首页 > 最新文献

JMIR mHealth and uHealth最新文献

英文 中文
Validity, Accuracy, and Safety Assessment of an Aerobic Interval Training Using an App-Based Prehabilitation Program (PROTEGO MAXIMA Trial) Before Major Surgery: Prospective, Interventional Pilot Study.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-10 DOI: 10.2196/55298
Sara Fatima Faqar Uz Zaman, Svenja Sliwinski, Lisa Mohr-Wetzel, Julia Dreilich, Natalie Filmann, Charlotte Detemble, Dora Zmuc, Felix Chun, Wojciech Derwich, Waldemar Schreiner, Wolf Bechstein, Johannes Fleckenstein, Andreas A Schnitzbauer
<p><strong>Background: </strong>Major surgery is associated with significant morbidity and a reduced quality of life, particularly among older adults and individuals with frailty and impaired functional capacity. Multimodal prehabilitation can enhance functional recovery after surgery and reduce postoperative complications. Digital prehabilitation has the potential to be a resource-sparing and patient-empowering tool that improves patients' preoperative status; however, little remains known regarding their safety and accuracy as medical devices.</p><p><strong>Objective: </strong>This study aims to test the accuracy and validity of a new software in comparison to the gold-standard electrocardiogram (ECG)-based heart rate measurement.</p><p><strong>Methods: </strong>The PROTEGO MAXIMA trial was a prospective interventional pilot trial assessing the validity, accuracy, and safety of an app-based exercise program. The Prehab App calculates a personalized, risk-stratified aerobic interval training plan based on individual risk factors and utilizes wearables to monitor heart rate. Healthy students and patients undergoing major surgery were enrolled. A structured risk assessment was conducted, followed by a 6-minute walking test and a 37-minute supervised interval session. During the exercise, patients wore app-linked wearables for heart rate and distance measurements, which were compared with standard ECG and treadmill measurements. Safety, accuracy, and usability assessments included testing alarm signals, while the occurrence of adverse events served as the primary and secondary outcome measures.</p><p><strong>Results: </strong>A total of 75 participants were included. The mean heart rate differences between wearables and standard ECG were ≤5 bpm (beats per minute) with a mean absolute percentage error of ≤5%. Regression analysis revealed a significant impact of the BMI (odds ratio 0.90, 95% CI 0.82-0.98, P=.02) and Timed Up and Go Test score (odds ratio 0.12, 95% CI 0.03-0.55, P=.006) on the accuracy of heart rate measurement; 29 (39%) patients experienced adverse events: pain (5/12, 42%), ECG electrode-related skin irritations (2/42, 17%), dizziness (2/42, 17%), shortness of breath (2/42, 17%), and fatigue (1/42, 8%). No cardiovascular or serious adverse events were reported, and no serious device deficiency was detected. There were no indications of clinically meaningful overexertion based on laboratory values measured before and after the 6-minute walking test and exercise. The differences in means and ranges were as follows: lactate (mmol/l), mean 0.04 (range -3 to 6; P=.47); creatinine kinase (U/l), mean 12 (range -7 to 43; P<.001); and sodium (mmol/l), mean -2 (range -11 to 12; P<.001).</p><p><strong>Conclusions: </strong>The interventional trial demonstrated the high safety of the exercise program and the accuracy of heart rate measurements using commercial wearables in patients before major surgery, paving the way for potential remote implem
{"title":"Validity, Accuracy, and Safety Assessment of an Aerobic Interval Training Using an App-Based Prehabilitation Program (PROTEGO MAXIMA Trial) Before Major Surgery: Prospective, Interventional Pilot Study.","authors":"Sara Fatima Faqar Uz Zaman, Svenja Sliwinski, Lisa Mohr-Wetzel, Julia Dreilich, Natalie Filmann, Charlotte Detemble, Dora Zmuc, Felix Chun, Wojciech Derwich, Waldemar Schreiner, Wolf Bechstein, Johannes Fleckenstein, Andreas A Schnitzbauer","doi":"10.2196/55298","DOIUrl":"10.2196/55298","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Major surgery is associated with significant morbidity and a reduced quality of life, particularly among older adults and individuals with frailty and impaired functional capacity. Multimodal prehabilitation can enhance functional recovery after surgery and reduce postoperative complications. Digital prehabilitation has the potential to be a resource-sparing and patient-empowering tool that improves patients' preoperative status; however, little remains known regarding their safety and accuracy as medical devices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to test the accuracy and validity of a new software in comparison to the gold-standard electrocardiogram (ECG)-based heart rate measurement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The PROTEGO MAXIMA trial was a prospective interventional pilot trial assessing the validity, accuracy, and safety of an app-based exercise program. The Prehab App calculates a personalized, risk-stratified aerobic interval training plan based on individual risk factors and utilizes wearables to monitor heart rate. Healthy students and patients undergoing major surgery were enrolled. A structured risk assessment was conducted, followed by a 6-minute walking test and a 37-minute supervised interval session. During the exercise, patients wore app-linked wearables for heart rate and distance measurements, which were compared with standard ECG and treadmill measurements. Safety, accuracy, and usability assessments included testing alarm signals, while the occurrence of adverse events served as the primary and secondary outcome measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 75 participants were included. The mean heart rate differences between wearables and standard ECG were ≤5 bpm (beats per minute) with a mean absolute percentage error of ≤5%. Regression analysis revealed a significant impact of the BMI (odds ratio 0.90, 95% CI 0.82-0.98, P=.02) and Timed Up and Go Test score (odds ratio 0.12, 95% CI 0.03-0.55, P=.006) on the accuracy of heart rate measurement; 29 (39%) patients experienced adverse events: pain (5/12, 42%), ECG electrode-related skin irritations (2/42, 17%), dizziness (2/42, 17%), shortness of breath (2/42, 17%), and fatigue (1/42, 8%). No cardiovascular or serious adverse events were reported, and no serious device deficiency was detected. There were no indications of clinically meaningful overexertion based on laboratory values measured before and after the 6-minute walking test and exercise. The differences in means and ranges were as follows: lactate (mmol/l), mean 0.04 (range -3 to 6; P=.47); creatinine kinase (U/l), mean 12 (range -7 to 43; P&lt;.001); and sodium (mmol/l), mean -2 (range -11 to 12; P&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The interventional trial demonstrated the high safety of the exercise program and the accuracy of heart rate measurements using commercial wearables in patients before major surgery, paving the way for potential remote implem","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e55298"},"PeriodicalIF":5.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Utility of Digital Phenotyping Based on Wrist Wearables and Smartphones in Psychosis: Observational Study.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-05 DOI: 10.2196/56185
Zixu Yang, Creighton Heaukulani, Amelia Sim, Thisum Buddhika, Nur Amirah Abdul Rashid, Xuancong Wang, Shushan Zheng, Yue Feng Quek, Sutapa Basu, Kok Wei Lee, Charmaine Tang, Swapna Verma, Robert J T Morris, Jimmy Lee

