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Huberty, Jennifer L., Jeni Green, Megan E. Puzia, Linda Larkey, Breanne Laird, Ana-Maria Vranceanu, Robert Vlisides-Henry, and Michael R. Irwin. "Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial." PLOS ONE 16, no. 1 (January 7, 2021): e0244717. http://dx.doi.org/10.1371/journal.pone.0244717.
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The objective of this randomized controlled trial was to test whether a commercially available, mindfulness meditation mobile app, (i.e., Calm app), was effective in reducing fatigue (primary outcome), pre-sleep arousal, and daytime sleepiness (secondary outcomes) in adults with sleep disturbance (Insomnia Severity Index Score >10) as compared to a wait-list control group. Associations between the use of the Calm app (i.e., adherence to the intervention) and changes in sleep quality was also explored in the intervention group only. Adults with sleep disturbance were recruited (N = 640). Eligible and consenting participants (N = 263) were randomly assigned to the intervention (n = 124) or a wait-list control (n = 139) group. Intervention participants were asked to meditate using the Calm app ≥10 minutes/day for eight weeks. Fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, mid- (4-weeks) and post-intervention (8-weeks) in both groups, whereas sleep quality was evaluated only in the intervention group. Findings from intent-to-treat analyses suggest the use of the Calm app for eight weeks significantly decreased daytime fatigue (p = .018) as well as daytime sleepiness (p = .003) and cognitive (p = .005) and somatic (p < .001) pre-sleep arousal as compared to the wait-list control group. Within the intervention group, use of the Calm app was associated with improvements in sleep quality (p < .001). This randomized controlled trial demonstrates that the Calm app can be used to treat fatigue, daytime sleepiness, and pre-sleep arousal in adults with sleep disturbance. Given that the Calm app is affordable and widely accessible, these data have implications for community level dissemination of a mobile app to improve sleep-related symptoms associated with sleep disturbance. Trial registration: ClinicalTrials.gov NCT04045275.
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Wang, Tze-Fang, Rou-Chen Huang, Su-Chen Yang, Chyuan Chou, and Lee-Chen Chen. "Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study." JMIR mHealth and uHealth 8, no. 7 (July 27, 2020): e18132. http://dx.doi.org/10.2196/18132.
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Background Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems. Objective This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app. Methods After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients’ quality of life, nursing care needs, and acceptance of the mHealth app. Results The physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (–7.24 vs –4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05). Conclusions Compared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients’ need for physiological care and improving their quality of life. Trial Registration ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968
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Adib, Riddhiman, Dipranjan Das, Sheikh Iqbal Ahamed, and Stacee Marie Lerret. "An mHealth App-Based Self-management Intervention for Family Members of Pediatric Transplant Recipients (myFAMI): Framework Design and Development Study." JMIR Nursing 5, no. 1 (January 4, 2022): e32785. http://dx.doi.org/10.2196/32785.
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Background Solid-organ transplantation is the treatment of choice for children with end-stage organ failure. Ongoing recovery and medical management at home after transplant are important for recovery and transition to daily life. Smartphones are widely used and hold the potential for aiding in the establishment of mobile health (mHealth) protocols. Health care providers, nurses, and computer scientists collaboratively designed and developed mHealth family self-management intervention (myFAMI), a smartphone-based intervention app to promote a family self-management intervention for pediatric transplant patients’ families. Objective This paper presents outcomes of the design stages and development actions of the myFAMI app framework, along with key challenges, limitations, and strengths. Methods The myFAMI app framework is built upon a theory-based intervention for pediatric transplant patients, with aid from the action research (AR) methodology. Based on initially defined design motivation, the team of researchers collaboratively explored 4 research stages (research discussions, feedback and motivations, alpha testing, and deployment and release improvements) and developed features required for successful inauguration of the app in the real-world setting. Results Deriving from app users and their functionalities, the myFAMI app framework is built with 2 primary components: the web app (for nurses’ and superadmin usage) and the smartphone app (for participant/family member usage). The web app stores survey responses and triggers alerts to nurses, when required, based on the family members’ response. The smartphone app presents the notifications sent from the server to the participants and captures survey responses. Both the web app and the smartphone app were built upon industry-standard software development frameworks and demonstrate great performance when deployed and used by study participants. Conclusions The paper summarizes a successful and efficient mHealth app-building process using a theory-based intervention in nursing and the AR methodology in computer science. Focusing on factors to improve efficiency enabled easy navigation of the app and collection of data. This work lays the foundation for researchers to carefully integrate necessary information (from the literature or experienced clinicians) to provide a robust and efficient solution and evaluate the acceptability, utility, and usability for similar studies in the future. International Registered Report Identifier (IRRID) RR2-10.1002/nur.22010
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Richards, Rebecca, Paul Kinnersley, Kate Brain, and Fiona Wood. "Cancer Clinicians’ Views Regarding an App That Helps Patients With Cancer Meet Their Information Needs: Qualitative Interview Study." JMIR Cancer 7, no. 2 (May 6, 2021): e23671. http://dx.doi.org/10.2196/23671.
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Background Many patients with cancer have unmet information needs during the course of the illness. Smart devices, such as smartphones and tablet computers, provide an opportunity to deliver information to patients remotely. We aim to develop an app intervention to help patients with cancer meet their illness-related information needs in noninpatient settings. In addition to the in-depth exploration of the issues faced by the target users of a potential intervention, it is important to gain an understanding of the context in which the intervention will be used and the potential influences on its adoption. As such, understanding the views of clinicians is key to the successful implementation of this type of app in practice. Additionally, clinicians have an awareness of their patients’ needs and can provide further insight into the type of app and features that might be most beneficial. Objective This study aims to explore cancer clinicians’ views on this type of intervention and whether they would support the use of an app in cancer care. Specifically, the perceived acceptability of an app used in consultations, useful app features, the potential benefits and disadvantages of an app, and barriers to app use were explored. Methods A total of 20 qualitative, semistructured interviews were conducted with 22 clinicians from urological, colorectal, breast, or gynecological cancer clinics across 2 hospitals in South Wales. The interviews were audio recorded, transcribed, and analyzed using thematic analysis. Results Clinicians felt that it would be acceptable for patients to use such an app in noninpatient settings, including during consultations. The benefits of this type of app were anticipated to be a more informed patient, an increased sense of control for patients, better doctor-patient communication, and a more efficient and effective consultation. In contrast, an increase in clinicians’ workload and poorer communication in consultations, which depended on the included app features, were identified as potential disadvantages. The anticipated barriers to app use included patients’ age and prior experience with smart technology, their access to smart devices, the confidentiality of information, and an avoidant coping approach to their condition. Conclusions This study suggests that clinicians should support their patients in using an app to help them meet their information needs both at home and during consultations. This study highlights some of the potential barriers for this type of intervention in practice, which could be minimized during the intervention design process.
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Chung, Kyungmi, Seoyoung Kim, Eun Lee, and Jin Young Park. "Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study." JMIR mHealth and uHealth 8, no. 8 (August 24, 2020): e17755. http://dx.doi.org/10.2196/17755.
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Background As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. Objective The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. Methods During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. Results Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. Conclusions This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.
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Alnasser, Aroub, Janet Kyle, Najla Aloumi, Abdulrahman Al-Khalifa, and Debbi Marais. "The Twazon Arabic Weight Loss App: App-Based Intervention for Saudi Women With Obesity." JMIR mHealth and uHealth 7, no. 5 (May 28, 2019): e10923. http://dx.doi.org/10.2196/10923.
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Sánchez-Gutiérrez, Teresa, Sara Barbeito, María Mayoral, Miguel Moreno, Sergio Ríos- Aguilar, Celso Arango, and Ana Calvo. "F20. THINK APP: A MOBILE APP–BASED INTERVENTION FOR ADOLESCENTS WITH FIRST-EPISODE PSYCHOSIS." Schizophrenia Bulletin 45, Supplement_2 (April 2019): S261—S262. http://dx.doi.org/10.1093/schbul/sbz018.432.
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Massie, Ariane, Keri-Leigh Cassidy, Michael Vallis, David Conn, Daria Parsons, Julie Spence Mitchell, Claire Checkland, and Kiran Rabheru. "Comparing a Clinician Assisted and App-Supported Positive Psychiatry Behavioral Activation Intervention." Innovation in Aging 4, Supplement_1 (December 1, 2020): 373–74. http://dx.doi.org/10.1093/geroni/igaa057.1203.
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Abstract Positive psychiatry offers a unique approach to promote brain health and well-being in aging populations. Health interventions are increasingly becoming available using self-guided apps, however, little is known about the effectiveness of app technology or the difference between in-person versus self-guided app methodology for behavioural activation. The objective of this study was to investigate the difference in users and outcomes between two formats of a positive psychiatry intervention to promote brain health and well-being in later-life: (1) clinician-assisted, and (2) independent app use for self-management. As part of a larger national knowledge translation intervention two methods of a behavioural activation intervention (Clinician-assisted vs. Independent app use) were retrospectively compared. Main outcomes were patient characteristics (age, sex, and completion rate), psychological outcomes (health and resilience, and well-being), and behavioural outcomes (goal attainment, and items of goal SMART-ness). Clinician-assisted patients (n=254) were more likely to be male, older, and had lower health and resilience scores at baseline than Independent app users (n=333). Clinician-assisted patients had notably higher completion rates (99.2% vs. 10.8%). Psychological outcomes were similar regardless of intervention method for those who completed the intervention. Clinician-assisted patients had higher rates of goal attainment and goal SMART-ness. A preliminary goal setting methodology for effective behavioural activation, to promote brain health and wellness, is given. Clinician-patient relationships were found to be an important factor for intervention completion, caution is given for app use referral. Results indicate a need for further exploration to determine best practices for health app use in clinical practice.
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Wei, Kevin S., Nasrien E. Ibrahim, Ashok A. Kumar, Sidhant Jena, Veronica Chew, Michal Depa, Namrata Mayanil, Joseph C. Kvedar, and Hanna K. Gaggin. "Habits Heart App for Patient Engagement in Heart Failure Management: Pilot Feasibility Randomized Trial." JMIR mHealth and uHealth 9, no. 1 (January 20, 2021): e19465. http://dx.doi.org/10.2196/19465.
