@Article{info:doi/10.2196/19359,
author="Abeler, Johannes
and B{\"a}cker, Matthias
and Buermeyer, Ulf
and Zillessen, Hannah",
title="COVID-19 Contact Tracing and Data Protection Can Go Together",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e19359",
keywords="COVID-19",
keywords="app",
keywords="contact tracing",
keywords="proximity tracing",
keywords="privacy",
keywords="data protection",
keywords="Bluetooth",
doi="10.2196/19359",
url="https://mhealth.jmir.org/2020/4/e19359/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32294052"
}


@Article{info:doi/10.2196/14897,
author="Miralles, Ignacio
and Granell, Carlos
and D{\'i}az-Sanahuja, Laura
and Van Woensel, William
and Bret{\'o}n-L{\'o}pez, Juana
and Mira, Adriana
and Castilla, Diana
and Casteleyn, Sven",
title="Smartphone Apps for the Treatment of Mental Disorders: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="2",
volume="8",
number="4",
pages="e14897",
keywords="mental health",
keywords="mental disorders",
keywords="treatment",
keywords="intervention",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
keywords="mobile apps",
keywords="systematic review",
abstract="Background: Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective: This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results: We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6\%) and anxiety disorders (18/158, 11.4\%). Of the total, 72.7\% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3\%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8\%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions: There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders. ",
doi="10.2196/14897",
url="https://mhealth.jmir.org/2020/4/e14897",
url="http://www.ncbi.nlm.nih.gov/pubmed/32238332"
}


@Article{info:doi/10.2196/15549,
author="Yang, Yang
and Chen, Helen
and Qazi, Hammad
and Morita, P. Plinio",
title="Intervention and Evaluation of Mobile Health Technologies in Management of Patients Undergoing Chronic Dialysis: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="3",
volume="8",
number="4",
pages="e15549",
keywords="mobile health",
keywords="renal dialysis",
keywords="health technology assessment",
keywords="patient outcome assessment",
abstract="Background: Studies have shown the effectiveness and user acceptance of mobile health (mHealth) technologies in managing patients with chronic kidney disease (CKD). However, incorporating mHealth technology into the standard care of patients with CKD still faces many challenges. To our knowledge, there are no reviews on mHealth interventions and their assessments concerning the management of patients undergoing dialysis. Objective: This study provided a scoping review on existing apps and interventions of mHealth technologies in adult patients undergoing chronic dialysis and identified the gaps in patient outcome assessment of mHealth technologies in the literature. Methods: We systematically searched PubMed (MEDLINE), Scopus, and the Cumulative Index to Nursing and Allied Health Literature databases, as well as gray literature sources. Two keywords, ``mHealth'' and ``dialysis,'' were combined to address the main concepts of the objectives. Inclusion criteria were as follows: (1) mHealth interventions, which are on a smartphone, tablet, or web-based portals that are accessible through mobile devices; and (2) adult patients (age ?18 years) on chronic dialysis. Only English papers published from January 2008 to October 2018 were included. Studies with mHealth apps for other chronic conditions, based on e-consultation or videoconferencing, non-English publications, and review papers were excluded. Results: Of the 1054 papers identified, 22 met the inclusion and exclusion criteria. Most studies (n=20) were randomized controlled trials and cohort studies. These studies were carried out in 7 countries. The main purposes of these mHealth interventions were as follows: nutrition or dietary self-monitoring (n=7), remote biometric monitoring (n=7), web-based portal (n=4), self-monitoring of in-session dialysis-specific information (n=3), and self-monitoring of lifestyle or behavioral change (n=1). The outcomes of the 22 included studies were organized into five categories: (1) patient satisfaction and acceptance, (2) clinical effectiveness, (3) economic assessment, (4) health-related quality of life, and (5) impact on lifestyle or behavioral change. The mHealth interventions showed neutral to positive results in chronic dialysis patient management, reporting no to significant improvement of dialysis-specific measurements and some components of the overall quality of life assessment. Evaluation of these mHealth interventions consistently demonstrated evidence in patients' satisfaction, high level of user acceptance, and reduced use of health resources and cost savings to health care services. However, there is a lack of studies evaluating safety, organizational, sociocultural, ethical, and legal aspects of mHealth technologies. Furthermore, a comprehensive cost-effectiveness and cost-benefit analysis of adopting mHealth technologies was not found in the literature. Conclusions: The gaps identified in this study will inform the creation of health policies and organizational support for mHealth implementation in patients undergoing dialysis. The findings of this review will inform the development of a comprehensive service model that utilizes mHealth technologies for home monitoring and self-management of patients undergoing chronic dialysis. ",
doi="10.2196/15549",
url="https://mhealth.jmir.org/2020/4/e15549",
url="http://www.ncbi.nlm.nih.gov/pubmed/32242823"
}


@Article{info:doi/10.2196/15446,
author="Cheikh-Moussa, Kamila
and Mira, Joaquin Jose
and Orozco-Beltran, Domingo",
title="Improving Engagement Among Patients With Chronic Cardiometabolic Conditions Using mHealth: Critical Review of Reviews",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="8",
volume="8",
number="4",
pages="e15446",
keywords="mHealth",
keywords="patients",
keywords="telemedicine",
keywords="engagement",
keywords="chronic disease",
keywords="cardiovascular disease",
keywords="diabetes",
keywords="obesity",
abstract="Background: The burden imposed by cardiometabolic diseases remains a principal health care system concern. Integration of mobile health (mHealth) interventions is helpful for telemonitoring of these patients, which enables patients to be more active and take part in their treatment, while being more conscious and gaining more control over the outcomes. However, little is known about the degree to which users engage, and the extent to which this interaction matches the usage pattern for which mHealth interventions were designed. Objective: The aim of this study was to describe the characteristics and results of studies on mHealth solutions that measured the effects of interventions with patient engagement in the context of chronic cardiometabolic diseases. Methods: A critical review of systematic reviews was conducted to recover data on interventions focused on the engagement of patients with chronic cardiometabolic diseases using mHealth technologies. Articles (from January 1, 2010) were searched in the Medlars Online International Literature Medline (Medline/Pubmed), Embase, Cochrane Library, PsycINFO, and Scielo databases. Only studies that quantified a measure of engagement by patients with cardiometabolic disease were included for analysis. The Critical Appraisal Skills Programme (CASP) was used to determine included studies considering the quality of the data provided. The Scottish Intercollegiate Guidelines Network (SIGN) checklist was used to assess the quality of the evidence according to the methodology used in the studies reviewed. Engagement was defined as the level of patient implication or participation in self-care interventions. Engagement measures included number of logs to the website or platform, frequency of usage, number of messages exchanged, and number of tasks completed. Results: Initially, 638 papers were retrieved after applying the inclusion and exclusion criteria. Finally, only three systematic reviews measuring engagement were included in the analysis. No reviews applying a meta-analysis approach were found. The three review articles described the results of 10 clinical trials and feasibility studies that quantified engagement and met the inclusion criteria assessed through CASP. The sample size varied between 6 and 270 individuals, who were predominantly men. Cardiac disease was the principal target in the comparison of traditional and mHealth interventions for engagement improvement. The level of patient engagement with mHealth technologies varied between 50\% and 97\%, and technologies incorporating smartphones with a reminder function resulted in the highest level of engagement. Conclusions: mHealth interventions are an effective solution for improving engagement of patients with chronic cardiometabolic diseases. However, there is a need for advanced analysis and higher-quality studies focused on long-term engagement with specific interventions. The use of smartphones with a single app that includes a reminder function appears to result in  better improvement in active participation, leading to higher engagement among patients with cardiometabolic diseases. ",
doi="10.2196/15446",
url="https://mhealth.jmir.org/2020/4/e15446",
url="http://www.ncbi.nlm.nih.gov/pubmed/32267239"
}


@Article{info:doi/10.2196/16055,
author="Romare, Charlotte
and Sk{\"a}r, Lisa",
title="Smart Glasses for Caring Situations in Complex Care Environments: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e16055",
keywords="anesthesia department",
keywords="critical care",
keywords="intensive care units",
keywords="scoping review",
keywords="smart glasses",
abstract="Background: Anesthesia departments and intensive care units represent two advanced, high-tech, and complex care environments. Health care in those environments involves different types of technology to provide safe, high-quality care. Smart glasses have previously been used in different health care settings and have been suggested to assist health care professionals in numerous areas. However, smart glasses in the complex contexts of anesthesia care and intensive care are new and innovative. An overview of existing research related to these contexts is needed before implementing smart glasses into complex care environments. Objective: The aim of this study was to highlight potential benefits and limitations with health care professionals' use of smart glasses in situations occurring in complex care environments. Methods: A scoping review with six steps was conducted to fulfill the objective. Database searches were conducted in PubMed and Scopus; original articles about health care professionals' use of smart glasses in complex care environments and/or situations occurring in those environments were included. The searches yielded a total of 20 articles that were included in the review. Results: Three categories were created during the qualitative content analysis: (1) smart glasses as a versatile tool that offers opportunities and challenges, (2) smart glasses entail positive and negative impacts on health care professionals, and (3) smart glasses' quality of use provides facilities and leaves room for improvement. Smart glasses were found to be both a helpful tool and a hindrance in caring situations that might occur in complex care environments. This review provides an increased understanding about different situations where smart glasses might be used by health care professionals in clinical practice in anesthesia care and intensive care; however, research about smart glasses in clinical complex care environments is limited. Conclusions: Thoughtful implementation and improved hardware are needed to meet health care professionals' needs. New technology brings challenges; more research is required to elucidate how smart glasses affect patient safety, health care professionals, and quality of care in complex care environments. ",
doi="10.2196/16055",
url="https://mhealth.jmir.org/2020/4/e16055/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310144"
}


@Article{info:doi/10.2196/16085,
author="Baker, Jess
and Kohlhoff, Jane
and Onobrakpor, Se-Inyenede
and Woolfenden, Sue
and Smith, Rebecca
and Knebel, Constanze
and Eapen, Valsamma",
title="The Acceptability and Effectiveness of Web-Based Developmental Surveillance Programs: Rapid Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="23",
volume="8",
number="4",
pages="e16085",
keywords="public health surveillance",
keywords="mass screening",
keywords="developmental disabilities",
keywords="neurodevelopmental disorders",
keywords="review literature as topic",
keywords="health care disparities",
abstract="Background: Web-based developmental surveillance programs may be an innovative solution to improving the early detection of childhood developmental difficulties, especially within disadvantaged populations. Objective: This review aimed to identify the acceptability and effectiveness of web-based developmental surveillance programs for children aged 0 to 6 years. Methods: A total of 6 databases and gray literature were searched using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses--informed protocol. Data extraction included variables related to health equity. Results: In total, 20 studies were identified. Most papers implemented web-based versions of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up screener for autism spectrum disorder or Parent Evaluation of Developmental Status screeners for broad developmental delay. Caregivers and practitioners indicated a preference for web-based screeners, primarily for user-friendliness, improved follow-up accuracy, time, and training efficiencies. Conclusions: Although evidence is limited as to the necessity of web- versus face-to-face--based developmental screening, there are clear efficiencies in its use. Trial Registration: PROSPERO CRD42019127894; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=127894 ",
doi="10.2196/16085",
url="https://mhealth.jmir.org/2020/4/e16085/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32324149"
}


@Article{info:doi/10.2196/15400,
author="Wang, Youfa
and Min, Jungwon
and Khuri, Jacob
and Xue, Hong
and Xie, Bo
and A Kaminsky, Leonard
and J Cheskin, Lawrence",
title="Effectiveness of Mobile Health Interventions on Diabetes and Obesity Treatment and Management: Systematic Review of Systematic Reviews",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="28",
volume="8",
number="4",
pages="e15400",
keywords="diabetes mellitus",
keywords="obesity",
keywords="overweight",
keywords="mHealth",
keywords="mobile app",
keywords="telemedicine",
abstract="Background: Diabetes and obesity have become epidemics and costly chronic diseases. The impact of mobile health (mHealth) interventions on diabetes and obesity management is promising; however, studies showed varied results in the efficacy of mHealth interventions. Objective: This review aimed to evaluate the effectiveness of mHealth interventions for diabetes and obesity treatment and management on the basis of evidence reported in reviews and meta-analyses and to provide recommendations for future interventions and research. Methods: We systematically searched the PubMed, IEEE Xplore Digital Library, and Cochrane databases for systematic reviews published between January 1, 2005, and October 1, 2019. We analyzed 17 reviews, which assessed 55,604 original intervention studies, that met the inclusion criteria. Of those, 6 reviews were included in our meta-analysis. Results: The reviews primarily focused on the use of mobile apps and text messaging and the self-monitoring and management function of mHealth programs in patients with diabetes and obesity. All reviews examined changes in biomarkers, and some reviews assessed treatment adherence (n=7) and health behaviors (n=9). Although the effectiveness of mHealth interventions varied widely by study, all reviews concluded that mHealth was a feasible option and had the potential for improving patient health when compared with standard care, especially for glycemic control (?0.3\% to ?0.5\% greater reduction in hemoglobin A1c) and weight reduction (?1.0 kg to ?2.4 kg body weight). Overall, the existing 6 meta-analysis studies showed pooled favorable effects of these mHealth interventions (?0.79, 95\% CI ?1.17 to ?0.42; I2=90.5). Conclusions: mHealth interventions are promising, but there is limited evidence about their effectiveness in glycemic control and weight reduction. Future research to develop evidence-based mHealth strategies should use valid measures and rigorous study designs. To enhance the effectiveness of mHealth interventions, future studies are warranted for the optimal formats and the frequency of contacting patients, better tailoring of messages, and enhancing usability, which places a greater emphasis on maintaining effectiveness over time. ",
doi="10.2196/15400",
url="https://mhealth.jmir.org/2020/4/e15400/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343253"
}


@Article{info:doi/10.2196/12677,
author="Zhou, Xiaoping
and Zhao, Jichao
and Liang, Xun",
title="Cyberphysical Human Sexual Behavior Acquisition System (SeBA): Development and Implementation Study in China",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="3",
volume="8",
number="4",
pages="e12677",
keywords="cyberphysical system",
keywords="sexual behavior",
keywords="smart sex toys",
keywords="mobile social network",
abstract="Background: Sexual health is one of the principal components of human well-being. Traditional methods for observing human sexual behavior typically adopt manual intervention approaches (eg, interviews). However, the data obtained by such traditional approaches suffer from intrinsic bias and limited sample sizes. Sexual behavioral data that are more reflective of the actualsituation can be collected by equipping sex toys with sensors. Objective: To address the limitations of traditional human sexual behavior data observation methods, a novel cyberphysical system is proposed to capture natural human sexual behavior data in China at the nationwide level. Methods: A cyberphysical human sexual behavior acquisition system (SeBA) was designed and implemented. SeBA jointly utilizes state of the art information and communication technologies such as smart sex toys, smartphones, and mobile social networks. Smart sex toys enable objective collection of data on human sexual behavior, while the mobile social network provides the possibility of partnered sex in a cyberphysical manner. The objectives and function settings are discussed, and the overall framework of the system architecture is presented. Results: Operation and privacy policies are proposed and the technical solution of SeBA is described. The effectiveness of SeBA was verified based on analysis of users' human sexual behavior data collected from January 2016 to June 2017. A total of 103,424 solo sexual behaviors were recorded involving 13,047 users, and 61,007 partnered sexual behaviors from 7,140 users were observed. The proportions of males and females in the solo and partnered sex groups were fairly consistent with recent statistics on unmarried individuals in China. We also found that only a small portion of individuals provided information on at least one other attribute besides the required input of gender, such as age, height, location, job, sex preferences, purposes, and interests. Conclusions: To the best of our knowledge, this is the first study to analyze objective human sexual behavior data at the nationwide level. Although the data are restricted to China, this study can provide insight for further research on human sexual behavior based on the huge amount of data available from wireless smart sex toys worldwide. It is anticipated that findings from such objective big data analyses can help deepen our understanding of sexual behavior, as well as improve sexual health and sexual wellness. ",
doi="10.2196/12677",
url="https://mhealth.jmir.org/2020/4/e12677",
url="http://www.ncbi.nlm.nih.gov/pubmed/32271153"
}


@Article{info:doi/10.2196/15561,
author="Chow, I. Philip",
title="Developing Mental or Behavioral Health Mobile Apps for Pilot Studies by Leveraging Survey Platforms: A Do-it-Yourself Process",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e15561",
keywords="app",
keywords="mental health",
keywords="mHealth",
abstract="Background: Behavioral 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. Objective: This 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). Methods: This 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. Results: This 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. Conclusions: As 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. ",
doi="10.2196/15561",
url="https://mhealth.jmir.org/2020/4/e15561",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310143"
}


