Use Of Mobile Health Technology Research Articles

Mobile health intervention and COVID-19 pandemic outbreak: insights from Indian context

PurposeThis paper discusses the need for government and healthcare organization to implement mobile phone-based solutions for healthcare during the Coronavirus (Covid-19) pandemic. It also highlights the challenges and/or barriers to the rapid introduction, implementation and management of these and other innovative solutions to health service delivery during the current situationDesign/methodology/approachThe data include both qualitative and quantitative, collected from the primary interview-based case study and questionnaire survey. It also uses insights from the general populations, healthcare professionals and health information technology developers to understand the role of a mobile health intervention in the COVID-19 pandemic outbreak.FindingsHealthcare professionals and health information technology developers are confident that the use of mobile health technology and applications has the ability to assist in monitoring and controlling the COVID-19 outbreak. The key advantages of using mobile phone technology are: increased awareness, improved assistance in tracking and testing casualties, improved assistance in seeking and scheduling health information and medical appointments, increased social distancing, improved overall productivity and quality of life. However, data demonstrated that lack of awareness and accessibility or unwillingness to use the technology, complex healthcare needs, application infrastructure, policies and a dearth of training and support are all barriers to successful implementation of this useful tool.Practical implicationsThis research has the potential to make a significant impact on government and healthcare policy through presenting a coherent argument for the importance of designing and deploying mobile health technology and applications for the general population.Originality/valueprior literature in this domain is inadequate in explaining the importance of mobile phone-based healthcare solutions for health service and during serious disease outbreaks and, in particular, within the Indian context. The findings of this study can be used by government and healthcare organizations to improve health governance during the current global pandemic.

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.

Increasing Awareness and Use of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Protocol for a Randomized Controlled Trial.

BackgroundHypertension remains one of the foremost noncommunicable diseases that most often lead to cardiovascular diseases and its different complications. The prevalence of hypertension in Bangladesh has been increasing. However, there are very limited studies that have evaluated the impact of health education and awareness development in mitigating the burden of hypertension and its complications in Bangladesh.ObjectiveThis study aims to increase awareness, enhance knowledge, and change lifestyle behaviors through health education and the use of mobile health (mHealth) technology among individuals with hypertension living in a rural community of Bangladesh.MethodsA randomized controlled trial is underway in a Mirzapur subdistrict of Bangladesh. This trial compares two groups of individuals with hypertension: The comparison arm receives health education and the intervention arm receives health education and a periodic mobile phone–based text message intervention. The trial duration is 5 months. The primary end point is participants’ actual behavior changes brought about by increased awareness and knowledge.ResultsEnrollment of participants started in August 2018, and collection of follow-up data was completed at the end of July 2019. A total of 420 participants volunteered to participate, and among them, 209 and 211 were randomly allocated to the intervention group and the control group, respectively. Among them, the ratio of males/females was 12.0/88.0 in the intervention group and 16.1/83.9 in the control group. Data cleaning and analyses have been completed and the results have been submitted for publication.ConclusionsPeriodic short education using mHealth technology in addition to face-to-face health education may be an effective method for increasing awareness and knowledge about behavioral changes and maintaining healthy lifestyle behaviors.Trial RegistrationBangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104, https://clinicaltrials.gov/ct2/show/NCT03614104; University hospital Medical Information Network (UMIN) R000033736, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_his_list.cgi?recptno=R000033736International Registered Report Identifier (IRRID)DERR1-10.2196/15523

American Indian chronic Renal insufficiency cohort study (AI-CRIC study)

BackgroundChronic kidney disease (CKD) is an increasing epidemic globally that is associated with adverse health outcomes including end stage kidney disease (ESKD), cardiovascular disease (CVD), and death. American Indians (AIs) have a higher prevalence of CKD than most other racial/ethnic groups, due in part to a high prevalence of type 2 diabetes. Other genetic and environmental factors not yet identified may also contribute to the disproportionate burden of CKD in AIs.MethodWe will establish 3 clinical centers to recruit AIs from the Southwest United States (US) to expand the Chronic Renal Insufficiency Cohort (CRIC) study. We will follow the current CRIC protocol for kidney and cardiovascular measures and outcomes, which include ambulatory monitoring of kidney function and the use of mobile health technologies for CVD sub-phenotyping, and compare the outcomes in AIs with those in other racial/ethnic groups in CRIC.DiscussionAI-CRIC will identify the role of various risk factors for rapid loss of kidney function among AIs of the Southwest US. In addition, to better understand the natural history of CKD and CVD in this high-risk population, we will identify unique risk factors for CKD and CVD progression in AIs. We will also compare event rates and risk factors for kidney and cardiovascular events in AIs with the other populations represented in CRIC.

