mHealth最新文献

Given the rise of telemonitoring and self-management, experts debate the respective advantages and disadvantages of these two approaches. To date, no study has directly compared the efficiency or cost-effectiveness of blood pressure (BP) telemonitoring initiated and supervised by healthcare professionals (HCPs) and self-management of patients autonomously following a prespecified plan, but both have been compared to standard in-office BP management. A 2017 meta-analysis showed that telemonitoring leads to faster BP reduction and a higher rate of patients reaching their BP target than standard care. A 2023 meta-analysis found that digital health intervention to assist patients, such as short message services (SMS), smartphone apps, and websites, led to a larger BP decrease compared to usual care but the high variability in study designs and potential biases temper these results. Currently, the evidence supporting self-management for BP control is less compelling than for telemonitoring. But clinical trials may not fully reflect real-world scenarios. Economic evaluations have not clearly shown that telemonitoring is more cost-effective than standard care. In some studies, healthcare costs were even higher in the telemonitoring group, although this must be weighed against the benefits. On the opposite, some digital self-management tools do not collect identifiable user information, therefore face fewer regulatory constraints, and finally are less costly. Telemonitoring requires significant involvement and time to devote from HCPs to manage data and respond to alerts, raising concerns about increased workload. On the opposite, self-management vs. telemonitoring reduces the workload for HCPs because patients manage their own BP readings and interactions with digital tools autonomously. Another critical aspect to consider is the relationship between patients and HCPs, which differs greatly between telemonitoring and self-management. However, we still lack a full understanding of patient and HCP expectations regarding autonomy and monitoring. The 2023 European Society of Hypertension (ESH) guidelines now endorse digital interventions and self-titration algorithms. There are many differences between self-managing and telemonitoring to claim that one is superior to the other. A more constructive approach is to explore how they can complement each other.

Background: With the advancements in mobile health (mHealth) technologies, sighted individuals can benefit from mobile apps and wearable devices to more easily manage their physical activity (PA) and wellness data through intuitive touch gestures and effective data visualizations. However, for blind and low-vision (BLV) individuals, these conventional interaction methods are often challenging, not only limiting their ability to use these technologies but also potentially diminishing their motivation to adopt them to support health-promoting behaviors. We aimed to develop a health monitoring application called Personalized and Conversational Health Agent (PCHA) that supports BLV individuals with self-monitoring and management of their PA and wellness data (e.g., step count, exercise duration, calories burned, heart rate).

Methods: Drawing on social cognitive theory and insights from prior needs assessment research, five key design goals were established to guide the development of the app's core features and functionalities. PCHA leverages a large language model (LLM) to enable a conversational health agent that can be installed on iPhone and Apple Watch devices. This conversational interface is designed to ensure accessibility and inclusivity, offering PA management tools through a voice user interface (VUI) that minimizes the navigation challenges often associated with traditional touchscreen-based systems. To ensure evidence-based PA guidance, a thorough review of scientific literature and published PA guidelines was conducted. Finally, two blind accessibility experts conducted the accessibility testing.

Results: Accessible user interface (UI) designs, featuring high color contrast, large buttons, and a simple layout, were created using Figma. The main features and functionalities include: (I) a voice health interview to assess users' basic health information; (II) PA recommendations to guide users toward achieving their PA goals; (III) a chat feature enabling human-like conversations with the app; (IV) a PA scheduling and reminder feature with haptic feedback on the Apple Watch; and (V) an in-exercise mode that provides audible updates on heart rate, PA duration, and walking speed. The app's mobile accessibility was found to be satisfactory.

Conclusions: A follow-up study involving BLV research participants will be conducted to improve the app's accessibility and usability, and to update its features and functionalities. More research is needed to fully harness the potential of LLMs in the new mHealth system to motivate PA behaviors for BLV populations. To deliver truly personalized PA feedback for BLV individuals, mHealth app developer should incorporate PA and wellness data specific to the BLV population, along with their unique personal and contextual factors that influence PA behaviors.