@Article{info:doi/10.2196/16507,
author="Bergquist, Ronny
and Vereijken, Beatrix
and Mellone, Sabato
and Corzani, Mattia
and Helbostad, L. Jorunn
and Taraldsen, Kristin",
title="App-based Self-administrable Clinical Tests of Physical Function: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="27",
volume="8",
number="4",
pages="e16507",
keywords="physical function",
keywords="mHealth app",
keywords="usability",
keywords="older people",
keywords="seniors",
abstract="Background: Objective measures of physical function in older adults are widely used to predict health outcomes such as disability, institutionalization, and mortality. App-based clinical tests allow users to assess their own physical function and have objective tracking of changes over time by use of their smartphones. Such tests can potentially guide interventions remotely and provide more detailed prognostic information about the participant's physical performance for the users, therapists, and other health care personnel. We developed 3 smartphone apps with instrumented versions of the Timed Up and Go (Self-TUG), tandem stance (Self-Tandem), and Five Times Sit-to-Stand (Self-STS) tests. Objective: This study aimed to test the usability of 3 smartphone app--based self-tests of physical function using an iterative design. Methods: The apps were tested in 3 iterations: the first (n=189) and second (n=134) in a lab setting and the third (n=20) in a separate home-based study. Participants were healthy adults between 60 and 80 years of age. Assessors observed while participants self-administered the tests without any guidance. Errors were recorded, and usability problems were defined. Problems were addressed in each subsequent iteration. Perceived usability in the home-based setting was assessed by use of the System Usability Scale, the User Experience Questionnaire, and semi-structured interviews. Results: In the first iteration, 7 usability problems were identified; 42 (42/189, 22.0\%) and 127 (127/189, 67.2\%) participants were able to correctly perform the Self-TUG and Self-Tandem, respectively. In the second iteration, errors caused by the problems identified in the first iteration were drastically reduced, and 108 (108/134, 83.1\%) and 106 (106/134, 79.1\%) of the participants correctly performed the Self-TUG and Self-Tandem, respectively. The first version of the Self-STS was also tested in this iteration, and 40 (40/134, 30.1\%) of the participants performed it correctly. For the third usability test, the 7 usability problems initially identified were further improved. Testing the apps in a home setting gave rise to some new usability problems, and for Self-TUG and Self-STS, the rates of correctly performed trials were slightly reduced from the second version, while for Self-Tandem, the rate increased. The mean System Usability Scale score was 77.63 points (SD 16.1 points), and 80-95\% of the participants reported the highest or second highest positive rating on all items in the User Experience Questionnaire. Conclusions: The study results suggest that the apps have the potential to be used to self-test physical function in seniors in a nonsupervised home-based setting. The participants reported a high degree of ease of use. Evaluating the usability in a home setting allowed us to identify new usability problems that could affect the validity of the tests. These usability problems are not easily found in the lab setting, indicating that, if possible, app usability should be evaluated in both settings. Before being made available to end users, the apps require further improvements and validation. ",
doi="10.2196/16507",
url="https://mhealth.jmir.org/2020/4/e16507/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32338616"
}


@Article{info:doi/10.2196/14543,
author="Liu, Ying-Chieh
and Wu, Sheng-Tang
and Lin, Shan-Ju
and Chen, Chien-Hung
and Lin, Yu-Sheng
and Chen, Hsin-Yun",
title="Usability of Food Size Aids in Mobile Dietary Reporting Apps for Young Adults: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e14543",
keywords="portion size measurement",
keywords="prototype",
keywords="user-centered design",
keywords="dietary reporting",
keywords="mobile health",
keywords="randomized controlled trial",
abstract="Background: Young adults are more likely to use self-managed dietary reporting apps. However, there is scant research examining the user experience of different measurement approaches for mobile dietary reporting apps when dealing with a wide variety of food shapes and container sizes. Objective: Field user experience testing was conducted under actual meal conditions to assess the accuracy, efficiency, and subjective reaction of three food portion measurement methods embedded in a developed mobile app. Key-in--based aid (KBA), commonly used in many current apps, relies on the user's ability to key in volumes or weights. Photo-based aid (PBA) extends traditional assessment methods, allowing users to scroll, observe, and select a reduced-size image from a set of options. Gesture-based aid (GBA) is a new experimental approach in which the user makes finger movements on the screen to roughly describe food portion boundaries accompanied by a background reference. Methods: A group of 124 young adults aged 19 to 26 years was recruited for a head-to-head randomized comparison and divided into 3 groups: a KBA (n=42) control group and PBA (n=41) and GBA (n=41) experimental groups. In total, 3 meals (ie, breakfast, lunch, and dinner) were served in a university cafeteria. Participants were provided with 25 dishes and beverages for selection, with a variety of food shapes and containers that reflect everyday life conditions. The accuracy of and time spent on realistic interaction during food portion estimation and the subjective reaction of each aid were recorded and analyzed. Results: Participants in the KBA group provided the highest accuracy in terms of hash brown weight (P=.004) and outperformed PBA or GBA for many soft drinks in cups. PBA had the best results for a cylindrical hot dog (P<.001), irregularly shaped pork chop (P<.001), and green tea beverage (660 mL; P<.001). GBA outperformed PBA for most drinks, and GBA outperformed KBA for some vegetables. The GBA group spent significantly more time assessing food items than the KBA and PBA groups. For each aid, the overall subjective reaction based on the score of the System Usability Scale was not significantly different. Conclusions: Experimental results show that each aid had some distinguishing advantages. In terms of user acceptance, participants considered all 3 aids to be usable. Furthermore, users' subjective opinions regarding measurement accuracy contradicted the empirical findings. Future work will consider the use of each aid based on food or container shape and integrate the various advantages of the 3 different aids for better results. Our findings on the use of portion size aids are based on realistic and diverse food items, providing a useful reference for future app improvement of an effective, evidence-based, and acceptable feature. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN36710750; http://www.controlled-trials.com/ISRCTN36710750. ",
doi="10.2196/14543",
url="https://mhealth.jmir.org/2020/4/e14543/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347805"
}


@Article{info:doi/10.2196/13536,
author="Steinman, Lesley
and Heang, Hen
and van Pelt, Maurits
and Ide, Nicole
and Cui, Haixia
and Rao, Mayuree
and LoGerfo, James
and Fitzpatrick, Annette",
title="Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="24",
volume="8",
number="4",
pages="e13536",
keywords="diabetes mellitus",
keywords="hypertension",
keywords="chronic disease",
keywords="noncommunicable diseases",
keywords="health educators",
keywords="mHealth",
keywords="qualitative",
keywords="disease management",
keywords="developing countries",
abstract="Background: In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo's database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. Objective: This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. Methods: We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. Results: We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor's consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. Conclusions: These mHealth messages are currently being tested in a cluster randomized controlled trial (\#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management. ",
doi="10.2196/13536",
url="https://mhealth.jmir.org/2020/4/e13536/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32329737"
}


@Article{info:doi/10.2196/17122,
author="Vasudevan, Lavanya
and Ostermann, Jan
and Moses, Marwerwe Sara
and Ngadaya, Esther
and Mfinanga, Godfrey Sayoki",
title="Patterns of Mobile Phone Ownership and Use Among Pregnant Women in Southern Tanzania: Cross-Sectional Survey",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="8",
volume="8",
number="4",
pages="e17122",
keywords="digital health",
keywords="mobile health",
keywords="pregnant women",
keywords="Tanzania",
abstract="Background: There is a paucity of subnational data on patterns of mobile phone ownership and use in Tanzania to inform the development of digital health interventions. Objective: The aim of this study is to assess patterns of mobile phone ownership and use in pregnant women to inform the feasibility and design of digital health interventions for promoting timely uptake of childhood vaccines in southern Tanzania. Methods: Between August and November 2017, pregnant women in their third trimester were enrolled at health facilities and from surrounding communities, and asked about their patterns of mobile phone ownership and use in an interviewer administered survey. Results: Of 406 women, only 3 had never used a phone. Most women (>98\%) could make and receive phone calls. Compared to urban women, rural women reported higher mobile phone use rates but were less likely to be sole owners of phones, and less likely to send or receive SMS, transact money, browse the internet, or use social media via mobile phones. Conclusions: The findings suggest high feasibility for digital health interventions delivered via mobile phones to pregnant women in southern Tanzania. The feasibility of smartphone-based interventions or strategies relying on the use of social media or the internet is limited. ",
doi="10.2196/17122",
url="https://mhealth.jmir.org/2020/4/e17122",
url="http://www.ncbi.nlm.nih.gov/pubmed/32267240"
}


@Article{info:doi/10.2196/14702,
author="Mazoteras-Pardo, Victoria
and Becerro-De-Bengoa-Vallejo, Ricardo
and Losa-Iglesias, Elena Marta
and L{\'o}pez-L{\'o}pez, Daniel
and Calvo-Lobo, C{\'e}sar
and Rodr{\'i}guez-Sanz, David
and Mart{\'i}nez-Jim{\'e}nez, Mar{\'i}a Eva
and Palomo-L{\'o}pez, Patricia",
title="An Automated Blood Pressure Display for Self-Measurement in Patients With Chronic Kidney Disease (iHealth Track): Device Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="2",
volume="8",
number="4",
pages="e14702",
keywords="iHealth Track",
keywords="validation",
keywords="blood pressure",
keywords="heart rate",
keywords="International Protocol",
abstract="Background: Hypertension is a global public health issue and is closely related to chronic kidney disorder (CKD). In people with CKD, strict monitoring of blood pressure is an important part of therapy. Objective: The aim of this research was to validate the iHealth Track blood pressure monitoring device for patients with CKD according to the European Society of Hypertension International Protocol 2010 (ESH-IP2). Methods: In total, 33 patients who received hemodialysis in Plasencia participated in the study. There were 9 successive measurements made, which conformed to the ESH-IP2. We calculated the differences between the standard reference device (Omron M3 Intellisense) and the test device (iHealth Track) for blood pressure and heart rate values. For 99 total comparisons of paired measurements, we classified differences into various categories (?5 mmHg, ?10 mmHg, and ?15 mmHg for blood pressure; ?3, ?5, and ?8 beats per minute for heart rate). Results: In 90 of 99 systolic blood pressure and 89 of 99 diastolic blood pressure comparisons between the devices, measurement differences were within 5 mmHg. In 81 of 99 heart rate comparisons between the devices, measurement differences were within 3 beats per minute. The mean differences between the test and reference standard measurements were 3.27 (SD 2.99) mmHg for systolic blood pressure, 3.59 (SD 4.55) mmHg for diastolic blood pressure, and 2.18 (SD 2.75) beats per minute for heart rate.We also observed that for both systolic and diastolic blood pressure, 31 of 33 participants had at least two of three comparisons between the devices with measurement differences less than 5 mmHg. For heart rate, 28 of 33 patients had at least two of three comparisons between the devices with measurement differences less than 3 beats per minute. Conclusions: To our knowledge, this is the first study to show that iHealth Track meets the requirements of the ESH-IP2 in patients with CKD. Therefore, the iHealth Track is suitable for use in renal patients. ",
doi="10.2196/14702",
url="https://mhealth.jmir.org/2020/4/e14702",
url="http://www.ncbi.nlm.nih.gov/pubmed/32238337"
}


@Article{info:doi/10.2196/17108,
author="Zahid, Mahnoor
and Gallant, L. Natasha
and Hadjistavropoulos, Thomas
and Stroulia, Eleni",
title="Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="22",
volume="8",
number="4",
pages="e17108",
keywords="pain measurement",
keywords="long-term care",
keywords="nursing",
keywords="technology Alzheimer disease",
keywords="mHealth",
abstract="Background: Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration. Objective: Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration---a newly developed tablet app version and the original paper-and-pencil version---with respect to the frequency of pain assessment and facility staff feedback. Methods: Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration. Results: The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration. Conclusions: This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration. ",
doi="10.2196/17108",
url="https://mhealth.jmir.org/2020/4/e17108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319955"
}


@Article{info:doi/10.2196/15028,
author="Busk, Jonas
and Faurholt-Jepsen, Maria
and Frost, Mads
and Bardram, E. Jakob
and Vedel Kessing, Lars
and Winther, Ole",
title="Forecasting Mood in Bipolar Disorder From Smartphone Self-assessments: Hierarchical Bayesian Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="1",
volume="8",
number="4",
pages="e15028",
keywords="bipolar disorder",
keywords="mood",
keywords="early medical intervention",
keywords="digital phenotyping",
keywords="machine learning",
keywords="forecasting",
keywords="Bayesian analysis",
abstract="Background: Bipolar disorder is a prevalent mental health condition that is imposing significant burden on society. Accurate forecasting of symptom scores can be used to improve disease monitoring, enable early intervention, and eventually help prevent costly hospitalizations. Although several studies have examined the use of smartphone data to detect mood, only few studies deal with forecasting mood for one or more days. Objective: This study aimed to examine the feasibility of forecasting daily subjective mood scores based on daily self-assessments collected from patients with bipolar disorder via a smartphone-based system in a randomized clinical trial. Methods: We applied hierarchical Bayesian regression models, a multi-task learning method, to account for individual differences and forecast mood for up to seven days based on 15,975 smartphone self-assessments from 84 patients with bipolar disorder participating in a randomized clinical trial. We reported the results of two time-series cross-validation 1-day forecast experiments corresponding to two different real-world scenarios and compared the outcomes with commonly used baseline methods. We then applied the best model to evaluate a 7-day forecast. Results: The best performing model used a history of 4 days of self-assessment to predict future mood scores with historical mood being the most important predictor variable. The proposed hierarchical Bayesian regression model outperformed pooled and separate models in a 1-day forecast time-series cross-validation experiment and achieved the predicted metrics, R2=0.51 and root mean squared error of 0.32, for mood scores on a scale of ?3 to 3. When increasing the forecast horizon, forecast errors also increased and the forecast regressed toward the mean of data distribution. Conclusions: Our proposed method can forecast mood for several days with low error compared with common baseline methods. The applicability of a mood forecast in the clinical treatment of bipolar disorder has also been discussed. ",
doi="10.2196/15028",
url="https://mhealth.jmir.org/2020/4/e15028",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234702"
}


@Article{info:doi/10.2196/15098,
author="Hyun, Chul
and McMenamin, Joseph
and Ko, Okhyun
and Kim, Soonsik",
title="Efficacy of a Mobile Texting App (HepTalk) in Encouraging Patient Participation in Viral Hepatitis B Care: Development and Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="1",
volume="8",
number="4",
pages="e15098",
keywords="chronic hepatitis B",
keywords="hepatitis B virus infection",
keywords="linkage to care",
keywords="mobile texting app",
keywords="remote consultation",
abstract="Background: Chronic hepatitis B virus (HBV) infection is a major cause of liver-related morbidity and mortality among Asian Americans in the United States. Despite the available resources, a majority of HBV-infected individuals are not able to access adequate health care owing to numerous barriers. Objective: This study aimed to assess the efficacy of a newly developed mobile texting app (HepTalk) in overcoming these barriers and improving patient engagement and health care access among HBV-infected and nonimmune individuals. Methods: HepTalk was employed for two-way communication between participants and patient navigators. A total of 82 Korean American participants who were either HBV infected or nonimmune to HBV, identified from a community hepatitis B campaign in New York, were enrolled in the study. After informed consent was obtained, both the frequency and themes of the text messages were evaluated. The effects of this communication on linkage to care at the end of the 6-month intervention period were analyzed and discussed. Results: On average, patient navigators sent and received 14 and 8 messages per participant, respectively, during the 6-month period. The themes of the messages were similar to the following 4 categories: finding providers, scheduling appointments with providers, health education, and financial issues. Of the 82 participants, 78 were linked to care within 6 months (a 95\% linkage rate). Conclusions: HepTalk may be employed as an effective and strategic tool to facilitate communicative interaction between patients and patient navigators or health care providers, thereby improving patient engagement and health care access. ",
doi="10.2196/15098",
url="https://mhealth.jmir.org/2020/4/e15098",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234704"
}


