K4Health

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This Digital Health Resource Library houses three legacy collections previously maintained by the Knowledge for Health (K4Health) Project. K4Health’s work was made possible by the support of the American People through the United States Agency for International Development (USAID) . K4Health was supported from 2008-2019 by USAID's Office of Population and Reproductive Health, Bureau for Global Health, under cooperative agreements with the Johns Hopkins University. K4Health was implemented by the Johns Hopkins Center for Communication Programs (CCP) in collaboration with FHI 360, Management Sciences for Health (MSH), and IntraHealth International. The K4Health Project ended in September 2019.

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Telemedicine and prostate cancer survivorship: a narrative review.
(0000-00-00) Agochukwu, Nnenaya Q; Skolarus, Ted A; Wittmann, Daniela
Prostate cancer survivors have unique needs that encompass diagnosis and treatment related side effects The provision of services for prostate cancer survivors is often limited by resources time constraints in traditional clinic visits payment and patient and provider comfort with discussion of sensitive topics including sexual and urinary health both of which are largely impacted by treatment Telemedicine the remote delivery of health care services using telephone mobile web and video platforms allows for potential cost savings in addition to ease and comfort as patients can engage in telemedicine based resources in the comfort of their homes Furthermore survivors prefer to seek information online making telemedicine approaches for prostate cancer survivorship care an ideal combination A majority of the telemedicine based interventions used the web followed by telephone mobile and video platforms In limited studies telemedicine delivery of survivorship care has equal efficacy to traditional care delivery In addition although older patients did not use the Internet regularly they were willing to adapt to Internet usage if it had the potential to increase their quality of life Telemedicine delivery of prostate cancer survivorship care is acceptable feasible cost effective and potentially preferred by prostate cancer survivors Additionally it emphasizes knowledge self management and self monitoring serving to increase self efficacy This specialized care allows for greater access and reaches a wider catchment area compared to traditional clinic visits This is especially important as the number of prostate cancer survivors increases and healthcare systems incorporate alternatives to traditional in person care
Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review.
(0000-00-00) Rivera-Romero, Octavio; Olmo, Alberto; Muñoz, Rocío; Stiefel, Pablo; Miranda, María Luisa; Beltrán, Luis M
BACKGROUND Hypertensive disorders are the most common complications during pregnancy occurring in 5 to 11 of pregnancies gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality especially in low and middle income countries LMIC where maternal and perinatal mortality ratios are still high Pregnant women with hypertensive disorders could greatly benefit from mobile health mHealth solutions as a novel way to identify and control early symptoms as shown in an increasing number of publications in the field Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource poor environments OBJECTIVE The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice METHODS A methodological review following a scoping methodology was conducted Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included categorizing articles in different groups Diagnosis and Monitoring mHealth Decision Support System Education and Health Promotion and seven research questions were posed to study the manuscripts RESULTS The search in electronic research databases yielded 327 articles After removing duplicates 230 articles were selected for screening Finally 11 articles met the inclusion criteria and data were extracted from them Very positive results in the improvement of maternal health and acceptability of solutions were found although most of the studies involved a small number of participants and none were complete clinical studies Accordingly none of the reported prototypes were integrated in the different health care systems Only 4 studies used sensors for physiological measurements and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget of special relevance in LMIC although again no extensive clinical validation has been carried out in these environments CONCLUSIONS mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice Although very positive results have been reported in terms of usability and the improvement of maternal health rigorous complete clinical trials are still necessary to support integration in health care systems There is a clear need for simple mHealth solutions specifically developed for resource poor environments that meet the United Nations Sustainable Development Goal SDG of enormous interest in LMIC
Short version of the Smartphone Addiction Scale in Chinese adults: Psychometric properties, sociodemographic, and health behavioral correlates.
