JMIR mHealth and uHealth最新文献

Background: Heart failure (HF) is a major healthcare challenge in the United States, with approximately 900,000 older adults hospitalized annually. Gaps in self-management, including unrecognized worsening symptoms and failure to adhere to dietary sodium restriction, can reduce quality of life and precipitate hospital admissions. Existing mHealth approaches to HF self-management have produced mixed results, highlighting the need for innovative strategies to improve post-discharge outcomes in at-risk patients.

Objective: The ManageHF trial aimed to evaluate the effectiveness of two just-in-time adaptive interventions (JITAIs) delivered via a mobile application to enhance HF self-management. The interventions focused on symptom recognition and lower dietary sodium restriction, with the goal of reducing readmissions and improving HRQOL over a 12-week period.

Methods: The trial was a 2x2 factorial, double-blind, randomized controlled study conducted across several U.S. institutions. Participants recently hospitalized for acute HF were randomized into four groups: both interventions, either intervention alone, or an active control. The primary outcome was a composite measure assessing time to all-cause death, time to first HF readmission, and HRQOL changes, using the Minnesota Living with Heart Failure Questionnaire (MLHFQ).

Results: Recruitment was hindered by the COVID-19 pandemic, leading to the early discontinuation of the trial. Of 62 participants enrolled, 43 completed the study. Participants were diverse, with a mean age of 55 years; 32% were female, and 55% were Black or African American. Most had HF with reduced ejection fraction . However, due to the early termination and small sample size, the ability to detect statistically significant differences was limited.

Conclusions: The ManageHF trial highlighted the potential of mobile health technology to support HF management, particularly in enhancing HRQOL. Future studies employing more effective recruitment and retention strategies are crucial for establishing the efficacy of these interventions with greater certainty.

Clinicaltrial:

Background: Mobile apps are powerful tools for promoting and sustaining healthy behaviors, including supporting diverse recovery pathways from substance use, including alcohol use disorder. Indeed, prior research strongly supports the notion that social connection through mobile platforms, supplemented by an in-person interaction, is vital in helping individuals strengthen their recovery and improve overall well-being and mental health. However, research into the digital footprints of mobile app users, as a strategy to assess app usage experiences in a recovery context, is lacking.

Objective: This study utilizes a dataset from The Phoenix app, a social media platform specifically designed for individuals impacted by substance use, including those in or seeking recovery, to identify core uses of the app, including how it is leveraged by members from a thematic and emotional valence context.

Methods: We applied natural language processing and deep learning methods to analyze a random sample of 19,685 posts. Analyses included the Bidirectional Encoder Representation from Transformers topic modeling tool to generate themes and a Valence Aware Dictionary and Sentiment Reasoner sentiment analysis to approximate emotional tone and mood from posts ranging from highly negative (-0.99) to highly positive (0.99).

Results: After removing duplicate and nonsensical posts, we retained a final sample size of 17,617 posts. Bidirectional Encoder Representation from Transformers topic modeling tool identified 10 topics (coherence score=0.48) within 2 overarching themes: (1) those related to engaging app members through in-person and online interactions (7 topics) and (2) as a forum to discuss more serious topics pertaining to substance use and mental health recovery (3 topics). Overall, the topics revealed a distinct and recurring theme of community support. Valence Aware Dictionary and Sentiment Reasoner sentiment analysis was 0.44 (SD 0.42), indicating highly positive posts, with only 429 (2.4%) being highly negative.

Conclusions: The study findings broadly show positive uses of The Phoenix app as a tool for social connections and community among people in recovery from substance use. With the high positive sentiment of posts, the app was distinct from other social media platforms (eg, X, Reddit, Facebook), which often feature a mix of highly positive and highly negative posts. Additional research is needed to confirm these results using a larger dataset and with comparative analysis of other recovery forums to contribute to the understanding of social media's role and function in changing health-related behaviors.

Background: Knee osteoarthritis is a prevalent cause of disability among older adults, emphasizing the need for effective and accessible self-management strategies. Mobile app-based personalized exercise programs predominantly overcome the barriers associated with traditional approaches.