@Article{info:doi/10.2196/16142,
author="Lancaster, Claire
and Koychev, Ivan
and Blane, Jasmine
and Chinner, Amy
and Wolters, Leona
and Hinds, Chris",
title="Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="2",
volume="8",
number="4",
pages="e16142",
keywords="technology assessment",
keywords="cognition",
keywords="smartphone",
keywords="mhealth",
keywords="mobile phone",
keywords="Alzheimer disease",
keywords="early diagnosis",
keywords="feasibility study",
keywords="ecological momentary assessment",
abstract="Background: By enabling frequent, sensitive, and economic remote assessment, smartphones will facilitate the detection of early cognitive decline at scale. Previous studies have sustained participant engagement with remote cognitive assessment over a week; extending this to a period of 1 month clearly provides a greater opportunity for measurement. However, as study durations are increased, the need to understand how participant burden and scientific value might be optimally balanced also increases. Objective: This study explored the little but often approach to assessment employed by the Mezurio app when prompting participants to interact every day for over a month. Specifically, this study aimed to understand whether this extended duration of remote study is feasible, and which factors promote sustained participant engagement over such periods. Methods: A total of 35 adults (aged 40-59 years) with no diagnosis of cognitive impairment were prompted to interact with the Mezurio smartphone app platform for up to 36 days, completing short, daily episodic memory tasks in addition to optional executive function and language tests. A subset (n=20) of participants completed semistructured interviews focused on their experience of using the app. Results: Participants complied with 80\% of the daily learning tasks scheduled for subsequent tests of episodic memory, with 88\% of participants still actively engaged by the final task. A thematic analysis of the participants' experiences highlighted schedule flexibility, a clear user interface, and performance feedback as important considerations for engagement with remote digital assessment. Conclusions: Despite the extended study duration, participants demonstrated high compliance with the schedule of daily learning tasks and were extremely positive about their experiences. Long durations of remote digital interaction are therefore definitely feasible but only when careful attention is paid to the design of the users' experience. ",
doi="10.2196/16142",
url="https://mhealth.jmir.org/2020/4/e16142",
url="http://www.ncbi.nlm.nih.gov/pubmed/32238339"
}


@Article{info:doi/10.2196/16395,
author="Baltaxe, Erik
and Embid, Cristina
and Aumatell, Eva
and Mart{\'i}nez, Mar{\'i}a
and Barberan-Garcia, Anael
and Kelly, John
and Eaglesham, John
and Herranz, Carmen
and Vargiu, Eloisa
and Montserrat, Maria Josep
and Roca, Josep
and Cano, Isaac",
title="Integrated Care Intervention Supported by a Mobile Health Tool for Patients Using Noninvasive Ventilation at Home: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="13",
volume="8",
number="4",
pages="e16395",
keywords="behavioral change",
keywords="eHealth",
keywords="noninvasive ventilation",
keywords="mobile health",
keywords="chronic diseases",
abstract="Background: Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by a mobile health (mHealth) app could enhance patient self-efficacy. It is widely accepted that mHealth-supported services can enhance productive interactions among the stakeholders involved in home-based respiratory therapies. Objective: This study aimed to measure changes in self-efficacy in patients with chronic respiratory failure due to diverse etiologies during a 3-month follow-up period after the intervention. Ancillary objectives were assessment of usability and acceptability of the mobile app as well as its potential contribution to collaborative work among stakeholders. Methods: A single-blind, single-center, randomized controlled trial was conducted between February 2019 and June 2019 with 67 adult patients with chronic respiratory failure undergoing home-based noninvasive ventilation. In the intervention group, a psychologist delivered a face-to-face motivational intervention. Follow-up was supported by a mobile app that allowed patients to report the number of hours of daily noninvasive ventilation use and problems with the therapy. Advice was automatically delivered by the mobile app in case of a reported problem. The control group received usual care. The primary outcome was the change in the Self Efficacy in Sleep Apnea questionnaire score. Secondary outcomes included app usability, app acceptability, continuity of care, person-centered care, and ventilatory parameters. Results: Self-efficacy was not significantly different in the intervention group after the intervention (before: mean 3.4, SD 0.6; after: mean 3.4, SD 0.5, P=.51). No changes were observed in adherence to therapy nor quality of life. Overall, the mHealth tool had a good usability score (mean 78 points) and high acceptance rate (mean score of 7.5/10 on a Likert scale). It was considered user-friendly (mean score of 8.2/10 on a Likert scale) and easy to use without assistance (mean score of 8.5/10 on a Likert scale). Patients also scored the perception of continuity of care and person-centered care as high. Conclusions: The integrated care intervention supported by the mobile app did not improve patient self-management.  However, the high acceptance of the mobile app might indicate potential for enhanced communication among stakeholders. The study identified key elements required for mHealth tools to provide effective support to collaborative work and personalized care. Trial Registration: ClinicalTrials.gov NCT03932175; https://clinicaltrials.gov/ct2/show/NCT03932175 ",
doi="10.2196/16395",
url="https://mhealth.jmir.org/2020/4/e16395/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32281941"
}


@Article{info:doi/10.2196/15514,
author="Glattacker, Manuela
and Boeker, Martin
and Anger, Robin
and Reichenbach, Frank
and Tassoni, Adrian
and Bredenkamp, Rainer
and Giesler, M. Juergen",
title="Evaluation of a Mobile Phone App for Patients With Pollen-Related Allergic Rhinitis: Prospective Longitudinal Field Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="17",
volume="8",
number="4",
pages="e15514",
keywords="mobile applications",
keywords="rhinitis, allergic, seasonal",
keywords="patient reported outcome measures",
keywords="prospective studies",
keywords="longitudinal studies",
keywords="usability",
keywords="effectiveness",
abstract="Background: Mobile health apps have great potential to support the self-management of chronic conditions such as allergic diseases, which constitute significant challenges in health care. However, the health app market is confusing for users, as it is vast, dynamic, and lacks scientific evidence regarding the effectiveness of the apps on offer. To our knowledge, no health app for pollen-related allergic rhinitis has been evaluated. Objective: The aim of our study was to evaluate the Husteblume mobile phone health app, developed in Germany to facilitate the self-management of pollen-related allergic rhinitis. Methods: We evaluated usability and changes in quality of life, health literacy, and self-efficacy for managing one's chronic disease. We conducted 2 online surveys of registered users of the app, 1 before and 1 after the 2017 pollen season, allowing for the analysis of both cross-sectional and longitudinal data in a field setting. Results: The sample comprised 661 app users at the first measurement point and 143 users at follow-up. The subgroup of study participants at follow-up rated the usability of the app as good or very good. There were no significant changes in patient-reported outcomes such as quality of life, health literacy, and self-efficacy between the 2 measurement points (P>.05). However, those reached at follow-up perceived subjective improvements due to the app: 55.9\% (80/143) reported being subjectively better informed about their allergy, 27.3\% (39/143) noted improved quality of life, 33.6\% (48/143) reported subjectively better coping with their allergy, and 28.0\% (40/143) felt better prepared for the consultation with their physician. Finally, 90.9\% (130/143) users did not identify any adverse effects of the app. Conclusions: Despite some methodological caveats, the results of the evaluation of the Husteblume app are encouraging for the subgroup using the app in the long term. However, further studies evaluating the effectiveness of the app are needed. Trial Registration: German Clinical Trials Register DRKS00011897; https://tinyurl.com/yxxrg9av ",
doi="10.2196/15514",
url="https://mhealth.jmir.org/2020/4/e15514/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301735"
}


@Article{info:doi/10.2196/14351,
author="Najm, Aurelie
and Lempp, Heidi
and Gossec, Laure
and Berenbaum, Francis
and Nikiphorou, Elena",
title="Needs, Experiences, and Views of People With Rheumatic and Musculoskeletal Diseases on Self-Management Mobile Health Apps: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e14351",
keywords="mHealth",
keywords="mixed methods",
keywords="mobile health apps",
keywords="rheumatic and musculoskeletal disease",
keywords="smartphone",
keywords="apps",
keywords="rheumatoid arthritis, digital health, mobile health",
abstract="Background: Despite the growing interest and exponential popularity of mobile health (mHealth) apps for long-term conditions such as rheumatic and musculoskeletal diseases (RMDs) and their self-management, patients are rarely directly consulted and involved in the app development process. Objective: This study aims to explore the needs, experiences, and views of people diagnosed with RMDs on mHealth apps. Methods: The study used a mixed methods approach: (1) an initial qualitative phase via a patient focus group in the UK and (2) a survey disseminated through national organizations for patients with RMDs across European countries, the United States, Canada, and Australia. Results: The focus group included six patients with life-long musculoskeletal conditions. Half had used a self-management app at least once. The use of existing apps was reported as time-consuming due to a lack of functionality. The need for bespoke apps was voiced by all participants. Among 424 patients across European countries, the United States, Canada, and Australia, the main age group was 45 to 54 years (122/424, 28.7\%), and 86.8\% (368/424) were women. Half of the respondents were aware of the existence of apps to support self-management of their RMDs (188/355, 53\%), with 42\% (79/188) of them currently using such devices. Patients were mostly interested in an app to self-monitor their health parameters (259/346, 74.9\%) and disease activity (221/346, 63.9\%) or communicate directly with their health care provider (200/346, 57.8\%). Conclusions: Patients considered that using an app could help them to self-manage their RMD condition if it was tailored to their needs and co-developed with health professionals. The development of such apps will require standardization and regular quality control. ",
doi="10.2196/14351",
url="https://mhealth.jmir.org/2020/4/e14351",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310151"
}


@Article{info:doi/10.2196/16814,
author="Bradway, Meghan
and Gabarron, Elia
and Johansen, Monika
and Zanaboni, Paolo
and Jardim, Patricia
and Joakimsen, Ragnar
and Pape-Haugaard, Louise
and {\AA}rsand, Eirik",
title="Methods and Measures Used to Evaluate Patient-Operated Mobile Health Interventions: Scoping Literature Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e16814",
keywords="mobile health",
keywords="apps",
keywords="self-management",
keywords="chronic disease",
keywords="noncommunicable diseases",
keywords="interventions",
keywords="patient-centered approach",
keywords="patient-operated intervention",
abstract="Background: Despite the prevalence of mobile health (mHealth) technologies and observations of their impacts on patients' health, there is still no consensus on how best to evaluate these tools for patient self-management of chronic conditions. Researchers currently do not have guidelines on which qualitative or quantitative factors to measure or how to gather these reliable data. Objective: This study aimed to document the methods and both qualitative and quantitative measures used to assess mHealth apps and systems intended for use by patients for the self-management of chronic noncommunicable diseases. Methods: A scoping review was performed, and PubMed, MEDLINE, Google Scholar, and ProQuest Research Library were searched for literature published in English between January 1, 2015, and January 18, 2019. Search terms included combinations of the description of the intention of the intervention (eg, self-efficacy and self-management) and description of the intervention platform (eg, mobile app and sensor). Article selection was based on whether the intervention described a patient with a chronic noncommunicable disease as the primary user of a tool or system that would always be available for self-management. The extracted data included study design, health conditions, participants, intervention type (app or system), methods used, and measured qualitative and quantitative data. Results: A total of 31 studies met the eligibility criteria. Studies were classified as either those that evaluated mHealth apps (ie, single devices; n=15) or mHealth systems (ie, more than one tool; n=17), and one study evaluated both apps and systems. App interventions mainly targeted mental health conditions (including Post-Traumatic Stress Disorder), followed by diabetes and cardiovascular and heart diseases; among the 17 studies that described mHealth systems, most involved patients diagnosed with cardiovascular and heart disease, followed by diabetes, respiratory disease, mental health conditions, cancer, and multiple illnesses. The most common evaluation method was collection of usage logs (n=21), followed by standardized questionnaires (n=18) and ad-hoc questionnaires (n=13). The most common measure was app interaction (n=19), followed by usability/feasibility (n=17) and patient-reported health data via the app (n=15). Conclusions: This review demonstrates that health intervention studies are taking advantage of the additional resources that mHealth technologies provide. As mHealth technologies become more prevalent, the call for evidence includes the impacts on patients' self-efficacy and engagement, in addition to traditional measures. However, considering the unstructured data forms, diverse use, and various platforms of mHealth, it can be challenging to select the right methods and measures to evaluate mHealth technologies. The inclusion of app usage logs, patient-involved methods, and other approaches to determine the impact of mHealth is an important step forward in health intervention research. We hope that this overview will become a catalogue of the possible ways in which mHealth has been and can be integrated into research practice. ",
doi="10.2196/16814",
url="https://mhealth.jmir.org/2020/4/e16814",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352394"
}


@Article{info:doi/10.2196/15608,
author="Roy, Alexandra
and Druker, Susan
and Hoge, A. Elizabeth
and Brewer, A. Judson",
title="Physician Anxiety and Burnout: Symptom Correlates and a Prospective Pilot Study of App-Delivered Mindfulness Training",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="1",
volume="8",
number="4",
pages="e15608",
keywords="anxiety",
keywords="burnout",
keywords="mindfulness",
keywords="app",
keywords="mHealth",
keywords="physician",
keywords="smartphone",
keywords="digital therapeutics",
abstract="Background: Physician burnout is on the rise, yet little is known about its relationship to anxiety. Mindfulness-based stress reduction has demonstrated decreases in anxiety, yet physicians have reported reluctance to engage in it due to significant time commitments. Objective: The aims of this study are to assess whether app-based mindfulness training can reduce anxiety in physicians and to explore if anxiety and burnout are correlated, thus leading to a reduction in both anxiety and burnout. Methods: This was a nonrandomized pilot study comprised of 34 physicians who worked in a large US health care network and reported having anxiety. The intervention was an app-based mindfulness program. The main outcome measure was anxiety, measured by the Generalized Anxiety Disorder-7 (GAD-7). The secondary outcome measures assessed burnout: cynicism and emotional exhaustion items from the Maslach Burnout Inventory. Results: GAD-7 scores decreased significantly at posttreatment (1 month after treatment initiation, 48\% reduction, P<.001) and at the 3-month follow-up (57\% reduction, P<.001). There was a significant correlation between anxiety and burnout (cynicism: r=.43; P=.01; emotional exhaustion: r=.71; P<.001). There was also a significant decrease in cynicism (50\% reduction, P=.003 at posttreatment; 50\% reduction, P=.009 at follow-up) and emotional exhaustion at both time points (20\% reduction, P<.001 at posttreatment; 20\% reduction, P=.003 at follow-up). Conclusions: This pilot study is the first to test an app-based mindfulness training program targeted at reducing anxiety with physicians and to demonstrate that in physicians, anxiety is correlated with burnout. These findings suggest that this may be an effective tool to reduce anxiety and burnout in physicians. Trial Registration: ClinicalTrials.gov NCT04137081; https://www.clinicaltrials.gov/ct2/show/NCT04137081 ",
doi="10.2196/15608",
url="https://mhealth.jmir.org/2020/4/e15608",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234708"
}


@Article{info:doi/10.2196/17767,
author="Ponzo, Sonia
and Morelli, Davide
and Kawadler, M. Jamie
and Hemmings, Rose Nicola
and Bird, Geoffrey
and Plans, David",
title="Efficacy of the Digital Therapeutic Mobile App BioBase to Reduce Stress and Improve Mental Well-Being Among University Students: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="6",
volume="8",
number="4",
pages="e17767",
keywords="anxiety",
keywords="depression",
keywords="mobile apps",
keywords="biofeedback",
keywords="mental health",
keywords="mobile phones",
keywords="technology",
abstract="Background: University students in the United Kingdom are experiencing increasing levels of anxiety. A program designed to increase awareness of one's present levels of well-being and suggest personalized health behaviors may reduce anxiety and improve mental well-being in students. The efficacy of a digital version of such a program, providing biofeedback and therapeutic content based on personalized well-being metrics, is reported here. Objective: The aim of this study was to test the efficacy and sustained effects of using a mobile app (BioBase) and paired wearable device (BioBeam), compared with a waitlist control group, on anxiety and well-being in university students with elevated levels of anxiety and stress. Methods: The study employed a randomized, waitlist-controlled trial with assessments at baseline, 2 weeks, postintervention (4 weeks), and follow-up (6 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored >14 points on the Depression, Anxiety, and Stress Scale-21 items (DASS-21) stress subscale or >7 points on the DASS-21 anxiety subscale, (3) owned an iOS mobile phone, (4) did not have any previous psychiatric or neurological conditions, (6) were not pregnant at the time of testing, and (7) were able to read and understand English. Participants were encouraged to use BioBase daily and complete at least one course of therapeutic content. A P value ?.05 was considered statistically significant. Results: We found that a 4-week intervention with the BioBase program significantly reduced anxiety and increased perceived well-being, with sustained effects at a 2-week follow-up. Furthermore, a significant reduction in depression levels was found following the 4-week usage of BioBase. Conclusions: This study shows the efficacy of a biofeedback digital intervention in reducing self-reported anxiety and increasing perceived well-being in UK university students. Results suggest that digital mental health interventions could constitute a novel approach to treat stress and anxiety in students, which could be combined or integrated with existing therapeutic pathways. Trial Registration: Open Science Framework (OSF.io) 2zd45; https://osf.io/2zd45/ ",
doi="10.2196/17767",
url="https://mhealth.jmir.org/2020/4/e17767",
url="http://www.ncbi.nlm.nih.gov/pubmed/31926063"
}