(0000-00-00) Luk, Tzu Tsun; Wang, Man Ping; Shen, Chen; Wan, Alice; Chau, Pui Hing; Oliffe, John; Viswanath, Kasisomayajula; Chan, Sophia Siu-Chee; Lam, Tai Hing
BACKGROUND AND AIMS Problematic smartphone use PSU is an emerging but understudied public health issue Little is known about the epidemiology of PSU at the population level We evaluated the psychometric properties of the Smartphone Addiction Scale Short Version SAS SV and examined its associated sociodemographic factors and health behaviors in Chinese adults in Hong Kong METHODS A random sample of 3 211 adults aged 18 years mean SD 43 3 15 7 45 3 men participated in a population based telephone survey in Hong Kong and completed the Chinese SAS SV Multivariable linear regressions examined the associations of sociodemographic factors health behaviors and chronic disease status with SAS SV score Data were weighted by age sex and education attainment distributions of the Hong Kong general population RESULTS The Chinese SAS SV is internally consistent Cronbach s 844 and stable over 1 week intraclass correlation coefficient 76 p Under 001 Confirmatory factor analysis supported a unidimensional structure established by previous studies The weighted prevalence of PSU was 38 5 95 confidence interval 36 9 40 2 Female sex younger age being married cohabitated or divorced separated vs unmarried and lower education level were associated with a higher SAS SV score all ps Under 05 Current smoking weekly to daily alcohol drinking and physical inactivity predict greater PSU after controlling for sociodemographic factors and mutual adjustment DISCUSSION AND CONCLUSIONS The Chinese SAS SV was found valid and reliable for assessing PSU in Hong Kong adults Several sociodemographic and health behavioral factors were associated with PSU at the population level which may have implication for prevention of PSU and future research
Student Evaluation of Distance Learning for Healthcare Professionals.
(0000-00-00) Monier, Elza Bernardes; Araújo, Denizar Vianna; Oliveira, Ana Emilia F; Baesse, Deborah C L; Pinho, Judith Rafaelle Oliveira; Brasil, Gabrielle V S; Mesquita, Mizraim N
BACKGROUND To meet the population s health needs it is necessary to have health professionals highly trained and updated with the latest skills The Brazilian government through the Open University of Brazilian National Health System UNA SUS offers continuing education with free access in distance learning DL modality OBJECTIVE This study aimed to analyze students perceptions regarding didactic and pedagogical aspects related to the content and activities educational resources and tutoring in a module offered by UNA SUS Federal University of Maranh o UFMA METHODS The authors analyzed a sample of 319 students enrolled in four postgraduate classes who had completed the communicable diseases module from 2013 to 2014 and responded to evaluation questions through the Integrated Management System SIGU questionnaire an auxiliary system for processing and interpreting assessments of DL modules offered by UNA SUS UFMA For statistical analysis evaluation variables were dichotomized into either a positive outcome great and good or a negative outcome bad and insufficient Data were analyzed using Statistical Package for the Social Sciences SPSS version 18 the significance level was set at 5 p Under 0 05 RESULTS The authors observed that 99 of the students evaluated the module positively Regarding the evaluation of the content and activities 53 169 43 6 139 and 3 4 11 of students evaluated the item unit workload as great good and bad respectively The highest rated item was tutor performance rated as great by 229 71 8 students CONCLUSIONS The results contributed to the improvement of DL courses offered by UNA SUS UFMA from the perspectives of controlling dropout rates and the development of public health services offered in Brazil
Electronic Patient-Reported Outcomes: The Time Is Ripe for Integration Into Patient Care and Clinical Research.
(0000-00-00) Schwartzberg, Lee
In the emerging team based approach to delivering cancer care collecting patient reported outcomes PROs provides longitudinal monitoring of treatment adverse effects disease complications functional statuses and psychological states throughout the cancer continuum for all providers to use Electronic systems offer added capabilities including easy quantitation of individual symptom items and aggregated scales standardization and longitudinal tracking of patient surveys for trend analysis over time An ideal electronic PRO ePRO platform is clinically relevant validated and reliable and would offer patient usability Additionally it should allow for automated responses to and from patients have scheduling functionality and send real time alerts to site personnel and patients Clinical interfaces should be easy to read and integrated into the electronic medical record Multiple ePRO systems often using electronic tablets have been created and are beginning to be widely deployed The Patient Care Monitor is one example of a system that has evolved into a comprehensive patient engagement platform with a complete review of systems survey and capabilities for mobile health usage Recent clinical trials have established ePRO systems as an effective method of providing information which aids improved patient outcomes including reduced health resource utilization and longer time on therapy ePROs are also increasingly incorporated into clinical trials where they can provide more thorough reporting of adverse events than can be captured by alternative methods Mobile devices have the potential to become the method by which all members of the provider team communicate with patients both at the point of care and between clinic visits to optimize care delivery
Kardia Mobile applicability in clinical practice: A comparison of Kardia Mobile and standard 12-lead electrocardiogram records in 100 consecutive patients of a tertiary cardiovascular care center.