Background: Digital phenotyping provides insights into an individual's digital behaviors and has potential clinical utility.

Objective: In this observational study, we explored digital biomarkers collected from wrist-wearable devices and smartphones and their associations with clinical symptoms and functioning in patients with schizophrenia.

Methods: We recruited 100 outpatients with schizophrenia spectrum disorder, and we collected various digital data from commercially available wrist wearables and smartphones over a 6-month period. In this report, we analyzed the first week of digital data on heart rate, sleep, and physical activity from the wrist wearables and travel distance, sociability, touchscreen tapping speed, and screen time from the smartphones. We analyzed the relationships between these digital measures and patient baseline measurements of clinical symptoms assessed with the Positive and Negative Syndrome Scale, Brief Negative Symptoms Scale, and Calgary Depression Scale for Schizophrenia, as well as functioning as assessed with the Social and Occupational Functioning Assessment Scale. Linear regression was performed for each digital and clinical measure independently, with the digital measures being treated as predictors.

Results: Digital data were successfully collected from both the wearables and smartphones throughout the study, with 91% of the total possible data successfully collected from the wearables and 82% from the smartphones during the first week of the trial-the period under analysis in this report. Among the clinical outcomes, negative symptoms were associated with the greatest number of digital measures (10 of the 12 studied here), followed by overall measures of psychopathology symptoms, functioning, and positive symptoms, which were each associated with at least 3 digital measures. Cognition and cognitive/disorganization symptoms were each associated with 1 or 2 digital measures.

Conclusions: We found significant associations between nearly all digital measures and a wide range of symptoms and functioning in a community sample of individuals with schizophrenia. These findings provide insights into the digital behaviors of individuals with schizophrenia and highlight the potential of using commercially available wrist wearables and smartphones for passive monitoring in schizophrenia.

{"title":"Utility of Digital Phenotyping Based on Wrist Wearables and Smartphones in Psychosis: Observational Study.","authors":"Zixu Yang, Creighton Heaukulani, Amelia Sim, Thisum Buddhika, Nur Amirah Abdul Rashid, Xuancong Wang, Shushan Zheng, Yue Feng Quek, Sutapa Basu, Kok Wei Lee, Charmaine Tang, Swapna Verma, Robert J T Morris, Jimmy Lee","doi":"10.2196/56185","DOIUrl":"10.2196/56185","url":null,"abstract":"<p><strong>Background: </strong>Digital phenotyping provides insights into an individual's digital behaviors and has potential clinical utility.</p><p><strong>Objective: </strong>In this observational study, we explored digital biomarkers collected from wrist-wearable devices and smartphones and their associations with clinical symptoms and functioning in patients with schizophrenia.</p><p><strong>Methods: </strong>We recruited 100 outpatients with schizophrenia spectrum disorder, and we collected various digital data from commercially available wrist wearables and smartphones over a 6-month period. In this report, we analyzed the first week of digital data on heart rate, sleep, and physical activity from the wrist wearables and travel distance, sociability, touchscreen tapping speed, and screen time from the smartphones. We analyzed the relationships between these digital measures and patient baseline measurements of clinical symptoms assessed with the Positive and Negative Syndrome Scale, Brief Negative Symptoms Scale, and Calgary Depression Scale for Schizophrenia, as well as functioning as assessed with the Social and Occupational Functioning Assessment Scale. Linear regression was performed for each digital and clinical measure independently, with the digital measures being treated as predictors.</p><p><strong>Results: </strong>Digital data were successfully collected from both the wearables and smartphones throughout the study, with 91% of the total possible data successfully collected from the wearables and 82% from the smartphones during the first week of the trial-the period under analysis in this report. Among the clinical outcomes, negative symptoms were associated with the greatest number of digital measures (10 of the 12 studied here), followed by overall measures of psychopathology symptoms, functioning, and positive symptoms, which were each associated with at least 3 digital measures. Cognition and cognitive/disorganization symptoms were each associated with 1 or 2 digital measures.</p><p><strong>Conclusions: </strong>We found significant associations between nearly all digital measures and a wide range of symptoms and functioning in a community sample of individuals with schizophrenia. These findings provide insights into the digital behaviors of individuals with schizophrenia and highlight the potential of using commercially available wrist wearables and smartphones for passive monitoring in schizophrenia.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e56185"},"PeriodicalIF":5.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Smartphone-Based Care Platform Versus Traditional Care in Primary Knee Arthroplasty in the Unites States: Cost Analysis.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-02-03 DOI: 10.2196/46047
Jess H Lonner, Ashwini Naidu-Helm, David Van Andel, Mike B Anderson, Richard Ditto, Roberta E Redfern, Jared Foran

Unlabelled: Cost savings were achieved with the use of a smartphone-based care management platform, considering several health care resources following knee arthroplasty procedures without negatively impacting clinical outcomes.