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Background Due to the complexity and chronicity of heart failure, engaging yet simple patient self-management tools are needed. Objective This study aimed to assess the feasibility and patient engagement with a smartphone app designed for heart failure. Methods Patients with heart failure were randomized to intervention (smartphone with the Habits Heart App installed and Bluetooth-linked scale) or control (paper education material) groups. All intervention group patients were interviewed and monitored closely for app feasibility while receiving standard of care heart failure management by cardiologists. The Atlanta Heart Failure Knowledge Test, a quality of life survey (Kansas City Cardiomyopathy Questionnaire), and weight were assessed at baseline and final visits. Results Patients (N=28 patients; intervention: n=15; control: n=13) with heart failure (with reduced ejection fraction: 15/28, 54%; male: 20/28, 71%, female: 8/28, 29%; median age 63 years) were enrolled, and 82% of patients (N=23; intervention: 12/15, 80%; control: 11/13, 85%) completed both baseline and final visits (median follow up 60 days). In the intervention group, 2 out of the 12 patients who completed the study did not use the app after study onboarding due to illnesses and hospitalizations. Of the remaining 10 patients who used the app, 5 patients logged ≥1 interaction with the app per day on average, and 2 patients logged an interaction with the app every other day on average. The intervention group averaged 403 screen views (per patient) in 56 distinct sessions, 5-minute session durations, and 22 weight entries per patient. There was a direct correlation between duration of app use and improvement in heart failure knowledge (Atlanta Heart Failure Knowledge Test score; ρ=0.59, P=.04) and quality of life (Kansas City Cardiomyopathy Questionnaire score; ρ=0.63, P=.03). The correlation between app use and weight change was ρ=–0.40 (P=.19). Only 1 out of 11 patients in the control group retained education material by the follow-up visit. Conclusions The Habits Heart App with a Bluetooth-linked scale is a feasible way to engage patients in heart failure management, and barriers to app engagement were identified. A larger multicenter study may be warranted to evaluate the effectiveness of the app. Trial Registration ClinicalTrials.gov NCT03238729; http://clinicaltrials.gov/ct2/show/NCT03238729
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Win, Hninyee, Samantha Russell, Betsy C. Wertheim, Victoria Maizes, Robert Crocker, Audrey J. Brooks, Ruben Mesa, et al. "Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study." JMIR Formative Research 6, no. 3 (March 31, 2022): e33581. http://dx.doi.org/10.2196/33581.
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Background Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine’s global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted.
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El-Jawahri, Areej, Joseph Greer, Emily M. Wright, Olivia Vanbenschoten, Lauren Waldman, and Jennifer S. Temel. "Development of a multicomponent psychological mobile application (app) for patients with acute myeloid leukemia (AML)." Journal of Clinical Oncology 36, no. 34_suppl (December 1, 2018): 166. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.166.
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166 Background: Patients newly diagnosed with AML experience substantial psychological distress as they confront a life-threatening diagnosis requiring an urgent 4-6 week hospitalization to initiate chemotherapy. Interventions to address psychological distress in this population are lacking. Methods: We used a five-step app development process to create a psychological intervention app targeting patients’ needs during the initial hospitalization following a new diagnosis of AML. Patients, caregivers, oncologists, psychologists, and nurses served as stakeholders and were involved in 1) developing a conceptual framework for the intervention; 2) creating an intervention manual that incorporates medical information, psychoeducation, and psychosocial skill-building corresponding to the illness trajectory; 3) translating the intervention manual into a storyline with gamification to enhance patient engagement; 4) creating initial wireframes of the app modules; and 5) refining the app through iterative testing. Results: The app consists of five 20-minute modules which the patient will complete weekly over a 5-week period. The modules consist of 1) supportive psychotherapy to address the initial shock of diagnosis; 2) psychoeducation to manage expectations and mobilize social supports; 3) psychosocial skill-building to promote effective coping; 4) self-care to promote positive health behaviors; and 4) a summary module to reinforce learning points from prior modules. Two bonus modules are available for patients who wish to engage in additional cognitive-based restructuring strategies. We utilized gamification strategies to enhance patient engagement including a) creating an app storyline focused on the patient’s journey during hospitalization; 2) creating a guide character doctor that accompanies the patient through their journey; 3) incorporating videos of AML survivors; and 4) developing a point reward system for completing the modules. Conclusions: We developed a novel psychological intervention app for patients with AML using an iterative development process. Future studies should assess the efficacy of the app in improving outcomes for patients with AML.
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Ignacio, Matt, Robert Garofalo, Cynthia Pearson, Lisa M. Kuhns, Josh Bruce, D. Scott Batey, Asa Radix, et al. "Pilot feasibility trial of the MyPEEPS mobile app to reduce sexual risk among young men in 4 cities." JAMIA Open 2, no. 2 (April 13, 2019): 272–79. http://dx.doi.org/10.1093/jamiaopen/ooz008.
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Abstract Objectives Our study team adapted the MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) curriculum, an evidence-based human immunodeficiency virus (HIV) prevention intervention, from a face-to-face, group-based intervention to an individual-level mobile responsive web-based intervention to improve HIV risk behaviors in very young men, aged 13–18 years. Materials and methods In adapting the MyPEEPS intervention to mobile app, we used a series of methodologies, including expert panel reviews, weekly team meetings with the software development company, and conducted in-depth interviews with very young men. Following the iterative process, we conducted a 6-week pre–post feasibility pilot trial with 40 young men in Birmingham, AL; Chicago, IL; New York City, NY; and Seattle, WA. Primary outcomes of interest were uptake of the app, accessibility and satisfaction. Results Across all 4 sites, 62.5% (25/40) of participants completed all modules in the app in an average of 28.85 (SD 21.69) days. Participants who did not attend to the follow-up visit did not complete any of the app modules. Overall participants reported that the app was easy to use, useful and has the potential to improve their sexual health knowledge and behavior and awareness in risky contexts. Participants also highly rated the app, information and interface quality of the app. Discussion Lessons learned from the pilot included the need for reminder systems and providing anticipatory guidance about Internet connectivity when using the app. These changes will be incorporated into study procedures for our multisite trial. Conclusion Overall, participants found the app to be highly usable and have the potential to positively improve their sexual risk behavior.
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Jaffar, Aida, Sherina Mohd Sidik, Chai Nien Foo, Noor Azimah Muhammad, Rosliza Abdul Manaf, and Nazhatussima Suhaili. "Preliminary Effectiveness of mHealth App-Based Pelvic Floor Muscle Training among Pregnant Women to Improve Their Exercise Adherence: A Pilot Randomised Control Trial." International Journal of Environmental Research and Public Health 19, no. 4 (February 18, 2022): 2332. http://dx.doi.org/10.3390/ijerph19042332.
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This pilot randomised control trial (RCT) aimed to evaluate the feasibility and preliminary effectiveness of conducting a full-powered trial for a newly developed pelvic floor muscle training (PFMT) app among pregnant women with urinary incontinence (UI) in Malaysia. This was a prospective, single-centre, single-blind, parallel, randomised controlled, pilot feasibility study—the Kegel Exercise Pregnancy Training app (KEPT app) trial. In total, 26 pregnant women with urinary incontinence from an urban healthcare clinic were recruited and randomly assigned to either intervention or waitlist control group. The intervention group received the KEPT app, while the control group received usual antenatal care (waitlist control). Of the 26 pregnant women, 16 (61.5%) completed the two-month follow-up. The recruitment rate was 54.2%, and the retention rate was 62.5% in the intervention group and 60% in the control group. There was a significant difference between intervention and control groups’ baseline measurement in the severity of UI (p = 0.031). The app improved their knowledge (p = 0.011) and self-efficacy (p = 0.038) after the first month and attitude (p = 0.034) after two months of intervention, compared with the control group. This study supports the feasibility of our future cluster RCT. The KEPT app demonstrates a promising effect in improving PFMT attitude and self-efficacy and potentially enhancing exercise adherence among pregnant women with UI. Trial registration: This study was prospectively registered on ClinicalTrials.gov on 19 February 2021 (NCT04762433).
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Petrenko, Christie LM, Jennifer Parr, Carson Kautz, Cristiano Tapparello, and Heather Carmichael Olson. "A Mobile Health Intervention for Fetal Alcohol Spectrum Disorders (Families Moving Forward Connect): Development and Qualitative Evaluation of Design and Functionalities." JMIR mHealth and uHealth 8, no. 4 (April 6, 2020): e14721. http://dx.doi.org/10.2196/14721.
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Background Fetal alcohol spectrum disorders (FASD) affect approximately 2% to 5% of the US population. However, most families are unable to access FASD-informed interventions. Barriers to care include the lack of a knowledgeable and skilled workforce and family-level barriers such as limited financial resources, inability to access childcare, and stigma. As a result, families often try peer-to-peer and self-help support strategies. However, they often take these strategies from disparate sources, which have quite variable intervention quality and empirical support. Objective This study aimed to initiate systematic development and evaluation of a mobile health intervention (app) for caregivers raising children with FASD. Focus groups were conducted to elicit participant perspectives on app design and functionalities to inform further app development. Methods The app, called FMF Connect, was derived from the scientifically validated Families Moving Forward (FMF) Program, a clinician-delivered behavioral consultation intervention. FMF Connect was intended for caregiver self-delivery and included five main components: (1) Learning Modules, (2) Family Forum, (3) Library, (4) Notebook, and (5) Dashboard. Focus group methods were used to solicit perspectives from diverse families during the early stages of app development. Questions were asked about interface design, relevance of components and content, and perceived barriers and facilitators of use. A total of 25 caregivers participated in 7 focus groups across 5 US cities. Data were analyzed thematically. Results Focus group participants were generally enthusiastic about the app interface design and components. Four global positive impression themes emerged, including (1) ease of access, (2) how the app guides and organizes information, (3) connection to other users and information, and (4) ability to share some content with others. Themes arose not only in discussions relating to positive app features but also when participants were asked about motivators for app use. Participants related how these positive global themes could address some system-level barriers, such as limited access to services, feeling isolated, and increased advocacy needs related to the societal lack of FASD knowledge. Participants identified many positive features about individual app components and functionalities. They also communicated potential barriers to use and raised important concerns and considerations relating to several app components. These included recognizability of the app based on the logo, and the balance of following the planned intervention sequence versus obtaining immediate answers. Also mentioned were privacy and dynamics within the Family Forum. Conclusions FMF Connect is a promising novel intervention with potential to reach many families in need and reduce significant barriers to care, resulting in a broader public health impact. Study findings will guide further app development both in terms of content and technological advances to optimize intervention effects. FMF Connect app development provides useful directions for other apps aimed at changing parenting practices.