@Article{info:doi/10.2196/18936,
author="Yasaka, M. Tyler
and Lehrich, M. Brandon
and Sahyouni, Ronald",
title="Peer-to-Peer Contact Tracing: Development of a Privacy-Preserving Smartphone App",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="7",
volume="8",
number="4",
pages="e18936",
keywords="COVID-19",
keywords="smartphone",
keywords="privacy",
keywords="contact tracing",
keywords="peer-to-peer",
keywords="epidemic",
keywords="personal data",
keywords="mobile phone",
keywords="coronavirus",
keywords="pandemic",
abstract="Background: The novel coronavirus disease 2019 (COVID-19) pandemic is an urgent public health crisis, with epidemiologic models predicting severe consequences, including high death rates, if the virus is permitted to run its course without any intervention or response. Contact tracing using smartphone technology is a powerful tool that may be employed to limit disease transmission during an epidemic or pandemic; yet, contact tracing apps present significant privacy concerns regarding the collection of personal data such as location. Objective: The aim of this study is to develop an effective contact tracing smartphone app that respects user privacy by not collecting location information or other personal data. Methods: We propose the use of an anonymized graph of interpersonal interactions to conduct a novel form of contact tracing and have developed a proof-of-concept smartphone app that implements this approach. Additionally, we developed a computer simulation model that demonstrates the impact of our proposal on epidemic or pandemic outbreak trajectories across multiple rates of adoption. Results: Our proof-of-concept smartphone app allows users to create ``checkpoints'' for contact tracing, check their risk level based on their past interactions, and anonymously self-report a positive status to their peer network. Our simulation results suggest that higher adoption rates of such an app may result in a better controlled epidemic or pandemic outbreak. Conclusions: Our proposed smartphone-based contact tracing method presents a novel solution that preserves privacy while demonstrating the potential to suppress an epidemic or pandemic outbreak. This app could potentially be applied to the current COVID-19 pandemic as well as other epidemics or pandemics in the future to achieve a middle ground between drastic isolation measures and unmitigated disease spread. ",
doi="10.2196/18936",
url="https://mhealth.jmir.org/2020/4/e18936",
url="http://www.ncbi.nlm.nih.gov/pubmed/32240973"
}


@Article{info:doi/10.2196/14802,
author="Lim, Lin Su
and Johal, Jolyn
and Ong, Wen Kai
and Han, Yixian Chad
and Chan, Huak Yiong
and Lee, Mei Yin
and Loo, Mun Wai",
title="Lifestyle Intervention Enabled by Mobile Technology on Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="13",
volume="8",
number="4",
pages="e14802",
keywords="diet",
keywords="NAFLD",
keywords="mHealth",
keywords="mobile app, weight loss",
keywords="liver enzymes",
keywords="lifestyle intervention",
abstract="Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) reaches up to 30\% in the Asian adult population, with a higher prevalence in obese patients. Weight reduction is typically recommended for patients at high risk or diagnosed with NAFLD, but is a challenge to achieve. Objective: We aimed to evaluate the effect of a lifestyle intervention with a mobile app on weight loss in NAFLD patients. Methods: This prospective randomized controlled trial included 108 adults with NAFLD confirmed by steatosis on ultrasound and a body mass index ?23 kg/m2 who were recruited from a fatty liver outpatient clinic. The patients were randomly allocated to either a control group (n=53) receiving standard care, consisting of dietary and lifestyle advice by a trained nurse, or an intervention group (n=55) utilizing the Nutritionist Buddy (nBuddy) mobile app in addition to receiving dietary and lifestyle advice by a dietitian. Body weight, alanine aminotransferase (ALT), aspartate aminotransferase (AST), waist circumference, and blood pressure were measured at baseline, and then at 3 and 6 months. Intention-to-treat and per-protocol analyses were used for statistical comparisons. Results: The intervention group had a 5-fold higher likelihood (relative risk 5.2, P=.003, 95\% CI 1.8-15.4) of achieving ?5\% weight loss compared to the control group at 6 months. The intervention group also showed greater reductions in weight (mean 3.2, SD 4.1 kg vs mean 0.5, SD 2.9 kg; P<.001), waist circumference (mean 2.9, SD 5.0 cm vs mean --0.7, SD 4.4 cm; P<.001), systolic blood pressure (mean 12.4, SD 14.8 mmHg vs mean 2.4, SD 12.4 mmHg; P=.003), diastolic blood pressure (mean 6.8, SD 8.9 mmHg vs mean --0.9, SD 10.0 mmHg; P=.001), ALT (mean 33.5, SD 40.4 IU/L vs mean 11.5, SD 35.2 IU/L; P=.004), and AST (mean 17.4, SD 27.5 U/L vs mean 7.4, SD 17.6 IU/L, P=.03) at 6 months. Conclusions: Lifestyle intervention enabled by a mobile app can be effective in improving anthropometric indices and liver enzymes in patients with NAFLD. This treatment modality has the potential to be extended to a larger population scale. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001001381;https://tinyurl.com/w9xnfmp ",
doi="10.2196/14802",
url="https://mhealth.jmir.org/2020/4/e14802/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32281943"
}


@Article{info:doi/10.2196/16217,
author="Laurens, C. Melissa
and Pieterse, E. Marcel
and Brusse-Keizer, Marjolein
and Salemink, Elske
and Ben Allouch, Somaya
and Bohlmeijer, T. Ernst
and Postel, G. Marloes",
title="Alcohol Avoidance Training as a Mobile App for Problem Drinkers: Longitudinal Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="14",
volume="8",
number="4",
pages="e16217",
keywords="mobile alcohol avoidance training",
keywords="approach bias",
keywords="cognitive bias modification",
keywords="alcohol",
abstract="Background: Alcohol use is associated with an automatic tendency to approach alcohol, and the retraining of this tendency (cognitive bias modification [CBM]) shows therapeutic promise in clinical settings. To improve access to training and to enhance participant engagement, a mobile version of alcohol avoidance training was developed. Objective: The aims of this pilot study were to assess (1) adherence to a mobile health (mHealth) app; (2) changes in weekly alcohol use from before to after training; and (3) user experience with regard to the mHealth app. Methods: A self-selected nonclinical sample of 1082 participants, who were experiencing problems associated with alcohol, signed up to use the alcohol avoidance training app Breindebaas for 3 weeks with at least two training sessions per week. In each training session, 100 pictures (50 of alcoholic beverages and 50 of nonalcoholic beverages) were presented consecutively in a random order at the center of a touchscreen. Alcoholic beverages were swiped upward (away from the body), whereas nonalcoholic beverages were swiped downward (toward the body). During approach responses, the picture size increased to mimic an approach movement, and conversely, during avoidance responses, the picture size decreased to mimic avoidance. At baseline, we assessed sociodemographic characteristics, alcohol consumption, alcohol-related problems, use of other substances, self-efficacy, and craving. After 3 weeks, 37.89\% (410/1082) of the participants (posttest responders) completed an online questionnaire evaluating adherence, alcohol consumption, and user satisfaction. Three months later, 19.03\% (206/1082) of the participants (follow-up responders) filled in a follow-up questionnaire examining adherence and alcohol consumption. Results: The 410 posttest responders were older, were more commonly female, and had a higher education as compared with posttest dropouts. Among those who completed the study, 79.0\% (324/410) were considered adherent as they completed four or more sessions, whereas 58.0\% (238/410) performed the advised six or more training sessions. The study identified a significant reduction in alcohol consumption of 7.8 units per week after 3 weeks (95\% CI 6.2-9.4, P<.001; n=410) and another reduction of 6.2 units at 3 months for follow-up responders (95\% CI 3.7-8.7, P<.001; n=206). Posttest responders provided positive feedback regarding the fast-working, simple, and user-friendly design of the app. Almost half of the posttest responders reported gaining more control over their alcohol use. The repetitious and nonpersonalized nature of the intervention was suggested as a point for improvement. Conclusions: This is one of the first studies to employ alcohol avoidance training in a mobile app for problem drinkers. Preliminary findings suggest that a mobile CBM app fulfils a need for problem drinkers and may contribute to a reduction in alcohol use. Replicating these findings in a controlled study is warranted. ",
doi="10.2196/16217",
url="https://mhealth.jmir.org/2020/4/e16217",
url="http://www.ncbi.nlm.nih.gov/pubmed/32286235"
}


@Article{info:doi/10.2196/15960,
author="Kendzor, E. Darla
and Businelle, S. Michael
and Waring, C. Joseph J.
and Mathews, J. Ashley
and Geller, W. Daryl
and Barton, M. Jocelyn
and Alexander, C. Adam
and H{\'e}bert, T. Emily
and Ra, K. Chaelin
and Vidrine, J. Damon",
title="Automated Mobile Delivery of Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="15",
volume="8",
number="4",
pages="e15960",
keywords="socioeconomic status",
keywords="smoking cessation",
keywords="incentives",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: Socioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. Smartphone ownership is increasing rapidly, including among low-income adults, and smartphone interventions for smoking cessation may increase access to smoking cessation treatment among socioeconomically disadvantaged adults. Objective: This study aimed to evaluate the feasibility of an automated smartphone-based approach to delivering financial incentives for smoking cessation. Methods: Socioeconomically disadvantaged adults initiating tobacco cessation treatment were followed from 1 week before a scheduled quit attempt through 26 weeks after the quit date. Participants received telephone counseling and nicotine replacement therapy. Smoking cessation was verified 5 times per week via smartphone prompts to self-report smoking status and submit a breath sample via a portable carbon monoxide (CO) monitor that was connected with participants' smartphones. Identity was verified during smoking status assessments using smartphone-based facial recognition software. When smoking abstinence and identity were verified, an automated credit card payment was triggered. Participants were incentivized for abstinence on the quit date and up to five days per week during the first 4 weeks after the scheduled quit date, with additional incentives offered during postquit weeks 8 and 12. In total, participants had the opportunity to earn up to US \$250 in abstinence-contingent incentives over the first 12 weeks of the quit attempt. Results: Participants (N=16) were predominantly female (12/16, 75\%) and non-Hispanic white (11/16, 69\%), black (4/16, 25\%), or Hispanic of any race (1/16, 6\%). Most participants (9/16, 56\%) reported an annual household income of <US \$11,000. During the first 4 weeks after the scheduled quit date, participants completed a median of 16 (out of 21; range 1-21) mobile smoking status assessments, and they earned a median of US \$28 in abstinence-contingent incentives (out of a possible US \$150; range US \$0-US \$135). Median earnings did not change during the 8- and 12-week incentivized follow-up periods (total median earnings over 12 weeks=US \$28; range US \$0-US \$167). During the first 4 weeks after the scheduled quit date, participants abstained from smoking on a median of 5 (out of 21) assessment days (range 0-20). At the in-person follow-up visits, the expired CO-confirmed 7-day point prevalence abstinence rates were 19\% (3/16) and 13\% (2/16) at 12 and 26 weeks postquit, respectively. Overall, most participants reported that the system was easy to use and that they would recommend this treatment to their friends and family. Conclusions: Preliminary data suggest that this smartphone-based approach to verifying identity and smoking status and automating the delivery of abstinence-contingent incentives to a credit card is feasible for use among socioeconomically disadvantaged adults. However, continued refinement is warranted. ",
doi="10.2196/15960",
url="https://mhealth.jmir.org/2020/4/e15960/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32293568"
}


@Article{info:doi/10.2196/14726,
author="Hendrie, A. Gilly
and Hussain, Sazzad M.
and Brindal, Emily
and James-Martin, Genevieve
and Williams, Gemma
and Crook, Anna",
title="Impact of a Mobile Phone App to Increase Vegetable Consumption and Variety in Adults: Large-Scale Community Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="17",
volume="8",
number="4",
pages="e14726",
keywords="mHealth",
keywords="vegetables",
keywords="healthy diet",
keywords="intervention study",
abstract="Background: Large-scale initiatives to improve diet quality through increased vegetable consumption have had small to moderate success. Digital technologies have features that are appealing for health-related behavior change interventions. Objective: This study aimed to describe the implementation and evaluation of a mobile phone app called VegEze, which aims to increase vegetable intake among Australian adults. Methods: To capture the impact of this app in a real-world setting, the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was utilized. An uncontrolled, quantitative cohort study was conducted, with evaluations after 21 and 90 days. The app was available in the Apple App Store and was accompanied by television, radio, and social media promotion. Evaluation surveys were embedded into the app using ResearchKit. The primary outcomes were vegetable intake (servings per day) and vegetable variety (types per day). Psychological variables (attitudes, intentions, self-efficacy, and action planning) and app usage were also assessed. Descriptive statistics and multiple linear regression were used to describe the impact of the app on vegetable intake and to determine the characteristics associated with the increased intake. Results: Data were available from 5062 participants who completed the baseline survey; 1224 participants completed the 21-day survey, and 273 completed the 90-day survey. The participants resided across Australia and were mostly women (4265/5062, 84.3\%) with a mean age of 48.2 years (SD 14.1). The mean increase in intake was 0.48 servings, from 3.06 servings at baseline to 3.54 servings at the end of the 21-day challenge (t1223=8.71; P<.001). The variety of vegetables consumed also increased by 0.35 types per day (t1123=9.59; P<.001). No changes in intake and variety were found from day 21 to the 90-day follow-up. Participants with the highest app usage increased their vegetable intake by 0.63 (SD 2.02) servings per day compared with 0.32 (SD 1.69) servings per day for those with the lowest app usage. On the basis of multiple linear regression, gender; age; BMI; psychological variables of self-efficacy, attitudes, intentions, and action planning specific to vegetable intake; baseline vegetable intake; and active days of app usage accounted for 23.3\% of the variance associated with the change in intake (F9,1208=42.09; P<.001). Baseline vegetable intake was the strongest predictor of change in intake (beta=?.495; P<.001), with lower baseline intake associated with a greater change in intake. Self-efficacy (beta=.116; P<.001), action planning (beta=.066; P=.02), BMI (beta=.070; P=.01), and app usage (beta=.081; P=.002) were all significant predictors of the change in intake. Conclusions: The VegEze app was able to increase intake by half a serving in a large sample of Australian adults. Testing the app in a real-world setting and embedding the consent process allowed for greater reach and an efficient, robust evaluation. Further work to improve engagement is warranted. ",
doi="10.2196/14726",
url="https://mhealth.jmir.org/2020/4/e14726/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301739"
}


@Article{info:doi/10.2196/14270,
author="Conroy, E. David
and Yang, Chih-Hsiang
and Lanza, T. Stephanie
and Smyth, M. Joshua
and Lagoa, M. Constantino",
title="Temporal Dynamics of Treatment Receipt in a Text Message Intervention for Physical Activity: Single-Group, Within-Person Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="22",
volume="8",
number="4",
pages="e14270",
keywords="short message service",
keywords="patient engagement",
keywords="mHealth",
keywords="physical activity",
keywords="sedentary behavior",
abstract="Background: Mobile technology has increased the reach of health behavior interventions but raised new challenges in assessing the fidelity of treatment receipt. Fidelity can be compromised if participant fatigue or burden reduces engagement, leading to missed or delayed treatments for just-in-time interventions. Objective: This study aimed to investigate the temporal dynamics of text message receipt confirmations. Methods: Community-dwelling adults (N=10) were sent five text messages daily for 4 months (5598 messages sent in total), with a financial incentive to confirm receipt of 75\% or more messages. Results: Overall, the message receipt confirmation rate was very high (5504/5598, 98.32\%) and timely (eg, two-thirds of confirmations within 2 min). Confirmation times were slightly slower on weekends (vs weekdays) and as a function of the cumulative time in the study. Neither time of message delivery nor message content was associated with message confirmation latencies. Conclusions: Participants receiving financial incentives to confirm text message receipt exhibit extremely high and fast confirmation rates, although receipt confirmations were somewhat less timely on weekends (vs weekdays) and later in the intervention. The social calendar and treatment fatigue should be considered when planning text message--based interventions, especially if treatments are intended for a just-in-time delivery that requires extended engagement and precise timing. ",
doi="10.2196/14270",
url="https://mhealth.jmir.org/2020/4/e14270/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319957"
}