{"title":"Smartphone-Based Care Platform Versus Traditional Care in Primary Knee Arthroplasty in the Unites States: Cost Analysis.","authors":"Jess H Lonner, Ashwini Naidu-Helm, David Van Andel, Mike B Anderson, Richard Ditto, Roberta E Redfern, Jared Foran","doi":"10.2196/46047","DOIUrl":"10.2196/46047","url":null,"abstract":"<p><strong>Unlabelled: </strong>Cost savings were achieved with the use of a smartphone-based care management platform, considering several health care resources following knee arthroplasty procedures without negatively impacting clinical outcomes.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e46047"},"PeriodicalIF":5.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Use of Artificial Intelligence and Wearable Inertial Measurement Units in Medicine: Systematic Review.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-29 DOI: 10.2196/60521
Ricardo Smits Serena, Florian Hinterwimmer, Rainer Burgkart, Rudiger von Eisenhart-Rothe, Daniel Rueckert
<p><strong>Background: </strong>Artificial intelligence (AI) has already revolutionized the analysis of image, text, and tabular data, bringing significant advances across many medical sectors. Now, by combining with wearable inertial measurement units (IMUs), AI could transform health care again by opening new opportunities in patient care and medical research.</p><p><strong>Objective: </strong>This systematic review aims to evaluate the integration of AI models with wearable IMUs in health care, identifying current applications, challenges, and future opportunities. The focus will be on the types of models used, the characteristics of the datasets, and the potential for expanding and enhancing the use of this technology to improve patient care and advance medical research.</p><p><strong>Methods: </strong>This study examines this synergy of AI models and IMU data by using a systematic methodology, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to explore 3 core questions: (1) Which medical fields are most actively researching AI and IMU data? (2) Which models are being used in the analysis of IMU data within these medical fields? (3) What are the characteristics of the datasets used for in this fields?</p><p><strong>Results: </strong>The median dataset size is of 50 participants, which poses significant limitations for AI models given their dependency on large datasets for effective training and generalization. Furthermore, our analysis reveals the current dominance of machine learning models in 76% on the surveyed studies, suggesting a preference for traditional models like linear regression, support vector machine, and random forest, but also indicating significant growth potential for deep learning models in this area. Impressively, 93% of the studies used supervised learning, revealing an underuse of unsupervised learning, and indicating an important area for future exploration on discovering hidden patterns and insights without predefined labels or outcomes. In addition, there was a preference for conducting studies in clinical settings (77%), rather than in real-life scenarios, a choice that, along with the underapplication of the full potential of wearable IMUs, is recognized as a limitation in terms of practical applicability. Furthermore, the focus of 65% of the studies on neurological issues suggests an opportunity to broaden research scope to other clinical areas such as musculoskeletal applications, where AI could have significant impacts.</p><p><strong>Conclusions: </strong>In conclusion, the review calls for a collaborative effort to address the highlighted challenges, including improvements in data collection, increasing dataset sizes, a move that inherently pushes the field toward the adoption of more complex deep learning models, and the expansion of the application of AI models on IMU data methodologies across various medical fields. This approach aims to enhance the reliabilit
{"title":"The Use of Artificial Intelligence and Wearable Inertial Measurement Units in Medicine: Systematic Review.","authors":"Ricardo Smits Serena, Florian Hinterwimmer, Rainer Burgkart, Rudiger von Eisenhart-Rothe, Daniel Rueckert","doi":"10.2196/60521","DOIUrl":"10.2196/60521","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Artificial intelligence (AI) has already revolutionized the analysis of image, text, and tabular data, bringing significant advances across many medical sectors. Now, by combining with wearable inertial measurement units (IMUs), AI could transform health care again by opening new opportunities in patient care and medical research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This systematic review aims to evaluate the integration of AI models with wearable IMUs in health care, identifying current applications, challenges, and future opportunities. The focus will be on the types of models used, the characteristics of the datasets, and the potential for expanding and enhancing the use of this technology to improve patient care and advance medical research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study examines this synergy of AI models and IMU data by using a systematic methodology, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to explore 3 core questions: (1) Which medical fields are most actively researching AI and IMU data? (2) Which models are being used in the analysis of IMU data within these medical fields? (3) What are the characteristics of the datasets used for in this fields?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median dataset size is of 50 participants, which poses significant limitations for AI models given their dependency on large datasets for effective training and generalization. Furthermore, our analysis reveals the current dominance of machine learning models in 76% on the surveyed studies, suggesting a preference for traditional models like linear regression, support vector machine, and random forest, but also indicating significant growth potential for deep learning models in this area. Impressively, 93% of the studies used supervised learning, revealing an underuse of unsupervised learning, and indicating an important area for future exploration on discovering hidden patterns and insights without predefined labels or outcomes. In addition, there was a preference for conducting studies in clinical settings (77%), rather than in real-life scenarios, a choice that, along with the underapplication of the full potential of wearable IMUs, is recognized as a limitation in terms of practical applicability. Furthermore, the focus of 65% of the studies on neurological issues suggests an opportunity to broaden research scope to other clinical areas such as musculoskeletal applications, where AI could have significant impacts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In conclusion, the review calls for a collaborative effort to address the highlighted challenges, including improvements in data collection, increasing dataset sizes, a move that inherently pushes the field toward the adoption of more complex deep learning models, and the expansion of the application of AI models on IMU data methodologies across various medical fields. This approach aims to enhance the reliabilit","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e60521"},"PeriodicalIF":5.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of an mHealth Intervention With Short Text Messages to Promote Treatment Adherence Among HIV-Positive Mexican Adults: Randomized Controlled Trial.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-28 DOI: 10.2196/57540
Luis Eduardo Del Moral Trinidad, Jaime Federico Andrade Villanueva, Pedro Martínez Ayala, Rodolfo Ismael Cabrera Silva, Melva Guadalupe Herrera Godina, Luz Alicia González-Hernández

Background: HIV continues to be a public health concern in Mexico and Latin America due to an increase in new infections, despite a decrease being observed globally. Treatment adherence is a pillar for achieving viral suppression. It prevents the spread of the disease at a community level and improves the quality and survival of people living with HIV. Thus, it is important to implement strategies to achieve sustained treatment adherence.

