mHealth最新文献

Background: Fitness applications are increasingly used to support physical activity and promote healthier lifestyles. However, maintaining long-term engagement remains a major challenge, as many users discontinue app use within weeks. While churn prediction has been studied in fitness centers or other industries, research on digital fitness apps is still limited and often relies on static models such as logistic regression. To address this gap, this study analyses user churn in fitness apps using survival analysis techniques to identify factors contributing to drop out, aiming to improve user engagement and retention strategies. The study objective is to assess the suitability of survival analysis for predicting user churn times in fitness applications.

Methods: The study analyzed data from 3,034 users of the Mammoth Hunters fitness application. Three distinct time-range approaches were employed for survival analysis, each paired with two censoring methods. Kaplan-Meier estimates assessed user dropout probabilities over time, supplemented by parametric survival models and cure fraction models. Model performance was evaluated using mean absolute error, Akaike Information Criterion (AIC), concordance index, and Cox-Snell residuals.

Results: Significant differences in retention were observed for multiple variables such as gender, activity level, training frequency, and body fat percentage (P=0.004) across all approaches. Men, older users, and those with higher training frequency showed longer engagement, while sedentary users and women disengaged earlier. LogNormal parametric models achieved the best predictive performance with mean absolute errors of 1.02, 1.94, and 3.32 weeks across time approaches. Cure models indicated that only a small fraction of users would remain engaged indefinitely.

Conclusions: This study highlights key factors driving user churn in the Mammoth Hunters fitness app, offering insights to help developers reduce dropout rates, enhance engagement, and improve user retention. Applying advanced survival and cure models can improve personalization, reduce dropout rates, and support sustainable health outcomes through digital fitness platforms.

Background: Tele-exercise-using mobile apps or digital platforms-has expanded access to guided physical activity, potentially contributing to public health. The motivational mechanisms that drive individuals to use mobile fitness apps may differ from more traditional forms of exercise and remain limited. Given that motivation undeniably plays a role in the uptake and maintenance of exercise, this study aims to provide insight into the motivational regulation of tele-exercise users, based on the self-determination theory.

Methods: An ad hoc scale was developed. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the psychometric properties of the scale. Data were inferentially analysed using the Mann-Whitney U test, Kruskal-Wallis test, and Bonferroni post hoc tests.

Results: The ad hoc scale showed adequate consistency indices with reliability values ≥0.83, for all (i.e., intrinsic, identified, introjected) motivation dimensions. CFA confirmed the factor structure, with loads >0.51, and composite reliabilities 0.54 to 0.74, for each factor. Construct validity was proven adequate through adjustment of indices tests [Comparative Fit Index (CFI) =0.990; Tucker & Lewis Index (TLI) =0.976, root mean square error of approximation (RMSEA) =0.058]. Statistically significant differences were found relative to sex, previous activity level and fitness goal, for some but not all motivation types (n=753). No statistically significant differences were found for motivation, relative to age.

Conclusions: The common understanding that intrinsic motivation is desirable for sustained behavior change may need to be reinterpreted for the field of leisure-time, tele-exercise. These findings provide new insights into how motivation varies among fitness app users and suggest that digital interventions may benefit from reframing motivational strategies to better support exercise adherence.

Background: The percentage of people owning smartphones is rapidly increasing due to the digitalization of modern society. Among the smartphone's features, route guidance using navigation applications establishes spontaneous and independent outdoor mobility, and can potentially support people's health. Despite some known concerns regarding smartphone use while walking, navigation performance and eye-tracking behavior while walking with navigation applications in real-world environments are unclear. This study aimed to investigate the association between gaze behavior, particularly glancing at smartphones, and navigation performance among adult users of navigation applications while walking.