Use of mobile health technologies for postoperative care in paediatric surgery: A systematic review

Introduction Mobile health (mHealth) is the use of mobile communication devices such as smartphones, wireless patient monitoring devices and tablet computers to deliver health services. Paediatric surgery patient care could potentially benefit from these technologies. This systematic review summarises the current literature on the use of mHealth for postoperative care after children’s surgery. Methods Seven databases were searched by a senior medical librarian. Studies were included if they reported the use of mHealth systems for postoperative care for children <18 years old. Data extraction and risk of bias assessment were performed in duplicate. Results A total of 18 studies were included after screening. mHealth use was varied and included appointment or medication reminders, postoperative monitoring and postoperative instruction delivery. mHealth systems included texting systems and mobile applications, and were implemented for a wide range of surgical conditions and countries. Discussion Studies showed that mHealth systems can increase the postoperative follow-up appointment attendance rate (p < 0.001), decrease the rate of postoperative complications and returns to the emergency department and reliably monitor postoperative pain. mHealth systems were generally appreciated by patients. Most non-randomised and randomised studies had many methodological problems, including lack of appropriate control groups, lack of blinding and a tendency to devote more time to the care of the intervention group. mHealth systems have the potential to improve postoperative care, but the lack of high-quality research evaluating their impact calls for further studies exploring evidence-based mHealth implementation.

Nurse-Led Education and Engagement for Diabetes Care in Sub-Saharan Africa: Protocol for a Mixed Methods Study.

BackgroundAs the impact of diabetes grows steeply in sub-Saharan Africa, improvement of the control and treatment of diabetes is a goal that health care systems in sub-Saharan Africa must achieve in the near future. Sub-Saharan Africa faces a number of challenges in addressing the increasing effects of diabetes. One important factor is the shortage of adequately trained health care workers. Diabetes management in sub-Saharan Africa would benefit from innovative approaches that are founded upon solid theoretical constructs, built upon existing human resources and infrastructure, and culturally tailored to the priorities and needs of the local population. Existing resources, such as mobile phones and task-shifting strategies, may be used to assist individuals with glycemic self-management and to facilitate management of additional day-to-day clinical responsibilities.ObjectiveThe objective of the Nurse-Led Education and Engagement Study for Diabetes Care (NEEDS) mixed-methods protocol is to develop a practical, collaborative, effective, and sustainable program for diabetes prevention and management specifically for patients with type 2 diabetes mellitus in sub-Saharan Africa. The protocol aims to improve access to care through task-shifting strategies and the use of mobile health technology.MethodsThis study was designed using a convergent parallel mixed-methods approach that consisted of surveys, key informant interviews, focus group discussions, and focused ethnography. Novel approaches, such as task-shifting strategies and the use of mobile technology, were implemented for type 2 diabetes mellitus health care in sub-Saharan Africa—currently an under-researched area.ResultsData collection began in February 2018, after ethics approval, at the Kwame Nkrumah University of Science and Technology. As of May 2020, participant surveys have been completed (N=100), key informant interviews (n=7) have been completed, and focus groups (5 focus groups; patients, n=18; caregivers, n=6; community leaders, n=2; and faith leaders, n=3) as well as focused ethnographic field observations have been completed. All audio recordings have been transcribed and transcripts of sessions recorded in Twi have been translated to English. Data analysis is currently underway and anticipated completion is in the spring of 2020. Following data analysis, investigators plan to publish study findings.ConclusionsInsights from this study will inform the preliminary development of a feasible and effective nurse-led education and engagement mobile health intervention that has the potential to reduce diabetes-related morbidity, mortality, and burden in sub-Saharan Africa.International Registered Report Identifier (IRRID)DERR1-10.2196/15408

Perception of male college students of Delhi University regarding the use of mobile health technology as a health promotion tool in India

