mHealth最新文献

Background: Mobile applications (apps) exist to promote early child development; however, few studies have examined use of these apps among low-income families. Our objectives were to measure engagement with the Engage, Develop, Learn (EDL) app and determine if it promoted engagement and behavior change among low-income caregivers.

Methods: We conducted a pilot study among English and Spanish-speaking, low-income families with children ages 12 to 15 months who received either the EDL app or injury prevention text messages. Baseline data were collected and interventions delivered over two home visits. App engagement was measured using messages opened. Caregiver development-promoting behaviors were measured with STIMQ score changes from baseline to follow-up at child age 2 years. We conducted key informant interviews among families randomized to receive the EDL app to identify barriers and facilitators to app use.

Results: A total of 100 caregivers were recruited at their children's preventive care visit with 50 randomized to receive the EDL app and 50 to receive the injury prevention text messages; however, only 25 in the development app and 34 in the injury prevention group completed both home visits. Follow-up data were collected from 14 in the development app group and 30 in the injury prevention group. Over 10 weeks, 24% (6/25) remained engaged with the development app. STIMQ scores did not differ between groups. Barriers included technical difficulties accessing the app, social stressors, and 'forgetting' to use it.

Conclusions: Our pilot randomized trial of a child development app suggests that it may not be effective for promoting behavior change among low-income caregivers due to low engagement.

Trial registration: This pilot trial was registered with ClinicalTrials.gov (ID NCT02717390).

[This corrects the article DOI: 10.21037/mhealth-22-41.].

Background: The rising prevalence of type 2 diabetes in Australia is a public health concern, contributing to significant disease burden and economic costs. Text-message programs have been shown to improve health outcomes for people with type 2 diabetes, however they remain underutilized, and no evidence exists on their cost-effectiveness or costs of scale up to a population level in Australia. This study aimed to determine the cost-effectiveness and cost-utility of a 6-month text-message intervention (DTEXT) to improve glycated hemoglobin (HbA1c) and self-management behaviors for Australian adults with type 2 diabetes.

Methods: A within-trial economic evaluation was conducted on the DTEXT randomized controlled trial. Incremental cost-effectiveness ratios (ICERs) were determined per 11 mmol/mol (1%) reduced HbA1c and per quality adjusted life year (QALY) gained, compared to usual care. Cost-effectiveness acceptability curves (CEAC) determined the probability of the intervention being cost-effective over a range of willingness to pay thresholds. A scenario analysis was conducted to determine how cost-effectiveness was impacted by using current implementation costs.

Results: The DTEXT intervention cost AU$36 (INT$24) per participant, with an ICER of AU$311 (INT$211) per 11 mmol/mol (1%) reduced HbA1c. Based on HbA1c outcomes, DTEXT had a 33% probability of being effective and cost-saving. Based on the QALY outcomes, the intervention had only a 24% probability of being cost-effective. Scenario analysis indicated costs per participant of AU$13 (INT$9) to deliver the intervention, with a reduced incremental cost effectiveness ratio of AU$151 (INT$103) per 11 mmol/mol (1%) reduced HbA1c and a 38% probability of being effective and cost-saving.

Conclusions: DTEXT was low cost and potentially scalable, but only had a low to moderate probability of being effective and cost saving. Further research should determine more targeted approaches that may improve cost-effectiveness.

Trial registration: ACTRN12617000416392.

Most individuals at risk for or already experiencing mental disorders have no access to mental health care. Digital mental health interventions (DMHIs) can be effective in preventing and treating mental disorders. A taxonomy of digital interventions was previously proposed to organize the different types of digital tools being developed to expand mental health service delivery. This article updates that framework and presents illustrations for four types of digital interventions specific to mental health and revises their definitions. The illustrations primarily focus on studies that include populations underrepresented in the literature to highlight the potential of DMHIs to reduce health disparities. Provider administered DMHIs (Type 1) and provider administered DMHIs with blended digital adjuncts (Type 2) are offered within a healthcare system. Self-help human supported/guided DMHIs with therapeutic or technical guidance (Type 3) are offered outside a healthcare system. And self-help fully automated DMHIs (Type 4) are interventions similar to self-help books, do not involve human support and are also offered outside a healthcare system. Type 1, 2, and 3 interventions are consumable, they require human time to administer and are limited by the number of hours a health care provider or guide (to promote adherence) is available. Type 4 interventions are non-consumable because these can be used an unlimited number of times anytime anywhere in the world without human interaction. Identifying DMHIs as belonging to one of these categories can promote the development of each category, guide future reviews and help disseminate those DMHIs to as many people as possible.

