mHealth最新文献

Background: Ghana implemented the District Health Information Management System 2 (DHIMS2) in 2012 for aggregate health data management. Later, e-Tracker instances were introduced in response to demand from funders and program implementers for patient-level longitudinal data visibility, and improved patient care and data quality. Digital transactional data capture (electronically recording and storing data generated at the point of service) in health facilities enables real-time data entry and retrieval and has improved data quality, patient care continuity, and health outcomes. Despite multiple e-Tracker implementations, these benefits have not been realized in Ghana. This case report examines digital transactional data capture for maternal and child health (MCH) services in the Savannah Region in 2023 and identifies the enablers and barriers to its uptake in resource-limited settings.

Case description: The United States Agency for International Development (USAID)-funded Country Health Information Systems and Data Use (CHISU) program implemented the MCH e-Tracker using a three-stage approach: training health providers and managers on e-Tracker use, providing post-training follow-up and supervision, and holding periodic review meetings to gather feedback. Two hundred and forty-one health facilities and 556 health providers enrolled in the e-Tracker system using 477 provided tablets. Facilities started using e-Tracker in June 2023 but continued using paper-based registers simultaneously for DHIMS2 reporting. Initially, 58.1% (140/241) of facilities used e-Tracker, but this fell to 22.8% (55/241) by December 2023. Although 64.7% (156/241) of facilities used e-Tracker for at least one month, only 16.6% (40/241) consistently used it for all 7 months of implementation. In contrast, 64.3% (155/241) of facilities consistently reported to DHIMS2 using paper-based data. Factors enabling user compliance and adoption of e-Tracker include end user commitment, understanding of system requirements, consistent training and reviews, and strong leadership. Challenges include frequent e-Tracker application updates, parallel use of paper and electronic systems, and internet connectivity issues.

Conclusions: Acceptability and use of e-Tracker in health facilities waned after the first month. Successful transition to electronic data capture requires strong local support systems and reduced staff workload to promote user compliance and ensure high data quality. In Ghana, stakeholders aim to transition at least one district in the region to fully electronic data capture by December 2024 by leveraging these lessons learned.

Background: Atrial fibrillation (AF) is a prevalent arrhythmia with significant public health implications, including increased risk of stroke and mortality. Early detection is challenging but crucial for managing complications. Wearable technology with photoplethysmography (PPG) offers a potential solution for long-term, non-invasive monitoring. This study aims to evaluate the performance of three artificial intelligence (AI) algorithms (Happitech, Preventicus, and Philips Biosensing AF) in detecting AF using PPG signals from a medical smartband and compare it with the gold standard electrocardiogram (ECG).

Methods: A medical smartband equipped with PPG technology was used to collect cardiovascular data from patients with and without AF. The sensitivity and specificity of the algorithm for detecting AF were determined by comparing their output to a trained technician's examination of concurrent ECG recordings.

Results: Seventy two participants (42% female, 57±17 years old) were included in this study. The medical smartband provided continuous PPG signals, with AI algorithms evaluating the data for AF episodes. The accuracy of AF detection by the algorithms was compared with that of the concurrent ECG recordings. Sensitivity varied between 80.0% (62.5-97.5%) and 97.6% (97.6-97.6%), specificity between 90.6% (80.5-100%) and 96.9% (90.8-100%).

Conclusions: This study demonstrates the potential of medical smartbands combined with PPG technology and AI algorithms for reliable AF detection. The findings suggest a promising direction for remote AF monitoring and early intervention, potentially reducing AF-related complications and healthcare costs.

Background: High-resistance inspiratory muscle strength training (IMST) is a time-efficient form of respiratory exercise shown to lower blood pressure in midlife and older adults (aged ≥50 years) in randomized controlled trials delivered in clinical research settings. The purpose of this study was to design a feasible and acceptable smartphone application (app) for independently delivering IMST for lowering blood pressure.

Methods: Two rounds of iterative focus groups comprised of midlife and older women and men with above-normal systolic blood pressure (self-reported ≥120 mmHg) were performed to gain feedback on interest in an IMST smartphone app and design features. Focus group results were analyzed using a Consensual Qualitative Research (CQR) coding and data analysis protocol. Clickable wireframes were developed based on focus group findings. The wireframes were then beta tested for usability and additional feedback from target users was obtained.

Results: Among midlife and older adults, there was considerable interest in app-delivered IMST as a lifestyle intervention for lowering blood pressure. Potential facilitators and barriers of use for a potential app also were uncovered. Furthermore, the app wireframes were found to be highly usable, indicating that the app is ready for full-scale programming.

Conclusions: We have designed a feasible and acceptable smartphone app for independently delivering blood pressure-lowering IMST in midlife and older adults.

Background: The prevalence of dependency is high, and it is an urgent problem requiring immediate solutions for elderly people. This study aimed to explore the association between mobile phone use, self-efficacy and dependency among elderly people.

