mHealth最新文献

Background: African American men experience higher rates of chronic diseases including diabetes, cardiovascular disease, and obesity compared to other race and gender groups. This population also has high levels of inactivity, one of the major risk facts for chronic disease. Due to the promise shown by mobile applications (apps) in providing tailored and easily accessible health interventions, we aimed to build an app designed for African American men to initiate and maintain their physical activity (PA) called MobileMen.

Methods: We conducted focus groups (n=24) with African American men to gain insight on the features and design aspects to include in the app prototype. We then used an iterative design process by conducting multiple rounds of beta (n=14) and useability (n=16) testing to create a prototype that was easy to use, visually pleasing, and culturally tailored. A satisfaction and helpfulness questionnaire and the System Usability Scale (SUS) were used as quantitative measures in addition to qualitative data provided by participants. Tasks were given to participants to test for ability to navigate and use the app features.

Results: The average satisfaction and helpfulness ratings from participants were 3.9/5 and 3.7/5 for beta testing and 4.3/5 and 4.1/5 for usability testing, which met the pre-determined criteria of ≥3.5. Only one of the satisfaction questions, which was about cultural tailoring for African American men, was below the pre-determined criteria (2.7). By round two of usability testing, the majority of tasks were able to be completed by all of the participants and the mean SUS score was 90.36 out of 100 which exceeded a priori feasibility criterion of a mean rating of 68.0. The feedback on the finalized features was positive, and participants expressed that they would use the app if it were on the market.

Conclusions: Based on both the qualitative and quantitative data obtained from multiple iterative design rounds, the MobileMen app was well received by the target population and is ready to be tested on a larger scale for effectiveness. The app is easy to use and contains culturally tailored features.

Background: Fibromyalgia is a syndrome characterized by widespread chronic pain, associated with fatigue, sleep disturbances, and cognitive impairment, among others. Effective management of fibromyalgia requires an integrated pharmacological and non-pharmacological approach that involves the patient in self-care. M-health devices are widely used as complementary resources for chronic pain management and patient empowerment. The objective of this study is to define the content of a mobile application, FibroApp, for the non-pharmacological management of fibromyalgia, based on the perspectives of patients and expert professionals.

Methods: FibroApp was developed through a qualitative design, with the unit of analysis being meaningful discourse fragments from interviews with key informants (rheumatologists, physiatrists, physical and occupational therapists, psychiatrists, and patients diagnosed with fibromyalgia). Atlas.ti software was used for the analysis and triangulation of literature and qualitative findings.

Results: The content of FibroApp, in consensus with the interviewees-both patients and experts-includes modules on physical activity or exercise, education, cognitive stimulation, reminders, and freely accessible supplementary material. The study highlighted the importance of social support, educational resources, and personalized exercise programs as essential components of the app.

Conclusions: The development of FibroApp underscores the potential of mHealth applications in enhancing the management of fibromyalgia by providing a multifaceted tool that addresses the physical, emotional, and educational needs of patients. The integration of social support, education, physical activity, and relaxation techniques within a mobile application offers a promising approach to improving the quality of life for individuals with fibromyalgia. Further research is needed to evaluate the app's effectiveness in larger, diverse populations.

Background: Globally, preschoolers' physical activity (PA) levels are lower than recommended. Digital interventions involving child-centered approaches hold promise for increasing PA behaviors. The objective of this cross-sectional study was to evaluate the acute effects of 3 custom mobile apps, Foods & Moves, on preschooler's PA outcomes in comparison with traditional physical education (PE) activities as part of the HEalthy EnviROnments (HEROs) Study.

Methods: Thirty-one children (17 boys, X_age =4.3±0.5 years; 42% Hispanic) participated in a 6-week parent-child intervention aimed at enhancing healthy eating and PA behaviors. Children's PA outcomes, including percentage of time spent in moderate PA (MPA%), vigorous PA (VPA%), moderate-to-vigorous PA (MVPA%), and cadence (steps/minute), were collected by ActiGraph GT9X Link accelerometers on each of the 3 apps (Jungle Gym, Jungle Gym-2, Spin-n-Move) and 2 traditional PE activities (obstacle course and PA skill building) during weekly workshops.

Results: Linear models revealed condition differences in VPA% [F(4,147) =10.18, P<0.001, η² =0.22], MVPA% [F(4,147) =13.46, P<0.001, η² =0.26], and cadence [F(4,147) =20.88, P<0.001, η² =0.35]. Pairwise comparisons indicated that VPA% for PA skill building, Jungle Gym, and Jungle Gym-2 was higher than the obstacle course (all P<0.001). MVPA% and cadence in PA skill building, Jungle Gym, Jungle Gym-2, and Spin-n-Move were higher compared to the obstacle course (all P<0.001).

Conclusions: The Foods & Moves apps prompted a considerable proportion of high-intensity PA, which is comparable to or higher than traditional PE activities, demonstrating the potential to use digital strategies to promote PA in preschoolers.

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.