mHealth最新文献

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.

Background: Reports show that in 2020 approximately 3.6 million live births were recorded in the United States, with an estimated 9-13% of these infants requiring neonatal intensive care unit (NICU) admission due to complex medical needs. In the NICUs, where newborns require specialized attention, an interplay unfolds between parents and their infants. Within these sterile walls, each touch, each whispered word, carries significance, creating strong connections during medical treatments.

Methods: Our research seeks to examine the intricate relationship between parents and infants in the NICU through careful scientific investigation. Specifically, this paper serves as a foundational review of literature that highlights the importance of continuing research in this field.

Results: By examining existing studies, we aim to underscore the importance of attachment between mothers and infants, the necessity of evaluating their individual stress responses, and monitoring physiological changes. Also, we intend to better understand the mutual relationship between mother and child in the NICU setting.

Conclusions: Ultimately, by identifying specific interventions that can mitigate the emotional and physiological stresses experienced by both mothers and infants in the NICU, we aim to identify technological needs of the kangaroo care (KC) program and integrate these findings into routine care practices. We expect that this investigation insights will encourage more research on how to promote a more nurturing environment that supports the health and well-being of both mother and child during a NICU stay.

Background: Parents learning about their children with medical complexity often use numerous health-related resources, including mobile health applications (mHealth apps). mHealth apps could provide broad access to key information and support, lower healthcare costs, and improve care. The quality of mHealth apps for this population has been a concern, but is currently unknown. The objective of this systematic review was to identify and evaluate the quality of publicly available mHealth apps designed for parents who are preparing or caring for medically complex infants.

Methods: A systematic search strategy was applied to identify mHealth apps in the Apple and Google Play app stores in November 2022 and replicated in August 2024. Apps with no cost, in English, designed for parents of infants with perinatal medical complexity requiring hospitalization were included. Apps for healthy pregnancies, children >1 year, non-parental caregivers or healthcare professionals, primarily for tracking/monitoring, or unrelated activities/products were excluded. Independent raters used the Mobile Application Rating Scale (MARS) subscales of Engagement, Functionality, Aesthetics, and Information to evaluate quality for each app. Mean ratings were calculated by subscale and for overall app quality.

Results: From 1,917 identified apps, 32 apps were downloaded and fully screened. The final sample of 15 unique apps were available on the Apple App Store, with six also available on the Google Play Store. Most apps focused on prematurity (n=6), followed by the neonatal intensive care experience (n=4), congenital heart disease (n=4), and hypoxic-ischemic encephalopathy (n=1). MARS ratings of the overall sample (mean =3.61, median =3.58; range, 2.65-4.68) indicated 20% (3/15) were of good quality and 67% (10/15) were of acceptable quality. Apps showed strengths in Functionality and Information and performed worst in Engagement.

Conclusions: The poorest quality found in Engagement suggests that most of these apps do not effectively target users' interests or needs. Notably, many suffered from a lack of recent updates or became unavailable. This decline appears to parallel the increasing integration of digital health technologies within healthcare systems, which could prompt testing of mHealth apps on health outcomes. High-quality mHealth apps that are valued by parents and offer evidence-based information and support are needed to extend care.

Background and objective: With the evolution of technology, the delivery modes of healthcare have been completely transformed. Since the first use of telemedicine in the late 20th century, it has continued to evolve with advancement of technology. Today, telemedicine does not need sophisticated equipment and expensive platforms. Using a singular device to offer a wide range of services is both desired and necessary to provide higher-quality care at greater quantities. The inclusion of smartphone-telemedicine in many high-income countries proves a plausible framework to build upon for inclusion in low- and middle-income countries (LMIC). The primary goal of this review is to analyze existing literature on smartphone-based telemedicine and assess the scalability of this form of care to provide both accessible and equal care for all.

Methods: This is a narrative review that analyzed English published literature in PubMed, Medline, Cochrane Reviews, and Google Scholar over the last 50 years.

Key content and findings: Smartphone-based telemedicine can be divided mainly to mHealth and teleconsultation. Both applications are proven cost-effective at different extents and can augment health in different capacities. While mHealth is more suitable for health behavior change, smartphone teleconsultations can be employed in direct patient care. Smartphones' applicability to different settings and flexibility make them ideal for telemedicine. This form of telemedicine might be more suitable for low-resource settings and LMIC due to compatibility with current infrastructure, ease of use, lower cost and high availability. However, ease of use comes with risk of overutilization and providers' burnout. Privacy, digital divide and health literacy are other barriers of accessing smartphone-based telemedicine. Growing smartphone penetration and technology advancement carry future potentials for scaling up smartphone telemedicine in LMIC to advance equity and equality. Still, policies and regulations need to be implemented to protect privacy while using smartphones for telemedicine.

Conclusions: Smartphone-based telemedicine is an applicable form of telemedicine for low-resource settings and LMIC. Not all mHealth applications are suitable for LMIC, but investing in smartphone-based telemedicine for teleconsultation can save lives and lower the cost of care to reach everyone efficiently without a huge burden in a cost-effective manner for many LMIC.

Background and objective: With the increased adoption of digital health solutions, such as telehealth, there is a need to consider current practices and considerations towards digital health Literacy. The objective of this review is to explore what digital health literacy considerations have been detailed in cystic fibrosis telehealth papers.

Methods: The found papers published from a recent systematic review exploring telehealth within cystic fibrosis care were taken and analysed. These papers were obtained from PubMed, Web of Science, and Scopus databases and included any paper written in English up to May 2021. Data pertaining to Health Literacy, Digital Literacy/Competency, Digital Health Literacy, Training, Readiness Assessments, and Sustained Use were extrapolated using Elicit AI Research Assistant 2024.