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Simpson, Sharon Anne, Lynsay Matthews, Juliana Pugmire, Alex McConnachie, Emma McIntosh, Elinor Coulman, Kathryn Hughes, et al. "An app-, web- and social support-based weight loss intervention for adults with obesity: the HelpMeDoIt! feasibility RCT." Public Health Research 8, no. 3 (March 2020): 1–270. http://dx.doi.org/10.3310/phr08030.
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Background Finding solutions to rising levels of obesity continues to be a major public health focus. Social support has an important role in successful weight loss, and digital interventions can reach a large proportion of the population at low cost. Objective To develop and assess the feasibility and acceptability of an application (app), web- and social support-based intervention in supporting adults with obesity to achieve weight loss goals. Design Stage 1 – intervention development phase involved three focus groups (n = 10) with users, and think-aloud interviews and field testing with another group (n = 28). Stage 2 – the intervention and evaluation methods were explored in a feasibility randomised controlled trial with economic and process evaluation. Setting Greater Glasgow and Clyde, UK. Participants Adults with a body mass index of ≥ 30kg/m2 who owned a smartphone and were interested in losing weight were randomised 2 : 1 (intervention : control) and followed up at 12 months. Recruitment took place in April–October 2016. Interventions The intervention group had access to HelpMeDoIt! for 12 months. This encouraged them to (1) set goals, (2) monitor progress and (3) harness social support by inviting ‘helpers’ from their existing social network. The control group received a healthy lifestyle leaflet. Main outcome measures Data from stage 1 informed the intervention design. Key measures in stage 2 assessed the feasibility and acceptability of the intervention and trial methods against prespecified progression criteria. Three primary outcomes were explored: body mass index, diet and physical activity. Secondary outcomes included weight, waist and hip circumference, social support, self-efficacy, motivation, mental health, health-related quality of life, NHS resource use, participant-borne costs and intervention costs. Qualitative interviews with participants (n = 26) and helpers (n = 9) explored the feasibility and acceptability of the trial methods and intervention. Results Stage 1 produced (1) a website that provided evidence-based information for lifestyle change and harnessing social support, and (2) an app that facilitated goal-setting, self-monitoring and supportive interaction between participants and their helper(s). Progression criteria were met, demonstrating that the intervention and trial methods were feasible and acceptable. A total of 109 participants (intervention, n = 73; control, n = 36) were recruited, with 84 participants (77%: intervention, 71%; control, 89%) followed up at 12 months. Data were successfully collected for most outcome measures (≥ 82% completion). Participants and helpers were generally positive, although helper engagement with the app was low. Of the 54 (74%) participants who downloaded the app, 48 (89%) used it twice or more, 28 helpers enrolled via the app, and 19 (36%) participants interacted with their helper(s) via the app. Interview data indicated that HelpMeDoIt! prompted support from helpers that often occurred without the helpers using the app. Limitations Early technical problems meant that some participants and helpers had difficulty accessing the app. Ethical constraints meant that we were unable to contact helpers directly for interview. Conclusions The HelpMeDoIt! study demonstrated that a weight loss intervention delivered via an app and a website is feasible and acceptable. Progression criteria were met, supporting further evaluation of the intervention. Future work To further explore (1) the motivation and engagement of helpers, (2) the programme theory and (3) the effectiveness and cost-effectiveness of the intervention. Trial registration Current Controlled Trials ISRCTN85615983. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Wang, Tianyu, Philip R. Stanforth, R. Y. Declan Fleming, J. Stuart Wolf Jr, Dixie Stanforth, and Hirofumi Tanaka. "A Mobile App With Multimodality Prehabilitation Programs for Patients Awaiting Elective Surgery: Development and Usability Study." JMIR Perioperative Medicine 4, no. 2 (December 30, 2021): e32575. http://dx.doi.org/10.2196/32575.
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Background Complying with a prehabilitation program is difficult for patients who will undergo surgery, owing to transportation challenges and a limited intervention time window. Mobile health (mHealth) using smartphone apps has the potential to remove barriers and improve the effectiveness of prehabilitation. Objective This study aimed to develop a mobile app as a tool for facilitating a multidisciplinary prehabilitation protocol involving blood flow restriction training and sport nutrition supplementation. Methods The app was developed using “Appy Pie,” a noncoding app development platform. The development process included three stages: (1) determination of principles and requirements of the app through prehabilitation research team meetings; (2) app prototype design using the Appy Pie platform; and (3) app evaluation by clinicians and exercise and fitness specialists, technical professionals from Appy Pie, and non–team-member users. Results We developed a prototype of the app with the core focus on a multidisciplinary prehabilitation program with accessory features to improve engagement and adherence to the mHealth intervention as well as research-focused features to evaluate the effects of the program on frailty status, health-related quality of life, and anxiety level among patients awaiting elective surgery. Evaluations by research members and random users (n=8) were consistently positive. Conclusions This mobile app has great potential for improving and evaluating the effectiveness of the multidisciplinary prehabilitation intervention in the format of mHealth in future.
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Chow, Philip I., Fabrizio Drago, Erin M. Kennedy, and Wendy F. Cohn. "A Novel Mobile Phone App Intervention With Phone Coaching to Reduce Symptoms of Depression in Survivors of Women’s Cancer: Pre-Post Pilot Study." JMIR Cancer 6, no. 1 (February 6, 2020): e15750. http://dx.doi.org/10.2196/15750.
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Background Psychological distress is a major issue among survivors of women’s cancer who face numerous barriers to accessing in-person mental health treatments. Mobile phone app–based interventions are scalable and have the potential to increase access to mental health care among survivors of women’s cancer worldwide. Objective This study aimed to evaluate the acceptability and preliminary efficacy of a novel app-based intervention with phone coaching in a sample of survivors of women’s cancer. Methods In a single-group, pre-post, 6-week pilot study in the United States, 28 survivors of women’s cancer used iCanThrive, a novel app intervention that teaches skills for coping with stress and enhancing well-being, with added phone coaching. The primary outcome was self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale). Emotional self-efficacy and sleep disruption were also assessed at baseline, 6-week postintervention, and 4 weeks after the intervention period. Feedback obtained at the end of the study focused on user experience of the intervention. Results There were significant decreases in symptoms of depression and sleep disruption from baseline to postintervention. Sleep disruption remained significantly lower at 4-week postintervention compared with baseline. The iCanThrive app was launched a median of 20.5 times over the intervention period. The median length of use was 2.1 min. Of the individuals who initiated the intervention, 87% (20/23) completed the 6-week intervention. Conclusions This pilot study provides support for the acceptability and preliminary efficacy of the iCanThrive intervention. Future work should validate the intervention in a larger randomized controlled study. It is important to develop scalable interventions that meet the psychosocial needs of different cancer populations. The modular structure of the iCanThrive app and phone coaching could impact a large population of survivors of women’s cancer.
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Brooke, Thomas, Herman Pfaeffle, Walter Guillory, Sorana raiciulescu, and Roseanne Ressner. "86. Making the APPropriate Choice: Utilization of a Smartphone Application to Optimize Antimicrobial Decisions Among Internal Medicine Trainees." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S55. http://dx.doi.org/10.1093/ofid/ofab466.086.
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Abstract Background Use of an application (App) to shape antimicrobial stewardship (AS) practice is largely unknown. Walter Reed National Military Medical Center (WRNNMC) is a tertiary military academic medical center where 2020 AS guidelines transitioned to a mobile App platform. This project aimed to determine barriers to AS and the impact of an App combined with educational sessions (ES) on Internal Medicine (IM) trainee prescribing practices for common Infectious Diseases (ID) syndromes. Methods After an orientation, participants completed a pre-intervention survey. Once weekly ES reinforcing App content was implemented over 12 weeks after which a post-intervention survey was completed. Each weekly session covered a specific ID syndrome. Survey data was analyzed using SPSS Version 27 with paired t-test. Results Amongst 81 IM trainees, 59 (73%) completed both pre- and post-intervention surveys, of whom 39% were PGY1, 31% PGY2, and 27% PGY3. Common AS barriers included lack of knowledge, deference to seniority, established habits, and time needed to make an informed decision. The App and ES improved performance of an antimicrobial timeout (78%), IV to PO switch (61%), therapy de-escalation (56%), and antibiogram knowledge (68%) with 90% of trainees reporting increased access. Weekly ES led to 75% reporting it had at least a moderate impact on learning. Across all ID syndromes, each PGY year reported increased confidence in management post-intervention (P< 0.001) but PGY1s in particular saw the largest gain in confidence with antibiogram, febrile neutropenia, and hospital/ventilator acquired pneumonia categories. Usage of the App increased from 42% to 90% after the intervention, and 95% modified their prescribing practice based on the App. The most common barrier to App usage was forgetting to use the App. Conclusion Utilization of an App combined with ES improved multiple domains of AS practice among IM trainees leading to a modification in antimicrobial prescribing practice in the vast majority of participants. PGY1 trainees in particular may see a large benefit which supports implementation of AS training early in the academic year. This model can be used to build a sustainable AS trainee curriculum augmenting the learning and management of common ID syndromes. Disclosures All Authors: No reported disclosures
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Brewer, LaPrincess, Sharonne Hayes, Amber Caron, Christina Smith, Karen Schaepe, Sarah Jenkins, Jacqueline Johnson, et al. "3082 Cardiovascular Health Promotion Among African-Americans: Community Participatory Approach to Design an Innovative Mobile-Health Intervention." Journal of Clinical and Translational Science 3, s1 (March 2019): 85. http://dx.doi.org/10.1017/cts.2019.196.
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OBJECTIVES/SPECIFIC AIMS: To translate a behavioral theory–informed, evidence-based, face-to-face health education program into an mHealth lifestyle intervention for African-Americans (AAs). METHODS/STUDY POPULATION: This mixed methods study consisted of 4 phases, using an iterative development process to intervention design with the AA community. In Phase 1, we held focus groups with AA community members and church partners (n=23) to gain insight regarding the needs and preferences of potential app end users. In Phase 2, the interdisciplinary research team synthesized input from Phase 1 for preliminary app design and content development. Phase 3 consisted of a sequential 3-meeting series with the church partners (n=13) for iterative app prototyping (assessment, cultural tailoring, final review). Phase 4 was a single group pilot study among AA church congregants (n=50) to assess app acceptability, usability, and satisfaction. RESULTS/ANTICIPATED RESULTS: Phase 1 focus groups indicated preferences for general and health related apps: multifunctional; high-quality graphics/visuals; evidence-based, yet simple health information; and social networking capability. Phase 2 integrated these preferences into the preliminary app prototype. Feedback from Phase 3 was used to refine the FAITH! App prototype for pilot testing. Phase 4 pilot testing indicated high acceptability, usability, and satisfaction of the FAITH! App. DISCUSSION/SIGNIFICANCE OF IMPACT: This study illustrates the process of using formative and CBPR approaches to design a culturally relevant, mHealth lifestyle intervention to address CV health disparities within the AA community. Given the positive perceptions of the app, our study supports the use of an iterative development process by others interested in implementing an mHealth lifestyle intervention for racial/ethnic minority communities.