(0000-00-00) Koltowski, Lukasz; Balsam, Pawel; Glłowczynska, Renata; Rokicki, Jakub K; Peller, Michal; Maksym, Jakub; Blicharz, Leszek; Maciejewski, Kacper; Niedziela, Magdalena; Opolski, Grzegorz; Grabowski, Marcin
BACKGROUND Mobile devices are gaining a rising number of users in all countries around the globe Novel solutions to diagnose patients with out of hospital onset of arrhythmic symptoms can be easily used to record such events but the effectiveness of these devices remain unknown METHODS In a group of 100 consecutive patients of an academic cardiology care center mean age 68 14 2 years males 66 a standard 12 lead electrocardiogram ECG and a Kardia Mobile KM record were registered Both versions were assessed by three independant groups of physicians RESULTS The analysis of comparisons for standard ECG and KM records showed that the latter is of lower quality p Under 0 001 It was non inferior for detection of atrial fibrillation and atrial flutter showed weaker rhythm detection in pacemaker stimulation p 0 008 and was superior in sinus rhythm detection p 0 02 though The sensitivity of KM to detect pathological Q wave was low compared to specificity 20 6 vs 93 7 respectively p Under 0 001 Basic intervals measured by the KM device namely PQ RR and QT were significantly different shorter than those observed in the standard ECG method 160 ms vs 180 ms p Under 0 001 853 ms vs 880 ms p 0 03 and 393 ms vs 400 ms p Under 0 001 respectively CONCLUSIONS Initial and indicative value of atrial fibrillation and atrial flutter detection in KM is comparable to results achieved in standard ECG KM was superior in detection of sinus rhythm than eye ball evaluation of 12 lead ECG Though the PQ and QT intervals were shorter in KM as compared to 12 lead ECG Clinical value needs to be verified in large studies though
Telemedicine: Past, present, and future.
(0000-00-00) Mahar, Jamal H; Rosencrance, James Gregory; Rasmussen, Peter A
Health-related quality of life on tele-monitoring for users with pacemakers 6 months after implant: the NORDLAND study, a randomized trial.
(0000-00-00) López-Villegas, Antonio; Catalán-Matamoros, Daniel; Lopez-Liria, Remedios; Enebakk, Terje; Thunhaug, Hilde; Lappegård, Knut Tore
BACKGROUND With an ageing population and widening indications for pacemakers implantation the number of persons carrying an implant is steadily increasing The routine follow up is thus a heavy burden for the respective NHS as well as for the patients and their relatives Most of them of the studies have been performed in densely populated areas and nearby to the hospital It is thus unknown whether these results could be applied also in rural areas such as Northern Norway with a more scattered population The aim of this study was to assess the effectiveness of tele monitoring TM in patients with pacemakers regarding reliability safety and health related quality of life compared to traditional follow up in outpatient clinic in a setting where geographical effects could possible influence the results METHODS The NORDLAND study is a controlled randomized non masked clinical trial in pacemaker patients with data collection carried out during the pre implant stage and after 6 months Between August of 2014 and November of 2015 50 patients were assigned to either a tele monitoring group n 25 or a conventional hospital monitoring HM group n 25 The EuroQol 5D EQ 5D utilities and visual analogue scale VAS and the Minnesota Living with Heart Failure Questionnaire MLHFQ were used to measure Health Related Quality of Life Baseline characteristics and number of hospital visits were also analyzed RESULTS The baseline characteristics of the two study groups were similar for EQ 5D utilities TM 0 81 HM 0 76 p 0 47 EQ 5D VAS TM 64 00 HM 64 88 p 0 86 and the MLHFQ TM 20 20 HM 28 96 p 0 07 At the 6 month follow up there were no significant differences between the groups in EQ 5D utilities TM 0 81 HM 0 76 p 0 54 and EQ 5D VAS scores TM 72 71 HM 59 79 p 0 08 The MLHFQ score was improved in both groups TM 4 40 HM 15 13 p Under 0 001 The number of in office visits was similar in both groups TM 1 24 vs HM 1 12 P 0 30 CONCLUSIONS The NORDLAND trial shows that HRQoL is improved after implant in both groups Without significant differences with regards to effectiveness and safety In addition provides a scientifically rigorous method to the field of HRQoL evaluations in patients with pacemakers TRIAL REGISTRATION ClinicalTrials gov NCT02237404 September 11 2014
Differences in mobile phone affinity between demographic groups: implications for mobile phone delivered interventions and programs.