@Article{info:doi/10.2196/17816,
author="Ifejika, L. Nneka
and Bhadane, Minal
and Cai, C. Chunyan
and Noser, A. Elizabeth
and Grotta, C. James
and Savitz, I. Sean",
title="Use of a Smartphone-Based Mobile App for Weight Management in Obese Minority Stroke Survivors: Pilot Randomized Controlled Trial With Open Blinded End Point",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="22",
volume="8",
number="4",
pages="e17816",
keywords="smartphone",
keywords="stroke",
keywords="obesity",
keywords="telemedicine",
keywords="minority groups",
keywords="cognitive dysfunction",
keywords="outcome assessment, health care",
abstract="Background: Minorities have an increased incidence of early-onset, obesity-related cerebrovascular disease. Unfortunately, effective weight management in this vulnerable population has significant barriers. Objective: Our objective was to determine the feasibility and preliminary treatment effects of a smartphone-based weight loss intervention versus food journals to monitor dietary patterns in minority stroke patients. Methods: Swipe out Stroke was a pilot prospective randomized controlled trial with open blinded end point. Minority stroke patients and their caregivers were screened for participation using cluster enrollment. We used adaptive randomization for assignment to a behavior intervention with (1) smartphone-based self-monitoring or (2) food journal self-monitoring. The smartphone group used Lose it! to record meals and communicate with us. Reminder messages (first 30 days), weekly summaries plus reminder messages on missed days (days 31-90), and weekly summaries only (days 91-180) were sent via push notifications. The food journal group used paper diaries. Both groups received 4 in-person visits (baseline and 30, 90, and 180 days), culturally competent counseling, and educational materials. The primary outcome was reduced total body weight. Results: We enrolled 36 stroke patients (n=23, 64\% African American; n=13, 36\% Hispanic), 17 in the smartphone group, and 19 in the food journal group. Mean age was 54 (SD 9) years; mean body mass index was 35.7 (SD 5.7) kg/m2; education, employment status, and family history of stroke or obesity did not differ between the groups. Baseline rates of depression (Patient Health Questionnaire-9 [PHQ-9] score median 5.5, IQR 3.0-9.5), cognitive impairment (Montreal Cognitive Assessment score median 23.5, IQR 21-26), and inability to ambulate (5/36, 14\% with modified Rankin Scale score 3) were similar. In total, 25 (69\%) stroke survivors completed Swipe out Stroke (13/17 in the smartphone group, 12/19 in the food journal group); 1 participant in the smartphone group died. Median weight change at 180 days was 5.7 lb (IQR --2.4 to 8.0) in the smartphone group versus 6.4 lb (IQR --2.2 to 12.5; P=.77) in the food journal group. Depression was significantly lower at 30 days in the smartphone group than in the food journal group (PHQ-9 score 2 vs 8; P=.03). Clinically relevant depression rates remained in the zero to minimal range for the smartphone group compared with mild to moderate range in the food journal group at day 90 (PHQ-9 score 3.5 vs 4.5; P=.39) and day 180 (PHQ-9 score 3 vs 6; P=.12). Conclusions: In a population of obese minority stroke survivors, the use of a smartphone did not lead to a significant difference in weight change compared with keeping a food journal. The presence of baseline depression (19/36, 53\%) was a confounding variable, which improved with app engagement. Future studies that include treatment of poststroke depression may positively influence intervention efficacy. Trial Registration: ClinicalTrials.gov NCT02531074; https://www.clinicaltrials.gov/ct2/show/NCT02531074 ",
doi="10.2196/17816",
url="https://mhealth.jmir.org/2020/4/e17816/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319963"
}


@Article{info:doi/10.2196/17530,
author="Carrasco-Hernandez, Laura
and J{\'o}dar-S{\'a}nchez, Francisco
and N{\'u}{\~n}ez-Benjumea, Francisco
and Moreno Conde, Jes{\'u}s
and Mesa Gonz{\'a}lez, Marco
and Civit-Balcells, Ant{\'o}n
and Hors-Fraile, Santiago
and Parra-Calder{\'o}n, Luis Carlos
and Bamidis, D. Panagiotis
and Ortega-Ruiz, Francisco",
title="A Mobile Health Solution Complementing Psychopharmacology-Supported Smoking Cessation: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="27",
volume="8",
number="4",
pages="e17530",
keywords="smoking cessation",
keywords="behavioral change",
keywords="health recommender systems",
keywords="mHealth",
keywords="randomized controlled trial",
abstract="Background: Smoking cessation is a persistent leading public health challenge. Mobile health (mHealth) solutions are emerging to improve smoking cessation treatments. Previous approaches have proposed supporting cessation with tailored motivational messages. Some managed to provide short-term improvements in smoking cessation. Yet, these approaches were either static in terms of personalization or human-based nonscalable solutions. Additionally, long-term effects were neither presented nor assessed in combination with existing psychopharmacological therapies. Objective: This study aimed to analyze the long-term efficacy of a mobile app supporting psychopharmacological therapy for smoking cessation and complementarily assess the involved innovative technology. Methods: A 12-month, randomized, open-label, parallel-group trial comparing smoking cessation rates was performed at Virgen del Roc{\'i}o University Hospital in Seville (Spain). Smokers were randomly allocated to a control group (CG) receiving usual care (psychopharmacological treatment, n=120) or an intervention group (IG) receiving psychopharmacological treatment and using a mobile app providing artificial intelligence--generated and tailored smoking cessation support messages (n=120). The secondary objectives were to analyze health-related quality of life and monitor healthy lifestyle and physical exercise habits. Safety was assessed according to the presence of adverse events related to the pharmacological therapy. Per-protocol and intention-to-treat analyses were performed. Incomplete data and multinomial regression analyses were performed to assess the variables influencing participant cessation probability. The technical solution was assessed according to the precision of the tailored motivational smoking cessation messages and user engagement. Cessation and no cessation subgroups were compared using t tests. A voluntary satisfaction questionnaire was administered at the end of the intervention to all participants who completed the trial. Results: In the IG, abstinence was 2.75 times higher (adjusted OR 3.45, P=.01) in the per-protocol analysis and 2.15 times higher (adjusted OR 3.13, P=.002) in the intention-to-treat analysis. Lost data analysis and multinomial logistic models showed different patterns in participants who dropped out. Regarding safety, 14 of 120 (11.7\%) IG participants and 13 of 120 (10.8\%) CG participants had 19 and 23 adverse events, respectively (P=.84). None of the clinical secondary objective measures showed relevant differences between the groups. The system was able to learn and tailor messages for improved effectiveness in supporting smoking cessation but was unable to reduce the time between a message being sent and opened. In either case, there was no relevant difference between the cessation and no cessation subgroups. However, a significant difference was found in system engagement at 6 months (P=.04) but not in all subsequent months. High system appreciation was reported at the end of the study. Conclusions: The proposed mHealth solution complementing psychopharmacological therapy showed greater efficacy for achieving 1-year tobacco abstinence as compared with psychopharmacological therapy alone. It provides a basis for artificial intelligence--based future approaches. Trial Registration: ClinicalTrials.gov NCT03553173; https://clinicaltrials.gov/ct2/show/NCT03553173 International Registered Report Identifier (IRRID): RR2-10.2196/12464 ",
doi="10.2196/17530",
url="https://mhealth.jmir.org/2020/4/e17530/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32338624"
}


@Article{info:doi/10.2196/18064,
author="Faro, M. Jamie
and Nagawa, S. Catherine
and Allison, A. Jeroan
and Lemon, C. Stephenie
and Mazor, M. Kathleen
and Houston, K. Thomas
and Sadasivam, S. Rajani",
title="Comparison of a Collective Intelligence Tailored Messaging System on Smoking Cessation Between African American and White People Who Smoke: Quasi-Experimental Design",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="27",
volume="8",
number="4",
pages="e18064",
keywords="machine learning",
keywords="computer-tailored health communication",
keywords="smoking cessation",
keywords="health disparities",
abstract="Background: The Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT) is a machine learning recommender system with a database of messages to motivate smoking cessation. PERSPeCT uses the collective intelligence of users (ie, preferences and feedback) and demographic and smoking profiles to select motivating messages. PERSPeCT may be more beneficial for tailoring content to minority groups influenced by complex, personally relevant factors. Objective: The objective of this study was to describe and evaluate the use of PERSPeCT in African American people who smoke compared with white people who smoke. Methods: Using a quasi-experimental design, we compared African American people who smoke with a historical cohort of white people who smoke, who both received up to 30 emailed tailored messages over 65 days. People who smoke rated the daily message in terms of perceived influence on quitting smoking for 30 days. Our primary analysis compared daily message ratings between the two groups using a t test. We used a logistic model to compare 30-day cessation between the two groups and adjusted for covariates. Results: The study included 119 people who smoke (African Americans, 55/119; whites, 64/119). At baseline, African American people who smoke were significantly more likely to report allowing smoking in the home (P=.002); all other characteristics were not significantly different between groups. Daily mean ratings were higher for African American than white people who smoke on 26 of the 30 days (P<.001). Odds of quitting as measured by 30-day cessation were significantly higher for African Americans (odds ratio 2.3, 95\% CI 1.04-5.53; P=.03) and did not change after adjusting for allowing smoking at home. Conclusions: Our study highlighted the potential of using a recommender system to personalize for African American people who smoke. Trial Registration: ClinicalTrials.gov NCT02200432; https://clinicaltrials.gov/ct2/show/NCT02200432 International Registered Report Identifier (IRRID): RR2-10.2196/jmir.6465 ",
doi="10.2196/18064",
url="https://mhealth.jmir.org/2020/4/e18064/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32338619"
}


@Article{info:doi/10.2196/14817,
author="Kim, Meelim
and Kim, Youngin
and Go, Yoonjeong
and Lee, Seokoh
and Na, Myeongjin
and Lee, Younghee
and Choi, Sungwon
and Choi, Jin Hyung",
title="Multidimensional Cognitive Behavioral Therapy for Obesity Applied by Psychologists Using a Digital Platform: Open-Label Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e14817",
keywords="obesity",
keywords="digital health care",
keywords="cognitive behavioral therapy",
keywords="mobile phone",
abstract="Background: Developing effective, widely useful, weight management programs is a priority in health care because obesity is a major health problem. Objective: This study developed and investigated a new, comprehensive, multifactorial, daily, intensive, psychologist coaching program based on cognitive behavioral therapy (CBT) modules. The program was delivered via the digital health care mobile services Noom Coach and InBody. Methods: This was an open-label, active-comparator, randomized controlled trial. A total of 70 female participants with BMI scores above 24 kg/m2 and no clinical problems besides obesity were randomized into experimental and control groups. The experimental (ie, digital CBT) group (n=45) was connected with a therapist intervention using a digital health care service that provided daily feedback and assignments for 8 weeks. The control group (n=25) also used the digital health care service, but practiced self-care without therapist intervention. The main outcomes of this study were measured objectively at baseline, 8 weeks, and 24 weeks and included weight (kg) as well as other body compositions. Differences between groups were evaluated using independent t tests and a per-protocol framework. Results: Mean weight loss at 8 weeks in the digital CBT group was significantly higher than in the control group (--3.1\%, SD 4.5, vs --0.7\%, SD 3.4, P=.04). Additionally, the proportion of subjects who attained conventional 5\% weight loss from baseline in the digital CBT group was significantly higher than in the control group at 8 weeks (32\% [12/38] vs 4\% [1/21], P=.02) but not at 24 weeks. Mean fat mass reduction in the digital CBT group at 8 weeks was also significantly greater than in the control group (--6.3\%, SD 8.8, vs --0.8\%, SD 8.1, P=.02). Mean leptin and insulin resistance in the digital CBT group at 8 weeks was significantly reduced compared to the control group (--15.8\%, SD 29.9, vs 7.2\%, SD 35.9, P=.01; and --7.1\%, SD 35.1, vs 14.4\%, SD 41.2, P=.04). Emotional eating behavior (ie, mean score) measured by questionnaire (ie, the Dutch Eating Behavior Questionnaire) at 8 weeks was significantly improved compared to the control group (--2.8\%, SD 34.4, vs 21.6\%, SD 56.9, P=.048). Mean snack calorie intake in the digital CBT group during the intervention period was significantly lower than in the control group (135.9 kcal, SD 86.4, vs 208.2 kcal, SD 166.3, P=.02). Lastly, baseline depression, anxiety, and self-esteem levels significantly predicted long-term clinical outcomes (24 weeks), while baseline motivation significantly predicted both short-term (8 weeks) and long-term clinical outcomes. Conclusions: These findings confirm that technology-based interventions should be multidimensional and are most effective with human feedback and support. This study is innovative in successfully developing and verifying the effects of a new CBT approach with a multidisciplinary team based on digital technologies rather than standalone technology-based interventions. Trial Registration: ClinicalTrials.gov NCT03465306; https://clinicaltrials.gov/ct2/show/NCT03465306 ",
doi="10.2196/14817",
url="https://mhealth.jmir.org/2020/4/e14817/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352391"
}


@Article{info:doi/10.2196/15806,
author="Hauser-Ulrich, Sandra
and K{\"u}nzli, Hansj{\"o}rg
and Meier-Peterhans, Danielle
and Kowatsch, Tobias",
title="A Smartphone-Based Health Care Chatbot to Promote Self-Management of Chronic Pain (SELMA): Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="3",
volume="8",
number="4",
pages="e15806",
keywords="conversational agent",
keywords="chatbot",
keywords="digital health",
keywords="pain self-management",
keywords="cognitive behavior therapy",
keywords="smartphone",
keywords="psychoeducation",
keywords="text-based",
keywords="health care",
keywords="chronic pain",
abstract="Background: Ongoing pain is one of the most common diseases and has major physical, psychological, social, and economic impacts. A mobile health intervention utilizing a fully automated text-based health care chatbot (TBHC) may offer an innovative way not only to deliver coping strategies and psychoeducation for pain management but also to build a working alliance between a participant and the TBHC. Objective: The objectives of this study are twofold: (1) to describe the design and implementation to promote the chatbot painSELfMAnagement (SELMA), a 2-month smartphone-based cognitive behavior therapy (CBT) TBHC intervention for pain self-management in patients with ongoing or cyclic pain, and (2) to present findings from a pilot randomized controlled trial, in which effectiveness, influence of intention to change behavior, pain duration, working alliance, acceptance, and adherence were evaluated. Methods: Participants were recruited online and in collaboration with pain experts, and were randomized to interact with SELMA for 8 weeks either every day or every other day concerning CBT-based pain management (n=59), or weekly concerning content not related to pain management (n=43). Pain-related impairment (primary outcome), general well-being, pain intensity, and the bond scale of working alliance were measured at baseline and postintervention. Intention to change behavior and pain duration were measured at baseline only, and acceptance postintervention was assessed via self-reporting instruments. Adherence was assessed via usage data. Results: From May 2018 to August 2018, 311 adults downloaded the SELMA app, 102 of whom consented to participate and met the inclusion criteria. The average age of the women (88/102, 86.4\%) and  men (14/102, 13.6\%) participating was 43.7 (SD 12.7) years. Baseline group comparison did not differ with respect to any demographic or clinical variable. The intervention group reported no significant change in pain-related impairment (P=.68) compared to the control group postintervention. The intention to change behavior was positively related to pain-related impairment (P=.01) and pain intensity (P=.01). Working alliance with the TBHC SELMA was comparable to that obtained in guided internet therapies with human coaches. Participants enjoyed using the app, perceiving it as useful and easy to use. Participants of the intervention group replied with an average answer ratio of 0.71 (SD 0.20) to 200 (SD 58.45) conversations initiated by SELMA. Participants' comments revealed an appreciation of the empathic and responsible interaction with the TBHC SELMA. A main criticism was that there was no option to enter free text for the patients' own comments. Conclusions: SELMA is feasible, as revealed mainly by positive feedback and valuable suggestions for future revisions. For example, the participants' intention to change behavior or a more homogenous sample (eg, with a specific type of chronic pain) should be considered in further tailoring of SELMA. Trial Registration: German Clinical Trials Register DRKS00017147; https://tinyurl.com/vx6n6sx,  Swiss National Clinical Trial Portal: SNCTP000002712; https://www.kofam.ch/de/studienportal/suche/70582/studie/46326. ",
doi="10.2196/15806",
url="https://mhealth.jmir.org/2020/4/e15806/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32242820"
}