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Petrinec, Amy, Cindy Wilk, Joel W. Hughes, Melissa D. Zullo, Yea-Jyh Chen, and Patrick A. Palmieri. "Delivering Cognitive Behavioral Therapy for Post–Intensive Care Syndrome–Family via a Mobile Health App." American Journal of Critical Care 30, no. 6 (November 1, 2021): 451–58. http://dx.doi.org/10.4037/ajcc2021962.
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Background Family members of intensive care unit (ICU) patients are at risk for post–intensive care syndrome– family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. Objectives To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. Methods This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. Results The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. Conclusions The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.
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Richards, Rebecca, Paul Kinnersley, Kate Brain, John Staffurth, and Fiona Wood. "The Preferences of Patients With Cancer Regarding Apps to Help Meet Their Illness-Related Information Needs: Qualitative Interview Study." JMIR mHealth and uHealth 7, no. 7 (July 31, 2019): e14187. http://dx.doi.org/10.2196/14187.
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Background The shift from inpatient to outpatient and community cancer care means that more patients with cancer need to manage their condition at home, without the direct supervision of their clinician. Subsequently, research has reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. Before designing an app intervention to help patients with cancer to meet their information needs, in-depth qualitative research is required to gain an understanding of the views of the target users. Objective We aimed to develop an app intervention to help patients meet their illness-related information needs in noninpatient settings. This study explored the information needs of patients with cancer and their preferences for an app and desired app features. Specifically, the perceived acceptability of an app, desired app features, and the potential benefits and disadvantages of, and barriers to, an app were explored. Methods Qualitative, one-on-one semistructured interviews were conducted with patients with urological, colorectal, breast, or gynecological cancers (N=23) across two hospitals in South Wales. Interviews were audio-taped, transcribed, and analyzed using a thematic analysis. Results Findings indicated that barriers to information exchange and understanding in consultations, and identification of reliable information sources between consultations, appeared to contribute to patients’ unmet information needs. Consequently, app feature suggestions included a question prompt list, a glossary of cancer terms, a resources feature, and a contacts feature. Anticipated benefits of this type of app included a more informed patient, improved quality of life, decreased anxiety, and increased confidence to participate in their care. The anticipated barriers to app use are likely to be temporary or can be minimized with regard to these findings during app development and implementation. Conclusions This study highlights the desire of patients with cancer for an app intervention to help them meet their information needs during and between consultations with their clinicians. This study also highlights the anticipated acceptability and benefits of this type of intervention; however, further research is warranted.
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Fukuoka, Yoshimi, Caryl L. Gay, Kevin L. Joiner, and Eric Vittinghoff. "A Novel Diabetes Prevention Intervention Using a Mobile App." American Journal of Preventive Medicine 49, no. 2 (August 2015): 223–37. http://dx.doi.org/10.1016/j.amepre.2015.01.003.
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Bailey, Daniel P., Lucie H. Mugridge, Feng Dong, Xu Zhang, and Angel M. Chater. "Randomised Controlled Feasibility Study of the MyHealthAvatar-Diabetes Smartphone App for Reducing Prolonged Sitting Time in Type 2 Diabetes Mellitus." International Journal of Environmental Research and Public Health 17, no. 12 (June 19, 2020): 4414. http://dx.doi.org/10.3390/ijerph17124414.
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This study evaluated the feasibility and acceptability of a self-regulation smartphone app for reducing prolonged sitting in people with Type 2 diabetes mellitus (T2DM). This was a two-arm, randomised, controlled feasibility trial. The intervention group used the MyHealthAvatar-Diabetes smartphone app for 8 weeks. The app uses a number of behaviour change techniques aimed at reducing and breaking up sitting time. Eligibility, recruitment, retention, and completion rates for the outcomes (sitting, standing, stepping, and health-related measures) assessed trial feasibility. Interviews with participants explored intervention acceptability. Participants with T2DM were randomised to the control (n = 10) and intervention groups (n = 10). Recruitment and retention rates were 71% and 90%, respectively. The remaining participants provided 100% of data for the study measures. The MyHealthAvatar-Diabetes app was viewed as acceptable for reducing and breaking up sitting time. There were preliminary improvements in the number of breaks in sitting per day, body fat %, glucose tolerance, attitude, intention, planning, wellbeing, and positive and negative affect in favour of the intervention group. In conclusion, the findings indicate that it would be feasible to deliver and evaluate the efficacy of the MyHealthAvatar-Diabetes app for breaking up sitting time and improving health outcomes in a full trial.
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Skvortsova, Aleksandrina, Talia Cohen Rodrigues, David de Buisonjé, Tobias Kowatsch, Prabhakaran Santhanam, Dieuwke S. Veldhuijzen, Henriët van Middendorp, and Andrea Evers. "Increasing the Effectiveness of a Physical Activity Smartphone Intervention With Positive Suggestions: Randomized Controlled Trial." Journal of Medical Internet Research 24, no. 3 (March 1, 2022): e32130. http://dx.doi.org/10.2196/32130.
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Background eHealth interventions have the potential to increase the physical activity of users. However, their effectiveness varies, and they often have only short-term effects. A possible way of enhancing their effectiveness is to increase the positive outcome expectations of users by giving them positive suggestions regarding the effectiveness of the intervention. It has been shown that when individuals have positive expectations regarding various types of interventions, they tend to benefit from these interventions more. Objective The main objective of this web-based study is to investigate whether positive suggestions can change the expectations of participants regarding the effectiveness of a smartphone physical activity intervention and subsequently enhance the number of steps the participants take during the intervention. In addition, we study whether suggestions affect perceived app effectiveness, engagement with the app, self-reported vitality, and fatigue of the participants. Methods This study involved a 21-day fully automated physical activity intervention aimed at helping participants to walk more steps. The intervention was delivered via a smartphone-based app that delivered specific tasks to participants (eg, setting activity goals or looking for social support) and recorded their daily step count. Participants were randomized to either a positive suggestions group (69/133, 51.9%) or a control group (64/133, 48.1%). Positive suggestions emphasizing the effectiveness of the intervention were implemented in a web-based flyer sent to the participants before the intervention. Suggestions were repeated on days 8 and 15 of the intervention via the app. Results Participants significantly increased their daily step count from baseline compared with 21 days of the intervention (t107=−8.62; P<.001) regardless of the suggestions. Participants in the positive suggestions group had more positive expectations regarding the app (B=−1.61, SE 0.47; P<.001) and higher expected engagement with the app (B=3.80, SE 0.63; P<.001) than the participants in the control group. No effects of suggestions on the step count (B=−22.05, SE 334.90; P=.95), perceived effectiveness of the app (B=0.78, SE 0.69; P=.26), engagement with the app (B=0.78, SE 0.75; P=.29), and vitality (B=0.01, SE 0.11; P=.95) were found. Positive suggestions decreased the fatigue of the participants during the 3 weeks of the intervention (B=0.11, SE 0.02; P<.001). Conclusions Although the suggestions did not affect the number of daily steps, they increased the positive expectations of the participants and decreased their fatigue. These results indicate that adding positive suggestions to eHealth physical activity interventions might be a promising way of influencing subjective but not objective outcomes of interventions. Future research should focus on finding ways of strengthening the suggestions, as they have the potential to boost the effectiveness of eHealth interventions. Trial Registration Open Science Framework 10.17605/OSF.IO/CWJES; https://osf.io/cwjes
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Dorsch, Michael P., Karen B. Farris, Brigid E. Rowell, Scott L. Hummel, and Todd M. Koelling. "The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial." JMIR mHealth and uHealth 9, no. 12 (December 7, 2021): e26185. http://dx.doi.org/10.2196/26185.
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Background The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (“app group”) used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (“no-app group”) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26% vs no-app group 12/41, 29%; hazard ratio 0.89, 95% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510
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Gire, Nadeem, Neil Caton, Mick McKeown, Naeem Mohmed, Joy Duxbury, James Kelly, Miv Riley, et al. "‘Care co-ordinator in my pocket’: a feasibility study of mobile assessment and therapy for psychosis (TechCare)." BMJ Open 11, no. 11 (November 2021): e046755. http://dx.doi.org/10.1136/bmjopen-2020-046755.
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ObjectivesThe aim of the project was to examine the acceptability and feasibility of a mobile phone application-based intervention ‘TechCare’, for individuals with psychosis in the North West of England. The main objectives were to determine whether appropriate individuals could be identified and recruited to the study and whether the TechCare App would be an acceptable intervention for individuals with psychosis.MethodsThis was a mixed methods feasibility study, consisting of a test-run and feasibility evaluation of the TechCare App intervention.SettingEarly Intervention Services (EIS) for psychosis, within an NHS Trust in the North West of England.ParticipantsSixteen participants (test-run n=4, feasibility study n=12) aged between 18 and 65 years recruited from the East, Central and North Lancashire EIS.InterventionA 6-week intervention, with the TechCare App assessing participants’ symptoms and responses in real-time and providing a personalised-guided self-help-based psychological intervention based on the principles of Cognitive Behaviorual Therapy (CBT).ResultsA total of 83.33% (n=10) of participants completed the 6-week feasibility study, with 70% of completers achieving the set compliance threshold of ≥33% engagement with the TechCare App system. Analysis of the qualitative data suggested that participants held the view that the TechCare was both an acceptable and feasible means of delivering interventions in real-time.ConclusionInnovative digital clinical technologies, such as the TechCare App, have the potential to increase access to psychological interventions, reduce health inequality and promote self-management with a real-time intervention, through enabling access to mental health resources in a stigma-free, evidence-based and time-independent manner.Trial registration numberClinicalTrials.gov Identifier: NCT02439619.