(0000-00-00) Sillice, Marie A; Dunsiger, Shira; Jennings, Ernestine; Lantini, Ryan; Bock, Beth C
Background The impact of any intervention or program delivered through mobile phones mHealth may be influenced by the individual recipient s relationship with his or her mobile phone However few studies have assessed the attitudes and preferences of different demographic groups with respect to mobile phone use This study assessed whether individuals demographic characteristics primary demographics PD race ethnicity gender and age are influential factors in attitudes and behaviors associated with mobile use pattern using the Mobile Phone Affinity Scale MPAS The MPAS examines six underlying constructs associated with mobile phone use Connectedness Productivity Empowerment Anxious Attachment Addiction and Continuous Use Methods U S adults n 1 055 mean age 32 5 years 10 Hispanic 86 3 white completed the MPAS and provided information about PD e g race ethnicity age and social demographic SocD characteristics e g having children employment Chi square analyses and multivariate analyses were used to assess the relationships among the PD and SocD variables and MPAS constructs Results Significant differences were found between PD and SocD variables all PUnder0 01 Specifically whites were more likely than non whites to be married and to be living with children while non Hispanics tended to report higher household income and education than Hispanics Women were more likely to report living with children and less likely to have full time employment than men all PUnder0 01 There was a significant effect of PD characteristics on MPAS constructs in that whites and women tended to score higher on some MPAS constructs than non whites and men all PUnder0 01 Similarly some SocD characteristics including employment status and living with children were differentially associated with some MPAS constructs all PUnder0 01 Conclusions Results indicate that there are differences in attitudes and use preferences to mobile phone use based on some of the primary and SocD demographic characteristics These findings provide important insights into mHealth intervention components that will increase appeal to different subgroups
Has the time come for self-management of blood pressure and antihypertensive medications by patients?
(0000-00-00) Omboni, Stefano
Experiences of patients with stroke and their caregivers with caregiver-mediated exercises during the CARE4STROKE trial.
(0000-00-00) Vloothuis, Judith; Depla, Marja; Hertogh, Cees; Kwakkel, Gert; van Wegen, Erwin
PURPOSE Caregiver mediated exercises are a novel way of delivering augmented exercise therapy for patients with stroke in which patients do additional therapeutic exercises together with a caregiver This explorative qualitative study is part of the CARE4STROKE trial and focused on how participants manage these exercises together The research questions were 1 how do the patient caregiver couples exercise together and 2 what does exercising together bring about besides more hours of practice METHODS Semi structured interviews were conducted with patients and caregivers who participated in the CARE4STROKE intervention Inductive thematic data analysis was applied RESULTS Seven patients and seven caregivers were interviewed Three different role dynamics were found during caregiver mediated exercises 1 patient in control 2 in concert and 3 the caregiver as informal carer In addition three themes were identified about what exercising together brings about a tailor made exercises through active involvement b preparation for the home situation and c opportunity to be involved CONCLUSION Different role dynamics are at play in caregiver mediated exercises and it is important for participating staff to be aware of their possible effects on the strain of patient or caregiver Caregiver mediated exercises were found to enhance individualization of the treatment plan and preparation for home discharge Implications for rehabilitation Caregiver mediated exercises in which a caregiver does exercises with a patient are currently under investigation as a new form of augmented exercise delivery after stroke Doing exercises together seems to make patient and caregivers actively involved in rehabilitation which they appreciate and which seems to help them prepare for the home situation Caregiver selection and monitoring role dynamics during exercising is an important task of the rehabilitation team
User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews.
