in health providers' interactions with patients and developers' understanding of patients and disease characteristics are critical. Future studies should incorporate advanced technology reflecting acceptability and the needs of the target population.

A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability.

Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings-from development to implementation-and to conduct further research on early health technology assessments to guide these processes.

Resilience Informatics in Public Health: Qualitative Analysis of Conference Proceedings.

In recent years, public health has confronted 2 formidable challenges: the devastating COVID-19 pandemic and the enduring threat of climate change. The convergence of these crises underscores the urgent need for resilient solutions. Resilience informatics (RI), an emerging discipline at the intersection of informatics and public health, leverages real-time data integration from health systems, environmental monitoring, and technological tools to develop adaptive responses to multifaceted crises. It offers promising avenues for mitigating and adapting to these challenges by proactively identifying vulnerabilities and fostering adaptive capacity in public health systems. Addressing critical questions regarding target audiences, privacy concerns, and scalability is paramount to fostering resilience in the face of evolving health threats. The University of Arizona held a workshop, titled Resilience Informatics in Public Health, in November 2023 to serve as a pivotal forum for advancing these discussions and catalyzing collaborative efforts within the field. This paper aims to present a qualitative thematic analysis of the findings from this workshop. A purposive sampling strategy was used to invite 40 experts by email from diverse fields, including public health, medicine, weather services, informatics, environmental science, and resilience, to participate in the workshop. The event featured presentations from key experts, followed by group discussions facilitated by experts. The attendees engaged in collaborative reflection and discussion on predetermined questions. Discussions were systematically recorded by University of Arizona students, and qualitative analysis was conducted. A detailed thematic analysis was performed using an inductive approach, supported by MAXQDA software to manage and organize data. Two independent researchers coded the transcripts; discrepancies in coding were resolved through consensus, ensuring a rigorous synthesis of the findings. The workshop hosted 27 experts at the University of Arizona, 21 (78%) of whom were from public health-related fields. Of these 27 experts, 8 (30%) were from the field of resilience. In addition, participants from governmental agencies, American Indian groups, weather services, and a mobile health organization attended. Qualitative analysis identified major themes, including the potential of RI tools, threats to resilience (eg, health care access, infrastructure, and climate change), challenges with RI tools (eg, usability, funding, and real-time response), and standards for RI tools (eg, technological, logistical, and sociological). The attendees emphasized the importance of equitable access, community engagement, and iterative development in RI projects. The RI workshop emphasized the necessity for accessible, user-friendly tools bridging technical knowledge and community needs. The workshop's conclusions provide a road map for future public health resilience, highlighting the need for scalable, culturally sensitive, community-driven interventions. Future directions include focused discussions to yield concrete outputs such as implementation guidelines and tool designs, reshaping public health strategies in the face of emerging threats.

Effectiveness of a Mobile Health Intervention (DOT Selfie) in Increasing Treatment Adherence Monitoring and Support for Patients With Tuberculosis in Uganda: Randomized Controlled Trial.

Directly observed therapy (DOT) is the standard method for monitoring adherence to tuberculosis (TB) treatment. However, implementing DOT poses challenges for both patients and providers due to limited financial and human resources. Increasing evidence suggests that emerging digital adherence technologies, such as video directly observed therapy (VDOT), can serve as viable alternatives. This study aims to evaluate the effectiveness of VDOT compared with usual care directly observed therapy (UCDOT). Between July 2020 and October 2021, we conducted a 2-arm, parallel-group, open-label randomized trial with a 1:1 assignment to receive either the VDOT intervention (n=72) or UCDOT (n=72) for treatment adherence monitoring at public health clinics in Kampala, Uganda. Each group was further stratified to ensure equal numbers of males and females. Eligible patients were aged 18-65 years, had a confirmed diagnosis of TB, and were undergoing daily treatment. The VDOT group was provided with a smartphone equipped with an app, while the UCDOT group followed the routine monitoring practices outlined by the Uganda National TB Program. We tested the hypothesis that VDOT was more effective than UCDOT for monitoring medication adherence. The primary outcome was adherence, defined as having ≥80% of the expected doses observed during the 6-month treatment period. An intention-to-treat analysis was conducted, and multivariable logistic regression was used to estimate the effect of the intervention on adherence monitoring. Adjusted relative risk ratios and their corresponding 95% CIs are presented. Secondary outcomes included treatment completion, loss to follow-up, death, and reasons for missed videos in the intervention group. The intention-to-treat analysis included 142 participants, with 2 excluded due to discontinuation of medication within the first week after enrollment. The median age of participants was 34 (IQR 26-45) years. The median fraction of expected doses observed (FEDO) was significantly higher in the VDOT group compared with the UCDOT group (100, IQR 80-100 vs 30, IQR 10-60, respectively; P<.001). When using a FEDO cutoff of ≥80% to define optimal adherence, 63 of 142 (44%) patients met the threshold, with a significant difference between the VDOT and UCDOT groups (56/71, 79% vs 7/71, 10%, P<.001). After adjusting for confounders, VDOT users were significantly more likely to achieve ≥80% of their expected doses observed compared with UCDOT users (adjusted risk ratio 8.4, 95% CI 4.16-17.0). The most common reasons for failing to submit videos of medication intake were an uncharged phone battery, forgetting to record videos during medication intake, and losing the smartphone. Enhanced VDOT was more effective than UCDOT in increasing adherence monitoring among patients with TB in Uganda. This evidence highlights the potential of digital technologies to improve treatment adherence monitoring and support in high TB burden settings with limited human resources. ClinicalTrials.gov NCT04134689; http://clinicaltrials.gov/ct2/show/NCT04134689.