Methods: This cross-sectional experimental study involved 33 healthy adults aged 20 years and older (20-81 years, 66.7% female) not requiring assistance with walking or activities of daily living. A route navigation task (RNT) of approximately 1,300 m was performed in a real outdoor environment. The participants were required to complete the route as quickly as possible, following the instructions of the navigation application. Simultaneously, the fixation time, number of fixations, number of saccades, total saccade angle, and number of glances at the smartphone were recorded using a wearable eye-tracking device. After checking the distribution of the obtained outcomes and performing correlation analysis, a generalized linear model (GLM) was created to investigate the relationship between the number of glances at the smartphone and the participants' navigation performance and gaze behavior. To confirm the validity of the estimates for each GLM, a bootstrap sample of 2,000 iterations was used to evaluate the estimates.

Results: Correlation analysis showed that the number of stops and route errors were moderately and positively correlated with the number of times participants glanced at their smartphones (P<0.05). In the original GLM, the number of stops and route errors showed a significant positive association with the number of glances at the smartphone (P<0.05). This significant positive relationship persisted even after examining the bootstrap sample.

Conclusions: In healthy adults, frequent screen glances while walking with a navigation application may interfere with navigation performance. Establishing an alternative navigation system that does not rely on screen-checking may help pedestrians move more efficiently and safely.

Background: Telemedicine (TM) is a growing field with the potential to improve healthcare delivery; however, it is important for proper implementation to understand how physicians perceive the benefits and limitations related to their use. With this study, our aim is to assess the perceptions and knowledge of TM among a sample of Ecuadorian healthcare providers.

Methods: We conducted a cross-sectional online survey-based study where participants answered a 12-item survey assessing their knowledge and perceptions towards TM. Demographic variables were analyzed applying descriptive statistics, and a chi-square goodness-of-fit test was used to assess the observed frequencies of each of the survey's queries. Multiple linear regression was performed to evaluate predictors of overall attitude regarding TM.

Results: In total, 382 participants completed the survey with an average age of 51.3 years [standard deviation (SD) 11.4]. Around half of the participants expressed low to very low familiarity with TM technology [χ² (4) =88.497, P<0.001]. Most of them considered to a high extent that TM is effective in reducing costs of patient care in hospitals [32.5%; n=124; χ² (4) =78.812, P<0.001]. Finally, 8 out of 10 participants expressed that a framework should be created to prevent breaches of data confidentiality when using TM [χ² (4) =250.749, P<0.001].

Conclusions: In this study, we identified a significant proportion of physicians who reported limited familiarity with TM, despite recognizing its potential benefits for patient care. Concerns regarding data confidentiality breaches and the risk of malpractice were highlighted as primary issues necessitating a framework to mitigate these risks. Future research is required to address the perceived technological barriers to ensure the safe and efficient implementation of TM in healthcare settings.

Background: Mobile health (mHealth) applications are widely used in Taiwan, yet their quality remains unregulated. The Mobile App Rating Scale (MARS) is a validated tool for assessing mHealth app quality, but a Traditional Chinese version has not been developed and validated. This study aimed to translate and validate the traditional Chinese version of MARS (MARS-TW) and assess its reliability and validity using a cross-cultural adaptation framework.

Methods: A three-phase cross-sectional study was conducted: (I) conceptual and item equivalence were evaluated by three experts; (II) semantic equivalence was assessed through forward and backward translation; (III) operational, measurement, and functional equivalence were tested on 44 mHealth apps related to cancer care (CC) and hypertension self-management (HTM), rated independently by two reviewers.

Results: The expert review confirmed conceptual and item equivalence. Semantic equivalence was achieved through iterative refinements. Reliability testing demonstrated good internal consistency (Cronbach's α ≥0.80) and inter-rater reliability [intraclass correlation coefficient (ICC) ≥0.76]. Convergent validity was supported by strong correlations within subscales [item-subscale (I-S) correlation >0.3, item-total (I-T) correlation >0.2], while divergent validity was acceptable (subscale correlations <0.70, P<0.05).

Conclusions: MARS-TW is a reliable and valid tool for evaluating Traditional Chinese mHealth apps. Future research should explore its applicability across broader health-related app categories.

Background: There are only a few online infant nutrition interventions based on a behavior change theory, and none have used a thematic analysis to understand which constructs may have contributed to behavioral change. We developed an online infant nutrition education web platform (Baby-Feed) based on the Social Cognitive Theory (SCT). This qualitative study aimed to identify among participants of the Baby-Feed intervention arm, which SCT behavior mediators (self-efficacy, outcome expectations, observational learning, and incentive motivation) influenced them to move them from intention into action to improve feeding behaviors.