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Baltaxe, Erik, Cristina Embid, Eva Aumatell, María Martínez, Anael Barberan-Garcia, John Kelly, John Eaglesham, et al. "Integrated Care Intervention Supported by a Mobile Health Tool for Patients Using Noninvasive Ventilation at Home: Randomized Controlled Trial." JMIR mHealth and uHealth 8, no. 4 (April 13, 2020): e16395. http://dx.doi.org/10.2196/16395.
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Background Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by a mobile health (mHealth) app could enhance patient self-efficacy. It is widely accepted that mHealth-supported services can enhance productive interactions among the stakeholders involved in home-based respiratory therapies. Objective This study aimed to measure changes in self-efficacy in patients with chronic respiratory failure due to diverse etiologies during a 3-month follow-up period after the intervention. Ancillary objectives were assessment of usability and acceptability of the mobile app as well as its potential contribution to collaborative work among stakeholders. Methods A single-blind, single-center, randomized controlled trial was conducted between February 2019 and June 2019 with 67 adult patients with chronic respiratory failure undergoing home-based noninvasive ventilation. In the intervention group, a psychologist delivered a face-to-face motivational intervention. Follow-up was supported by a mobile app that allowed patients to report the number of hours of daily noninvasive ventilation use and problems with the therapy. Advice was automatically delivered by the mobile app in case of a reported problem. The control group received usual care. The primary outcome was the change in the Self Efficacy in Sleep Apnea questionnaire score. Secondary outcomes included app usability, app acceptability, continuity of care, person-centered care, and ventilatory parameters. Results Self-efficacy was not significantly different in the intervention group after the intervention (before: mean 3.4, SD 0.6; after: mean 3.4, SD 0.5, P=.51). No changes were observed in adherence to therapy nor quality of life. Overall, the mHealth tool had a good usability score (mean 78 points) and high acceptance rate (mean score of 7.5/10 on a Likert scale). It was considered user-friendly (mean score of 8.2/10 on a Likert scale) and easy to use without assistance (mean score of 8.5/10 on a Likert scale). Patients also scored the perception of continuity of care and person-centered care as high. Conclusions The integrated care intervention supported by the mobile app did not improve patient self-management. However, the high acceptance of the mobile app might indicate potential for enhanced communication among stakeholders. The study identified key elements required for mHealth tools to provide effective support to collaborative work and personalized care. Trial Registration ClinicalTrials.gov NCT03932175; https://clinicaltrials.gov/ct2/show/NCT03932175
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Kittler, Christoph, Lukas Stenzel, Darko Jekauc, and Oliver Stoll. "Implementation of an App-Based Blended Mindfulness Intervention in a Bundesliga Youth Academy Targeting Goalkeepers: A Case Study." Case Studies in Sport and Exercise Psychology 5, no. 1 (January 1, 2021): 95–105. http://dx.doi.org/10.1123/cssep.2021-0006.
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Integrating extensive sport psychological interventions into the daily routine of young football players poses a problem. This case study aimed to describe the implementation of an app-based blended mindfulness intervention in a German Bundesliga youth academy to improve goalkeepers’ (n = 6) attention. A mindfulness app was combined with regular group workshops. The study included an outcome evaluation based on pre- and postintervention assessments of attention performance and process evaluation based on recorded training time and collected qualitative data. The results showed an improvement in the players’ Frankfurt Attention Inventory-2 L scores and K scores. The training time with the app was low (M = 30.51 min), but high (M = 200.00 min) without the app. To implement an app-based intervention successfully, the results imply that players need more assistance with the app, and time management and informal training should be incorporated into sport-specific exercises.
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Cohen, Rinat, Gal Maydan, Shai Brill, and Jiska Cohen-Mansfield. "Improving Staff-Family End-of-Life Communication at Israeli Geriatric Facilities by Using a Mobile App." Innovation in Aging 5, Supplement_1 (December 1, 2021): 515. http://dx.doi.org/10.1093/geroni/igab046.1992.
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Abstract Family caregivers (FCs) of persons institutionalized at geriatric facilities present significant unmet communication needs regarding receiving regular updates about their loved one’s condition and having available healthcare professionals (HPs) to approach when needed. We developed and tested a mobile-app for staff-family communication with both parties having active roles in app planning to tailor it to their needs and abilities. The app includes a daily-update module for FCs and a chat option for FCs and HPs. App use was piloted at one geriatric-medical-center for 15 months (unit-level randomization resulted in one complex-care and one assisted-ventilation unit in each group- intervention and control) and one single-unit nursing-home for three months. Personal interviews were conducted with 55 FCs (28 from intervention-group and 27 FCs from control-group) before-and-after app use (with mean duration of use 1.6[S.D.=.6] months. Most participants were women and the children of the patients; their mean age was 55.9 years (S.D.=12.4). Repeated-measures Analysis-of-Variance for the end-of-life communication sub-scale on the Quality-of-communication questionnaire yielded a main effect for time (F(1,53)=8.31, p=.006) with both groups’ ratings increasing over time and an interaction effect (F(1,53)=4.78, p=.033) with a greater increase for intervention-group compared to control-group. Intervention-group participants rated the app as convenient to use. Qualitative data revealed that FCs perceived app use as improving quality of communication with the HPs who used it and improving their own well-being. The app offers a feasible and an effective mode of communication that incorporates technology in daily communication between FCs and HPs while addressing FCs’ unmet needs.
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Pallejà-Millán, Meritxell, Cristina Rey-Reñones, Maria Luisa Barrera Uriarte, Esther Granado-Font, Josep Basora, Gemma Flores-Mateo, and Jordi Duch. "Evaluation of the Tobbstop Mobile App for Smoking Cessation: Cluster Randomized Controlled Clinical Trial." JMIR mHealth and uHealth 8, no. 6 (June 26, 2020): e15951. http://dx.doi.org/10.2196/15951.
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Background Mobile apps provide an accessible way to test new health-related methodologies. Tobacco is still the primary preventable cause of death in industrialized countries, constituting an important public health issue. New technologies provide novel opportunities that are effective in the cessation of smoking tobacco. Objective This paper aims to evaluate the efficacy and usage of a mobile app for assisting adult smokers to quit smoking. Methods We conducted a cluster randomized clinical trial. We included smokers older than 18 years who were motivated to stop smoking and used a mobile phone compatible with our mobile app. We carried out follow-up visits at 15, 30, and 45 days, and at 2, 3, 6, and 12 months. Participants of the intervention group had access to the Tobbstop mobile app designed by the research team. The primary outcomes were continuous smoking abstinence at 3 and 12 months. Results A total of 773 participants were included in the trial, of which 602 (77.9%) began the study on their D-Day. Of participants in the intervention group, 34.15% (97/284) did not use the app. The continuous abstention level was significantly larger in the intervention group participants who used the app than in those who did not use the app at both 3 months (72/187, 38.5% vs 13/97, 13.4%; P<.001) and 12 months (39/187, 20.9% vs 8/97, 8.25%; P=.01). Participants in the intervention group who used the app regularly and correctly had a higher probability of not being smokers at 12 months (OR 7.20, 95% CI 2.14-24.20; P=.001) than the participants of the CG. Conclusions Regular use of an app for smoking cessation is effective in comparison with standard clinical practice. Trial Registration Clinicaltrials.gov NCT01734421; https://clinicaltrials.gov/ct2/show/NCT01734421
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Kenny, Rachel, Amanda Fitzgerald, Ricardo Segurado, and Barbara Dooley. "Is there an app for that? A cluster randomised controlled trial of a mobile app–based mental health intervention." Health Informatics Journal 26, no. 3 (November 8, 2019): 1538–59. http://dx.doi.org/10.1177/1460458219884195.
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Demand for the use of mobile apps in mental health interventions has grown in recent years, particularly among adolescents who experience elevated levels of distress. However, there is a scarcity of evidence for the effectiveness of these tools within this population. The aim of this study was to test the effectiveness of CopeSmart, a mental health mobile app, using a multicentre cluster randomised controlled trial design. Participants were 15–18-years-olds (N = 560) recruited from 10 schools randomly assigned to an intervention or control condition. Intervention participants used the app over a 4-week period. Multi-level modelling analyses revealed no significant changes in the intervention group from pre-test to post-test, when compared to the control group, in terms of emotional distress, well-being, emotional self-awareness or coping strategies. Findings suggest that a 4-week app-based intervention may not be enough to elicit intra-personal changes in mental health outcomes in a general adolescent population.
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Li, Jie, Peishan Ning, Peixia Cheng, David C. Schwebel, Yang Yang, Xiang Wei, Jieyi He, Wanhui Wang, Ruotong Li, and Guoqing Hu. "Factors Associated With Dropout of Participants in an App-Based Child Injury Prevention Study: Secondary Data Analysis of a Cluster Randomized Controlled Trial." Journal of Medical Internet Research 23, no. 1 (January 29, 2021): e21636. http://dx.doi.org/10.2196/21636.
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Background Mobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. Objective We explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. Methods The cluster RCT compared two groups of an app-based intervention for caregivers of 3-6–year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. Results In total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P<.001), at 28.9% (437/1510) in the intervention group and 35.7% (503/1410) in the control group. For the intervention group, the only significant predictor of attrition risk was participants who learned fewer knowledge segments (aOR 2.69, 95% CI 1.19-6.09). For the control group, significant predictors of attrition risk were lower monthly login frequency (aOR 1.48, 95% CI 1.00-2.18), learning fewer knowledge segments (aOR 1.70, 95% CI 1.02-2.81), and shorter learning durations during app engagement (aOR 2.39, 95% CI 1.11-5.15). Demographic characteristics were unrelated to attrition. Conclusions Engagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition. Trial Registration Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-018-5790-1
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Gonze, Bárbara De Barros, Ricardo Da Costa Padovani, Maria Do Socorro Simoes, Vinicius Lauria, Neli Leite Proença, Evandro Fornias Sperandio, Thatiane Lopes Valentim Di Paschoale Ostolin, et al. "Use of a Smartphone App to Increase Physical Activity Levels in Insufficiently Active Adults: Feasibility Sequential Multiple Assignment Randomized Trial (SMART)." JMIR Research Protocols 9, no. 10 (October 23, 2020): e14322. http://dx.doi.org/10.2196/14322.