Objective: The objective of this study is to evaluate the effectiveness of a mobile health (mHealth) intervention based on SMS text messages to increase antiretroviral therapy (ART) adherence for HIV-positive adults.

Methods: A randomized controlled trial was performed at the Hospital Civil de Guadalajara - Fray Antonio Alcalde on HIV-positive adults who had initiated ART. The mHealth intervention included the use of SMS text messages as a reminder system for upcoming medical examinations and ART resupply to increase adherence. This intervention was provided to 40 participants for a 6-month period. A control group (n=40) received medical attention by the standard protocol used in the hospital. Intervention effectiveness was assessed by quantifying CD4+ T cells and viral load, as well as a self-report of adherence by the patient.

Results: The intervention group had greater adherence to ART than the control group (96% vs 92%; P<.001). In addition, the intervention group had better clinical characteristics, including a lower viral load (141 copies/mL vs 2413 copies/mL; P<.001) and a trend toward higher CD4+ T cells counts (399 cells/μL vs 290 cells/μL; P=.15).

Conclusions: These results show that an mHealth intervention significantly improves ART adherence. Implementing mHealth programs could enhance the commitment of HIV-positive adults to their treatment.

{"title":"Effectiveness of an mHealth Intervention With Short Text Messages to Promote Treatment Adherence Among HIV-Positive Mexican Adults: Randomized Controlled Trial.","authors":"Luis Eduardo Del Moral Trinidad, Jaime Federico Andrade Villanueva, Pedro Martínez Ayala, Rodolfo Ismael Cabrera Silva, Melva Guadalupe Herrera Godina, Luz Alicia González-Hernández","doi":"10.2196/57540","DOIUrl":"10.2196/57540","url":null,"abstract":"<p><strong>Background: </strong>HIV continues to be a public health concern in Mexico and Latin America due to an increase in new infections, despite a decrease being observed globally. Treatment adherence is a pillar for achieving viral suppression. It prevents the spread of the disease at a community level and improves the quality and survival of people living with HIV. Thus, it is important to implement strategies to achieve sustained treatment adherence.</p><p><strong>Objective: </strong>The objective of this study is to evaluate the effectiveness of a mobile health (mHealth) intervention based on SMS text messages to increase antiretroviral therapy (ART) adherence for HIV-positive adults.</p><p><strong>Methods: </strong>A randomized controlled trial was performed at the Hospital Civil de Guadalajara - Fray Antonio Alcalde on HIV-positive adults who had initiated ART. The mHealth intervention included the use of SMS text messages as a reminder system for upcoming medical examinations and ART resupply to increase adherence. This intervention was provided to 40 participants for a 6-month period. A control group (n=40) received medical attention by the standard protocol used in the hospital. Intervention effectiveness was assessed by quantifying CD4+ T cells and viral load, as well as a self-report of adherence by the patient.</p><p><strong>Results: </strong>The intervention group had greater adherence to ART than the control group (96% vs 92%; P<.001). In addition, the intervention group had better clinical characteristics, including a lower viral load (141 copies/mL vs 2413 copies/mL; P<.001) and a trend toward higher CD4+ T cells counts (399 cells/μL vs 290 cells/μL; P=.15).</p><p><strong>Conclusions: </strong>These results show that an mHealth intervention significantly improves ART adherence. Implementing mHealth programs could enhance the commitment of HIV-positive adults to their treatment.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e57540"},"PeriodicalIF":5.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being-Related Outcomes in Police Officers: Longitudinal Mixed Design Study.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-28 DOI: 10.2196/60708
Herman Jaap de Vries, Roos Delahaij, Marianne van Zwieten, Helen Verhoef, Wim Kamphuis
<p><strong>Background: </strong>Wearable sensor technologies, often referred to as "wearables," have seen a rapid rise in consumer interest in recent years. Initially often seen as "activity trackers," wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being-related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals.</p><p><strong>Objective: </strong>The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being-related outcomes in police officers and (2) whether extending a basic "off-the-shelf" wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness.</p><p><strong>Methods: </strong>A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions.</p><p><strong>Results: </strong>The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25-0.46) but consistent effect on 8 of 15 of the stress- and well-being-related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes.</p><p><strong>Conclusions: </strong>Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being-related outcomes. Complementing the
{"title":"The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being-Related Outcomes in Police Officers: Longitudinal Mixed Design Study.","authors":"Herman Jaap de Vries, Roos Delahaij, Marianne van Zwieten, Helen Verhoef, Wim Kamphuis","doi":"10.2196/60708","DOIUrl":"10.2196/60708","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Wearable sensor technologies, often referred to as \"wearables,\" have seen a rapid rise in consumer interest in recent years. Initially often seen as \"activity trackers,\" wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being-related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being-related outcomes in police officers and (2) whether extending a basic \"off-the-shelf\" wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25-0.46) but consistent effect on 8 of 15 of the stress- and well-being-related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being-related outcomes. Complementing the ","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e60708"},"PeriodicalIF":5.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
mHealth-Based Diabetes Prevention Program for Chinese Mothers With Abdominal Obesity: Randomized Controlled Trial.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-24 DOI: 10.2196/47837
Qinyuan Huang, Qinyi Zhong, Yanjing Zeng, Yimeng Li, James Wiley, Man Ping Wang, Jyu-Lin Chen, Jia Guo