@Article{info:doi/10.2196/16496,
author="Zhang, Yuanjin
and Fan, Dongsheng
and Ji, Hong
and Qiao, Shudong
and Li, Xia",
title="Treatment Adherence and Secondary Prevention of Ischemic Stroke Among Discharged Patients Using Mobile Phone- and WeChat-Based Improvement Services: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="15",
volume="8",
number="4",
pages="e16496",
keywords="stroke",
keywords="secondary prevention",
keywords="WeChat",
keywords="self-monitoring",
abstract="Background: Real-world studies have indicated that adherence is important for guaranteeing medication effectiveness. Few studies have tested the feasibility and efficacy of WeChat-based improvement services, via mobile phone, in secondary prevention-specific follow-up among discharged stroke patients. Objective: We evaluated a quadruple-domain, WeChat-based service for ischemic stroke secondary prevention designed to improve treatment adherence of discharged patients. This service focuses on sending reminders for drug use, blood pressure recording, and glucose recording; it also records medication use. We compared the endpoint event rate between WeChat self-monitoring and traditional monitoring. Methods: A cohort study was used to determine the feasibility of a physician-assisted, WeChat-based improvement service and follow-up self-monitoring platform for the secondary prevention of ischemic stroke. The platform was developed by the Peking University Third Hospital based on the information-motivation-behavioral skills model. The overall adherence rate was calculated as the proportion of medication doses verified via uploading. The ischemic endpoint event rate and medication noncompliance rate were compared between traditional prevention monitoring and WeChat self-monitoring. Factors influencing adherence were summarized. Results: The 1-year follow-up event rate of the WeChat self-monitoring group was 11.9\% (12/101), which was less than that of the traditional group (21/157, 13.4\%). Compared with the traditional group, the risk ratio of the WeChat group was 0.983 (95\% CI 0.895-1.080); this difference was not noted to be significant. The 1-year medication noncompliance ratio tended to be lower in the WeChat monitoring group (3/101, 3.0\%) than in the traditional group (11/157, 7.0\%; $\chi$2=1.9, df=1, P=.16). Of the platform registry participants, 89.7\% (210/234: 167 hospital-based and 43 community-based participants) adhered to inputting information into WeChat for 8-96 weeks. The average adherence time was 16.54 (SD 0.80, range 2-24) months. The average decrease in adherence was 4 participants (1.1\%) per month. Being a member of a community-based population was an influencing factor for good adherence at the 2-year follow-up (OR 2.373, 95\% CI 1.019-5.527, P=.045), whereas transient ischemic attack was an influencing factor for poor adherence at the 2-year follow-up (OR 0.122, 95\% CI 0.016-0.940, P=.04). Conclusions: Use of WeChat self-monitoring showed a trend of increasing medication compliance and decreasing ischemic endpoint event rate compared with traditional monitoring. However, there were ceiling effects in the outcomes, and a relatively small sample size was used. Male participants displayed better adherence to WeChat self-monitoring. The community-based population displayed good adherence when using WeChat self-monitoring. Trial Registration: ClinicalTrials.gov NCT02618265; https://clinicaltrials.gov/ct2/show/NCT02618265 ",
doi="10.2196/16496",
url="https://mhealth.jmir.org/2020/4/e16496",
url="http://www.ncbi.nlm.nih.gov/pubmed/32293574"
}


@Article{info:doi/10.2196/15789,
author="Prinjha, Suman
and Ricci-Cabello, Ignacio
and Newhouse, Nikki
and Farmer, Andrew",
title="British South Asian Patients' Perspectives on the Relevance and Acceptability of Mobile Health Text Messaging to Support Medication Adherence for Type 2 Diabetes: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e15789",
keywords="type 2 diabetes",
keywords="South Asians",
keywords="text messages",
keywords="self-management",
keywords="medication adherence",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
abstract="Background: The prevalence of type 2 diabetes (T2D) is greater in South Asian populations and health outcomes are poorer compared with other ethnic groups. British South Asians are up to six times more likely to have T2D than the general population, to develop the condition at a younger age, and to experience diabetes-related complications. Interventions to support people in managing their condition can potentially reduce debilitating complications. Evidence to support the use of digital devices in T2D management, including mobile phones, has shown positive impacts on glycemic control. There is increasing recognition that health interventions that are culturally adapted to the needs of specific groups are more likely to be relevant and acceptable, but evidence to support the effectiveness of adapted interventions is limited and inconclusive. Objective: This formative study aimed to explore the perceptions and views of British South Asian patients with T2D on mobile health SMS text messaging to support medication adherence, aimed at the general UK population. Methods: Eight exploratory focus groups were conducted in Leicester, the United Kingdom, between September 2017 and March 2018. A diverse sample of 67 adults took part. Results: British South Asian people with T2D who use digital devices, including mobile phones, felt that short messages to support medication adherence would be acceptable and relevant, but they also wanted messages that would support other aspects of self-management too. Participants were particularly interested in content that met their information needs, including information about South Asian foods, commonly used herbs and spices, natural and herbal approaches used in the United Kingdom and in South Asia, and religious fasting. Short messages delivered in English were perceived to be acceptable, often because family members could translate for those unable to read or understand the messages. Suggestions to support patients unable to understand short messages in English included having them available in different formats, and disseminated in face-to-face groups for those who did not use digital devices. Conclusions: Exploring the views of British South Asian patients about SMS text messaging aimed at the general UK population is important in maximizing the potential of such an intervention. For such a digital system to meet the needs of UK South Asian populations, it may also have to include culturally relevant messages sent to those who opt to receive them. It is equally important to consider how to disseminate message content to patients who do not use digital devices to help reduce health inequalities. ",
doi="10.2196/15789",
url="https://mhealth.jmir.org/2020/4/e15789/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310150"
}


@Article{info:doi/10.2196/17328,
author="Demirci, R. Jill
and Suffoletto, Brian
and Doman, Jack
and Glasser, Melissa
and Chang, C. Judy
and Sereika, M. Susan
and Bogen, L. Debra",
title="The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e17328",
keywords="breast feeding",
keywords="perceived insufficient milk",
keywords="text messaging",
keywords="short message service",
keywords="cell phone",
keywords="mobile phone",
keywords="telemedicine",
keywords="mHealth",
keywords="randomized controlled trial",
abstract="Background: Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined. Objective: This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)---the single, leading modifiable cause of unintended breastfeeding reduction and cessation. Methods: We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message--based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging--based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum. Results: Participants randomized to MILK (87/124, 70.2\% white and 84/124, 67.7\% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3\%) elected to stop MILK messages, and 3 (2.4\%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54\% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants' pre-existing breastfeeding knowledge and unique breastfeeding trajectory. Conclusions: Prenatal and postpartum evidence--based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered. Trial Registration: ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969 ",
doi="10.2196/17328",
url="https://mhealth.jmir.org/2020/4/e17328",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347815"
}


@Article{info:doi/10.2196/14721,
author="Petrenko, LM Christie
and Parr, Jennifer
and Kautz, Carson
and Tapparello, Cristiano
and Olson, Carmichael Heather",
title="A Mobile Health Intervention for Fetal Alcohol Spectrum Disorders (Families Moving Forward Connect): Development and Qualitative Evaluation of Design and Functionalities",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="6",
volume="8",
number="4",
pages="e14721",
keywords="fetal alcohol spectrum disorders",
keywords="fetal alcohol syndrome",
keywords="parenting",
keywords="children",
keywords="mobile health",
keywords="mHealth",
keywords="treatment",
abstract="Background: Fetal alcohol spectrum disorders (FASD) affect approximately 2\% to 5\% of the US population. However, most families are unable to access FASD-informed interventions. Barriers to care include the lack of a knowledgeable and skilled workforce and family-level barriers such as limited financial resources, inability to access childcare, and stigma. As a result, families often try peer-to-peer and self-help support strategies. However, they often take these strategies from disparate sources, which have quite variable intervention quality and empirical support. Objective: This study aimed to initiate systematic development and evaluation of a mobile health intervention (app) for caregivers raising children with FASD. Focus groups were conducted to elicit participant perspectives on app design and functionalities to inform further app development. Methods: The app, called FMF Connect, was derived from the scientifically validated Families Moving Forward (FMF) Program, a clinician-delivered behavioral consultation intervention. FMF Connect was intended for caregiver self-delivery and included five main components: (1) Learning Modules, (2) Family Forum, (3) Library, (4) Notebook, and (5) Dashboard. Focus group methods were used to solicit perspectives from diverse families during the early stages of app development. Questions were asked about interface design, relevance of components and content, and perceived barriers and facilitators of use. A total of 25 caregivers participated in 7 focus groups across 5 US cities. Data were analyzed thematically. Results: Focus group participants were generally enthusiastic about the app interface design and components. Four global positive impression themes emerged, including (1) ease of access, (2) how the app guides and organizes information, (3) connection to other users and information, and (4) ability to share some content with others. Themes arose not only in discussions relating to positive app features but also when participants were asked about motivators for app use. Participants related how these positive global themes could address some system-level barriers, such as limited access to services, feeling isolated, and increased advocacy needs related to the societal lack of FASD knowledge. Participants identified many positive features about individual app components and functionalities. They also communicated potential barriers to use and raised important concerns and considerations relating to several app components. These included recognizability of the app based on the logo, and the balance of following the planned intervention sequence versus obtaining immediate answers. Also mentioned were privacy and dynamics within the Family Forum. Conclusions: FMF Connect is a promising novel intervention with potential to reach many families in need and reduce significant barriers to care, resulting in a broader public health impact. Study findings will guide further app development both in terms of content and technological advances to optimize intervention effects. FMF Connect app development provides useful directions for other apps aimed at changing parenting practices. ",
doi="10.2196/14721",
url="https://mhealth.jmir.org/2020/4/e14721",
url="http://www.ncbi.nlm.nih.gov/pubmed/32250274"
}


@Article{info:doi/10.2196/14376,
author="Molina-Recio, Guillermo
and Molina-Luque, Rafael
and Jim{\'e}nez-Garc{\'i}a, M. Ana
and Ventura-Puertos, E. Pedro
and Hern{\'a}ndez-Reyes, Alberto
and Romero-Salda{\~n}a, Manuel",
title="Proposal for the User-Centered Design Approach for Health Apps Based on Successful Experiences: Integrative Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="22",
volume="8",
number="4",
pages="e14376",
keywords="mHealth",
keywords="user-centered development",
keywords="focus groups",
keywords="discussion groups",
keywords="interdisciplinarity",
abstract="Background: Different strategies encompassed within mHealth have shown themselves to be effective for maintaining good health or controlling certain diseases. However, there is usually a very high rate of abandonment of health apps. Therefore, it would seem obvious that there is a need for involving the end users (whether they are health professionals, patients, or both) in the design process from the early stages in order to enable their needs and characteristics to be identified. In this sense, it is common knowledge that focusing on the user permits the consideration of valuable details aimed at making the correct adjustment between the patient, the technology, and the organization of attention. Objective: The goal of the research was to propose a methodology based on the review of previous successful user experiences in setting up health apps by using qualitative techniques (focus groups and discussion groups) that includes the participation of information technology and health professionals and the patients themselves. Methods: An integrative review was made of studies in which a qualitative methodology was employed mainly through focus and/or discussion groups for the design and development of health apps, consulting diverse databases (PubMed, Scopus, and Proquest) with the following search strategy: ``mHealth AND apps AND focus group OR discussion group.'' A total of 69 papers were included in the review. Results: A proposal structured in 4 sessions of variable duration was made in which information technology and health professionals and patients take part: composing, preparing, and organizing contents (session 1); testing structure and usability (session 2); does the app fit the needs of end users? (session 3); and last testing---keep on improving (session 4). Throughout the sessions, we propose studying aspects like previous user experiences in mHealth, barriers to the adoption of mHealth, interface contents, management and browsability, usability, perceived quality, security and privacy, capacity to self-manage disease with the app, ergonomics, and glanceability, etc. Specific tools that have proved useful in previous research for measuring these aspects are presented. Conclusions: These work sessions would be based on predominantly qualitative methodologies although, as they evolve, validated questionnaires permitting the assessment of the objectivity of certain technical aspects could be incorporated. With this proposal, a project centered on end users could be effected, responding to their needs. However, this requires validation that will be made via implementation in the development of health apps, with the subsequent measurement of results in terms of adherence and improvement in the clinical variables of the end users. ",
doi="10.2196/14376",
url="https://mhealth.jmir.org/2020/4/e14376/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319965"
}


@Article{info:doi/10.2196/15780,
author="Hou, I-Ching
and Lan, Min-Fang
and Shen, Shan-Hsiang
and Tsai, Yu Pei
and Chang, Jen King
and Tai, Hao-Chih
and Tsai, Ay-Jen
and Chang, Polun
and Wang, Tze-Fang
and Sheu, Shuh-Jen
and Dykes, C. Patricia",
title="The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e15780",
keywords="breast cancer",
keywords="mobile health application",
keywords="self-management",
keywords="design thinking",
abstract="Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient's perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. ",
doi="10.2196/15780",
url="https://mhealth.jmir.org/2020/4/e15780/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352390"
}


@Article{info:doi/10.2196/14836,
author="Gong, Enying
and Zhang, Zongmuyu
and Jin, Xurui
and Liu, Yishan
and Zhong, Lumin
and Wu, Yao
and Zhong, Xuefeng
and Yan, L. Lijing
and Oldenburg, Brian",
title="Quality, Functionality, and Features of Chinese Mobile Apps for Diabetes Self-Management: Systematic Search and Evaluation of Mobile Apps",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="7",
volume="8",
number="4",
pages="e14836",
keywords="diabetes mellitus",
keywords="self-management",
keywords="mobile apps",
keywords="China",
abstract="Background: The emergence and advancement of mobile technologies offer a promising opportunity for people with diabetes to improve their self-management. Despite the proliferation of mobile apps, few studies have evaluated the apps that are available to the millions of people with diabetes in China. Objective: This study aimed to conduct a systematic search of Chinese mobile apps for diabetes self-management and to evaluate their quality, functionality, and features by using validated rating scales. Methods: A systematic search was conducted to identify Chinese apps for diabetes self-management in the four most popular Chinese language mobile app stores. Apps were included if they were designed for diabetes self-management and contained at least one of the following components: blood glucose management, dietary and physical activity management, medication taking, and prevention of diabetes-related comorbidities. Apps were excluded if they were unrelated to health, not in Chinese, or the targeted users are health care professionals. Apps meeting the identified inclusion criteria were downloaded and evaluated by a team of 5 raters. The quality, functionalities, and features of these apps were assessed by using the Mobile App Rating Scale (MARS), the IMS Institute for Healthcare Informatics Functionality score, and a checklist of self-management activities developed based on the Chinese diabetes self-management guideline, respectively. Results: Among 2072 apps searched, 199 were eligible based on the inclusion criteria, and 67 apps were successfully downloaded for rating. These 67 apps had an average MARS score of 3.42 out of 5, and 76\% (51/67) of the apps achieved an acceptable quality (MARS score >3.0). The scores for the four subdomains of MARS were 3.97 for functionality, 3.45 for aesthetics, 3.21 for information, and 3.07 for engagement. On average, reviewed apps applied five out of the 19 examined behavior change techniques, whereas the average score on the subjective quality for the potential impact on behavior change is 3 out of 5. In addition, the average score on IMS functionality was 6 out of 11. Functionalities in collecting, recording, and displaying data were mostly presented in the reviewed apps. Most of the apps were multifeatured with monitoring blood glucose and tracking lifestyle behaviors as common features, but some key self-management activities recommended by clinical guidelines, such as stress and emotional management, were rarely presented in these apps. Conclusions: The general quality of the reviewed apps for diabetes self-management is suboptimal, although the potential for improvement is significant. More attention needs to be paid to the engagement and information quality of these apps through co-design with researchers, public health practitioners, and consumers. There is also a need to promote the awareness of the public on the benefit and potential risks of utilizing health apps for self-management. ",
doi="10.2196/14836",
url="https://mhealth.jmir.org/2020/4/e14836",
url="http://www.ncbi.nlm.nih.gov/pubmed/32255432"
}