The development of mobile telephones has made it possible to design blood pressure (BP) monitors with data transmission via cellular lines, contributing to the emergence of "e-health". Today, the direct-to-consumer marketing of devices create a new context allowing an algorithmic processing of information for remote decision-making either by the patient or by a healthcare professional. The home BP telemonitoring (HBPT) is the remote transmission of BP values, measured at home and transmitted to the doctor's office or hospital, by means of telehealth strategies. In this context, randomized controlled trials (RCTs) studies have demonstrated HBPT ability in improving patients' compliance and adherence to treatment and in accomplishing better hypertension control rates. The level of evidence for the drop in BP is "moderate" and the place of HBPT is not clearly established in current practice. Digital interventions have the potential to support patient in self-management. This approach presupposes the prior acquisition of skills, the level of which must be adapted to the level of health literacy of each patient. Few of medical applications (mobile apps or web-apps) for hypertension can be regarded as accurate and safe for clinical use and to date, we do not have high quality evidence to determine the overall effect of the use smartphone apps on BP control.

Healthcare in the 21^st century has become more dependent on technologies than ever before). The cultural transformation called digital health has brought a range of advanced technologies into the practice of medicine and the delivery of healthcare. This has led to a rise of consumerism, an approach that would put the interests of the patients on top of those of healthcare or medical professionals in general. Companies that have traditionally been involved with developing medications, medical technologies and biotech inventions, have started to turn to developing digital health-related solutions and products. This is the change in healthcare that has started to attract companies that have never been involved with this industry. Companies like Amazon, Google (and their parent company, Alphabet), Microsoft, NVIDIA, IBM, Apple and Samsung would primarily fall into this category. Technology giants have clear incentives to enter the healthcare market as patients and medical professionals turn more to technological products to obtain, access and analyze health and medical data. However, without precious healthcare data, tech giants face a challenge in developing relevant technologies that could be implemented in the clinical practice, therefore they started to collaborate with healthcare institutions that traditionally own and store such health data. We reviewed those collaborations between tech giants and healthcare institutions that have been made public to provide a picture about the nature of these collaborations and their purposes. Our goal was to shed light on the potential privacy consequences as well as the technological advantages of tech giants' collaborating with healthcare institutions. To our knowledge, this is the first review of such collaborations in the medical literature.

Background and objective: Human immunodeficiency virus (HIV) continues to affect sexual and gender minorities, predominantly men who have sex with men (MSM). Stigma, medical mistrust, and apprehension towards discussing sexual health with one's medical provider are significant barriers in seeking or accessing preventive services. Those obstacles could be surpassed through novel digital and electronic health interventions, specifically with virtual avatar technology. Avatars are digital self-representative agents that are controlled with an interactive electronic device. Avatars allow for virtual self-immersion within infinitely customizable environments to practice skill building, fostering relationships and more, through an optional incognito approach. The objective of this narrative review is to examine recent uses of and developments in avatar technology, highlight the personalization attribute of this technology, and evaluate its strengths and limitations as a tool for HIV prevention among MSM.

Methods: We reviewed recent scientific literature generated by PubMed that use virtual avatar technology in HIV prevention and treatment among populations put at risk. Articles that met the inclusion criteria were then categorized on how the avatar technology was used.

Key content and findings: We identified eleven studies that met inclusion criteria. Avatar technology was found to create a comfortable environment for participants to address and discuss their sexual behaviors with less hesitation. Avatars can build rapport with populations put at high risk, creating an opportunity for reevaluation of their sexual behavior while assisting them in being able seek information, preventive services, or treatment for HIV or other sexually transmitted infections (STIs).