<p><strong>Background: </strong>Among people with abdominal obesity, women are more likely to develop diabetes than men. Mobile health (mHealth)-based technologies provide the flexibility and resource-saving opportunities to improve lifestyles in an individualized way. However, mHealth-based diabetes prevention programs tailored for busy mothers with abdominal obesity have not been reported yet.</p><p><strong>Objective: </strong>The aim of this study is to evaluate the feasibility and acceptability of an mHealth-based diabetes prevention program and its preliminary efficacy in reducing weight-related variables, behavioral variables, psychological variables, and diabetes risk among Chinese mothers with abdominal obesity over 6 months.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted at health management centers in 2 tertiary hospitals in Changsha, China. The mHealth group (n=40) received 12 weekly web-based lifestyle modification modules for diabetes prevention, 6 biweekly individualized health education messages based on their goal settings, and a Fitbit tracker. The control group (n=40) received 12 weekly web-based general health education modules, 6 biweekly general health education messages, and a Fitbit tracker. Data were collected at baseline, 3 months, and 6 months on the feasibility and acceptability outcomes, weight-related variables (waist circumference and BMI), diabetes risk scores, glycemic levels, behavioral variables (daily step count, active minutes, fruit and vegetable intake, calorie consumption, and sleep duration), and psychological variables (self-efficacy and social support for physical activity and diet, perceived stress, and quality of life). Generalized estimating equations were used for data analysis.</p><p><strong>Results: </strong>Approximately 85% (68/80) of the participants completed 6 months of follow-up assessments. Regarding the feasibility and acceptance of the program in the mHealth group, the average number of modules reviewed was 7.9 out of 12, and the satisfaction score was 4.37 out of 5. Significant improvements at 6 months between the intervention and control groups were found in waist circumference (β=-2.24, 95% CI -4.12 to -0.36; P=.02), modifiable diabetes risk scores (β=-2.5, 95% CI -4.57 to -0.44; P=.02), daily steps (β=1.67, 95% CI 0.06-3.29; P=.04), self-efficacy for physical activity (β=1.93, 95% CI 0.44-3.43; P=.01), social support for physical activity (β=2.27, 95% CI 0.80-3.74; P=.002), and physical health satisfaction (β=0.82, 95% CI 0.08-1.55; P=.03). No differences were found in BMI, total diabetes risk score, daily active minutes, daily intake of fruits and vegetables, sleep duration, daily calorie consumption, self-efficacy, and social support for diet (P>.05).</p><p><strong>Conclusions: </strong>This study addresses the potential role of tailored lifestyle interventions based on mHealth technology by offering tailored web-based health modules and health information
{"title":"mHealth-Based Diabetes Prevention Program for Chinese Mothers With Abdominal Obesity: Randomized Controlled Trial.","authors":"Qinyuan Huang, Qinyi Zhong, Yanjing Zeng, Yimeng Li, James Wiley, Man Ping Wang, Jyu-Lin Chen, Jia Guo","doi":"10.2196/47837","DOIUrl":"10.2196/47837","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Among people with abdominal obesity, women are more likely to develop diabetes than men. Mobile health (mHealth)-based technologies provide the flexibility and resource-saving opportunities to improve lifestyles in an individualized way. However, mHealth-based diabetes prevention programs tailored for busy mothers with abdominal obesity have not been reported yet.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study is to evaluate the feasibility and acceptability of an mHealth-based diabetes prevention program and its preliminary efficacy in reducing weight-related variables, behavioral variables, psychological variables, and diabetes risk among Chinese mothers with abdominal obesity over 6 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A randomized controlled trial was conducted at health management centers in 2 tertiary hospitals in Changsha, China. The mHealth group (n=40) received 12 weekly web-based lifestyle modification modules for diabetes prevention, 6 biweekly individualized health education messages based on their goal settings, and a Fitbit tracker. The control group (n=40) received 12 weekly web-based general health education modules, 6 biweekly general health education messages, and a Fitbit tracker. Data were collected at baseline, 3 months, and 6 months on the feasibility and acceptability outcomes, weight-related variables (waist circumference and BMI), diabetes risk scores, glycemic levels, behavioral variables (daily step count, active minutes, fruit and vegetable intake, calorie consumption, and sleep duration), and psychological variables (self-efficacy and social support for physical activity and diet, perceived stress, and quality of life). Generalized estimating equations were used for data analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Approximately 85% (68/80) of the participants completed 6 months of follow-up assessments. Regarding the feasibility and acceptance of the program in the mHealth group, the average number of modules reviewed was 7.9 out of 12, and the satisfaction score was 4.37 out of 5. Significant improvements at 6 months between the intervention and control groups were found in waist circumference (β=-2.24, 95% CI -4.12 to -0.36; P=.02), modifiable diabetes risk scores (β=-2.5, 95% CI -4.57 to -0.44; P=.02), daily steps (β=1.67, 95% CI 0.06-3.29; P=.04), self-efficacy for physical activity (β=1.93, 95% CI 0.44-3.43; P=.01), social support for physical activity (β=2.27, 95% CI 0.80-3.74; P=.002), and physical health satisfaction (β=0.82, 95% CI 0.08-1.55; P=.03). No differences were found in BMI, total diabetes risk score, daily active minutes, daily intake of fruits and vegetables, sleep duration, daily calorie consumption, self-efficacy, and social support for diet (P&gt;.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study addresses the potential role of tailored lifestyle interventions based on mHealth technology by offering tailored web-based health modules and health information","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e47837"},"PeriodicalIF":5.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Feature Selection for Physical Activity Prediction Using Ecological Momentary Assessments to Personalize Intervention Timing: Longitudinal Observational Study.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-24 DOI: 10.2196/57255
Devender Kumar, David Haag, Jens Blechert, Josef Niebauer, Jan David Smeddinck

Background: There has been a surge in the development of apps that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a long-term and sustainable impact on the user. Just-in-time adaptive interventions (JITAIs) that are based on passive sensing of the user's current context (eg, via smartphones and wearables) have been devised to enhance the effectiveness of these apps and foster PA. JITAIs aim to provide personalized support and interventions such as encouraging messages in a context-aware manner. However, the limited range of passive sensing capabilities often make it challenging to determine the timing and context for delivering well-accepted and effective interventions. Ecological momentary assessment (EMA) can provide personal context by directly capturing user assessments (eg, moods and emotions). Thus, EMA might be a useful complement to passive sensing in determining when JITAIs are triggered. However, extensive EMA schedules need to be scrutinized, as they can increase user burden.