@Article{info:doi/10.2196/17246,
author="Keutzer, Lina
and Wicha, G. Sebastian
and Simonsson, SH Ulrika",
title="Mobile Health Apps for Improvement of Tuberculosis Treatment: Descriptive Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="21",
volume="8",
number="4",
pages="e17246",
keywords="mHealth",
keywords="video observed treatment",
keywords="eHealth",
keywords="model-informed precision dosing",
keywords="MIPD",
keywords="tuberculosis",
keywords="mobile apps",
keywords="therapeutic drug monitoring",
keywords="smartphone",
abstract="Background: Mobile health (mHealth) is a rapidly emerging market, which has been implemented in a variety of different disease areas. Tuberculosis remains one of the most common causes of death from an infectious disease worldwide, and mHealth apps offer an important contribution to the improvement of tuberculosis treatment. In particular, apps facilitating dose individualization, adherence monitoring, or provision of information and education about the disease can be powerful tools to prevent the development of drug-resistant tuberculosis or disease relapse. Objective: The aim of this review was to identify, describe, and categorize mobile and Web-based apps related to tuberculosis that are currently available. Methods: PubMed, Google Play Store, Apple Store, Amazon, and Google were searched between February and July 2019 using a combination of 20 keywords. Apps were included in the analysis if they focused on tuberculosis, and were excluded if they were related to other disease areas or if they were games unrelated to tuberculosis. All apps matching the inclusion criteria were classified into the following five categories: adherence monitoring, individualized dosing, eLearning/information, diagnosis, and others. The included apps were then summarized and described based on publicly available information using 12 characteristics. Results: Fifty-five mHealth apps met the inclusion criteria and were included in this analysis. Of the 55 apps, 8 (15\%) were intended to monitor patients' adherence, 6 (11\%) were designed for dosage adjustment, 29 (53\%) were designed for eLearning/information, 3 (6\%) were focused on tuberculosis diagnosis, and 9 (16\%) were related to other purposes. Conclusions: The number of mHealth apps related to tuberculosis has increased during the past 3 years. Although some of the discovered apps seem promising, many were found to contain errors or provided harmful or wrong information. Moreover, the majority of mHealth apps currently on the market are focused on making information about tuberculosis available (29/55, 53\%). Thus, this review highlights a need for new, high-quality mHealth apps supporting tuberculosis treatment, especially those supporting individualized optimized treatment through model-informed precision dosing and video observed treatment. ",
doi="10.2196/17246",
url="https://mhealth.jmir.org/2020/4/e17246/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32314977"
}


@Article{info:doi/10.2196/16140,
author="Jacomet, Christine
and Ologeanu-Taddei, Roxana
and Prouteau, Justine
and Lambert, C{\'e}line
and Linard, Fran{\c{c}}oise
and Bastiani, Pascale
and Dellamonica, Pierre",
title="Adoption and Attitudes of eHealth Among People Living With HIV and Their Physicians: Online Multicenter Questionnaire Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="15",
volume="8",
number="4",
pages="e16140",
keywords="survey",
keywords="HIV",
keywords="eHealth",
keywords="internet for information retrieval",
keywords="health applications",
keywords="connected objects",
keywords="telemedicine",
keywords="collection of digitized personal information",
abstract="Background: The development of electronic health (eHealth) has offered the opportunity for remote care provision. eHealth addresses issues for patients and professionals favoring autonomy and compliance, respectively, while fostering closer links both between patients and health care professionals and among health care professionals themselves. Objective: The aim of this study was to analyze the patterns of use, benefits, and perceived obstacles in eHealth among people living with HIV (PLHIV) and their caring physicians at hospitals. Methods: An online multicenter observational survey was conducted October 15-19, 2018 in 51 medical units across France by means of self-administered questionnaires to collect sociodemographic and medical data, and perceptions of eHealth. Multiple correspondence analysis followed by mixed unsupervised classification were performed to analyze data of the respondents. Results: A total of 279 PLHIV and 219 physicians responded to all parts of the questionnaire. Three groups of PLHIV were identified based on multivariate analysis. Group 1 comprised ``eHealth believers'' (121/279, 43.4\%), who were more frequently above 60 years old and more likely to be receiving treatments other than antiretrovirals. Group 2, the ``technology skeptics'' (86/279, 30.8\%), comprised more women with at least one child. Group 3, the ``internet adopters'' (72/279, 25.8\%), were more frequently under 49 years of age, men who have sex with men, and more likely to use mobile apps for obtaining wellness/health information and related subjects. Three groups of physicians also emerged. Group 1 comprised those ``strongly confident in eHealth'' (95/219, 43.4\%), who more frequently used mobile apps for wellness/health information and were more likely to accept prescription assistance software. Group 2 comprised physicians ``strongly opposed to eHealth'' (80/219, 36.5\%), frequently asserting that eHealth challenges confidentiality. Group 3 were ``open to eHealth'' (44/219, 20.1\%), comprising a higher proportion of infectious disease specialists, and were more likely to believe that medical apps are useful for patient education and information. No link was found between the groups of PLHIV and physicians. Conclusions: The literature on eHealth mainly classifies people as enthusiasts and skeptics; however, we identified a third profile among both PLHIV and physicians, albeit without a direct link between them. For PLHIV, this third group is attentive to eHealth for improving their health condition, and for physicians, this group considers eHealth to offer benefits to patients and their own practice. ",
doi="10.2196/16140",
url="https://mhealth.jmir.org/2020/4/e16140/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32293581"
}


@Article{info:doi/10.2196/15095,
author="Aquino, Maria
and Munce, Sarah
and Griffith, Janessa
and Pakosh, Maureen
and Munnery, Mikayla
and Seto, Emily",
title="Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="17",
volume="8",
number="4",
pages="e15095",
keywords="high-risk pregnancy",
keywords="blood pressure",
keywords="preeclampsia",
keywords="telemetry",
keywords="telemedicine",
keywords="mHealth",
keywords="eHealth",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: High blood pressure complicates 2\% to 8\% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions. Objective: The aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP? Methods: A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review. Results: Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65\%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention's design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles. Conclusions: Although current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions. ",
doi="10.2196/15095",
url="https://mhealth.jmir.org/2020/4/e15095/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301744"
}


@Article{info:doi/10.2196/15344,
author="Tacchino, Andrea
and Veldkamp, Renee
and Coninx, Karin
and Brulmans, Jens
and Palmaers, Steven
and H{\"a}m{\"a}l{\"a}inen, P{\"a}ivi
and D'hooge, Mieke
and Vanzeir, Ellen
and Kalron, Alon
and Brichetto, Giampaolo
and Feys, Peter
and Baert, Ilse",
title="Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="16",
volume="8",
number="4",
pages="e15344",
keywords="tablet",
keywords="mobile device",
keywords="cognitive rehabilitation",
keywords="cognitive impairment",
keywords="dual-task training",
keywords="cognitive-motor interference",
keywords="dual-task cost",
keywords="adherence",
keywords="multiple sclerosis",
keywords="walking",
abstract="Background: Dual tasking constitutes a large portion of most activities of daily living; in real-lifesituations, people need to not only maintain balance and mobility skills, but also perform other cognitive or motor tasks at the same time. Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective: To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods: CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C\# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results: The adherence rate was 91\%. DTT was perceived as ``somewhat difficult'' (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions: CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS. ",
doi="10.2196/15344",
url="https://mhealth.jmir.org/2020/4/e15344/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343258"
}


@Article{info:doi/10.2196/17258,
author="Guo, Xitong
and Chen, Shuqing
and Zhang, Xiaofei
and Ju, Xiaofeng
and Wang, Xifu",
title="Exploring Patients' Intentions for Continuous Usage of mHealth Services: Elaboration-Likelihood Perspective Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="6",
volume="8",
number="4",
pages="e17258",
keywords="mHealth services",
keywords="health consciousness",
keywords="elaboration-likelihood model",
keywords="health behavior",
keywords="patients' continuous usage",
abstract="Background: With the increasingly rapid development of Web 2.0 technologies, the application of mobile health (mHealth) care in the field of health management has become popular. Accordingly, patients are able to access consulting services and effective health information online without temporal and geographical constraints. The elaboration-likelihood model (ELM) is a dual-process persuasion theory that describes the change of attitudes and behavior. Objective: In this study, we drew on the ELM to investigate patients' continuous usage intentions regarding mHealth services. In addition, we further examined which route---central or peripheral---has a stronger impact on a patient's usage of health care management. Methods: To meet these objectives, five hypotheses were developed and empirically validated using a field survey to test the direct and indirect effects, via attitude, of the two routes on continuous usage intention. Results: We found that patients' perceived mHealth information quality and perceived mHealth system quality had a positive effect on their personal attitudes. The results revealed that social media influence had a positive effect on a patient's attitude toward mHealth services. In particular, our findings suggest that a patient's health consciousness has a positive effect on the relationship between social media influence and attitude. Conclusions: This study contributes to the mHealth services literature by introducing the ELM as a referent theory for research, as well as by specifying the moderating role of health consciousness. For practitioners, this study introduces influence processes as policy tools that managers can employ to motivate the uptake of mHealth services within their organizations. ",
doi="10.2196/17258",
url="https://mhealth.jmir.org/2020/4/e17258",
url="http://www.ncbi.nlm.nih.gov/pubmed/32250277"
}


@Article{info:doi/10.2196/10733,
author="Guillodo, Elise
and Lemey, Christophe
and Simonnet, Mathieu
and Walter, Michel
and Baca-Garc{\'i}a, Enrique
and Masetti, Vincent
and Moga, Sorin
and Larsen, Mark
and 
and Ropars, Juliette
and Berrouiguet, Sofian",
title="Clinical Applications of Mobile Health Wearable--Based Sleep Monitoring: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="1",
volume="8",
number="4",
pages="e10733",
keywords="sleep",
keywords="eHealth",
keywords="telemedicine",
keywords="review",
keywords="medicine",
keywords="wearable electronic devices",
abstract="Background: Sleep disorders are a major public health issue. Nearly 1 in 2 people experience sleep disturbances during their lifetime, with a potential harmful impact on well-being and physical and mental health. Objective: The aim of this study was to better understand the clinical applications of wearable-based sleep monitoring; therefore, we conducted a review of the literature, including feasibility studies and clinical trials on this topic. Methods: We searched PubMed, PsycINFO, ScienceDirect, the Cochrane Library, Scopus, and the Web of Science through June 2019. We created the list of keywords based on 2 domains: wearables and sleep. The primary selection criterion was the reporting of clinical trials using wearable devices for sleep recording in adults. Results: The initial search identified 645 articles; 19 articles meeting the inclusion criteria were included in the final analysis. In all, 4 categories of the selected articles appeared. Of the 19 studies in this review, 58 \% (11/19) were comparison studies with the gold standard, 21\% (4/19) were feasibility studies, 15\% (3/19) were population comparison studies, and 5\% (1/19) assessed the impact of sleep disorders in the clinic. The samples were heterogeneous in size, ranging from 1 to 15,839 patients. Our review shows that mobile-health (mHealth) wearable--based sleep monitoring is feasible. However, we identified some major limitations to the reliability of wearable-based monitoring methods compared with polysomnography. Conclusions: This review showed that wearables provide acceptable sleep monitoring but with poor reliability. However, wearable mHealth devices appear to be promising tools for ecological monitoring. ",
doi="10.2196/10733",
url="https://mhealth.jmir.org/2020/4/e10733",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234707"
}


@Article{info:doi/10.2196/14969,
author="Liao, Jing
and Xiao, Hai-Yan
and Li, Xue-Qi
and Sun, Shu-Hua
and Liu, Shi-Xing
and Yang, Yung-Jen
and Xu, (Roman) Dong",
title="A Social Group-Based Information-Motivation-Behavior Skill Intervention to Promote Acceptability and Adoption of Wearable Activity Trackers Among Middle-Aged and Older Adults: Cluster Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="9",
volume="8",
number="4",
pages="e14969",
keywords="mobile health",
keywords="group exercise",
keywords="social influence",
keywords="behavior change",
keywords="cluster randomized controlled trial",
abstract="Background: Wearable activity trackers offer potential to optimize behavior and support self-management. To assist older adults in benefiting from mobile technologies, theory-driven deployment strategies are needed to overcome personal, technological, and sociocontextual barriers in technology adoption. Objective: To test the effectiveness of a social group--based strategy to improve the acceptability and adoption of activity trackers by middle-aged and older adults. Methods: A cluster randomized controlled trial was conducted among 13 groups of middle-aged and older adults (?45 years) performing group dancing (ie, square dancing) as a form of exercise in Guangzhou from November 2017 to October 2018. These dancing groups were randomized 1:1 into two arms, and both received wrist-worn activity trackers and instructions at the baseline face-to-face assessment. Based on the Information-Motivation-Behavior Skill framework, the intervention arm was also given a tutorial on the purpose of exercise monitoring (Information), encouraged to participate in exercise and share their exercise records with their dancing peers (Motivation), and were further assisted with the use of the activity tracker (Behavior Skill). We examined two process outcomes: acceptability evaluated by a 14-item questionnaire, and adoption assessed by the uploaded step count data. Intention-to-treat analysis was applied, with the treatment effects estimated by multilevel models. Results: All dancing groups were followed up for the postintervention reassessment, with 61/69 (88\%) participants of the intervention arm (7 groups) and 56/80 (70\%) participants of the control arm (6 groups). Participants' sociodemographic characteristics (mean age 62 years, retired) and health status were comparable between the two arms, except the intervention arm had fewer female participants and lower cognitive test scores. Our intervention significantly increased the participants' overall acceptability by 6.8 points (95\% CI 2.2-11.4), mainly driven by promoted motivation (adjusted group difference 2.0, 95\% CI 0.5-3.6), increased usefulness (adjusted group difference 2.5, 95\% CI 0.9-4.1), and better perceived ease of use (adjusted group difference 1.2, 95\% CI 0.1-2.4), whereas enjoyment and comfort were not increased (adjusted group difference 0.9, 95\% CI --0.4-2.3). Higher adoption was also observed among participants in the intervention arm, who were twice as likely to have valid daily step account data than their controlled counterparts (adjusted incidence relative risk [IRR]=2.0, 95\% CI 1.2-3.3). The average daily step counts (7803 vs 5653 steps/day for the intervention and control, respectively) were similar between the two arms (adjusted IRR=1.4, 95\% CI 0.7-2.5). Conclusions: Our social group--based deployment strategy incorporating information, motivation, and behavior skill components effectively promoted acceptability and adoption of activity trackers among community-dwelling middle-aged and older adults. Future studies are needed to examine the long-term effectiveness and apply this social engagement strategy in other group settings or meeting places. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOC-17013185; https://tinyurl.com/vedwc7h. ",
doi="10.2196/14969",
url="https://mhealth.jmir.org/2020/4/e14969",
url="http://www.ncbi.nlm.nih.gov/pubmed/32271151"
}


@Article{info:doi/10.2196/14306,
author="Tsanas, Athanasios
and Woodward, Elizabeth
and Ehlers, Anke",
title="Objective Characterization of Activity, Sleep, and Circadian Rhythm Patterns Using a Wrist-Worn Actigraphy Sensor: Insights Into Posttraumatic Stress Disorder",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e14306",
keywords="actigraphy",
keywords="sleep",
keywords="Geneactiv",
keywords="posttraumatic stress disorder",
keywords="wearable technology",
abstract="Background: Wearables have been gaining increasing momentum and have enormous potential to provide insights into daily life behaviors and longitudinal health monitoring. However, to date, there is still a lack of principled algorithmic framework to facilitate the analysis of actigraphy and objectively characterize day-by-day data patterns, particularly in cohorts with sleep problems. Objective: This study aimed to propose a principled algorithmic framework for the assessment of activity, sleep, and circadian rhythm patterns in people with posttraumatic stress disorder (PTSD), a mental disorder with long-lasting distressing symptoms such as intrusive memories, avoidance behaviors, and sleep disturbance. In clinical practice, these symptoms are typically assessed using retrospective self-reports that are prone to recall bias. The aim of this study was to develop objective measures from patients' everyday lives, which could potentially considerably enhance the understanding of symptoms, behaviors, and treatment effects. Methods: Using a wrist-worn sensor, we recorded actigraphy, light, and temperature data over 7 consecutive days from three groups: 42 people diagnosed with PTSD, 43 traumatized controls, and 30 nontraumatized controls. The participants also completed a daily sleep diary over 7 days and the standardized Pittsburgh Sleep Quality Index questionnaire. We developed a novel approach to automatically determine sleep onset and offset, which can also capture awakenings that are crucial for assessing sleep quality. Moreover, we introduced a new intuitive methodology facilitating actigraphy exploration and characterize day-by-day data across 49 activity, sleep, and circadian rhythm patterns. Results: We demonstrate that the new sleep detection algorithm closely matches the sleep onset and offset against the participants' sleep diaries consistently outperforming an existing open-access widely used approach. Participants with PTSD exhibited considerably more fragmented sleep patterns (as indicated by greater nocturnal activity, including awakenings) and greater intraday variability compared with traumatized and nontraumatized control groups, showing statistically significant (P<.05) and strong associations (|R|>0.3). Conclusions: This study lays the foundation for objective assessment of activity, sleep, and circadian rhythm patterns using passively collected data from a wrist-worn sensor, facilitating large community studies to monitor longitudinally healthy and pathological cohorts under free-living conditions. These findings may be useful in clinical PTSD assessment and could inform therapy and monitoring of treatment effects. ",
doi="10.2196/14306",
url="https://mhealth.jmir.org/2020/4/e14306/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310142"
}