Background: Mobile health (mHealth) is a term used for the practice of medicine and public health supported by mobile devices. The mHealth field has emerged as a sub-segment of the eHealth which is the use of information and communication technology for health services. Majority of students own mobile phones and spend several hours per day on mobile phones plus there was an increasing consumer demand for mHealth in India. This ubiquitous presence of mobile phones makes it easier to use them as a health promotion tool.Methods: A cross sectional study was conducted between November 2013 and August 2014 among 274 male college students of Delhi University who were the participants in a randomized intervention trial evaluating the use of mobile text messaging in reducing the lifestyle risk factors and asked about their opinion regarding the mobile health approach.Results: Most of the respondents were aged 17 to 22 years (72%), pursuing science stream of education (68%), with fewer hostellers (36%) than day scholars (64%). Majority of the study participants (&gt;90%) were satisfied with the mobile health messaging approach and most of the students (96%) felt mHealth technology could be a useful health promotion tool in India.Conclusions: The current study shows that majority of the study participants were satisfied in receiving health promotional text messages as a part of mobile health approach and felt that this mHealth technology could be a useful health promotion tool in India. This study shows cost-effective, client-driven and universally available mobile technology can be used as a tool for health promotion.

Food for Thought: A Qualitative Evaluation of Caregiver Preferences for Food Insecurity Screening and Resource Referral.

Although there is growing interest in screening for food insecurity (FI) in the clinical setting, little research exists describing the effect of screening practices on caregiver comfort and willingness to disclose social risk, or what factors affect eventual engagement with food resources. In this qualitative study, we conducted 40 semistructured interviews with caregivers of pediatric patients who reported FI in the emergency department of an urban, freestanding children's hospital. All interviews were digitally recorded and transcribed. We used content analysis with constant comparison to code interviews inductively and identified emerging themes through an iterative process. Three primary themes emerged as factors affecting caregiver comfort in FI screening and engagement with resources: perceived negative repercussions associated with screening, perception of need, and effective connection with food resources. While most caregivers reported comfort with FI screening, intentional steps to provide anonymity and reduce stigma in the screening process were important in facilitating disclosure of social need. Engagement with resources was influenced by caregiver prioritization of food access within a milieu of life stressors, and the perception of personal need relative to their peers. Furthermore, caregivers suggested practices to facilitate effective connection with food resources such as use of mobile health technology, geographically based resources, and personalized connections. This study demonstrates the importance of screening methods that reduce judgment and preserves caregiver privacy, referring families to resources that are geographically accessible, and developing creative strategies that enhance families' connection to resources, such as with use of mobile technology.

Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users.

BackgroundInjury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan.ObjectiveThis study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users.MethodsA cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment.ResultsA total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6% (338/361) of participants had no experience using mHealth technology for wound care.ConclusionsOur study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes.

Rationalizing personal health management (PHM) policy: Identifying health IT use patterns via observations of daily living (ODLs) data

ObjectivesManaging personal health information is mainly dependent upon individual users’ adoption and use of new health technology. Despite the increasing popularity of mobile health apps, recent endeavors of self-health management have been somewhat limited to fitness management whose apps have selective features and capabilities. Under this context, it raises a question as to whether health consumers are capable of adopting and utilizing mobile health apps with varying features and capabilities in order to manage both medical and fitness health information. MethodsBorrowing from a theoretical lens of observations of daily living (ODLs), the authors posit that if individual health consumers can record their daily activities with both health and non-health related mobile IT, such self-tracking information can then serve as an evaluation tool for measuring their future capabilities of new health IT adoption. To explore the phenomenon, we administered an online survey to collect technology-related ODL data from 226 international health consumers with known ODL survey items. ResultsBy applying confirmatory factor analysis and K-means cluster analysis, we found health consumers’ use of social and finance-related technology are closely linked to the use of mobile health technology in their daily living. Moreover, health consumers who actively use all three technologies (i.e., social, financial and health technologies) tend to have affinitive perceptions toward health management outcomes. ConclusionThe findings of this study can inform health policymakers to vie for more effective mobile health technology in rationalizing personal health management (PHM) policy.

Mental Health Apps in China: Analysis and Quality Assessment.