Machine learning models for preventative mobile health asthma control

Introduction Asthma attacks are set off by triggers such as pollutants from the environment, respiratory viruses, physical activity and allergens. The aim of this research is to create a machine learning model using data from mobile health technology to predict and appropriately warn a patient to avoid such triggers. Methods Lightweight machine learning models, XGBoost, Random Forest, and LightGBM were trained and tested on cleaned asthma data with a 70-30 train-test split. The models were measured on Precision Score, Accuracy Score, Recall Score, F1 Score and model speed. Results The best model, XGBoost, obtained an Accuracy score of 0.902, Recall score of 0.904, Precision score of 0.835, and F1 score of 0.860 and a model training speed of 14 s. Conclusion As proved by the XGBoost model, predicting asthma triggers can be a viable option for asthma control using machine learning. In addition, the actionable information of triggers, allows patients to make behavior changes. However there will still need to be work testing the system in a mobile health system.

Patient-Centered mHealth Intervention to Improve Self-Care in Patients With Chronic Heart Failure: Phase 1 Randomized Controlled Trial.

Heart failure (HF) is one of the most common causes of hospital readmission in the United States. These hospitalizations are often driven by insufficient self-care. Commercial mobile health (mHealth) technologies, such as consumer-grade apps and wearable devices, offer opportunities for improving HF self-care, but their efficacy remains largely underexplored. The objective of this study was to examine the feasibility, acceptability, safety, and preliminary efficacy of a patient-centered mHealth intervention (iCardia4HF) that integrates 3 consumer mHealth apps and devices (Heart Failure Health Storylines, Fitbit, and Withings) with a program of individually tailored SMS text messages to improve HF self-care. We conducted a phase 1 randomized controlled trial. Eligible patients had stage C HF, were aged ≥40 years, and had New York Heart Association (NYHA) class I, II, or III HF. Patients were randomly assigned to either iCardia4HF plus usual care or to usual care only and were observed for 8 weeks. Key feasibility measures were recruitment and retention rates. The primary efficacy outcome was change in HF self-care subscale scores (maintenance, symptom perception, and self-care management) at 8 weeks, assessed with the Self-Care Heart Failure Index (SCHFI; version 7.2). Key secondary outcomes were modifiable behaviors targeted by the intervention (health beliefs, self-efficacy, and HF knowledge), health status, and adherence to daily self-monitoring of 2 core vital signs (body weight and blood pressure). A total of 27 patients were enrolled in the study and randomly assigned to iCardia4HF (n=13, 48%) or usual care (n=14, 52%). Of these 27 patients, 11 (41%) in the intervention group (iCardia4HF) and 14 (52%) in the usual care group started their assigned care and were included in the full analysis. Patients' mean age was 56 (SD 8.3) years, 44% (11/25) were female, 92% (23/25) self-reported race as Black, 76% (19/25) had NYHA class II or III HF, and 60% (15/25) had HF with reduced left ventricular ejection fraction. Participant retention, completion of study visits, and adherence to using the mHealth apps and devices for daily self-monitoring were high (>80%). At 8 weeks, the mean group differences in changes in the SCHFI subscale scores favored the intervention over the control group: maintenance (Cohen d=0.19, 95% CI -0.65 to 1.02), symptom perception (Cohen d=0.33, 95% CI -0.51 to 1.17), and self-care management (Cohen d=0.25, 95% CI -0.55 to 1.04). The greatest improvements in terms of effect size were observed in self-efficacy (Cohen d=0.68) and health beliefs about medication adherence (Cohen d=0.63) and self-monitoring adherence (Cohen d=0.94). There were no adverse events due to the intervention. iCardia4HF was found to be feasible, acceptable, and safe. A larger trial with a longer follow-up duration is warranted to examine its efficacy among patients with HF. ClinicalTrials.gov NCT03642275; https://clinicaltrials.gov/study/NCT03642275.