Background and objective: Social and digital determinants of health are increasingly recognized as critical drivers of health outcomes, particularly in Africa, where economic disparities, geographic divides, and evolving digital infrastructures present unique challenges. Addressing these determinants is crucial for reducing health inequities and improving access to healthcare across the continent. This review synthesizes the current understanding of social and digital determinants of health within the African context, emphasizing their regional variations, research gaps, and potential interventions.

Methods: A narrative review approach was adopted, conducting a targeted search of literature from databases such as PubMed and Google Scholar, alongside grey literature from organizations like the World Health Organization (WHO). The review focused on studies published between 2000 and 2023, covering social determinants like socioeconomic status, education, and healthcare access, as well as emerging digital determinants such as digital literacy and mobile technology use. Thematic analysis was performed to categorize findings and identify regional variations, particularly in North, sub-Saharan, Eastern, Western, and Central Africa.

Key content and findings: The review highlights significant disparities in both social and digital determinants across African regions. Urban-rural divides, economic inequalities, and limited healthcare infrastructure pose persistent challenges. Digital determinants are increasingly influencing health outcomes, with countries like Kenya leading in mobile health innovations, while others, particularly in rural areas, struggle with poor internet penetration. Research gaps were identified, particularly the need for longitudinal data and integration of digital determinants into health surveillance systems like health and demographic surveillance systems (HDSS).

Conclusions: Social and digital determinants of health significantly impact health outcomes in Africa. Addressing these disparities through targeted interventions, improved infrastructure, and digital health innovations is essential for reducing inequities. Further research, particularly longitudinal studies, is critical for understanding the evolving role of digital determinants in African healthcare systems and shaping effective public health policies.

Background: Telehealth is an important tool for improving access to health care in underserved areas. This scoping review explores the evidence for implementing telehealth as a mode for delivering primary health care (PHC) consultations by general practitioners (GPs) to rural and remote patients in high income countries.

Methods: Peer reviewed publications were sourced from CINAHL, PubMed, and the Web of Science. The Joanna Briggs Institute's (JBI) methodology for scoping reviews was followed. Data from each paper were coded deductively to five themes: (I) telehealth structures and processes; (II) patient and provider preferences for telehealth; (III) positive and negative outcomes of telehealth; (IV) characteristics of providers, practices and patients affecting telehealth adoption; and (V) barriers and enablers to the use of telehealth.

Results: Sixty papers were included. Rural and remote populations accept telehealth because of profound impacts on their otherwise long travel times, high travel costs, logistical difficulties and overcoming the generally lower availability of GPs in these locations. Providing face-to-face GP care to isolated small populations is also resource intensive and limited by GP availability, with provider travel time, travel costs and accommodation costs adding to the overall costs of service provision. The main concerns about telehealth were reduced ability to conduct physical examinations, privacy and data security, heavier clinic workloads and poorer relationships. Telehealth was most acceptable for after-hours and follow-up consultations. Effective telehealth required adequate connectivity and digital infrastructure and training of staff to support the patient and PHC provider, which was especially important if there were cultural differences or communication difficulties. Few studies focussed on the experience of telehealth for First Nations people or use of telehealth for PHC service delivery in remote locations.

Conclusions: Telehealth can be used as a supplementary mode for delivering PHC services to improve access and continuity of care in rural and remote locations, especially when there is a pre-existing relationship between the PHC provider and the patient. We recommend identifying contextual indicators and putting in place adequate monitoring and evaluation frameworks if introducing telehealth in rural and remote contexts and in the context of First Nations peoples.

Background: Certified peer support specialists (CPSs) can empower individuals with serious mental illness (SMI) to engage with mobile health interventions designed to improve medical and psychiatric self-management. This study pilot-tested PeerTECH, a digital, 12-session intervention adapted from Integrated Illness Management and Recovery and delivered by CPSs, to assess its feasibility, acceptability, and preliminary effectiveness in enhancing self-management among individuals with SMI compared to peer support as usual (PSAU).

Methods: A two-arm pilot randomized controlled trial was conducted with individuals diagnosed with SMI and at least one medical comorbidity. Participants were randomly assigned to either PeerTECH, a 12-week structured mobile health intervention delivered by CPSs, or PSAU (peer support without mobile technology). Outcome measures related to medical and psychiatric self-management were assessed at baseline and 12 weeks. Data was analysed using linear mixed-effects regression models to compare outcomes between groups. Feasibility and acceptability were evaluated by participant retention rates, intervention adherence, and participant-reported satisfaction.