Methods: This community-based study was conducted in 33 locations in China. A total of 2,195 participants aged ≥60 years were selected using a complex multistage sampling design. All data were collected using questionnaires by face-to-face interviews. Dependency was measured using the standardized Minnesota Multiphasic Personality Inventory-II. Self-efficacy was assessed using the Chinese version of the General Self-Efficacy Scale. Cumulative logistic regression models were used to evaluate the association between dependency and the use of mobile phones. Analysis of covariance (ANCOVA) was conducted to evaluate the association between the self-efficacy level and the frequency of mobile phone use.

Results: More than 90% of elderly people reported that they used a mobile phone. The high frequency of mobile phone use was significantly associated with low level of dependency and high level of self-efficacy. The frequency of mobile phone use was negatively associated with the times of received community health services.

Conclusions: Individuals who use mobile phones have a low level of dependency and a high level of self-efficacy. These findings suggest that mobile phone is an important mental health resource for improving dependency and increasing self-efficacy among elderly people.

Background and objective: This narrative review examines peer support services for caregivers of people with dementia, focusing on mHealth interventions. Family caregivers of people with dementia experience high rates of stress and depression, burnout, and physical health decline. Traditionally, in-person peer support has been a bedrock of family caregiver programs. However, in-person peer support interventions are not accessible or acceptable for many caregivers. mHealth, or mobile health, refers to the use of mobile devices and technology to deliver health-related services or education. Several digital mHealth innovations have been developed to facilitate caregiver peer support, but the evidence for these approaches is unclear. We aimed to summarize the evidence on digital mHealth peer support interventions for family caregivers of persons living with dementia.

Methods: A search was conducted using PubMed and Google Scholar for studies published between January 2007 and January 2024, with keywords such as "caregiver", "peer support", "dementia", and "digital". Two reviewers independently screened and selected relevant studies, resolving discrepancies through consensus.

Key content and findings: Many studies show a positive correlation between group and one-on-one peer support interventions and psychological well-being, personal growth, and the development of coping skills. There were inconclusive results regarding the relationship between peer support interventions and clinical outcomes. Emerging digital platforms have demonstrated usability and acceptability, reducing caregiver depression and stress. However, access disparities related to digital literacy and socioeconomic factors remain significant barriers.

Conclusions: Digital peer support for informal caregivers of persons with dementia shows promising evidence for improving caregivers' support and psychological health. As the science of digital peer support advances, mHealth delivery of caregiver peer support interventions will likely have an increasingly important role in supporting caregivers' mental health and well-being.

Computer-assisted psychotherapy programs have demonstrated efficacy and potential for improving access to mental health services. However, little is known about their implementation, uptake and acceptability in real-world settings. As a quality improvement effort, we designed and implemented a computer-assisted cognitive-behavioral therapy (cCBT) program for adults in an outpatient specialty mental health clinic. We sought to increase access to psychotherapy services while maintaining good patient uptake and acceptability. The program included two pathways: (I) a cCBT-only pathway in which new clinic patients had access to online modules and up to ten 30-min telehealth appointments with a mental health clinician; and (II) an augmented-psychotherapy pathway in which clinicians recommended and incorporated online modules to patients already established in the clinic. The online content for the program was a vendor website that included 9 modules with written content, videos and interactive exercises to teach cognitive-behavioral skills. Twenty-seven patients started the program over 12 months (18 in the cCBT-only pathway and 9 in the augmented-psychotherapy pathway). Twelve patients (44.4%) completed all 9 modules of the program and 18 (66.7%) completed at least half the program. Engagement was higher in the cCBT-only pathway than in the augmented-psychotherapy pathway. Twelve of 18 cCBT-only patients responded to an acceptability survey with 83.3% indicating they were satisfied and 41.7% indicating the program met their needs. Clinician satisfaction was good among all three participating clinicians. The cCBT-only program provided timely access to psychotherapy services for new patients but uptake was very low with just 2.4% of new patients contacting the clinic for psychotherapy starting in the cCBT-only pathway. Many new callers elected to receive external referrals for more traditional forms of psychotherapy. Based on this low uptake, computer-assisted psychotherapies may fit best in settings where patients have not yet identified the specific type of care they wish to seek. Systems looking to adopt similar programs may also benefit from allowing ample time to develop industry partnerships, carefully considering the customizability and technical support available for online products, and introducing the programs to patients early in treatment.

Background: The increasing prevalence of irritable bowel syndrome (IBS) in Saudi Arabia has led to a growing interest in understanding how patients seek health information online. While it is known that digital platforms, such as search engines, social media, and artificial intelligence (AI) chatbots, are commonly used for health information seeking, there is limited knowledge about the specific behaviors of IBS patients in this context and how these behaviors correlate with their self-care activities. This study aimed to explore online health information-seeking behavior and its correlation with self-care activities among patients with IBS in Saudi Arabia, focusing on the use of these digital platforms.

Methods: A cross-sectional survey was conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, from January to July 2023. The survey, available in both English and Arabic, targeted IBS patients aged 16 years or older. The questionnaire covered demographics, general internet usage, online health information-seeking behavior, and IBS knowledge and awareness.