(0000-00-00) Stawarz, Katarzyna; Preist, Chris; Tallon, Debbie; Wiles, Nicola; Coyle, David
BACKGROUND Hundreds of mental health apps are available to the general public With increasing pressures on health care systems they offer a potential way for people to support their mental health and well being However although many are highly rated by users few are evidence based Equally our understanding of what makes apps engaging and valuable to users is limited OBJECTIVE The aim of this paper was to analyze functionality and user opinions of mobile apps purporting to support cognitive behavioral therapy for depression and to explore key factors that have an impact on user experience and support engagement METHODS We systematically identified apps described as being based on cognitive behavioral therapy for depression We then conducted 2 studies In the first we analyzed the therapeutic functionality of apps This corroborated existing work on apps fidelity to cognitive behavioral therapy theory but we also extended prior work by examining features designed to support user engagement Engagement features found in cognitive behavioral therapy apps for depression were compared with those found in a larger group of apps that support mental well being in a more general sense Our second study involved a more detailed examination of user experience through a thematic analysis of publicly available user reviews of cognitive behavioral therapy apps for depression RESULTS We identified 31 apps that purport to be based on cognitive behavioral therapy for depression Functionality analysis study 1 showed that they offered an eclectic mix of features including many not based on cognitive behavioral therapy practice Cognitive behavioral therapy apps used less varied engagement features compared with 253 other mental well being apps The analysis of 1287 user reviews of cognitive behavioral therapy apps for depression study 2 showed that apps are used in a wide range of contexts both replacing and augmenting therapy and allowing users to play an active role in supporting their mental health and well being Users including health professionals valued and used apps that incorporated both core cognitive behavioral therapy and non cognitive behavioral therapy elements but concerns were also expressed regarding the unsupervised use of apps Positivity was seen as important to engagement for example in the context of automatic thoughts users expressed a preference to capture not just negative but also positive ones Privacy security and trust were crucial to the user experience CONCLUSIONS Cognitive behavioral therapy apps for depression need to improve with respect to incorporating evidence based cognitive behavioral therapy elements Equally a positive user experience is dependent on other design factors including consideration of varying contexts of use App designers should be able to clearly identify the therapeutic basis of their apps but they should also draw on evidence based strategies to support a positive and engaging user experience The most effective apps are likely to strike a balance between evidence based cognitive behavioral therapy strategies and evidence based design strategies including the possibility of eclectic therapeutic techniques
Cost Analysis of a Store and Forward Teledermatology Consult System in Philadelphia.
(0000-00-00) Yang, Xiaoshi; Barbieri, John S; Kovarik, Carrie L
BACKGROUND Store and forward SAF teledermatology TD has the potential to increase access to timely high quality care for underserved populations However the cost effectiveness of TD for underserved populations is uncertain OBJECTIVE This study evaluates the potential cost savings associated with a SAF TD program implemented for an underserved population in the city health clinics of urban Philadelphia METHODS We performed a retrospective analysis of SAF TD consultations for 700 outpatients managed in 12 Philadelphia primary care clinics Primary care providers PCPs were asked to specify a treatment plan as well as the type of care for the patient in the absence of the TD service Analysis compared cost of each patient case using the TD consult model versus conventional care RESULTS Twenty seven percent 189 700 of in person dermatology clinic visits and 3 29 23 700 of emergency room ER visits were avoided using TD Compared to conventional care mean expected cost savings were 10 00 52 65 per TD consult In sensitivity analyses these estimated savings remained positive across a range of parameters LIMITATIONS The cost analysis relies on several assumptions regarding the cost of care and indirect costs were not included CONCLUSION Teledermatology can be a cost saving model while increasing access to dermatologic care
Barriers to and Facilitators of Engagement With Remote Measurement Technology for Managing Health: Systematic Review and Content Analysis of Findings.