Key content and findings: From the 26 papers, the data of interest was sparse and mostly unavailable for this review. This may be due to several reasons; however the implication of this mitigation is discussed with reference to the digital divide, health in-equalities, and safety.

Conclusions: This review highlights that a structured approach to assess digital health literacy of care teams and people with cystic fibrosis is critical to the future success of safe telehealth use, and other digital health solutions.

Background: Youth from racial and ethnic minoritized groups have experienced an increase in suicidal thoughts and behaviors (STBs) in recent years. Mobile health technology (mHealth) and digital phenotyping hold promise as means to measure STBs and related risk factors in these groups. Such tools are more likely to be successful when designed with input from the youth and caregivers who will use the technology. This study aimed to refine a digital phenotyping smartphone application, GeoMood, customized to measure STBs and relevant risk factors, such as family conflict and experiences of discrimination. The app was designed to collect passive data from smartphones (e.g., location, phone usage), as well as short-response survey data via ecological momentary assessments (EMAs) to further understand digital phenotypes of STBs.

Methods: We conducted semi-structured qualitative interviews with five youths of color and five caregivers to obtain feedback and refine the smartphone application, GeoMood. The ultimate goal of the interviews was to assess the app's potential acceptability from the two sets of users for whom the app was developed. Both youth and caregivers reviewed the youth version, which differs from the caregiver version content by the inclusion of items addressing suicidal behavior. Interviews were analyzed using a qualitative manifest analytic approach.

Results: Youth found the app to be an acceptable tool for measuring STBs. Caregivers were concerned about assessing self-injury explicitly.

Conclusions: Youth and caregiver feedback confirms openness by participating youth to using mHealth tools for measurement of STBs, but caregivers experience hesitation with the direct questions of such tools. Feedback was useful in refining the mobile tool and suggests multimodal assessment (text and emoji prompts) may appeal to users. Results from this study may improve the acceptability of future apps designed to measure and address disparities among particularly vulnerable groups of youth.

While telehealth was widely used to provide human immunodeficiency virus (HIV) care during the coronavirus disease 2019 (COVID-19) pandemic, research evaluating viral suppression by visit type is conflicting. This study assessed variation in viral load (VL) testing and outcomes by visit type for routine HIV care visits among people living with HIV (PWH) at a large academic health center in central North Carolina (NC). Electronic health records (EHRs) data from the Duke University Infectious Disease (ID) Clinic in NC were extracted in aggregated form. Pearson's Chi-square (χ²) tests were used to examine variation in VL testing and virologic suppression (VS) in 2022 by visit type patterns in the first year of the pandemic. Tipping point (TP) sensitivity analyses were conducted. EHR data from 1,835 PWH were included. Between March 16, 2020 and March 15, 2021, 53% of PWH received in-person HIV care only, 32% received a combination of telehealth and in-person care, and 15% received telehealth care only. About 20% of PWH did not have any VL test recorded in 2022. Among PWH with a VL test, 90% were virologically suppressed at all tests in 2022. Visit type was significantly associated with VL testing (P<0.001). The proportion of people who had no VL test in 2022 was larger among telehealth only users (31%) as compared to in-person only or PWH who received a combination (19% and 18%, respectively). VS in 2022 did not differ by visit type pattern in the first year of the pandemic (P=0.36) among PWH with a VL test in 2022. TP analyses identified that the proportion of unsuppressed VL tests among PWH without any VL test in 2022 would need to be multiplied by 2.1 to result in a statistically significant difference in VS by visit type (P=0.045). Our findings indicate that VL outcomes among telehealth users who had VL testing results documented in EHR at least one year later did not differ from in-person HIV care users. However, VL testing uptake was lower among telehealth only users suggesting the need for strategies such as remote VL testing to ensure regular VL testing among PWH who use telehealth HIV care.

Background: Numerous mobile phone applications have been developed with the goal of producing behavior changes that lead to weight loss and enhanced health. However, the evidence basis for these applications is often lacking, which renders them ineffective for altering health behaviors. Therefore, the purpose of this study was to examine the potential benefits of a novel mobile application, The FASTer Way to Fat Loss^® (FW).

Methods: Forty-two overweight, but otherwise healthy women were recruited for this parallel study and randomly assigned to an exercise and nutrition education only control (CON, n=21) or an integrated mobile application group (FW, n=21), which included exercise training and dietary modifications that were overseen by an individually assigned coach. Both groups were assessed at baseline and 6 weeks post-intervention for body composition, blood health indices, and multiple questionnaires for self-esteem and body image. Absolute mean differences within and between groups were measured using unpaired t-tests with statistical significance set at P<0.05.

Results: Compared to the CON group (0.56±1.54 kg), the FW group significantly reduced total mass (-1.21±1.82 kg; P=0.002), fat mass (0.42±1.38 vs. -1.45±1.23 kg; P<0.001), body fat percentage (0.23%±1.33% vs. -1.24%±1.32%; P=0.001), and body mass index (0.24±0.59 vs. -0.46±0.60 kg/m²; P<0.001); whereas no significant between-group differences were detected for lean body mass (P=0.86). Additionally, total cholesterol was significantly reduced in the FW group (-5.2±14.9 mg/dL) compared to the CON group (8.7±22.8 mg/dL; P=0.03). There were no other significant between-group differences in blood lipid profiles, blood health indices, or subjective measures of self-esteem and body image.

Conclusions: An integrated, multifactorial smartphone application (FASTer Way^®) elicited positive changes in body composition and total cholesterol in six-weeks. Future research should investigate these effects in other populations to better generalize these results.

Trial registration: ClinicalTrials.gov NCT05813548.