Results: In this study, 451 IBS patients completed the survey. Notably, 95.1% of participants were internet users, primarily accessing health information through mobile phones and search engines. The results highlighted a significant correlation between online health information-seeking behaviors and self-care practices (P=0.009) like exercise and dietary adjustments, despite a moderate basic knowledge [standard deviation (SD) 2.26%] of IBS. Symptomatically, 93.3% experienced abdominal pain weekly, yet 63% did not fully meet the Rome criteria for IBS. Common management strategies included hydration, diet modifications, and exercise. About 28.4% visited the emergency room (ER) for severe symptoms, and 20% regularly consulted doctors every 3-6 months. Surprisingly, 80% were unaware of the FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, often suggested for IBS.

Conclusions: The research indicates a rise in digital health literacy among IBS patients in Saudi Arabia, highlighting the need for accurate and culturally appropriate online resources. It suggests that healthcare professionals and policymakers should direct patients to reliable information and address the digital divide to enhance self-care and IBS management outcomes.

Background: Colorectal cancer (CRC) screening uptake among South Asian immigrants in the US is the lowest (61.1%) of all immigrant groups (e.g., 65.9% among East Asians and 71.3% among Hispanics). Culture-specific factors influence their reluctance to screen for CRC, despite the availability of easily accessible, non-invasive screening tools, like the fecal immunochemical test (FIT). The current study utilizes a virtual health assistant (VHA) tailored to inform and educate Bangladeshi immigrants about FIT.

Methods: We conducted usability tests to understand Bangladeshi immigrants' informational needs, barriers, facilitators, and visual and linguistic preferences. After 20 minutes of interaction with the VHA, we conducted semi-structured interviews with 30 participants. Participants also filled out a questionnaire of demographic information and VHA gender and ethnic appearance preferences. A qualitative content analysis using the constant comparative method generated themes.

Results: A total of 30 participants (16 women, 14 men) with a mean age of 39.2 years participated. Informational needs included eight themes: (I) risk-reducing behaviors/habits, (II) post-intervention (information desired after interacting with the VHA), (III) CRC-related content (e.g., symptoms, causes, impact on the body, etc.), (IV) financial considerations of FIT, (V) personalized content/options, (VI) pre-test information (how to prepare for the FIT kit use, e.g., "do I need to fast?"), (VII) comparison to other CRC screening options, and (VIII) more specificity of information (i.e., using more measurable language, avoiding vague language like "some", "more", etc.). Major barriers were (I) lack of control, (II) lack of sophistication in VHA animation features, (III) lack of interactiveness, and (IV) lack of a trustworthy source. Facilitators were (I) convenience (of using VHA), (II) social cues (of interacting with a VHA), and (III) content (provided by the VHA). In terms of VHA's appearance, which was a combination of its apparent gender and ethnicity, participants demonstrated varied preferences but the majority (n=17) preferred gender concordant VHA. As for linguistic preference, participants generally mentioned either English or an option to choose a language for themselves while claiming that other Bangladeshi immigrants would prefer the Bangla language.

Conclusions: Participants were open to using a VHA to learn about CRC, either instead of or along with talking to a clinician about it. However, recommendations to improve animated features of the VHA included more detailed and Bangladeshi population-specific information and provided choices to select preferred languages and appearance of the VHA. Future studies should empirically test the required levels of tailoring to effectively increase CRC screening among Bangladeshi immigrants.

Background: The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid adoption of telehealth services to maintain healthcare access for treating substance use disorders (SUDs) and mental health care (MHC). However, the impacts of telehealth expansion policies adopted in 2020 on access to addiction treatment in North Dakota (ND) and Minnesota (MN) remain unclear. This study examines the impact of the COVID-19 pandemic on utilization of telehealth services for SUDs and MHC in ND and MN.

Methods: We conducted a quasi-experimental study design using Medicaid telehealth claims data from 2018 to 2022. Segmented regression analysis of interrupted time series (ITS) data was employed to assess the impact of the COVID-19 pandemic (March 2020) on telehealth service utilization.

Results: From 2018 to 2022, there were 580,186 telehealth claims for SUDs (MN: 545,676; ND: 34,510) and 3.4 million claims for MHC (MN: 3.3 million; ND: 85,391). The mean telehealth utilization rate for SUDs was 5.2 vs. 7.3 per 1,000 beneficiaries and for MHC was 12.6 vs. 45.2 per 1,000 beneficiaries in ND and MN, respectively. The pandemic led to significant increases in telehealth use: ND (SUDs: +22.7/1,000; MHC: +59.8/1,000) and MN (SUDs: +30/1,000; MHC: +185.5/1,000). ND saw smaller initial increases but more gradual declines over time (SUDs: -0.42/1,000/month; MHC: -1.03/1,000/month) compared to MN (SUDs: -0.43/1,000/month; MHC: -2.78/1,000/month).

Conclusions: The COVID-19 pandemic significantly increased Medicaid telehealth utilization for SUDs and MHC in both states. MN experienced larger initial increases with steeper declines, while ND showed more sustainable utilization trends, indicating potential for sustained improvements in access to behavioral health services.