BackgroundMental disorders have been a great burden on health care systems, affecting the quality of life of millions of people worldwide. Developing countries, including China, suffer from the double burden of both the increasing mental health issues in population and the deficiency in mental health care resources. The use of mobile health technologies, especially for mobile phone apps, can be a possible solution.ObjectiveThis review aimed to describe the features and assess the quality of mental health apps in major mobile phone app markets in China and further discuss the priorities for mental health app development.MethodsKeywords including psychology, psychological health, psychological hygiene, psychological health service(s), mental, mental health, mental hygiene, mental health service(s), depression, and anxiety were searched in Chinese in 3 Android app markets (Baidu Mobile Assistant, Tencent MyApp, and 360 Mobile Assistant) and iOS App Store independently. Mental health apps were then selected according to established criteria for in-depth analysis and quality assessment by the Mobile App Rating Scale.ResultsIn total, 63 of 997 mental health apps were analyzed in depth, of which 78% (49/63) were developed by commercial entities for general population, 17% (11/63) were for patients or clients of specialized psychiatric hospitals or counseling agencies, 3% (2/63) were by government or local Centers for Disease Control and Prevention for general information, and 2% (1/63) for students of a university. Major built-in features of the apps included counseling services, mental health education, and self-assessment of mental health status by validated self-rating scales. The overall quality score of the MH apps was acceptable.ConclusionsMental health apps are emerging in the area of mobile health in China. Popular mental health apps usually provide a synthetic platform organizing resources of information, knowledge, counseling services, self-tests, and management for the general population with mental health-related inquiries. The quality of the apps was rated as acceptable on average, suggesting some space for improvement. Official guidelines and regulations are urgently required for the field in the future.

Constructing an assessment framework for the quality of asthma smartphone applications

BackgroundEnhancing the self-management capability of asthma patients can improve their level of asthma control. Although the use of mobile health technology among asthmatics to facilitate self-management has become a growing area of research, studies of mobile health applications (apps), especially for evaluating indicators of asthma apps, are deficient in scope. This study aimed to develop a reliable framework to assess asthma apps (i.e., content and behavior change strategies) using the Delphi survey technique.MethodsAn initial list of quality rating criteria for asthma apps was derived from reviewing the literature and experts in the fields of respiratory disease and nursing informatics rated the items on the list in three rounds. The weights of items were determined employing an analytic hierarchy process (AHP).ResultsSixty-two items were retained within 10 domains. Consensus was reached on 32 items concerning asthma self-management education, 25 items concerning behavioral change strategies, and five items concerning principles for app design. There was moderate agreement among participants across all items in round three. The weights of the dimensions, sub-dimensions, and items ranged from 0.049 to 0.203, 0.138 to 1.000, and 0.064 to 1.000, respectively. All random consistency ratio values were less than 0.1.ConclusionsAsthma self-management education and strategies are essential parts to support self-management for patients. This analysis provides evidence of evaluating criteria for apps targeting chronic and common diseases.

Feasibility of Atrial Fibrillation Screening With Mobile Health Technologies at Pharmacies.

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Thus, the aim of our study was to evaluate the smartphone-based electrocardiogram (ECG) recordings aimed at AF screening at Polish pharmacies. Prospective AF screening among patients aged ≥65 years was conducted at 10 pharmacies using Kardia Mobile with a dedicated application (Kardia app). Prior AF was a study exclusion criterion. CHA2DS2-VASc score (congestive heart failure, hypertension, age, diabetes mellitus, previous stroke/transient ischemic attack, female sex, and vascular disease) has been collected from every patient. A single-lead ECG has been acquired by the placement of fingers from each hand on the pads. Kardia app diagnosis has been evaluated by the cardiologist. A total of 525 ECGs were performed. Kardia app diagnosis was provided in 490 cases. In 437 (89.18%) cases, it was "normal" rhythm, in 17 (3.47%) recordings "possible AF," in 23 (4.69%) ECGs "unreadable," and in 13 (2.65%) "unclassified". After the cardiologist reevaluation, the new AF was identified in 7 (1.33%) patients. Sensitivity and specificity of Kardia app in detecting AF was 100% (95% confidence interval [CI]: 71.5%-100%) and 98.7% (95% CI: 97.3%-99.5%), respectively. The positive predictive value was 64.7% (95% CI: 38.3%-85.7%) and the negative predictive value was 100% (95% CI: 99.2%-100%). CHA2DS2-VASc score was 2.14 ± 0.69 for those with new AF and 3.33 ± 1.26 in the non-AF group. Kardia app is capable of fast screening and detecting AF with high sensitivity and specificity. The possible diagnosis of AF deserves additional cardiological evaluation. The results obtained in patients with low CHA2DS2-VASc score and "silent" AF confirm the importance of routine AF screening. Cardiovascular screening with the use of mobile health technology is feasible at pharmacies.