Methods: This qualitative study employed semi-structured interviews with 20 caregivers from the intervention arm of the Baby-Feed trial. The Baby-Feed online trial was a randomized, controlled, parallel trial that tested an educational website providing real-time feedback on infant feeding and weight gain among 155 caregivers with infants less than 4 months old and followed them until their infant completed the scheduled 9-month well-baby visit. Participants completed an interview with five questions (one or two per construct of the SCT: self-efficacy, outcome expectations, observational learning, and incentive motivation). Methods associated with deductive and inductive analysis were utilized to develop key themes on early feeding practices.

Results: Among first-time mothers (n=10), 100% reported that their confidence either slightly or greatly increased with the use of Baby-Feed. Caregivers (n=11; 55%) reported that they found the "Educational Resources by Nutrition Experts" to be very helpful in their food choices and for modeling infant feeding behaviors. Some (n=3; 15%) also reported that they shared their newly acquired knowledge with others (i.e., friends, spouse, and grandparents), reinforcing the value of the information and that it would benefit others.

Conclusions: Caregivers found the Baby-Feed website to be a helpful tool to increase their confidence in feeding their baby.

Background: Dietary and physical activity behaviors can influence the development of breast cancer. This study aimed to evaluate the effectiveness of a web-app-based intervention in improving diet and physical activity among women aged 25-45 years residing in northern Spain.

Methods: A randomized experimental study was conducted with two groups: an intervention group (IG) and a control group (CG). The Motiva.Diaf questionnaire was used to evaluate the impact of a web-app-based intervention on dietary and physical activity behaviors (range: 0= lowest adherence, 12= highest adherence to healthy behaviors). Women in the IG participated in a 12-week intervention based on the Behavior Change Wheel Model. The web-app provided information on both behaviors.

Results: A total of 289 women completed the study (IG =101; CG =188). Considering the combined behaviors for IG (diet and physical activity), between PRE-intervention [8.12; standard deviation (SD) =2.51] and POST-intervention (8.46; SD =2.53), the score was significantly higher in POST [P=0.001; 95% confidence interval (CI): -0.546 to -0.140]. Similarly, significant improvements were observed in specific behavioral recommendations within the IG, with higher scores in dietary behaviors (P<0.001; 95% CI: -0.419 to -0.141), and in physical activity between IG and CG at POST (P=0.04; 95% CI: -0.531 to -0.014). Previous adherence to recommendations was a predictor of POST-intervention adherence to healthy behaviors (Standardized β =0.645; 95% CI: 0.773-0.886; R² =67%).

Conclusions: The intervention has proven effective in improving adherence to healthy dietary and physical activity behaviors. Policymakers should prioritize the development of these digital interventions as they can play a crucial role in addressing challenges faced by healthcare systems and meeting societal demands. Therefore, healthcare professionals can implement them.

Trial registration: ClinicalTrials.gov NCT05267171.

Background: The role of technology in disease management has gained significant attention, mobile health technology for obstructive sleep apnea (OSA) remains underdeveloped, with limited research exploring its applications. This study explored OSA individuals' health literacy, perceived needs for improvement, information preferences, and acceptance of smartphone-based messaging interventions.

Methods: The study comprised two parts. Part 1 was a cross-sectional, self-administered online survey using non-probability convenience sampling conducted in the inpatient ward and outpatient clinic of Queen Mary Hospital, Hong Kong, from May to July 2020. The questionnaire assessed health literacy, perceived needs, and views on smartphone-based messaging interventions to enhance self-management of OSA. Written consent was obtained, and the survey took approximately 10 minutes to complete. Part 2 involved a focus group interview in August 2020 with nine randomly selected participants from Part 1, exploring their views on perceived needs and smartphone-based messaging interventions.