Conclusions: Given the increased use of digital technology in health and prevention, avatars might be useful in sexual health education and HIV prevention among populations put at risk. The benefits and potential in utilizing this technology for HIV prevention are highlighted.

Background: Mobile health (mHealth) has been used to promote sexual and reproductive health (SRH) education and services; however, little is known about the use of mHealth to improve safe abortion knowledge and access to safe abortion services among female sex workers (FSWs). This study evaluated the feasibility and effectiveness of iConnect intervention through changes in knowledge on safe abortion and changes in perceived barriers to safe abortion services among FSWs in Vietnam.

Methods: iConnect mobile app was developed as an interactive platform to deliver safe abortion education and referral to safe abortion services through short messaging services (SMS) enhanced by tele-counseling for 512 FSWs in Hanoi, Vietnam. A pretest-posttest evaluation was conducted using questionnaire-based phone interviews administered to 251 participants at baseline and 3 months following the intervention. Non-parametric tests evaluated the change in abortion knowledge, behaviors, and perceived barriers to safe abortion.

Results: There were significant improvements in the knowledge on safe abortion among the study participants. Specifically, FSWs' knowledge of correct gestational ages (≤22 weeks) for medical abortion increased from 78.9% at baseline to 96.8% (P=0.001). Knowledge of correct gestational ages for medical abortion at the private clinic increased from 45.3% to 63.1% (P=0.001). Knowledge on the consequences of unsafe abortion increased from 75.2% to 92.1% (P=0.001). In addition, perceived stigma and discrimination when seeking safe abortion decreased from 36.5% to 27.8% (P=0.036) and worry about the lack of confidentiality decreased from 23.3% to 15.5% (P=0.035).

Conclusions: The evaluation results showed the initial effectiveness of a mobile app-based intervention in improving access to safe abortion information and services among FSWs. A future study is needed to establish the efficacy of the intervention for scaling up in Vietnam and elsewhere.

Background: Although the prevalence of smoking is significantly higher among sexual and gender minorities (SGM) than the general population, no text-based smoking cessation intervention has been specifically tailored to this group. The objective of this phase of our study was to develop SmokefreeSGM, an SGM-tailored text-based smoking cessation program, and pilot test its design to inform the refinement of the program.

Methods: SmokefreeSGM was adapted from SmokefreeTXT, the National Cancer Institute's text-based smoking cessation program, to respond to the needs of SGM smokers. In addition to tailored text messages, SmokefreeSGM includes a new keyword, STRESS, to address the unique psychosocial stressors of SGM smokers. Text messages were distributed to users over a 6-week period, and participants were provided with nicotine patches to aid their efforts to quit smoking. Demographic and tobacco use information was collected at baseline. Quantitative (related to engagement and usability) and qualitative (related to usability and acceptability) data was also collected at the 1-month assessment.

Results: A total of 18 SGM smokers were recruited for the pilot test. 38.9% of participants were male, 38.9% were female, and 22.2% were nonbinary. 27.8% of participants identified as gay, 11.1% as lesbians, 27.8% as bisexual females, 16.7% as bisexual males, and the remaining 16.7% as other. At baseline, two-thirds (66.7%) were moderate to highly dependent on nicotine and 44.4% had made more than five attempts to quit smoking. The average engagement rate for bidirectional text messages was 63.8%. However, the response rate to the tailored text messages (54%) was higher than the non-tailored text messages (41.9%). Nine participants completed the 1-month assessment and interview (50% retention rate). The System Usability Scale (SUS) score was 81.67 (±15.46). Furthermore, four major themes emerged from our qualitative analysis of the interviews (i.e., appreciation for the intervention, program, content, and drawbacks).

Conclusions: Findings from the pilot test of SmokefreeSGM are not only encouraging in terms of engagement, usability and acceptability, but have also informed the refinement of the program prior to launching a feasibility trial.