Overcoming Language Barriers Using an Information Video on Spinal Anesthesia for Cesarean Delivery: Implementation and Impact on Maternal Anxiety

It is unknown whether the implementation of an information video on spinal anesthesia for cesarean delivery, narrated in a patient's first language, reduces anxiety, increases satisfaction, and improves doctor-patient communication if there is a language barrier. In South Africa, most doctors speak English, and patients speak Xhosa, with educational and cultural disparities existing in many doctor-patient interactions. One hundred seventy-five Xhosa patients scheduled for elective cesarean delivery were enrolled in the study. The first 92 patients received "usual care" verbal explanations of the spinal anesthesia procedure (control group); the next 83 patients watched a spinal anesthesia information video (intervention group), narrated in Xhosa. Videos were displayed using smartphones. Maternal anxiety was assessed before and after spinal explanation, using a Numerical Visual Analog Anxiety Scale (NVAAS). A difference in postexplanation NVAAS score of 1.5 points between intervention and control groups was regarded as clinically significant. Patient satisfaction was assessed using the Maternal Satisfaction Scale for Cesarean Section (MSSCS). The mean (standard deviation [SD]) age (31.5 years [5.2 years] and 32.1 years [5.4 years]) and preexplanation NVAAS score (4.2 [3.2] and 4.0 [3.0]) of the intervention and control groups, respectively, showed no difference at baseline. The mean (SD) postexplanation decrease in NVAAS score was greater in the intervention than in the control group (1.6 [3.5] vs 0.7 [2.3]; P = .046; unadjusted mean difference, 0.9 points [95% confidence interval {CI}, 0.02-1.8]). A linear regression model for the postexplanation NVAAS score showed that the intervention effect was significantly associated with the preexplanation score (P = .002), adjusted for age and English fluency. Patients with preexplanation NVAAS scores ≥5 showed a statistically significant intervention effect. There was no significant difference in patient satisfaction between the intervention and control groups. The smartphone was an accessible and convenient display medium for the video. Ninety-nine percent of patients exposed to the intervention would recommend watching the video before the procedure. In this pilot study, lower NVAAS scores were observed in anxious patients, when a Xhosa information video was used to ameliorate challenges posed by a doctor-patient language barrier. It is easily implemented and demonstrates a novel use of mobile health technology. The study provides baseline data to inform sample size calculations for future studies. A high level of patient recommendation for the video suggests that this is an agreeable practice.

A Systematic Review of Mobile Phone Interventions (SMS/IVR/Calls) to Improve Adherence and Retention to Antiretroviral Treatment in Low-and Middle-Income Countries.

The use of mobile health technologies (mHealth) to ameliorate HIV care has considerably risen in low- and middle-income countries (LMICs) since 2010. Yet, the discrepancies in the results of accompanying studies warrant an updated and systematic consolidation of all available evidence. We report a systematic review of studies testing whether text/image messages, interactive voice response reminders, or calls promote adherence and retention to antiretroviral therapy (ART) in LMICs. We systematically compiled studies published in English until June 2018 from PubMed/Medline, Web of Science, WHO database, ProQuest Dissertations and Theses, and manual search. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 and used frequency analysis to assess reported findings. In total, we compiled 35 published articles: 27 completed studies and 8 protocols. Among the main 27 studies, 17 examine adherence, 5 retention, and 5 both measures. Results indicate that 56% report positive and statistically significantly impacts of mHealth on primary outcomes, the remaining 44% report insignificant results. While 41% of studies found a positive and significant effect for adherence, only 12% improved retention. The evidence shows ambiguous results (with high variability) about the effectiveness of mobile phone-assisted mHealth interventions to boost adherence and retention to ART. The literature also points to short follow-up periods, small samples, and limited geographical coverage. Hence, future research should focus on evaluating longer interventions with more patients spread across wider areas to address whether mHealth can be effectively used in LMICs.

The Nurse LEADership for Implementing Technologies - Mobile Health Model (Nurse LEAD-IT - mHealth).