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Background The sequential multiple assignment randomized trial (SMART) design allows for changes in the intervention during the trial period. Despite its potential and feasibility for defining the best sequence of interventions, so far, it has not been utilized in a smartphone/gamified intervention for physical activity. Objective We aimed to investigate the feasibility of the SMART design for assessing the effects of a smartphone app intervention to improve physical activity in adults. We also aimed to describe the participants’ perception regarding the protocol and the use of the app for physical activity qualitatively. Methods We conducted a feasibility 24-week/two-stage SMART in which 18 insufficiently active participants (<10,000 steps/day) were first randomized to group 1 (smartphone app only), group 2 (smartphone app + tailored messages), and a control group (usual routine during the protocol). Participants were motivated to increase their step count by at least 2000 steps/day each week. Based on the 12-week intermediate outcome, responders continued the intervention and nonresponders were rerandomized to subsequent treatment, including a new group 3 (smartphone app + tailored messages + gamification) in which they were instructed to form groups to use several game elements available in the chosen app (Pacer). We considered responders as those with any positive slope in the linear relationship between weeks and steps per day at the end of the first stage of the intervention. We compared the accelerometer-based steps per day before and after the intervention, as well as the slopes of the app-based steps per day between the first and second stages of the intervention. Results Twelve participants, including five controls, finished the intervention. We identified two responders in group 1. We did not observe relevant changes in the steps per day either throughout the intervention or compared with the control group. However, the rerandomization of five nonresponders led to a change in the slope of the steps per day (median −198 steps/day [IQR −279 to −103] to 20 steps/day [IQR −204 to 145]; P=.08). Finally, in three participants from group 2, we observed an increase in the number of steps per day up to the sixth week, followed by an inflection to baseline values or even lower (ie, a quadratic relationship). The qualitative analysis showed that participants’ reports could be classified into the following: (1) difficulty in managing the app and technology or problems with the device, (2) suitable response to the app, and (3) difficulties to achieve the goals. Conclusions The SMART design was feasible and changed the behavior of steps per day after rerandomization. Rerandomization should be implemented earlier to take advantage of tailored messages. Additionally, difficulties with technology and realistic and individualized goals should be considered in interventions for physical activity using smartphones. Trial Registration Brazilian Registry of Clinical Trials RBR-8xtc9c; http://www.ensaiosclinicos.gov.br/rg/RBR-8xtc9c/.
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MacIsaac, Angela, Aislin R. Mushquash, Shakira Mohammed, Elizabeth Grassia, Savanah Smith, and Christine Wekerle. "Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study." JMIR mHealth and uHealth 9, no. 1 (January 4, 2021): e25087. http://dx.doi.org/10.2196/25087.
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Background The effects of adverse childhood experiences (ACEs) on mental health, self-regulatory capacities, and overall resilience are well-known. Given such effects, ACEs may play a role in how individuals adjust to challenges later in life. Of interest in this study is the transition to university, a time of heightened stress when adapting to circumstances is required and when those with ACEs may need additional in-the-moment support to exercise resilience. A smartphone app may provide a worthwhile and readily accessible medium for a resilience intervention, provided behavioral outcomes are adequately evaluated. Objective This study evaluates the impact of an innovative, smartphone app–based resilience intervention. The JoyPop app was designed to promote resilience through the use of self-regulatory skills such as emotion regulation and executive functioning. Among a sample of first-year undergraduate students, we explored whether use of the app would be associated with positive changes in resilience and related outcomes, and whether these benefits were influenced by level of childhood adversity. Methods Participants (N=156) were requested to use the JoyPop app for 4 weeks, at least twice daily. Changes in resilience, emotion regulation, executive functioning, and depression were assessed after 2 and 4 weeks of app usage using multilevel modeling. Results The sample of 156 participants included 123 females and 33 males, with a mean age of 19.02 years (SD 2.90). On average participants used the app on 20.43 of the possible 28 days (SD 7.14). App usage was associated with improvements in emotion regulation (χ21=44.46; P<.001), such that it improved by 0.25 points on the 18-point scale for each additional day of app usage, and symptoms of depression (χ21=25.12; P<.001), such that depression symptoms were reduced by .08 points on the 9-point scale with each additional day of app usage. An interaction between ACEs and days of app usage existed for emotion regulation, such that participants with more adversity evidenced a faster rate of change in emotion regulation (P=.02). Conclusions Results highlight that daily incorporation of an app-based resilience intervention can help youth who have experienced adversity to improve emotion regulation skills and experience reductions in depression. The JoyPop app represents an important step forward in the integration of resilience intervention research with a technology-based medium that provides in-the-moment support.
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Yu, Kexin, Shinyi Wu, Mandong Liu, Haojun Jiang, and Iris Chi. "REFLECTIVE THINKING OF THE CSMP APP CO-DESIGN AND ALPHA-TESTING PROCESS." Innovation in Aging 3, Supplement_1 (November 2019): S547. http://dx.doi.org/10.1093/geroni/igz038.2013.
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Abstract Time and transportation barriers prevented caregivers with busy schedules to attend the CSMP. Developing a CSMP mobile application (app) and testing its feasibility was hypothesized to increase the accessibility of the CSMP to caregivers. Applying a user-participatory approach, seven caregivers who attended the CSMP in-person intervention participated in a 2-hour co-design session. A CSMP app prototype was developed based on the co-design interview results. The same seven caregivers and another five caregivers who were naïve to the CSMP intervention participated in a 2-hour alpha testing interview to provide feedback to the app prototype. Compared to co-design, participants were able to provide more constructive suggestions regarding app design when the app prototype was shown. The user participatory approach is a dialogue between researchers’ knowledge framework and users’ lived experience. Both agreement and disagreement regarding app design were identified, yet how to address the discrepancy has not been discussed in the literature.
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Collins, Daniel A. J., Samuel B. Harvey, Isobel Lavender, Nicholas Glozier, Helen Christensen, and Mark Deady. "A Pilot Evaluation of a Smartphone Application for Workplace Depression." International Journal of Environmental Research and Public Health 17, no. 18 (September 16, 2020): 6753. http://dx.doi.org/10.3390/ijerph17186753.
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Interventions delivered via mobile apps show particular promise in tackling the burden of common mental disorders. Appropriately targeting these interventions to at-risk populations is critical to their success. This pilot study aimed to assess the usability, feasibility, acceptability, and preliminary effects of an app-based intervention designed to target depressive symptoms in a stressed working population. Anchored, a smartphone app including a 30-day program of mindfulness and cognitive and behavioural therapeutic components, was tested in a pre-post pilot study with participants recruited via social media advertisements. Eligible participants (N = 81) were Australian adults who were employed and reported elevated stress levels on a single-item screening measure. Follow-up assessment occurred 5 weeks after baseline. The primary outcome measure was change in depressive symptoms, with secondary outcomes measuring change in anxiety, wellbeing, stress, resilience, exercise, alcohol use, absenteeism, and work performance. User feedback and in-app data were analysed to assess engagement and intervention adherence. At follow-up, there were significant reductions in depressive symptoms (t61 = 6.35; p < 0.001) and anxiety symptoms (t60 = 7.35; p < 0.001), along with significantly reduced cases of likely new onset depression compared to baseline (24% vs. 6%, p = 0.012). Significant improvements were also seen in wellbeing (t60 = −5.64; p < 0.001), resilience (t60 = −3.89; p < 0.001), stress (t61 = 11.18; p < 0.001), and alcohol use (t60 = 3.40; p = 0.001). Participants reported no significant changes in work performance, absenteeism or exercise. There were satisfactory levels of app usability, feasibility, and acceptability. Most participants found the app easy to use (93.2%), understood the app content well (83.0%), and rated the app highly or very highly overall (72.9%). User feedback suggestions were predominantly focused on improving app navigation and user interface. This pilot study provides encouraging evidence that Anchored has potentially beneficial effects, and is usable, feasible, and acceptable as an app-based intervention for the working population experiencing elevated stress. Further testing of Anchored in a randomised controlled trial is required to investigate its efficacy as an intervention for workplace mental ill-health.
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Byambasuren, Oyungerel, Elaine Beller, Tammy Hoffmann, and Paul Glasziou. "mHealth App Prescription in Australian General Practice: Pre-Post Study." JMIR mHealth and uHealth 8, no. 6 (June 1, 2020): e16497. http://dx.doi.org/10.2196/16497.
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Background Evidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. Objective This study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation intervention to increase app prescription. Methods A single-group, before-and-after study was conducted in Australian general practice. GPs were given prescription pads for 6 mHealth apps and reported the number of prescriptions dispensed for 4 months. After the reporting of month 2, a 2-minute video of one of the apps was randomly selected and sent to each GP. Data were collected through a prestudy questionnaire, monthly electronic reporting, and end-of-study interviews. The primary outcome was the number of app prescriptions (total, monthly, per GP, and per GP per fortnight). Secondary outcomes included confidence in prescribing apps (0-5 scale), the impact of the intervention video on subsequent prescription numbers, and acceptability of the interventions. Results Of 40 GPs recruited, 39 commenced, and 36 completed the study. In total, 1324 app prescriptions were dispensed over 4 months. The median number of apps prescribed per GP was 30 (range 6-111 apps). The median number of apps prescribed per GP per fortnight increased from the pre-study level of 1.7 to 4.1. Confidence about prescribing apps doubled from a mean of 2 (not so confident) to 4 (very confident). App videos did not affect subsequent prescription rates substantially. Post-study interviews revealed that the intervention was highly acceptable. Conclusions mHealth app prescription in general practice is feasible, and our implementation intervention was effective in increasing app prescription. GPs need more tailored education and training on the value of mHealth apps and knowledge of prescribable apps to be able to successfully change their prescribing habits to include apps. The future of sustainable and scalable app prescription requires a trustworthy electronic app repository of prescribable mHealth apps for GPs.
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MacDonald, James, Nicole Amoyal, Lauren Nisotel, Giselle Katiria Perez, Lara Traeger, Jennifer S. Temel, William F. Pirl, Steven A. Safren, and Joseph A. Greer. "Mobile application of cognitive behavioral therapy for anxiety and advanced cancer." Journal of Clinical Oncology 33, no. 29_suppl (October 10, 2015): 220. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.220.