Objective: The aim of the study was to use machine learning to balance the feature set size of EMA questions with the prediction accuracy regarding of enacting PA.

Methods: A total of 43 healthy participants (aged 19-67 years) completed 4 EMA surveys daily over 3 weeks. These surveys prospectively assessed various states, including both motivational and volitional variables related to PA preparation (eg, intrinsic motivation, self-efficacy, and perceived barriers) alongside stress and mood or emotions. PA enactment was assessed retrospectively via EMA and served as the outcome variable.

Results: The best-performing machine learning models predicted PA engagement with a mean area under the curve score of 0.87 (SD 0.02) in 5-fold cross-validation and 0.87 on the test set. Particularly strong predictors included self-efficacy, stress, planning, and perceived barriers, indicating that a small set of EMA predictors can yield accurate PA prediction for these participants.

Conclusions: A small set of EMA-based features like self-efficacy, stress, planning, and perceived barriers can be enough to predict PA reasonably well and can thus be used to meaningfully tailor JITAIs such as sending well-timed and context-aware support messages.

{"title":"Feature Selection for Physical Activity Prediction Using Ecological Momentary Assessments to Personalize Intervention Timing: Longitudinal Observational Study.","authors":"Devender Kumar, David Haag, Jens Blechert, Josef Niebauer, Jan David Smeddinck","doi":"10.2196/57255","DOIUrl":"10.2196/57255","url":null,"abstract":"<p><strong>Background: </strong>There has been a surge in the development of apps that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a long-term and sustainable impact on the user. Just-in-time adaptive interventions (JITAIs) that are based on passive sensing of the user's current context (eg, via smartphones and wearables) have been devised to enhance the effectiveness of these apps and foster PA. JITAIs aim to provide personalized support and interventions such as encouraging messages in a context-aware manner. However, the limited range of passive sensing capabilities often make it challenging to determine the timing and context for delivering well-accepted and effective interventions. Ecological momentary assessment (EMA) can provide personal context by directly capturing user assessments (eg, moods and emotions). Thus, EMA might be a useful complement to passive sensing in determining when JITAIs are triggered. However, extensive EMA schedules need to be scrutinized, as they can increase user burden.</p><p><strong>Objective: </strong>The aim of the study was to use machine learning to balance the feature set size of EMA questions with the prediction accuracy regarding of enacting PA.</p><p><strong>Methods: </strong>A total of 43 healthy participants (aged 19-67 years) completed 4 EMA surveys daily over 3 weeks. These surveys prospectively assessed various states, including both motivational and volitional variables related to PA preparation (eg, intrinsic motivation, self-efficacy, and perceived barriers) alongside stress and mood or emotions. PA enactment was assessed retrospectively via EMA and served as the outcome variable.</p><p><strong>Results: </strong>The best-performing machine learning models predicted PA engagement with a mean area under the curve score of 0.87 (SD 0.02) in 5-fold cross-validation and 0.87 on the test set. Particularly strong predictors included self-efficacy, stress, planning, and perceived barriers, indicating that a small set of EMA predictors can yield accurate PA prediction for these participants.</p><p><strong>Conclusions: </strong>A small set of EMA-based features like self-efficacy, stress, planning, and perceived barriers can be enough to predict PA reasonably well and can thus be used to meaningfully tailor JITAIs such as sending well-timed and context-aware support messages.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e57255"},"PeriodicalIF":5.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Barriers and Facilitators in Implementing a Telemonitoring Application for Patients With Chronic Kidney Disease and Health Professionals: Ancillary Implementation Study of the NeLLY (New Health e-Link in the Lyon Region) Stepped-Wedge Randomized Controlled Trial.
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-22 DOI: 10.2196/50014
Marion Delvallée, Abdallah Guerraoui, Lucas Tchetgnia, Jean-Pierre Grangier, Nassira Amamra, Anne-Laure Camarroque, Julie Haesebaert, Agnès Caillette-Beaudoin
<p><strong>Background: </strong>The use of telemonitoring to manage renal function in patients with chronic kidney disease (CKD) is recommended by health authorities. However, despite these recommendations, the adoption of telemonitoring by both health care professionals and patients faces numerous challenges.</p><p><strong>Objective: </strong>This study aims to identify barriers and facilitators in the implementation of a telemonitoring program for patients with CKD, as perceived by health care professionals and patients, and to explore factors associated with the adoption of the program. This study serves as a process evaluation conducted alongside the cost-effectiveness NeLLY (New Health e-Link in the Lyon Region) trial.</p><p><strong>Methods: </strong>A mixed methods approach combining a quantitative questionnaire and semistructured interviews was conducted among nurses, nephrologists, and patients with stages 3 and 4 CKD across 10 renal care centers in France that have implemented telemonitoring. The Technology Acceptance Model (TAM) and the Consolidated Framework for Implementation Research (CFIR) were used to design the questionnaires and interview guides. The dimensions investigated included ease of use, perceived usefulness, and intention to use (TAM), as well as characteristics of the intervention, local and general context, individual factors, and processes (CFIR). The adoption of telemonitoring was assessed based on the frequency with which patients connected to the telemonitoring device. Determinants of telemonitoring use were analyzed using nonparametric tests, specifically the Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. Thematic analysis was conducted on the transcriptions of semistructured interviews. Both quantitative and qualitative results, including data from patients and professionals, were integrated to provide a comprehensive understanding of the factors associated with the use of remote monitoring in CKD.