Sabrina B Kitaka, Joseph Rujumba, Sarah K Zalwango, Betsy Pfeffer, Lubega Kizza, Juliane P Nattimba, Ashley B Stephens, Nicolette Nabukeera-Barungi, Chelsea S Wynn, Juliet N Babirye, John Mukisa, Ezekiel Mupere, Melissa S Stockwell
Background: Cervical cancer is currently the leading female cancer in Uganda. Most women are diagnosed with late-stage disease. Human papillomavirus (HPV) vaccination is the single most important primary preventive measure. While research regarding text message vaccine reminder use is strong in the U.S., their use has not yet been demonstrated in a pre-teen and adolescent population in Sub-Saharan Africa or other low- and middle-income countries.
Objective: The objective of this pilot randomized controlled trial was to assess the impact of vaccine reminders with embedded interactive educational information on timeliness of HPV vaccination in Kampala, Uganda.
Methods: In this randomized-controlled trial conducted in 2022, caregivers of adolescents needing a first or second HPV vaccine dose were recruited from an adolescent clinic and three community health centres in Kampala, Uganda. Families (n=154) were randomized 1:1 into intervention vs. usual care, stratified by dose (initiation, completion), language (English, Luganda) within each site. Intervention caregivers received a series of automated, personalized text messages or automated phone calls, based on family preference. Five messages were sent before the due date including both static and interactive educational information with five follow-up messages for those unvaccinated. Receipt of needed dose by 24 weeks post-enrolment was assessed by chi square, regression and Kaplan-Meier with log rank test. All analyses were intention-to-treat.
Results: Overall, 154 caregivers enrolled (51.3% dose 1; 48.7% dose 2), and 64.3% spoke Luganda. Among the intervention arm, 62% requested text message and 38% automated phone reminders. There was no significant difference in requested mode by HPV vaccine dose or language. Intervention adolescents were more likely to receive a needed dose by 24 weeks (65.4% vs. 37.7%; p<0.001; RR 1.7 95% CI 1.2-2.4). There was no interaction by dose or language. There was no difference in vaccination by those requesting text message vs. phone reminders (65.3% vs 63.3%, p=0.86). The number needed to message for one additional vaccination was 3.6 (95% CI 2.3-8.2). Kaplan-Meier curves demonstrated more timely vaccination in the intervention arm (p<0.001).
Conclusions: In this novel trial, text message and automated phone reminders were effective in promoting more timely HPV vaccination in this population.
{"title":"SEARCH Study: SMS and Automated Phone Reminders for HPV Vaccination in Uganda: Randomized Controlled Trial.","authors":"Sabrina B Kitaka, Joseph Rujumba, Sarah K Zalwango, Betsy Pfeffer, Lubega Kizza, Juliane P Nattimba, Ashley B Stephens, Nicolette Nabukeera-Barungi, Chelsea S Wynn, Juliet N Babirye, John Mukisa, Ezekiel Mupere, Melissa S Stockwell","doi":"10.2196/63527","DOIUrl":"https://doi.org/10.2196/63527","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is currently the leading female cancer in Uganda. Most women are diagnosed with late-stage disease. Human papillomavirus (HPV) vaccination is the single most important primary preventive measure. While research regarding text message vaccine reminder use is strong in the U.S., their use has not yet been demonstrated in a pre-teen and adolescent population in Sub-Saharan Africa or other low- and middle-income countries.</p><p><strong>Objective: </strong>The objective of this pilot randomized controlled trial was to assess the impact of vaccine reminders with embedded interactive educational information on timeliness of HPV vaccination in Kampala, Uganda.</p><p><strong>Methods: </strong>In this randomized-controlled trial conducted in 2022, caregivers of adolescents needing a first or second HPV vaccine dose were recruited from an adolescent clinic and three community health centres in Kampala, Uganda. Families (n=154) were randomized 1:1 into intervention vs. usual care, stratified by dose (initiation, completion), language (English, Luganda) within each site. Intervention caregivers received a series of automated, personalized text messages or automated phone calls, based on family preference. Five messages were sent before the due date including both static and interactive educational information with five follow-up messages for those unvaccinated. Receipt of needed dose by 24 weeks post-enrolment was assessed by chi square, regression and Kaplan-Meier with log rank test. All analyses were intention-to-treat.</p><p><strong>Results: </strong>Overall, 154 caregivers enrolled (51.3% dose 1; 48.7% dose 2), and 64.3% spoke Luganda. Among the intervention arm, 62% requested text message and 38% automated phone reminders. There was no significant difference in requested mode by HPV vaccine dose or language. Intervention adolescents were more likely to receive a needed dose by 24 weeks (65.4% vs. 37.7%; p<0.001; RR 1.7 95% CI 1.2-2.4). There was no interaction by dose or language. There was no difference in vaccination by those requesting text message vs. phone reminders (65.3% vs 63.3%, p=0.86). The number needed to message for one additional vaccination was 3.6 (95% CI 2.3-8.2). Kaplan-Meier curves demonstrated more timely vaccination in the intervention arm (p<0.001).</p><p><strong>Conclusions: </strong>In this novel trial, text message and automated phone reminders were effective in promoting more timely HPV vaccination in this population.</p><p><strong>Clinicaltrial: </strong>ClinicalTrials.gov Identifier: NCT05151367.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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":"<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","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}
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}
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}
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":"<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","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}
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}
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":"<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 ","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}
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":"<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","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}
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}
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":"<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","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}