Quality of Life in Adults with Atopic Dermatitis in Relation to Disease Severity: Nationwide Data in Japan.

The impact of atopic dermatitis (AD) on daily life and different levels of quality of life (QOL) according to AD severity has not been fully elucidated. This study aimed to assess QOL in relation to the AD severity in Japan. This observational study used anonymized data of health insurance association members and their families registered to a mobile health app. The QOL measures included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensional five-level descriptive system (EQ-5D-5L), Work Productivity and Activity Impairment (WPAI), and sleep disturbance Numerical Rating Scale (NRS). The data were assessed according to AD severity: the Patient-Oriented Eczema Measure (POEM: 0-2, "clear/almost clear"; 3-7, "mild"; 8-16, "moderate"; 17-24, "severe"; 25-28, "very severe"); and itch NRS (0-10). Of 1507 adults with AD symptoms or undergoing treatments, 882 were identified with AD diagnosis records. Of those, 229 (26.0%), 242 (27.4%), 273 (31.0%), and 138 (15.6%) were included in the clear/almost clear, mild, moderate, and severe/very severe POEM groups, with mean ± standard deviation DLQI scores of 2.0 ± 2.7, 3.6 ± 3.3, 6.1 ± 4.4, and 10.4 ± 5.7, respectively. Higher DLQI scores were observed with increasing POEM severity and itch NRS (Spearman's rank correlation coefficient 0.629 and 0.615, respectively). EQ-5D-5L scores slightly lowered with increasing POEM severity, whereas WPAI percentage slightly increased. Sleep disturbance NRS increased with increasing AD severity in terms of POEM and itch NRS. Adults identified with AD diagnosis records (n = 882) yielded higher WPAI percentages than those without (n = 1204) in all four domains (Wilcoxon rank sum test, p < 0.001 for all). This study, using real-world data in Japan, presented valuable data on the relationship between AD severity and various aspects of QOL. The data suggested greater QOL impairment with increasing AD severity; even at lower severity levels, QOL was impacted to some extent. The results highlight the need for careful consideration during clinical practice.

Cardiomeds, an mHealth App for Self-Management to Support Swiss Patients With Heart Failure: 2-Stage Mixed Methods Usability Study.

Mobile health apps have shown promising results in improving self-management of several chronic diseases in patients. We have developed a mobile health app (Cardiomeds) dedicated to patients with heart failure (HF). This app includes an interactive medication list; daily self-monitoring of symptoms, weight, blood pressure, and heart rate; and educational information on HF delivered through various formats. This study aimed to perform a mixed methods usability study of Cardiomeds. Smartphone users with HF were recruited from the HF outpatient clinic at the University Hospital of Geneva. The usability test was conducted in 2 stages, with modifications made to the app after the first stage to address major usability issues. Each stage required 10 participants to perform 14 tasks, such as entering vital signs, entering a new medication and time of intake, or finding information about HF. Each task was timed, sessions were recorded, and all data were anonymized. After completing the tasks, patients completed the System Usability Scale 10-item questionnaire and answered 5 open questions about their perceptions of Cardiomeds. Twenty patients with HF, 75% (15/20) of whom were men, with a mean age of 55 years, were included in this study. The average time to complete all 14 tasks was 18 (SD 5.7) minutes. Manual medication entry was the most time-consuming task, taking an average of 154.40 (SD 68.08) seconds in the first stage, 103.10 (SD 42.76) seconds in the second stage, and 128 (SD 63) seconds overall. The mean overall success rate was 77% (SD 0.23%) for the first stage and 94% (SD 0.07%) for the second stage. A total of 30% (3/10) of participants in the first stage completed all tasks without any help compared with 50% (5/10) of participants during the second stage. The average System Usability Scale score was 80% (SD 17%), showing a slight increase from 79% (SD 16%) in the first stage to 80% (SD 28%) in the second stage, which qualifies the app as "good" in terms of usability. Between the 2 stages, part of the app interface was redesigned to address the key issues identified in the first stage. Despite these improvements, problems related to guidance were frequent and comprised 36% (8/22) of the problems in the first stage and 40% (6/15) in the second stage. In response to open questions, 85% (17/20) of the participants responded that they would like to use the app when it became available. The usability test indicated that Cardiomeds is a suitable and user-friendly app for patients with HF. The app will be further tested in a randomized clinical trial (2022-00731) after acute HF hospitalization to assess its impact on patients' knowledge about HF, self-care, and quality of life.