</p><p><strong>Results: </strong>A total of 42 professionals and 128 patients with CKD responded to our questionnaire. Among these, 11 professionals and 13 patients participated in interviews. Nurses, who were responsible for patient follow-up, regularly used telemonitoring (8/13, 62%, at least once a month), while nephrologists, who were responsible for prescribing it, were primarily occasional users (5/8, 63%, using it less than once a month). Among professionals, the main obstacles identified were the heavy workload generated by telemonitoring, lack of training, and insufficient support for nurses. Among the 128 patients, 46 (35.9%) reported using the application at least once a week. The main barriers for patients were issues related to computer use, as well as the lack of feedback and communication with health care professionals. The main facilitators identified by both professionals and patients for using telemonitoring were the empowerment of patients in managing their health and the reduction of the burden asso
{"title":"Barriers and Facilitators in Implementing a Telemonitoring Application for Patients With Chronic Kidney Disease and Health Professionals: Ancillary Implementation Study of the NeLLY (New Health e-Link in the Lyon Region) Stepped-Wedge Randomized Controlled Trial.","authors":"Marion Delvallée, Abdallah Guerraoui, Lucas Tchetgnia, Jean-Pierre Grangier, Nassira Amamra, Anne-Laure Camarroque, Julie Haesebaert, Agnès Caillette-Beaudoin","doi":"10.2196/50014","DOIUrl":"10.2196/50014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The use of telemonitoring to manage renal function in patients with chronic kidney disease (CKD) is recommended by health authorities. However, despite these recommendations, the adoption of telemonitoring by both health care professionals and patients faces numerous challenges.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to identify barriers and facilitators in the implementation of a telemonitoring program for patients with CKD, as perceived by health care professionals and patients, and to explore factors associated with the adoption of the program. This study serves as a process evaluation conducted alongside the cost-effectiveness NeLLY (New Health e-Link in the Lyon Region) trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A mixed methods approach combining a quantitative questionnaire and semistructured interviews was conducted among nurses, nephrologists, and patients with stages 3 and 4 CKD across 10 renal care centers in France that have implemented telemonitoring. The Technology Acceptance Model (TAM) and the Consolidated Framework for Implementation Research (CFIR) were used to design the questionnaires and interview guides. The dimensions investigated included ease of use, perceived usefulness, and intention to use (TAM), as well as characteristics of the intervention, local and general context, individual factors, and processes (CFIR). The adoption of telemonitoring was assessed based on the frequency with which patients connected to the telemonitoring device. Determinants of telemonitoring use were analyzed using nonparametric tests, specifically the Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. Thematic analysis was conducted on the transcriptions of semistructured interviews. Both quantitative and qualitative results, including data from patients and professionals, were integrated to provide a comprehensive understanding of the factors associated with the use of remote monitoring in CKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 42 professionals and 128 patients with CKD responded to our questionnaire. Among these, 11 professionals and 13 patients participated in interviews. Nurses, who were responsible for patient follow-up, regularly used telemonitoring (8/13, 62%, at least once a month), while nephrologists, who were responsible for prescribing it, were primarily occasional users (5/8, 63%, using it less than once a month). Among professionals, the main obstacles identified were the heavy workload generated by telemonitoring, lack of training, and insufficient support for nurses. Among the 128 patients, 46 (35.9%) reported using the application at least once a week. The main barriers for patients were issues related to computer use, as well as the lack of feedback and communication with health care professionals. The main facilitators identified by both professionals and patients for using telemonitoring were the empowerment of patients in managing their health and the reduction of the burden asso","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e50014"},"PeriodicalIF":5.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of a Mobile Health Intervention (DOT Selfie) in Increasing Treatment Adherence Monitoring and Support for Patients With Tuberculosis in Uganda: Randomized Controlled Trial. 增强视频直接观察治疗(DOT自拍)的有效性,这是一种移动健康干预措施,可提高乌干达结核病患者的治疗依从性监测和支持:一项随机对照试验。
IF 5.4 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-16 DOI: 10.2196/57991
Juliet Nabbuye Sekandi, Esther Buregyeya, Sarah Zalwango, Damalie Nakkonde, Patrick Kaggwa, Trang Ho Thu Quach, David Asiimwe, Lynn Atuyambe, Kevin Dobbin
<p><strong>Background: </strong>Directly observed therapy (DOT) is the standard method for monitoring adherence to tuberculosis (TB) treatment. However, implementing DOT poses challenges for both patients and providers due to limited financial and human resources. Increasing evidence suggests that emerging digital adherence technologies, such as video directly observed therapy (VDOT), can serve as viable alternatives.</p><p><strong>Objective: </strong>This study aims to evaluate the effectiveness of VDOT compared with usual care directly observed therapy (UCDOT).</p><p><strong>Methods: </strong>Between July 2020 and October 2021, we conducted a 2-arm, parallel-group, open-label randomized trial with a 1:1 assignment to receive either the VDOT intervention (n=72) or UCDOT (n=72) for treatment adherence monitoring at public health clinics in Kampala, Uganda. Each group was further stratified to ensure equal numbers of males and females. Eligible patients were aged 18-65 years, had a confirmed diagnosis of TB, and were undergoing daily treatment. The VDOT group was provided with a smartphone equipped with an app, while the UCDOT group followed the routine monitoring practices outlined by the Uganda National TB Program. We tested the hypothesis that VDOT was more effective than UCDOT for monitoring medication adherence. The primary outcome was adherence, defined as having ≥80% of the expected doses observed during the 6-month treatment period. An intention-to-treat analysis was conducted, and multivariable logistic regression was used to estimate the effect of the intervention on adherence monitoring. Adjusted relative risk ratios and their corresponding 95% CIs are presented. Secondary outcomes included treatment completion, loss to follow-up, death, and reasons for missed videos in the intervention group.