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220 Background: We previously demonstrated the efficacy of a brief, in-person cognitive behavioral therapy (CBT) program for alleviating anxiety in patients with advanced cancer. The aim of the current study was to adapt this program to an interactive, patient-centered mobile tablet application (CBT app) for self-delivery, ideally to enhance dissemination and patient access to the CBT intervention. Methods: Development of the CBT app proceeded in two phases. First, we enrolled five patients with advanced cancer and anxiety (HADS-Anxiety subscale score ≥ 8) to review a preliminary CBT app prototype and to provide qualitative feedback regarding intervention acceptability and utility. Using content analysis of the recorded data, we identified key themes in patient feedback and refined the CBT app content and design accordingly. Finally, a multidisciplinary team of clinical researchers (n=7) specializing in healthcare technology, psychiatry, and psychology conducted an extensive iterative review process to vet and finalize the CBT app intervention. Results: Patients reported that the CBT app content was comprehensible, easily navigated, and helpful in addressing a breadth of concerns relevant to patients with anxiety and advanced cancer. Specifically, patients reported that case examples, tailored feedback, accessible interactive features, and content summaries were important for engagement with the program. The multidisciplinary study team used patient feedback to adapt the CBT app prototype to a tablet design consisting of six modules that teach skills for practicing relaxation, staying present-focused, coping with fears related to cancer, and pacing activities. To enhance patient engagement, features also included homework assignments, symptom distress tracking, and tailored algorithms and branching logic based on patient responses. Conclusions: Patient interviews confirmed acceptability of the CBT app content. Expert clinician feedback also supported the tablet design for self-administration of the intervention to reduce patient burden. We are currently conducting a randomized controlled trial to assess the efficacy of the CBT app for improving anxiety symptoms in patients with advanced cancer. Clinical trial information: NCT02286466.
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Moltrecht, Bettina, Praveetha Patalay, Jessica Deighton, and Julian Edbrooke-Childs. "A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial." JMIR mHealth and uHealth 9, no. 7 (July 14, 2021): e21837. http://dx.doi.org/10.2196/21837.
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Background Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale. Objective This study investigates the use of a new app-based intervention designed to support children’s emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context. Methods As part of an interdisciplinary development framework, the app is being evaluated in a 3-month trial across 4 primary schools. In total, 144 children (aged 10-12 years) took part and accessed the intervention app in the classroom or at home. Outcomes regarding usability, acceptability, and implementation opportunities were assessed through digital user data, self-report questionnaires (132/144, 91.6%), and semistructured interviews with children (19/144, 13.2%) and teachers (6/8, 75%). Results The app usage data showed that 30% (128/426) of the users were returning users. Self-report data indicated that 40.1% (53/132) of the children had not used the app, whereas 57.5% (76/132) had used it once or more. Of the children who had used the app, 67% (51/76) reported that the app was helpful. Interviews with children and teachers suggested positive experiences with the app and that it helped them to calm down and relax. Children reported that they perceived the app as acceptable, usable, and helpful. In terms of the intervention’s usability, most features functioned well; however, certain technical issues were reported, which may have led to reduced engagement levels. Teachers not only reported overall positive experiences but also discussed access difficulties and reported a lack of content as one of the main barriers to implementing the app. Having a web-based app significantly enhanced accessibility across devices and settings and provided teachers with more opportunities to use it. We identified the need for new, activating app features in addition to the existing, primarily relaxing ones. The findings indicated that it is possible to use and evaluate an app intervention in the school context and that the app could help enhance children’s emotion regulation. We discuss areas for improvement regarding the app, study design, and future implementation strategies. Conclusions We share important insights with regard to the development, implementation, and evaluation of a new app for supporting children’s emotion regulation in schools. Our results demonstrate that mental health apps represent a promising means to facilitate effective mental health service provision in and outside of the school context. Important lessons learned are shared to support other researchers and clinicians on similar journeys.
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Huang, Zhilian, Eberta Tan, Elaine Lum, Peter Sloot, Bernhard Otto Boehm, and Josip Car. "A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial." JMIR mHealth and uHealth 7, no. 9 (September 12, 2019): e14914. http://dx.doi.org/10.2196/14914.
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Background The efficacy of smartphone apps for improving medication adherence in type 2 diabetes is not well studied in Asian populations. Objective This study aimed to determine the feasibility, acceptability, and clinical outcomes of using a smartphone app to improve medication adherence in a multiethnic Asian population with type 2 diabetes. Methods We block randomized 51 nonadherent and digitally literate patients with type 2 diabetes between the ages of 21 and 75 years into two treatment arms (control: usual care; intervention: usual care+Medisafe app) and followed them up for 12 weeks. Recruitment occurred at a public tertiary diabetes specialist outpatient center in Singapore. The intervention group received email reminders to complete online surveys monthly, while the control group only received an email reminder(s) at the end of the study. Barriers to medication adherence and self-appraisal of diabetes were assessed using the Adherence Starts with Knowledge-12 (ASK-12) and Appraisal of Diabetes Scale (ADS) questionnaires at baseline and poststudy in both groups. Perception toward medication adherence and app usage, attitude, and satisfaction were assessed in the intervention group during and after the follow-up period. Sociodemographic data were collected at baseline. Clinical data (ie, hemoglobin A1c, body mass index, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels) were extracted from patients’ electronic medical records. Results A total of 51 (intervention group: 25 [49%]; control group: 26 [51%]) participants were randomized, of which 41 (intervention group: 22 [88.0%]; control group: 19 [73.1%]) completed the poststudy survey. The baseline-adjusted poststudy ASK-12 score was significantly lower in the intervention group than in the control group (mean difference: 4.7, P=.01). No changes were observed in the clinical outcomes. The average 12-week medication adherence rate of participants tracked by the app was between 38.3% and 100% in the intervention group. The majority (>80%) of the participants agreed that the app was easy to use and made them more adherent to their medication. Conclusions Our feasibility study showed that among medication-nonadherent patients with type 2 diabetes, a smartphone app intervention was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence, but did not improve clinical outcomes in a developed Asian setting.
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Poort, Hanneke, Annelise Ryan, Katelyn MacDougall, Paige Malinowski, Anna MacDonald, Zach Markin, William Pirl, Joseph Greer, and Karen Fasciano. "Feasibility and Acceptability of a Mobile Phone App Intervention for Coping With Cancer as a Young Adult: Pilot Trial and Thematic Analysis." Journal of Medical Internet Research 23, no. 6 (June 11, 2021): e25069. http://dx.doi.org/10.2196/25069.
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Background Many young adult patients do not receive adequate psychosocial services to help them cope with cancer. Objective This study aims to assess the feasibility and acceptability of a smartphone app (iaya) intervention that was designed to create an engaged community of young adult patients and help them learn emotional coping skills. Methods For this single-group pilot trial, 25 young adult patients aged 18-39 years who were receiving active cancer treatment were asked to use the iaya app for 12 weeks. To collect app use data, we used Mixpanel, an analytics platform for apps. Feasibility was assessed through rates of app sessions and the number of coping exercises engaged, and intervention acceptability was evaluated by using an app usability questionnaire and through qualitative interviews at study completion. We collected patient-reported outcome data at baseline and at week 12 to explore self-efficacy for coping with cancer, self-efficacy for managing emotions, perceived emotional support, and quality of life. Results Baseline patient-reported outcome data indicated that participants scored relatively low on perceived emotional support but reasonably high on self-efficacy for coping with cancer and managing emotions as well as quality of life. Participants had a mean of 13 app sessions (SD 14) and 2 coping exercises (SD 3.83) in 12 weeks. Only 9% (2/23) of participants met our combined feasibility definition of ≥10 app sessions and ≥3 coping skills from different categories. The participants’ mean usability score was 73.7% (SD 10.84), which exceeded our predefined threshold of ≥70%, and qualitative feedback was generally positive. Conclusions Although perceived acceptable by patients, the iaya smartphone app did not meet the a priori feasibility criteria as a stand-alone app intervention. Future studies should screen participants for unmet coping needs and consider integrating the app as part of psychosocial care for young adult patients.
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Boe Danbjørg, Dorthe, Lis Wagner, Bjarne Rønde Kristensen, and Jane Clemensen. "Nurses’ Experience of Using an Application to Support New Parents after Early Discharge: An Intervention Study." International Journal of Telemedicine and Applications 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/851803.
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Background.A development towards earlier postnatal discharge presents a challenge to find new ways to provide information and support to families. A possibility is the use of telemedicine.Objective.To explore how using an app in nursing practice affects the nurses’ ability to offer support and information to postnatal mothers who are discharged early and their families.Design.Participatory design. An app with a chat, a knowledgebase, and automated messages was tried out between hospital and parents at home.Settings.The intervention took place on a postnatal ward with approximately 1,000 births a year.Participants.At the onset of the intervention, 17 nurses, all women, were working on the ward. At the end of the intervention, 16 nurses were employed, all women.Methods.Participant observation and two focus group interviews. The data analysis was inspired by systematic text condensation.Results.The nurses on the postnatal ward consider that the use of the app gives families easier access to timely information and support.Conclusions.The app gives the nurses the possibility to offer support and information to the parents being early discharged. The app is experienced as a lifeline that connects the homes of the new parents with the hospital.
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Husain, Nusrat, Nadeem Gire, James Kelly, Joy Duxbury, Mick McKeown, Miv Riley, Christopher DJ Taylor, et al. "TechCare: mobile assessment and therapy for psychosis – an intervention for clients in the Early Intervention Service: A feasibility study protocol." SAGE Open Medicine 4 (January 1, 2016): 205031211666961. http://dx.doi.org/10.1177/2050312116669613.
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Objectives: Technological advances in healthcare have shown promise when delivering interventions for mental health problems such as psychosis. The aim of this project is to develop a mobile phone intervention for people with psychosis and to conduct a feasibility study of the TechCare App. Methods: The TechCare App will assess participant’s symptoms and respond with a personalised guided self-help-based psychological intervention with the aim of exploring feasibility and acceptability. The project will recruit 16 service users and 8–10 health professionals from the Lancashire Care NHS Foundation Trust Early Intervention Service. Results: In strand 1 of the study, we will invite people to discuss their experience of psychosis and give their opinions on the existing evidence-based treatment (cognitive behavioural therapy) and how the mobile app can be developed. In strand 2, we will complete a test run with a small number of participants (n = 4) to refine the mobile intervention (TechCare). Finally, in strand 3 of the study, the TechCare App will be examined in a feasibility study with 12 participants. Conclusion: It has been suggested that there is a need for a rapid increase in the efforts to develop the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services globally.
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Wong, William Chi Wai, Lin Song, Christopher See, Stephanie Tze Hei Lau, Wai Han Sun, Kitty Wai Ying Choi, and Joseph Tucker. "Using Crowdsourcing to Develop a Peer-Led Intervention for Safer Dating App Use: Pilot Study." JMIR Formative Research 4, no. 4 (April 21, 2020): e12098. http://dx.doi.org/10.2196/12098.