@Article{info:doi/10.2196/15704,
author="Keogh, Alison
and Dorn, F. Jonas
and Walsh, Lorcan
and Calvo, Francesc
and Caulfield, Brian",
title="Comparing the Usability and Acceptability of Wearable Sensors Among Older Irish Adults in a Real-World Context: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e15704",
keywords="wearable technology",
keywords="usability",
keywords="mixed methods",
keywords="user satisfaction",
abstract="Background: Wearable devices are valuable assessment tools for patient outcomes in contexts such as clinical trials. To be successfully deployed, however, participants must be willing to wear them. Another concern is that usability studies are rarely published, often fail to test devices beyond 24 hours, and need to be repeated frequently to ensure that contemporary devices are assessed. Objective: This study aimed to compare multiple wearable sensors in a real-world context to establish their usability within an older adult (>50 years) population. Methods: Eight older adults wore seven devices for a minimum of 1 week each: Actigraph GT9x, Actibelt, Actiwatch, Biovotion, Hexoskin, Mc10 Biostamp\_RC, and Wavelet. Usability was established through mixed methods using semistructured interviews and three questionnaires, namely, the Intrinsic Motivation Inventory (IMI), the System Usability Scale (SUS), and an acceptability questionnaire. Quantitative data were reported descriptively and qualitative data were analyzed using deductive content analysis. Data were then integrated using triangulation. Results: Results demonstrated that no device was considered optimal as all scored below average in the SUS (median, IQR; min-max=57.5, 12.5; 47.5-63.8). Hexoskin was the lowest scored device based on the IMI (3.6; 3.4-4.5), while Biovotion, Actibelt, and Mc10 Biostamp\_RC achieved the highest median results on the acceptability questionnaire (3.6 on a 6-point Likert scale). Qualitatively, participants were willing to accept less comfort, less device discretion, and high charging burdens if the devices were perceived as useful, namely through the provision of feedback for the user. Participants agreed that the purpose of use is a key enabler for long-term compliance. These views were particularly noted by those not currently wearing an activity-tracking device. Participants believed that wrist-worn sensors were the most versatile and easy to use, and therefore, the most suitable for long-term use. In particular, Actiwatch and Wavelet stood out for their comfort. The convergence of quantitative and qualitative data was demonstrated in the study. Conclusions: Based on the results, the following context-specific recommendations can be made: (1) researchers should consider their device selection in relation to both individual and environmental factors, and not simply the primary outcome of the research study; (2) if researchers do not wish their participants to have access to feedback from the devices, then a simple, wrist-worn device that acts as a watch is preferable; (3) if feedback is allowed, then it should be made available to help participants remain engaged; this is likely to apply only to people without cognitive impairments; (4) battery life of 1 week should be considered as a necessary feature to enhance data capture; (5) researchers should consider providing additional information about the purpose of devices to participants to support their continued use. ",
doi="10.2196/15704",
url="https://mhealth.jmir.org/2020/4/e15704/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310149"
}


@Article{info:doi/10.2196/17544,
author="Chong, L. Kimberly P.
and Guo, Z. Julia
and Deng, Xiaomeng
and Woo, P. Benjamin K.",
title="Consumer Perceptions of Wearable Technology Devices: Retrospective Review and Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e17544",
keywords="wearable technology devices",
keywords="Fitbit",
keywords="Amazon",
keywords="sleep",
abstract="Background: Individuals of all ages are becoming more health conscious, and wearable technology devices (eg, Fitbit and Apple Watch) are becoming increasingly popular in encouraging healthy lifestyles. Objective: The aim of this paper was to explore how consumers use wearable devices. Methods: A retrospective review was done on the top-rated verified purchase reviews of the Fitbit One posted on Amazon.com between January 2014 and August 2018. Relevant themes were identified by qualitatively analyzing open-ended reviews. Results: On retrieval, there were 9369 reviews with 7706 positive reviews and 1663 critical reviews. The top 100 positive and top 100 critical comments were subsequently analyzed. Four major themes were identified: sleep hygiene (``charts when you actually fall asleep, when you wake up during the night, when you're restless--and gives you a cumulative time of ``actual sleep'' as well as weekly averages.''), motivation (``25 lbs lost after 8 months -- best motivator ever!''), accountability (``platform to connect with people you know and set little competitions or group\ldotsfun accountability if you set a goal with a friend/family.''), and discretion (``able to be clipped to my bra without being seen.''). Alternatively, negative reviewers felt that the wearable device's various tracking functions, specifically steps and sleep, were inaccurate. Conclusions: Wearable technology devices are an affordable, user-friendly application that can support all individuals throughout their everyday lives and potentially be implemented into medical surveillance, noninvasive medical care, and mobile health and wellness monitoring. This study is the first to explore wearable technology device use among consumers, and further studies are needed to examine the limitless possibilities of wearable devices in health care. ",
doi="10.2196/17544",
url="https://mhealth.jmir.org/2020/4/e17544/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310148"
}


@Article{info:doi/10.2196/14707,
author="Chow, Hsueh-Wen
and Yang, Chao-Ching",
title="Accuracy of Optical Heart Rate Sensing Technology in Wearable Fitness Trackers for Young and Older Adults: Validation and Comparison Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="28",
volume="8",
number="4",
pages="e14707",
keywords="pulse",
keywords="photoplethysmography",
keywords="wearable device",
keywords="aerobic exercise",
abstract="Background: Wearable fitness trackers are devices that can record and enhance physical activity among users. Recently, photoplethysmography (PPG) devices that use optical heart rate sensors to detect heart rate in real time have become popular and help in monitoring and controlling exercise intensity. Although the benefits of using optical heart rate monitors have been highlighted through studies, the accuracy of the readouts these commercial devices generate has not been widely assessed for different age groups, especially for the East Asian population with Fitzpatrick skin type III or IV. Objective: This study aimed to examine the accuracy of 2 wearable fitness trackers with PPG to monitor heart rate in real time during moderate exercise in young and older adults. Methods: A total of 20 young adults and 20 older adults were recruited for this study. All participants were asked to undergo a series of sedentary and moderate physical activities using indoor aerobic exercise equipment. In this study, the Polar H7 chest-strapped heart rate monitor was used as the criterion measure in 2 fitness trackers, namely Xiaomi Mi Band 2 and Garmin Vivosmart HR+. The real-time, second-by-second heart rate data obtained from both devices were recorded using the broadcast heart rate mode. To critically analyze the results, multiple statistical parameters including the mean absolute percentage error (MAPE), Lin concordance correlation coefficient (CCC), intraclass correlation coefficient, the Pearson product moment correlation coefficient, and the Bland-Altman coefficient were determined to examine the performances of the devices. Results: Both test devices exhibited acceptable overall accuracy as heart rate sensors based on several statistical tests. Notably, the MAPE values were below 10\% (the designated threshold) in both devices (GarminYoung=3.77\%; GarminSenior=4.73\%; XiaomiYoung=7.69\%; and XiaomiSenior=6.04\%). The scores for reliability test of CCC for Garmin were 0.92 (Young) and 0.80 (Senior), whereas those for Xiaomi were 0.76 (Young) and 0.73 (Senior). However, the results obtained using the Bland-Altman analysis indicated that both test optical devices underestimated the average heart rate. More importantly, the study documented some unexpected outlier readings reported by these devices when used on certain participants. Conclusions: The study reveals that commonly used optical heart rate sensors, such as the ones used herein, generally produce accurate heart rate readings irrespective of the age of the user. However, users should avoid relying entirely on these readings to indicate exercise intensities, as these devices have a tendency to produce erroneous, extreme readings, which might misinterpret the real-time exercise intensity. Future studies should therefore emphasize the occurrence rate of such errors, as this will likely benefit the development of improved models of heart rate sensors. ",
doi="10.2196/14707",
url="https://mhealth.jmir.org/2020/4/e14707/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343255"
}


@Article{info:doi/10.2196/14841,
author="Migueles, H. Jairo
and Cadenas-Sanchez, Cristina
and Aguiar, J. Elroy
and Molina-Garcia, Pablo
and Solis-Urra, Patricio
and Mora-Gonzalez, Jose
and Garc{\'i}a-M{\'a}rmol, Eduardo
and Shiroma, J. Eric
and Labayen, Idoia
and Chill{\'o}n, Palma
and L{\"o}f, Marie
and Tudor-Locke, Catrine
and Ortega, B. Francisco",
title="Step-Based Metrics and Overall Physical Activity in Children With Overweight or Obesity: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="28",
volume="8",
number="4",
pages="e14841",
keywords="motion sensor",
keywords="pedometer",
keywords="sedentary behavior",
keywords="MVPA",
keywords="cadence",
abstract="Background: Best-practice early interventions to increase physical activity (PA) in children with overweight and obesity should be both feasible and evidence based. Walking is a basic human movement pattern that is practical, cost-effective, and does not require complex movement skills. However, there is still a need to investigate how much walking---as a proportion of total PA level---is performed by children who are overweight and obese in order to determine its utility as a public health strategy. Objective: This study aimed to (1) investigate the proportion of overall PA indicators that are explained by step-based metrics and (2) study step accumulation patterns relative to achievement of public health recommendations in children who are overweight and obese. Methods: A total of 105 overweight and obese children (mean 10.1 years of age [SD 1.1]; 43 girls) wore hip-worn accelerometers for 7 days. PA volumes were derived using the daily average of counts per 15 seconds, categorized using standard cut points for light-moderate-vigorous PA (LMVPA) and moderate-to-vigorous PA (MVPA). Derived step-based metrics included volume (steps/day), time in cadence bands, and peak 1-minute, 30-minute, and 60-minute cadences. Results: Steps per day explained 66\%, 40\%, and 74\% of variance for counts per 15 seconds, LMVPA, and MVPA, respectively. The variance explained was increased up to 80\%, 92\%, and 77\% by including specific cadence bands and peak cadences. Children meeting the World Health Organization recommendation of 60 minutes per day of MVPA spent less time at zero cadence and more time in cadence bands representing sporadic movement to brisk walking (ie, 20-119 steps/min) than their less-active peers. Conclusions: Step-based metrics, including steps per day and various cadence-based metrics, seem to capture a large proportion of PA for children who are overweight and obese. Given the availability of pedometers, step-based metrics could be useful in discriminating between those children who do or do not achieve MVPA recommendations. Trial Registration: ClinicalTrials.gov NCT02295072; https://clinicaltrials.gov/ct2/show/NCT02295072 ",
doi="10.2196/14841",
url="https://mhealth.jmir.org/2020/4/e14841/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343251"
}


@Article{info:doi/10.2196/18411,
author="Huang, Zhilian
and Tan, Eberta
and Lum, Elaine
and Sloot, Peter
and Boehm, Otto Bernhard
and Car, Josip",
title="Correction: A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e18411",
doi="10.2196/18411",
url="https://mhealth.jmir.org/2020/4/e18411",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348282"
}


@Article{info:doi/10.2196/19454,
author="Zhang, Yuanjin
and Fan, Dongsheng
and Ji, Hong
and Qiao, Shudong
and Li, Xia",
title="Correction: Treatment Adherence and Secondary Prevention of Ischemic Stroke Among Discharged Patients Using Mobile Phone- and WeChat-Based Improvement Services: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e19454",
doi="10.2196/19454",
url="https://mhealth.jmir.org/2020/4/e19454/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348276"
}


@Article{info:doi/10.2196/18516,
author="Mayer, Angel Miguel
and Rodr{\'i}guez Blanco, Octavi
and Torrejon, Antonio",
title="Correction: Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e18516",
doi="10.2196/18516",
url="https://mhealth.jmir.org/2020/4/e18516",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352925"
}


@Article{info:doi/10.2196/15282,
author="Hsiang, Elaine
and Offer, Claudine
and Prescott, Maximo
and Rodriguez, Amy
and Behar, Emily
and Matheson, Tim
and Santa Maria, Diane
and Santos, Glenn-Milo",
title="Bridging the Digital Divide Among Racial and Ethnic Minority Men Who Have Sex With Men to Reduce Substance Use and HIV Risk: Mixed Methods Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e15282",
keywords="ecological momentary assessment",
keywords="men who have sex with men",
keywords="text messaging",
keywords="substance use",
keywords="HIV",
keywords="digital divide",
keywords="focus group",
abstract="Background: Ecological momentary assessment (EMA) is a promising data collection tool for mobile health interventions targeting episodic health behaviors. For substance-using men who have sex with men (SUMSM), EMA is becoming more widely utilized in efforts to characterize substance use and sexual risk factors for HIV transmission. However, recent literature demonstrates emerging concerns over compliance and lower EMA engagement and data concordance among racial and ethnic minority SUMSM. Objective: This study aimed to provide a qualitative evaluation of the barriers and facilitators of EMA as a data collection tool among racial and ethnic minority SUMSM. Methods: Between October and November 2017, 45 racial and ethnic minority SUMSM were recruited from a list of prior research participants at the San Francisco Department of Public Health to participate in daily EMA surveys on their substance use and sexual health behaviors for 1 week, followed by in-person focus groups (FGs). A total of 4 FGs explored the participants' experiences with the surveys, issues regarding privacy and confidentiality, and suggestions for improvement. Qualitative analysis was performed using content analysis. Descriptive statistics and Fisher exact tests were used to assess the associations between demographics or substance use behaviors and EMA completion. Results: Overall, 93.9\% (295/314) of all delivered surveys were initiated, and of those, 98.0\% (289/295) were completed. Neither participant demographics, including race (P=.65) or age (P=.43), nor substance use behaviors, including the frequency of alcohol (P=.40) or methamphetamine (P=.91) use or any cocaine (P=.28), crack (P=.99), or polysubstance use (P=.24), were found to be associated with survey completion. Overall, participants were receptive to the text message--based EMA surveys. Facilitators included survey timing, user-friendly survey design, survey-stimulated self-reflection, coding of sensitive phrases, and other privacy benefits of a mobile survey. Barriers included an inability to correct texting errors and participants' perception of judgment or stigmatization related to questions about condomless sex. To improve EMA compliance and uptake, participants suggested adding response confirmations, clarifying survey language, and continuing to diversify the study audience. Conclusions: EMA appears to be feasible and acceptable among this sample of racial and ethnic minority SUMSM. Close attention to EMA study design and the development of nonjudgmental, contextualized questions regarding stigmatized health behaviors may be critical to further improve EMA compliance. ",
doi="10.2196/15282",
url="https://mhealth.jmir.org/2020/4/e15282/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347807"
}


@Article{info:doi/10.2196/19139,
author="Ekong, Iniobong
and Chukwu, Emeka
and Chukwu, Martha",
title="COVID-19 Mobile Positioning Data Contact Tracing and Patient Privacy Regulations: Exploratory Search of Global Response Strategies and the Use of Digital Tools in Nigeria",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="27",
volume="8",
number="4",
pages="e19139",
keywords="COVID-19",
keywords="contact tracing",
keywords="Nigeria's National Data Protection Regulation",
keywords="General Data Protection Regulation",
keywords="GDPR",
keywords="coronavirus",
keywords="surveillance",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
abstract="Background: The coronavirus disease (COVID-19) pandemic is the biggest global economic and health challenge of the century. Its effect and impact are still evolving, with deaths estimated to reach 40 million if unchecked. One effective and complementary strategy to slow the spread and reduce the impact is to trace the primary and secondary contacts of confirmed COVID-19 cases using contact tracing technology. Objective: The objective of this paper is to survey strategies for digital contact tracing for the COVID-19 pandemic and to present how using mobile positioning data conforms with Nigeria's data privacy regulations. Methods: We conducted an exploratory review of current measures for COVID-19 contact tracing implemented around the world. We then analyzed how countries are using mobile positioning data technology to reduce the spread of COVID-19. We made recommendations on how Nigeria can adopt this approach while adhering to the guidelines provided by the National Data Protection Regulation (NDPR). Results: Despite the potential of digital contact tracing, it always conflicts with patient data privacy regulations. We found that Nigeria's response complies with the NDPR, and that it is possible to leverage call detail records to complement current strategies within the NDPR. Conclusions: Our study shows that mobile position data contact tracing is important for epidemic control as long as it conforms to relevant data privacy regulations. Implementation guidelines will limit data misuse. ",
doi="10.2196/19139",
url="https://mhealth.jmir.org/2020/4/e19139/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310817"
}