Results: The study demonstrated that the randomized control trial design was feasible and acceptable, with 72.73% of approached patients consenting to participate. PeerTECH delivery was engaging, with 90% of participants initiating the intervention, approximately 80% completing it, and participants engaging in text exchanges on 70% of possible days, averaging 10 text exchanges. The intervention was found to be acceptable, with 100% of participants reporting satisfaction, and safe, with no adverse events. Statistically significant improvements were observed in PeerTECH compared to PSAU in physical health outcomes, as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 Physical Health scores (P=0.023). Clinically meaningful improvements in the Integrated Management and Recovery Scale and PROMIS-derived utility scores (EuroQol 5-Dimension Scale, Health Utilities Index) were also observed.

Conclusions: The Peer-Led Mobile Health Intervention demonstrated feasibility and effectiveness in enhancing self-management among individuals with SMI and chronic comorbidities.

Trial registration: This trial was registered at ClinicalTrials.gov (NCT04481737).

Telehealth has gained traction since the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) virus [coronavirus disease 2019 (COVID-19)] pandemic. Telehealth is especially useful in plastic surgery, given the visual nature of many plastic surgery problems. However, research on the accessibility of virtual consultations in plastic surgery is limited. The purpose of this study was to evaluate the accessibility of initial virtual consultations in academic and community-based plastic surgery practices through evaluation of online resources and to discuss the implications of these findings as they apply to patient access to care. We evaluated the websites of academic and community-based plastic surgery practices in the USA. All practices were contacted for confirmation of the availability of virtual consultation. Data was collected on practice characteristics, including region, availability of virtual consultations on practice websites, and types of services offered by community-based programs. Standard statistical analysis was performed using chi-square and Fisher's exact tests. A total of 88 academic and 500 community-based plastic surgery practice websites were evaluated. Community-based practices offered more virtual consultations than academic practices (64.5% vs. 25.0%, P<0.001). As it pertains to telehealth marketing, overall availability of virtual consultations on the websites of academic and community-based practices was lacking and there was no difference between the two groups (21.6% vs. 13.8%, respectively, P=0.06). Community-based practices that offered only cosmetic surgery offered more virtual consultations than those that offered both cosmetic and reconstructive surgery (75.0% vs. 54.0%, P<0.001). Our findings suggest that community-based and academic plastic surgery practices are under-utilizing telehealth and telehealth marketing as it applies to virtual consultations. Despite the widespread adoption of telehealth since the COVID-19 pandemic, there is high variability in the accessibility of virtual consultations in plastic surgery across academic and community-based practices and broader implementation should be considered to increase transparency of services and accessibility to care.

Background: Digital health tools have grown in their usage and popularity since the coronavirus disease 2019 (COVID-19) pandemic, when healthcare providers were required to find methods of monitoring and engaging with their patients while also practicing social distancing. The process of building any digital product is arduous and complicated, and successful deployment within a healthcare system involves navigating a complex landscape of regulations, cybersecurity requirements, and the unique considerations of each healthcare institution, in addition to managing general product maintenance and adapting to ongoing technological advancements. The aim of this study was to utilize stakeholder feedback to create an improved, modular, scalable, and disease agnostic digital health solution while also identifying common challenges and considerations for deploying health technology.

Methods: Our large interdisciplinary team has been part of several digital health solutions that have been utilized in multiple areas of healthcare. Here, we discuss this journey, lessons learned and describe the recent culmination of this work in the development of Nanbar Health, a digital health solution that integrates patient-reported symptoms via a mobile application, biometrics collected from smartwatches and wearables, and electronic health record (EHR) data to build complex symptom networks and predictive algorithms, all with the goal of better understanding the disease experience of individuals living with various illnesses.

Results: This article provides details about our previously built tools, methodology, challenges, insights, and the findings our team made during the development process, alongside considerations that should be made during the development and integration of any digital health solution.