(0000-00-00) Simblett, Sara; Greer, Ben; Matcham, Faith; Curtis, Hannah; Polhemus, Ashley; Ferrão, José; Gamble, Peter; Wykes, Til
BACKGROUND Remote measurement technology refers to the use of mobile health technology to track and measure change in health status in real time as part of a person s everyday life With accurate measurement remote measurement technology offers the opportunity to augment health care by providing personalized precise and preemptive interventions that support insight into patterns of health related behavior and self management However for successful implementation users need to be engaged in its use OBJECTIVE Our objective was to systematically review the literature to update and extend the understanding of the key barriers to and facilitators of engagement with and use of remote measurement technology to guide the development of future remote measurement technology resources METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines involving original studies dating back to the last systematic review published in 2014 We included studies if they met the following entry criteria population people using remote measurement technology approaches to aid management of health intervention remote measurement technology system comparison group no comparison group specified outcomes qualitative or quantitative evaluation of the barriers to and facilitators of engagement with this system and study design randomized controlled trials feasibility studies and observational studies We searched 5 databases MEDLINE IEEE Xplore EMBASE Web of Science and the Cochrane Library for articles published from January 2014 to May 2017 Articles were independently screened by 2 researchers We extracted study characteristics and conducted a content analysis to define emerging themes to synthesize findings Formal quality assessments were performed to address risk of bias RESULTS A total of 33 studies met inclusion criteria employing quantitative qualitative or mixed methods designs Studies were conducted in 10 countries included male and female participants with ages ranging from 8 to 95 years and included both active and passive remote monitoring systems for a diverse range of physical and mental health conditions However they were relatively short and had small sample sizes and reporting of usage statistics was inconsistent Acceptability of remote measurement technology according to the average percentage of time used 64 86 5 and dropout rates 0 44 was variable The barriers and facilitators from the content analysis related to health status perceived utility and value motivation convenience and accessibility and usability CONCLUSIONS The results of this review highlight gaps in the design of studies trialing remote measurement technology including the use of quantitative assessment of usage and acceptability Several processes that could facilitate engagement with this technology have been identified and may drive the development of more person focused remote measurement technology However these factors need further testing through carefully designed experimental studies TRIAL REGISTRATION International Prospective Register of Systematic Reviews PROSPERO CRD42017060644 https www crd york ac uk PROSPERO display record php RecordID 60644 Archived by WebCite at http www webcitation org 70K4mThTr
Examining Predictors of Real-World User Engagement with Self-Guided eHealth Interventions: Analysis of Mobile Apps and Websites Using a Novel Dataset.
(0000-00-00) Baumel, Amit; Kane, John M
BACKGROUND The literature suggests that the product design of self guided electronic health eHealth interventions impacts user engagement Traditional trial settings however do not enable the examination of these relationships in real world use OBJECTIVE This study aimed to examine whether the qualities of product design research evidence and publicly available data predict real world user engagement with mobile and Web based self guided eHealth interventions METHODS This analysis included self guided mobile and Web based eHealth interventions available to the public with their qualities assessed using the Enlight suite of scales Scales included Usability Visual Design User Engagement Content Therapeutic Persuasiveness Therapeutic Alliance Credibility and Research Evidence Behavioral data on real world usage were obtained from a panel that provides aggregated nonpersonal information on user engagement with websites and mobile apps based on a time window of 18 months that was set between November 1 2016 and April 30 2018 Real world user engagement variables included average usage time for both mobile apps and websites and mobile app user retention 30 days after download RESULTS The analysis included 52 mobile apps downloads median 38 600 interquartile range IQR 116 000 and 32 websites monthly unique visitors median 5689 IQR 30 038 Results point to moderate correlations between Therapeutic Persuasiveness Therapeutic Alliance and the 3 user engagement variables 31 rs 51 Ps 03 Visual Design User Engagement and Content demonstrated similar degrees of correlation with mobile app engagement variables 25 rs 49 Ps 04 but not with average usage time of Web based interventions Positive correlations were also found between the number of reviews on Google Play and average app usage time r 58 PUnder 001 and user retention after 30 days r 23 P 049 Although several product quality ratings were positively correlated with research evidence the latter was not significantly correlated with real world user engagement Hierarchical stepwise regression analysis revealed that either Therapeutic Persuasiveness or Therapeutic Alliance explained 15 to 26 of user engagement variance Data on Google Play number of reviews explained 15 of the variance of mobile app usage time above Enlight ratings however publicly available data did not significantly contribute to explaining the variance of the other 2 user engagement variables CONCLUSIONS Results indicate that the qualities of product design predict real world user engagement with eHealth interventions The use of real world behavioral datasets is a novel way to learn about user behaviors creating new avenues for eHealth intervention research
Prescribing an App? Oncology Providers' Views on Mobile Health Apps for Cancer Care.