Purpose of the paper: To describe the development of a testable conceptual model that examines the relationship between implementation leadership characteristics and nurses' use of mobile health technologies (mHealth) as part of their nursing practice. The model is currently being tested in the pan-Canadian context. Primary concepts and issues to be addressed: The 2014 and 2017 Canada-wide surveys of nurses' use of technologies reported seemingly low rates of mobile technology use: 3% in 2014 and 7% in 2017(Canada Health Infoway 2014, 2017). The agenda to increase the use of mHealth by nurses persists, though understanding of nurses' use of mHealth remains underexplored. Nurses' usage of mHealth has primarily been examined using technology acceptance models, which are limited in their ability to account for unique aspects of nursing practice. The Nurse LEADership for Implementing Technologies (Nurse LEAD-IT) - mHealth (Nurse LEAD-IT - mHealth) model draws concepts from implementation science, computer science, organizational behaviour, information science and nursing to develop a testable conceptual model. The model facilitates examination of the relationship between nurses' use of mHealth and leaders' implementation characteristics (proactivity, knowledge, support and perseverance) and technology acceptance (perceived usefulness and perceived ease of use), while controlling for factors that influence technology use (previous experience and voluntariness of use) and nurses' acceptance of evidence-based practice (age, gender and education). Significance and/or implications for nurse leaders: The Nurse LEAD-IT model can aid in delineating the pragmatic skills and knowledge necessary for nursing leaders to successfully implement mHealth initiatives in nursing practice settings. Use of mHealth in Canadian nursing settings remain in the emergent stages; results from the testing of this conceptual model will be timely and important in informing current and future strategies by nursing leaders to best situate the development and implementation of mHealth for successful uptake and usage in nursing.

The Development of a Diabetes Application for Patients With Poorly Controlled Type 2 Diabetes Mellitus.

The prevalence of patients with diabetes mellitus has increased in recent years. This has resulted in increased demand for face-to-face diabetes education by diabetes nurse clinicians. The use of mobile-health technologies in diabetes education is an innovative way of learning and has the potential to engage patients and influence positive health behaviors, including meeting desired goals and diabetes-related outcomes. The aim of the study was to develop and test the usability and feasibility of an empirical diabetes application for patients with type 2 diabetes mellitus. The mobile-based, gamified Diabetes Application was developed based on a full systems development life-cycle framework. Eight patients with poorly controlled type 2 diabetes mellitus completed a pilot study that consisted of a postapplication survey to assess the usability and feasibility of the diabetes application. The findings affirmed the usefulness and feasibility of the diabetes application for patients with diabetes mellitus. It increased awareness, enriched knowledge, promoted user engagement, motivated positive behaviors, and affirmed patient belief in diabetes self-management. This article discusses the development and evaluation of the diabetes application, including modifications made based on the results of the pilot study.

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study.

BackgroundHeart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use.ObjectiveThis study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease.MethodsWe performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management.ResultsWe enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems.ConclusionsmHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.

Using Mobile Text and Media to Complement Teaching in a Facial Reconstruction Training Module in Haiti

(1) To describe electronic communication between global surgeons and trainees in a low-middle income country (LMIC) and to gauge appeal of the WhatsApp platform (2) To introduce a novel intensive ear reconstruction teaching module for surgical capacity building using simulation in a LMIC. Prospective cohort study. University-based medical center in Haiti. Eleven otolaryngology trainees and faculty in Haiti. Three months prior to on-site arrival, a WhatsApp Messenger group was created for information-sharing and distribution of teaching materials. A surgical curriculum was created to incorporate didactics, cartilage framework simulation, and live surgery. During the intensive on-site week, WhatsApp was used to distribute materials and to recap learning points from each case, with pre- and postoperative surgical photographs circulated. Postmodule written, oral, and practical testing was conducted on the final day, and a postmodule survey was administered a month later. Post-tests scores were significantly improved from pretests scores. Initial scores on the written, oral, and practical tests averaged 24.6%. Postmodule scores averaged 86.9% (p < 0.001). Participants rated the use of WhatsApp to be highly important to their learning and requested further use of mobile health technology. WhatsApp Messenger technology complemented a reconstructive surgery education module in a LMIC. WhatsApp provides opportunities for premodule patient screening, real-time discussion, and postmodule review. Its usage was well-received by Haitian otolaryngology trainees and faculty. Our results suggest that the combination of didactic teaching, simulated surgery, and live surgery resulted in successful transfer of both skills and knowledge.

Patient's Perspective on Using Mobile Technology as an Aid to Psychotherapy

This piece draws from a patient’s perspective on his treatment using mobile health technology in conjunction with weekly group and individual psychotherapy. Research has demonstrated that using telepsychology as part of mental health treatment shows great promise to help advance the field of psychotherapy. Using mobile health technology such as mobile phone apps allows for collaboration with patients and their providers. This was written after several consultations with an individual diagnosed with borderline personality disorder who prefers to remain anonymous but was forthcoming with information regarding his use of mobile health technology in order to benefit the field of mental telepsychology.