Conclusions: Nanbar Health is a comprehensive digital health tool developed over multiple years by an interdisciplinary team, utilizing user-centered design, longitudinal data, and predictive algorithms to better understand an individual's illness experiences. The development of such digital health solutions requires extensive planning, efficient multidisciplinary teamwork, and careful consideration of factors needed to build sustainable and modular mobile health (mHealth) apps. Future improvements should focus on developing disease-agnostic solutions, improving data capture strategies, and creating streamlined processes for EHR integration to enhance healthcare technology adoption and patient care.

Background: Physical activity (PA) is crucial for health promotion and chronic illness prevention. As chronic illness is increasing among women in young adulthood, there is an urgent need for effective strategies to encourage PA in this population. An improved understanding of PA behaviors and their determinants in daily life among women of reproductive age (i.e., ages 18-50 years) would help to inform intervention efforts. The purpose of this scoping review is to synthesize methods and evidence for studies of time-sensitive predictors of PA among women of reproductive age, and to identify key gaps to be addressed.

Methods: Searches in Academic Search Complete, PubMed, MEDLINE, PsycInfo, and Web of Science identified observational or experimental studies that used a mobile tool (e.g., wearable PA sensor). Studies were eligible for inclusion if the primary outcome was objectively assessed PA, the predictor was assessed at least once daily, and if participants did not have a medical or psychiatric contraindication to performing PA.

Results: Of the initial 1,874 results, 7 articles that described 6 unique studies met inclusion criteria, with a total of 858 participants. Sample sizes ranged from 30 to 292, and mean age from 20.0 to 42.1 years. We summarized participant characteristics, study characteristics, and findings. Most studies were observational (71.4%). Common PA outcomes were step count and minutes of moderate-to-vigorous PA, assessed using commercially available or research-grade devices. PA predictors were assessed at 2 levels (i.e., person or day/moment), with considerable variability in the frequency of assessment.

Conclusions: This review highlights strengths and weaknesses of the current evidence base and identifies key opportunities for advancing our understanding of PA behaviors among women of reproductive age.

Background: For telemedicine to be implemented and sustained in low- and middle-income countries (LMIC), it must be accessible, equitable, affordable, and compatible with current infrastructures. This study is to evaluate the views of pediatric healthcare practitioners in Ethiopia toward using an instant messaging app (Telegram) to conduct tele-consultations and asynchronous medical education.

Methods: The study adopted a qualitative method via in-person interviews or message exchange to get greater insights and deeper meanings of pediatric doctors in Ethiopia about the use of Telegram chat groups for teleconsultations and medical education. Coding and Thematic analysis were applied to identify common themes and data analysis.

Results: The study attracted ten pediatric doctors for in-depth interviews and four text exchanges. All participants expressed positive attitudes toward telemedicine through simpler phone-based platforms. Telegram was the preferred application over WhatsApp and Zoom due to its compatibility with limited internet connections, multidimensional views of data, and an unlimited number of participants. Having a Telegram chat made it easy to get teleconsultation and improve pediatric knowledge. Pediatricians from non-academic institutions and rural areas viewed the chat group as a source of continuous medical education. A rural pediatrician stated, "In our hospital, we don't have morning sessions or case presentations, so it (the group) gives us a platform to read further, to learn further." Residents found Telegram as a vital tool for their learning, with one resident stating, "I think Telegram is part of our residency." Lack of consultation culture, fear of being judged, and hierarchy limited the number of teleconsultations and participation in educational discussions. Internet availability, digital divide, lack of physical exam, and privacy concerns were the main barriers to using Telegram for teleconsultations. Having international experts to answer consultations was viewed as a challenge and an advantage at the same time. It is a challenge when the international expert does not understand the culture or local resources. It is an advantage as the expert can introduce new updates and innovative interventions. A pediatrician said, "There are different groups of experts from here and from abroad as well…Yeah, that makes it an ideal thing.".

Conclusions: Telegram is already used by pediatric providers in Ethiopia for telemedicine and medical education. This affordable intervention can improve access and ease the burden of consultations for all providers while meeting current infrastructure. It has potential to be scaled up and regulated to improve pediatric telemedicine in Ethiopia and many LMIC.