(0000-00-00) Berkowitz, Callie M; Zullig, Leah L; Koontz, Bridget F; Smith, Sophia K
INTRODUCTION Although there are over 500 mobile health mHealth applications apps available for download in the field of oncology little research has addressed their acceptability among health care providers In addition the providers perspectives regarding patient app use has been largely unexamined We conducted a qualitative study to explore opportunities and barriers for mHealth app use for oncology care METHODS We developed a structured interview guide focusing on acceptability appropriateness feasibility and sustainability of the use of apps in cancer care We interviewed 15 oncology providers about their attitudes and preferences De identified audio recordings were transcribed and coded for emerging themes RESULTS Providers interviewed included physicians n 8 and advanced practice n 3 and supportive services n 4 providers who care for a wide range of cancer types ages ranged from 32 to 68 years Interviews lasted approximately 30 minutes Oncology providers reported limited exposure to mHealth apps in patient care but were generally open to recommending or prescribing apps in the future Key themes included opportunities for mobile app use including general health promotion tracking symptoms and engaging patients and barriers to implementation including access to technology responsibility workflow and the source of the app itself CONCLUSION Our results show openness among oncology providers to using mHealth technology as part of patient care but concerns regarding implementation Designing acceptable apps may be challenging and require involvement of key stakeholders partnering with trustworthy institutions and outcome based research
Video-based CBT-E improves eating patterns in obese patients with eating disorder: A single case multiple baseline study.
(0000-00-00) Abrahamsson, N; Ahlund, L; Ahrin, E; Alfonsson, S
BACKGROUND AND OBJECTIVES Cognitive Behavioral Therapy CBT is effective for treating eating disorders but it may be difficult to reach patients living far from urban centers Mobile video based psychotherapy may potentially improve service reach but has not yet been evaluated The purpose of this study was to investigate the effects of mobile video based CBT for eating disorder and to explore the feasibility to use this technology in clinical care METHODS A controlled single case multiple baseline design was used which allowed for statistical analyses with randomization tests and non overlap of all pairs NAP Five patients in the first stage of eating disorder treatment were included and the main outcome variable was daily meal frequency Secondary outcome variables included eating disorder symptoms psychological distress and treatment satisfaction RESULTS The treatment resulted in a significant p Under 01 increase in daily meal frequency with medium to large effect sizes combined NAP 89 Four participants reported reliable improvements in eating disorder symptoms and three reported improvements in mood The participants reported high satisfaction with the treatment and with the mobile video application despite some technical problems LIMITATIONS Self reported data on eating behavior is prone to be biased and the results of single case studies may have limited generalizability CONCLUSION CBT can be delivered effectively via a mobile video application and despite some technological issues can be well received by patients All participants in this study had previous low access to mental health services and reported high satisfaction with the treatment format
Factors Affecting User Acceptance in Overuse of Smartphones in Mobile Health Services: An Empirical Study Testing a Modified Integrated Model in South Korea.