Objective: This study aimed to evaluate the feasibility and preliminary efficacy of a 6-week mobile app-based self-exercise program that incorporates a multimonitoring system, weekly progress tracking, and dynamic exercise adjustments used by physiotherapists, and compares them with those of a conventional paper-based self-exercise program in older patients with chronic knee osteoarthritis.

Methods: A total of 29 participants aged ≥60 years with chronic knee pain and radiographic evidence of osteoarthritis were randomized at a 2:1 ratio to either the intervention (19/29, 66%; mobile app-based program) or control (10/29, 34%; paper-based program) group. The mobile app delivered a personalized exercise program, which was tailored by physiotherapists based on remote monitoring of patient-reported symptoms. Feasibility outcomes included retention, adherence, and satisfaction rates, as well as safety. Preliminary clinical outcomes included changes from baseline to 6 weeks in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, Numeric Rating Scale (NRS) pain, and other functional measures.

Results: A total of 26 participants (n=16, 62% intervention and n=10, 38% control) completed the 6-week assessment, with retention rates of 84% and 100%, respectively. No adverse events were reported. Adherence was high in the intervention group, with 69% exercising ≥5 days per week and 88% reporting high satisfaction. The intervention group exhibited significant reductions in the WOMAC total score (median change -11.00, 95% CI -23.00 to -2.50; P=.01) and NRS pain score (mean change -2.12, 95% CI -3.13 to -1.11; P<.001).

Conclusions: The mobile app-based personalized exercise program was feasible, safe, and well-accepted among older patients with knee osteoarthritis. High adherence and satisfaction support the practicality of this approach, and preliminary improvements in pain and function suggest potential clinical benefit. A larger, adequately powered trial is warranted to confirm the effectiveness of digital self-exercise interventions for knee osteoarthritis management.

Background: The adoption of mobile health (mHealth) technologies among older adults remains significantly lower than in younger populations, despite their potential to promote healthier lifestyles and mitigate age-related health risks.

Objective: This study aims to explore the perspectives of retirement-age adults on mHealth interventions, identifying factors that influence their adoption, such as persuasive elements in the app design and psychological techniques.

Methods: A qualitative focus group study was conducted with 19 Spanish participants recruited from urban community settings in Madrid, Spain (mean age 61.5 years; 15/19, 79% women). Participants discussed their attitudes, barriers, and preferences for mHealth tools. Focus groups were recorded, transcribed, and coded using an iterative process to ensure rigorous data analysis. An abductive approach was followed, using the persuasive design principles framework and the behavior change techniques' taxonomy, and representing any theme outside those frameworks.

Results: Participants expressed generally positive attitudes toward mHealth tools, favoring intuitive, user-friendly designs that are minimally time-demanding. However, significant barriers also emerged, such as low digital literacy and concerns about technology dependence. Key design preferences (persuasive design principles) and psychological techniques (behavior change techniques) were deemed beneficial, with preferred features such as tailored and meaningful goal-setting, self-monitoring, positive feedback (eg, congratulating messages after achieving a goal; social rewards), and a moderated use of notifications and prompts. Participants also stressed the importance of age-appropriate recommendations (eg, suggested diets for their age and characteristics) and design (eg, accessible, easy-to-use interfaces and human-like communication). Additionally, some preferences appeared to be culturally grounded (eg, rejection of anglicisms and the desire for locally relevant content, such as suggested activities specific to Madrid). Social support mechanisms, such as group activities and peer interactions through mHealth, were seen as critical for fostering motivation and engagement.

Conclusions: mHealth interventions for this population should offer accessible and easy-to-use interfaces along with initial tutorials, facilitating an easy onboarding to overcome low digital literacy, thereby enhancing both usability and initial adoption. Furthermore, by providing meaningful, tailored content (eg, personalized diets and goals) and social features that foster peer connection (eg, user chats or organized activities), these tools may better support sustained engagement over time.