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Background Smartphone-based dating apps are rapidly transforming how people seek potential sexual and romantic partners. However, they can also increase the risk of unsafe sexual behaviors, harassment, and infringement of personal privacy. Current research on interventions for safer dating app use remains insufficient. Objective The goal of this study was to describe the development of an intervention for safer dating app usage using crowdsourcing and peer-led approaches. Methods This paper describes the development of an intervention program designed to promote safer dating app use among college students. Crowdsourcing and peer-led approaches were adopted during key stages of the development process. Focus group discussions were held to assess the experience and needs of dating app users. A crowdsourcing contest then solicited ideas for performance objectives for the intervention. These objectives were grouped to further identify practical strategies. A one-day intensive workshop was subsequently held with peer mentors to brainstorm ideas for the production of creative interventional materials. The intervention programs were produced and tested in a pilot study. The app’s effectiveness will be evaluated in a cluster randomized controlled trial. Results The intervention program consists of a risk assessment tool, a first-person scenario game, and four short videos. The risk assessment tool, comprised of 14 questions, will give the participant a score to determine their level of risk of adverse events when using dating apps. The scenario game is a first-person simulation game where the players are presented with choices when faced with different scenarios. The short videos each last 2-4 minutes, with points of discussion aimed at addressing the risks of using dating apps. The programs were piloted and were found to be relatable and helpful when further modifications were made. Conclusions Potential challenges identified during the development process included data management and analysis, sustaining peer mentors’ interests and participation, and balancing between providing more information and perpetuating social stigma around dating app use. By integrating new approaches, such as crowdsourcing and the peer-led approach, in developing an intervention for safer dating app use, our development process provides a viable model for developing future interventions to address the risks associated with dating app use.
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Lee, Jisan, and Jeongeun Kim. "Can menstrual health apps selected based on users’ needs change health-related factors? A double-blind randomized controlled trial." Journal of the American Medical Informatics Association 26, no. 7 (April 4, 2019): 655–66. http://dx.doi.org/10.1093/jamia/ocz019.
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Abstract Objective Most healthcare providers are reluctant to use health apps for healthcare because there is no rigorous way of choosing the best app for their patient or consumer. Accordingly, we developed a new method of app selection that fully considers target users’ needs. This study verified whether health apps selected based on target users’ needs can influence health-related factors. Materials and Methods We conducted a randomized control trial of women with dysmenorrhea and premenstrual syndrome using App A (the best app selected using the new method) and App B (the app with the highest number of users worldwide). The intervention was performed over 4 months to include at least 3 menstrual cycles. Results Sixty-one app users completed the 16-week intervention. While users rated both apps as higher in quality than previously used menstrual apps, only App A users showed significant improvements in overall satisfaction, app outcome expectancy, the number of days with records, app social influence, intent to recommend, and the possibility of behavioral or cognitive changes in their symptom management. The number of menus used increased over time. While the app self-efficacy and the number of relief methods did not significantly differ between groups, they still showed an increase in App A users. Conclusions When a menstrual app reflected users’ needs, they recorded their symptoms more often and reported higher app quality, satisfaction, and intention to recommend. This study can not only benefit the selection of menstrual apps, but also confirm that mobile health apps can improve health-related factors.
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Pearson, Nicole, Meghan Finch, Rachel Sutherland, Melanie Kingsland, Luke Wolfenden, Taya Wedesweiler, Vanessa Herrmann, and Sze Lin Yoong. "An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children’s Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial." Journal of Medical Internet Research 24, no. 3 (March 17, 2022): e27760. http://dx.doi.org/10.2196/27760.
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Background Interventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. Objective This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. Methods A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). Conclusions The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379
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Stecher, Chad, Mariah Sullivan, and Jennifer Huberty. "Using Personalized Anchors to Establish Routine Meditation Practice With a Mobile App: Randomized Controlled Trial." JMIR mHealth and uHealth 9, no. 12 (December 22, 2021): e32794. http://dx.doi.org/10.2196/32794.
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Background Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence. Objective The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm. Methods We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength. Results A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2%), female (77/101, 76.2%), and college educated (ie, bachelor’s or graduate degree; 82/101, 81.2%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95% CI 1.02-1.35; P=.007). Conclusions The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine. Trial Registration ClinicalTrials.gov NCT04378530; https://clinicaltrials.gov/ct2/show/NCT04378530
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van der Velde, Miriam, Karin Valkenet, Edwin Geleijn, Marjoke Kruisselbrink, Marije Marsman, Liedewij MJ Janssen, Jelle P. Ruurda, et al. "Usability and Preliminary Effectiveness of a Preoperative mHealth App for People Undergoing Major Surgery: Pilot Randomized Controlled Trial." JMIR mHealth and uHealth 9, no. 1 (January 7, 2021): e23402. http://dx.doi.org/10.2196/23402.
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Background Major surgery is associated with negative postoperative outcomes such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mobile health (mHealth) could be an effective new approach. Objective The objectives of this pilot study were to (1) evaluate the usability of the Be Prepared mHealth app prototype for people undergoing major surgery, (2) explore whether the app was capable of bringing about a change in risk behaviors, and (3) estimate a preliminary effect of the app on functional recovery after major surgery. Methods A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total, 86 people undergoing major surgery participated. Participants in the intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires. Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about the usability of the app were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data. Results Seventy-nine people—40 in the intervention group and 39 in the control group—were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that patients considered the Be Prepared app to have acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app. Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values (β=–2.4 [95% CI –5.9 to 1.1]). Conclusions The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified with which the app and future research can be optimized. Trial Registration Netherlands Trial Registry NL8623; https://www.trialregister.nl/trial/8623
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Sullivan, Patrick Sean, Rob Stephenson, Sabina Hirshfield, Cyra Christina Mehta, Ryan Zahn, Jose A. Bauermeister, Keith Horvath, et al. "Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men." Journal of Medical Internet Research 24, no. 2 (February 2, 2022): e34574. http://dx.doi.org/10.2196/34574.
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Background Gay, bisexual, and other men who have sex with men (GBMSM) face the highest burden of HIV in the United States, and there is a paucity of efficacious mobile health (mHealth) HIV prevention and care interventions tailored specifically for GBMSM. We tested a mobile app combining prevention messages and access to core prevention services for GBMSM. Objective This study aims to measure the efficacy of the Mobile Messaging for Men (M-cubed) app and related services to increase HIV prevention and care behaviors in diverse US GBMSM. Methods We conducted a randomized open-label study with a waitlist control group among GBMSM in 3 groups (low-risk HIV-negative group, high-risk HIV-negative group, and living-with-HIV [LWH] group) recruited online and in venues in Atlanta, Detroit, and New York City. Participants were randomly assigned to receive access to the app immediately or at 9 months after randomization. The app provided prevention messages in 6 domains of sexual health and offered ordering of at-home HIV and sexually transmitted infection test kits, receiving preexposure prophylaxis (PrEP) evaluations and navigation, and service locators. Serostatus- and risk-specific prevention outcomes were evaluated at baseline, at the end of the intervention period, and at 3, 6, and 9 months after the intervention period. Results In total, 1226 GBMSM were enrolled and randomized; of these 611 (49.84%) were assigned to the intervention group and 608 (99.51%) were analyzed, while 615 (50.16%) were assigned to the control group and 612 (99.51%) were analyzed. For high-risk GBMSM, allocation to the intervention arm was associated with higher odds of HIV testing during the intervention period (adjusted odds ratio [aOR] 2.02, 95% CI 1.11-3.66) and with higher odds of using PrEP in the 3 months after the intervention period (aOR 2.41, 95% CI 1.00-5.76, P<.05). No changes in HIV prevention or care were associated with allocation to the intervention arm for the low-risk HIV-negative and LWH groups. Conclusions Access to the M-cubed app was associated with increased HIV testing and PrEP use among high-risk HIV-negative GBMSM in 3 US cities. The app could be made available through funded HIV prevention providers; additional efforts are needed to understand optimal strategies to implement the app outside of the research setting. Trial Registration ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247 International Registered Report Identifier (IRRID) RR2-10.2196/16439
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Krzyzanowski, Michelle C., Paul N. Kizakevich, Vanessa Duren-Winfield, Randall Eckhoff, Joel Hampton, Loneke T. Blackman Carr, Georgia McCauley, et al. "Rams Have Heart, a Mobile App Tracking Activity and Fruit and Vegetable Consumption to Support the Cardiovascular Health of College Students: Development and Usability Study." JMIR mHealth and uHealth 8, no. 8 (August 5, 2020): e15156. http://dx.doi.org/10.2196/15156.
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Background With the increasing use of mobile devices to access the internet and as the main computing system of apps, there is a growing market for mobile health apps to provide self-care advice. Their effectiveness with regard to diet and fitness tracking, for example, needs to be examined. The majority of American adults fail to meet daily recommendations for healthy behavior. Testing user engagement with an app in a controlled environment can provide insight into what is effective and not effective in an app focused on improving diet and exercise. Objective We developed Rams Have Heart, a mobile app, to support a cardiovascular disease (CVD) intervention course. The app tracks healthy behaviors, including fruit and vegetable consumption and physical activity, throughout the day. This paper aimed to present its functionality and evaluated adherence among the African American college student population. Methods We developed the app using the Personal Health Informatics and Intervention Toolkit, a software framework. Rams Have Heart integrates self-reported health screening with health education, diary tracking, and user feedback modules to acquire data and assess progress. The parent study, conducted at a historically black college and university-designated institution in southeastern United States, consisted of a semester-long intervention administered as an academic course in the fall, for 3 consecutive years. Changes were made after the cohort 1 pilot study, so results only include cohorts 2 and 3, comprising a total of 115 students (n=55 intervention participants and n=54 control participants) aged from 17 to 24 years. Data collected over the study period were transferred using the secure Hypertext Transfer Protocol Secure protocol and stored in a secure Structured Query Language server database accessible only to authorized persons. SAS software was used to analyze the overall app usage and the specific results collected. Results Of the 55 students in the intervention group, 27 (49%) students in cohort 2 and 25 (45%) in cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, app participation dropped off gradually until exam week when most students no longer participated. The average fruit and vegetable intake increased slightly, and activity levels decreased over the study period. Conclusions Rams Have Heart was developed to allow daily tracking of fruit and vegetable intake and physical activity to support a CVD risk intervention for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. We conducted an analysis of app usage, function, and user results. Although a mobile app provides privacy and flexibility for user participation in a research study, Rams Have Heart did not improve compliance or user outcomes. Health-oriented research studies relying on apps in support of user goals need further evaluation.