(0000-00-00) Lee, Seo-Joon; Choi, Mun Joo; Rho, Mi Jung; Kim, Dai-Jin; Choi, In Young
Smartphones have become crucial in people s everyday lives including in the medical field However as people become close to their smartphones this leads easily to overuse Overuse leads to fatigue due to lack of sleep depressive symptoms and social relationship failure and in the case of adolescents it hinders academic achievement Self control solutions are needed and effective tools can be developed through behavioral analysis Therefore the aim of this study was to investigate the determinants of users intentions to use m Health for smartphone overuse interventions A research model was based on TAM and UTAUT which were modified to be applied to the case of smartphone overuse The studied population consisted of 400 randomly selected smartphone users aged from 19 to 60 years in South Korea Structural equation modeling was conducted between variables to test the hypotheses using a 95 confidence interval Perceived ease of use had a very strong direct positive association with perceived usefulness and perceived usefulness had a very strong direct positive association with behavioral intention to use Resistance to change had a direct positive association with behavioral intention to use and lastly social norm had a very strong direct positive association with behavioral intention to use The findings that perceived ease of use influenced perceived usefulness that perceived usefulness influenced behavioral intention to use and social norm influenced behavioral intention to use were in accordance with prior related research Other results that were not consistent with previous research imply that these are unique behavioral findings regarding smartphone overuse This research identifies the critical factors that need to be considered when implementing systems or solutions in the future for tackling the issue of smartphone overuse
An addiction-based mobile health weight loss intervention: protocol of a randomized controlled trial.
(0000-00-00) Vidmar, Alaina P; Salvy, Sarah J; Pretlow, Robert; Mittelman, Steven D; Wee, Choo Phei; Fink, Cassandra; Steven Fox, D; Raymond, Jennifer K
BACKGROUND The notion of obesity as an addictive process is controversial However studies show that between 5 9 and 30 7 of adolescents with obesity report food or eating addiction Few weight management interventions have tested techniques based on addiction medicine principles METHODS This multi center randomized control trial RCT is designed to test the effectiveness of a mobile health mHealth weight loss intervention based on addiction principles such as withdrawal and tolerance in a sample of 180 adolescents ages 14 18 recruited from four pediatric weight management clinics in Southern California Akin to a Multiphase Optimization Strategy MOST design evaluating multicomponent behavioral interventions we will compare the combination of an app phone coaching App Coach to app alone App and in clinic multi disciplinary Clinic intervention arms The primary outcome is mean change in zBMI and BMIp95 over 18 months We hypothesize that youth who receive App Coach will have a greater reduction in body weight over the 18 month study period at a lower cost than standard of care models Secondary outcomes include adherence to treatment regimen intervention satisfaction effect of the intervention on metabolic factors and activity level We will also explore potential moderators of intervention effectiveness such as addictive eating habits self regulation and executive functioning CONCLUSIONS New and creative approaches are needed to address pediatric obesity If successful this RCT may provide an innovative and cost effective mHealth approach based on addiction methods for weight loss among adolescents with overweight and obesity
Patient-perceived acceptability of a virtual world-based cardiac rehabilitation program.
(0000-00-00) Brewer, LaPrincess C; Kaihoi, Brian; Schaepe, Karen; Zarling, Kathleen; Squires, Ray W; Thomas, Randal J; Kopecky, Stephen
Background Despite its benefits cardiac rehabilitation CR participation rates remain subpar Telehealth lifestyle interventions have emerged as modalities to enhance CR accessibility Virtual world VW technology may provide a means to increase CR use Objectives This pilot study assessed the feasibility and acceptability of a VW based CR program as an extension to medical center based CR Our goal is to apply the study results toward the design of a patient centered VW platform prototype with high usability understandability and credibility Methods Patients n 8 25 women recently enrolled in outpatient CR at Mayo Clinic Rochester Minnesota participated in a 12 week VW health education program and provided feedback on the usability design and satisfaction of the intervention at baseline and completion A mixed methods approach was used to analyze the participant perceptions of the intervention Results Overall there were positive participant perceptions of the VW experience There was unanimous high satisfaction with the graphical interface appearance and ease of use Participants placed value on the convenience accessibility and social connectivity of the remote program as well as the novelty of the simulation platform presentations which aided in memorability of key concepts Greater than 80 of participants reported that the program improved their health knowledge and helped to maintain better health habits Conclusions Our pilot study revealed the feasibility and acceptability of an innovative VW based CR program among cardiac patients This novel delivery method for CR has the potential to influence healthy lifestyle change and to increase accessibility to vulnerable populations with higher cardiovascular disease burdens

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