</p><p><strong>Results: </strong>The intention-to-treat analysis included 142 participants, with 2 excluded due to discontinuation of medication within the first week after enrollment. The median age of participants was 34 (IQR 26-45) years. The median fraction of expected doses observed (FEDO) was significantly higher in the VDOT group compared with the UCDOT group (100, IQR 80-100 vs 30, IQR 10-60, respectively; P<.001). When using a FEDO cutoff of ≥80% to define optimal adherence, 63 of 142 (44%) patients met the threshold, with a significant difference between the VDOT and UCDOT groups (56/71, 79% vs 7/71, 10%, P<.001). After adjusting for confounders, VDOT users were significantly more likely to achieve ≥80% of their expected doses observed compared with UCDOT users (adjusted risk ratio 8.4, 95% CI 4.16-17.0). The most common reasons for failing to submit videos of medication intake were an uncharged phone battery, forgetting to record videos during medication intake, and losing the smartphone.</p><p><strong>Conclusions: </strong>Enhanced VDOT was more effective than UCDOT in increasing adherence monitoring among patients with TB in Uganda. Th
背景:直接观察治疗(DOT)是监测结核病治疗依从性的标准。然而,由于缺乏财政和人力资源,DOT的实施对患者和提供者来说是困难的。越来越多的证据表明,视频直接观察疗法(VDOT)等新兴的数字依从性技术可以作为一种选择。目的:本研究的目的是评价VDOT与常规护理DOT的有效性。方法:在2020年7月至2021年10月期间,我们在乌干达坎帕拉的公共卫生诊所进行了一项双组平行、开放标签、1:1分配的随机试验,接受VDOT干预(n=72)或常规护理DOT (n=72),以监测治疗依从性。每组进一步分层,使男女人数相等。符合条件的患者年龄为18-65岁,确诊为结核病并接受日常治疗。VDOT组收到了装有应用程序的智能手机,而UCDOT组则按照乌干达国家结核病项目的常规做法监测治疗情况。我们检验了VDOT在监测药物依从性方面比UCDOT更有效的假设。主要结局是依从性,定义为在6个月的治疗期间观察到>=预期剂量的80%。我们进行了意向治疗(ITT)分析,并进行了多变量逻辑回归来估计干预对依从性监测的影响。我们给出了调整后的相对风险比和相关的95%置信区间。干预组的次要结局是治疗完成、随访失败、死亡和错过视频的原因。结果:意向治疗分析包括142名参与者。2名受试者因在入组后第一周内未能继续用药而被排除。中位年龄34岁(IQR:26-45岁)。VDOT组的平均预期剂量率(FEDO)显著高于UCDOT组(90%平均FEDO vs 30%平均FEDO, p < 0.001)。当使用FEDO临界值bb0 =80%作为最佳依从性时,63例(44%)患者达到了设定的阈值,VDOT和UCDOT之间存在显著差异(78.9% vs. 9.9%, p=< 0.001)。在调整混杂因素后,与UCDOT(调整后的RR)相比,VDOT使用者更有可能观察到>=80%的预期剂量。8.4, 95% ci 4.16-17.0)。未能提交服药视频的最常见原因是手机电池未充电、服药过程中忘记录制视频、丢失智能手机。结论:在乌干达的结核病患者中,增强的VDOT比UCDOT更有效地提高了对治疗依从性的观察。这一证据表明,在人力资源有限的结核病高负担环境中,数字技术有望改善对治疗依从性的监测和支持。临床试验:ClinicalTrials.govNCT04134689, http://clinicaltrials.gov/ct2/show/NCT04134689。
{"title":"Effectiveness of a Mobile Health Intervention (DOT Selfie) in Increasing Treatment Adherence Monitoring and Support for Patients With Tuberculosis in Uganda: Randomized Controlled Trial.","authors":"Juliet Nabbuye Sekandi, Esther Buregyeya, Sarah Zalwango, Damalie Nakkonde, Patrick Kaggwa, Trang Ho Thu Quach, David Asiimwe, Lynn Atuyambe, Kevin Dobbin","doi":"10.2196/57991","DOIUrl":"10.2196/57991","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Directly observed therapy (DOT) is the standard method for monitoring adherence to tuberculosis (TB) treatment. However, implementing DOT poses challenges for both patients and providers due to limited financial and human resources. Increasing evidence suggests that emerging digital adherence technologies, such as video directly observed therapy (VDOT), can serve as viable alternatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to evaluate the effectiveness of VDOT compared with usual care directly observed therapy (UCDOT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Between July 2020 and October 2021, we conducted a 2-arm, parallel-group, open-label randomized trial with a 1:1 assignment to receive either the VDOT intervention (n=72) or UCDOT (n=72) for treatment adherence monitoring at public health clinics in Kampala, Uganda. Each group was further stratified to ensure equal numbers of males and females. Eligible patients were aged 18-65 years, had a confirmed diagnosis of TB, and were undergoing daily treatment. The VDOT group was provided with a smartphone equipped with an app, while the UCDOT group followed the routine monitoring practices outlined by the Uganda National TB Program. We tested the hypothesis that VDOT was more effective than UCDOT for monitoring medication adherence. The primary outcome was adherence, defined as having ≥80% of the expected doses observed during the 6-month treatment period. An intention-to-treat analysis was conducted, and multivariable logistic regression was used to estimate the effect of the intervention on adherence monitoring. Adjusted relative risk ratios and their corresponding 95% CIs are presented. Secondary outcomes included treatment completion, loss to follow-up, death, and reasons for missed videos in the intervention group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The intention-to-treat analysis included 142 participants, with 2 excluded due to discontinuation of medication within the first week after enrollment. The median age of participants was 34 (IQR 26-45) years. The median fraction of expected doses observed (FEDO) was significantly higher in the VDOT group compared with the UCDOT group (100, IQR 80-100 vs 30, IQR 10-60, respectively; P&lt;.001). When using a FEDO cutoff of ≥80% to define optimal adherence, 63 of 142 (44%) patients met the threshold, with a significant difference between the VDOT and UCDOT groups (56/71, 79% vs 7/71, 10%, P&lt;.001). After adjusting for confounders, VDOT users were significantly more likely to achieve ≥80% of their expected doses observed compared with UCDOT users (adjusted risk ratio 8.4, 95% CI 4.16-17.0). The most common reasons for failing to submit videos of medication intake were an uncharged phone battery, forgetting to record videos during medication intake, and losing the smartphone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Enhanced VDOT was more effective than UCDOT in increasing adherence monitoring among patients with TB in Uganda. Th","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":" ","pages":"e57991"},"PeriodicalIF":5.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
JMIR mHealth and uHealth
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1