Results: A total of 108 participants (82% men; 40.7% aged ≥60 years) were included. Participants self-reported their OSA severity as mild (21.3%), moderate (17.6%), and severe (23.1%), while 38% were unaware of their severity. The results showed low OSA-related health literacy among participants, with no significant differences by age or years since diagnosis. Most participants (76.8%) expressed a strong desire to improve their health. High demand for OSA-related information was reported, including sleep quality (83.3%), OSA-related knowledge (82.4%), weight control (81.5%), habit improvement (78.7%), and emotional management (66.7%). The messaging intervention was well accepted, with high feasibility (82.4%) and usability (72.2%).

Conclusions: This study highlights low OSA-related health literacy and a strong demand for authoritative health information. Most found that the messaging intervention was feasible and useful in improving health-related habits and OSA management. The study underscores the need for tailored health education, personalized interventions targeting perceived needs, and innovative messaging solutions to enhance treatment adherence and self-management in OSA individuals.

The advancement of telemedicine (TM) practices has enabled greater access for allergists to assess suspected drug allergies. While penicillin allergy delabeling by drug challenges may not seem suitable for TM due to the need for close patient observation and rapid access to emergency care, it is important not to shy away from discussing the potential for initial drug hypersensitivity assessments and even direct amoxicillin oral provocation in low-risk patients under TM conditions. Through an extensive literature analysis, this narrative review discusses clinical practices, eligibility criteria, and safety considerations regarding virtual care for safe penicillin allergy delabeling in such patients. Emphasis is placed on risk stratification using recently validated clinical tools and expert opinion strategies, such as PEN-FAST [penicillin (PEN) allergy, an occurrence of five or fewer years ago (F), anaphylaxis or angioedema (A), severe cutaneous adverse reaction/SCAR (S), and treatment required for allergic reaction (T)] score and European Academy of Allergy and Clinical Immunology (EAACI)/European Network on Drug Allergy (ENDA) practical recommendations, to identify the low-risk patients suitable for remote assessment and TM-supported amoxicillin challenges, if necessary, which may be performed in outpatient departments, long-term care facilities or other remote settings, including the patient's home. The clinical practice review summarizes initial evaluation protocols, virtual monitoring procedures in case of low-risk oral provocations, and post-challenge follow-up, underlining the importance of informed consent, patient education, and caregiver presence. Oral H1 antihistamines are recommended for symptomatic relief if needed, and the benefits of acquiring an epinephrine autoinjector solely for the challenge represent a juncture for shared decision-making. While TM offers promising avenues to expand access to penicillin allergy delabeling in low-risk individuals, it is not a substitute for in-person evaluation in high- or intermediate-risk cases. The review also highlights technological, ethical, and legal challenges, serving only as an informational resource.

Background: Mobile applications for health care escort services (MA-HCES) have emerged as an innovative solution to assist patients during hospital visits and improve service delivery efficiency. Despite their growing presence, their adoption among specific populations such as medical students remains understudied. This research aimed to evaluate the effects of perceived ease of use, perceived usefulness, attitudes, facilitating conditions and perceived behavioral control on behavioral intention and the utilization of MA-HCES among medical college students.

Methods: Employing a quantitative research design, data were collected through questionnaires distributed to the target population of medical college students. The data were analyzed and the research hypotheses were tested via the item-objective congruence (IOC) index, pilot test, confirmatory factor analysis (CFA), and structural equation modeling (SEM) methods.

Results: Findings indicated that perceived usefulness exerted the most significant influence on the behavioral intention to utilize MA-HCES. Additionally, perceived ease of use, attitudes, facilitating conditions and perceived behavioral control had positive effects on college students' behavioral intention to use MA-HCES. Consequently, behavioral intention was found to significantly influence actual use behavior.

Conclusions: A survey was conducted among 511 medical college students to collect data, and a SEM was used to test the research model. The findings suggest that perceived ease of use, attitudes, facilitating conditions, and perceived behavioral control positively influence college students' intention to utilize MA-HCES. Therefore, behavioral intention has a substantial effect on use behavior. This study introduces a novel model that can accurately forecast the behavioral intentions of medical college students to use MA-HCES, making valuable contributions to both practical application and theoretical understanding.