Mobile health in communication disorders: willingness to use, attitude, advantages, and challenges from the perspective of patients

IntroductionCommunication disorders are one of the most common disorders that, if not treated in childhood, can cause many social, educational, and psychological problems in adulthood. One of the technologies that can be helpful in these disorders is mobile health (m-Health) technology. This study aims to examine the attitude and willingness to use this technology and compare the advantages and challenges of this technology and face-to-face treatment from the perspective of patients.MethodsThis descriptive study was conducted with a researcher-made questionnaire and investigated the willingness and attitude of patients with communication disorders to use mobile health technology. The face and content validity of the questionnaire were examined with the help of experts in speech therapy, health information management, and medical informatics. Chi-square, Fisher's exact test, and the Kruskal–Wallis test were used to analyze the relationship between variables. Also, the challenges and advantages of mobile health technology and face-to-face treatment were extracted from the patient's answers and presented in the form of main themes and sub-themes.ResultsOne hundred seventy patients participated in this study. The results of this study showed that 57 (33.5%) participants preferred face-to-face visits, 11 (6.5%) preferred m-Health, and 102 (60.0%) preferred the combination of mobile applications and the face-to-face visits method. The results showed a statistically significant relationship between "Residence (rural or urban)", "Having trouble traveling to speech therapy centers", and "Delaying treatment due to lack of access to speech therapists" with treatment methods (face-to-face, mobile health, face to face and mobile health). Accessibility and convenience, treatment efficacy and variety, patient empowerment and confidence, family involvement and support, cost and time efficiency, treatment adherence and completion, and comfort and lifestyle compatibility were six categories related to the advantages of mobile health technology from the point of view of patients with communication disorders. Also, technological challenges, effectiveness and quality concerns, patient experience and engagement, and trust and confidence issues were mobile health challenges from the patients' point of view.ConclusionThe results of this study showed that patients tend to use both face-to-face interactions and mobile health. Integrating both m-Health and traditional methods can optimize speech therapy outcomes. Addressing challenges such as inadequate technological infrastructure and data security is crucial for successful implementation.

Effectiveness of Mobile Health Applications for Cardiometabolic Risk Reduction in Urban and Rural India: A Pilot, Randomized Controlled Study.

mHealth technology has the potential to deliver personalized health care; however, data on cardiometabolic risk factors are limited. This study aims to assess the effectiveness of mobile health applications (apps) on cardiometabolic risk factor reduction in adults aged 25 to 60 years in urban and rural India. The study design was a pilot randomized controlled trial conducted in Tamil Nadu, India. Smartphone users (25-60 years) with basic literacy and at high risk of developing diabetes (Indian Diabetes Risk Score ≥30 and/or fasting blood sugar [FBS] 100-125 mg/dL) were recruited. Four mobile apps (two commercially available, two novel) for cardiometabolic risk reduction were evaluated. Primary outcome (weight loss) was analyzed using intention-to-treat analysis with post hoc analysis and logistic regression models adjusted for confounders. A total of 5264 participants were screened, and 610 were recruited into the study. Participants (7%) dropped out largely due to the COVID-19 pandemic. Data from 567 participants were used for the final analysis. In the intention-to-treat analysis, a significant reduction in body weight was observed in the intervention group as compared with control, more so in the urban (-2.40 kg, 95% confidence interval [CI] = [-3.10, -1.69], P < .001) compared with rural population (-1.19 kg, 95% CI = [-1.55, -0.82], P < .001). Intervention group participants showed significant reductions in body mass index, waist circumference, blood pressure, FBS, total serum cholesterol, and a positive effect on dietary and physical activity behaviors compared with controls. mHealth interventions can reduce diabetes risk, improve cardiometabolic health, and improve lifestyle behaviors in South Asian populations. The trial is registered with the Central Trials Registry, India (CTRI/2020/03/024327).

Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study.

Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app's learning center. A total of 7572 pregnant persons were enrolled in the TodaysBaby Program-3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID-a leading cause of infant death after 1 month of age-appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact.