This article provides a critical overview and best-evidence synthesis of the use of mobile health (mHealth) technology among persons with chronic pain and their health care providers and examines the ...future benefits and barriers of implementing mHealth technology in clinical care. We critically review articles about electronic pain diaries, pain assessment programs, text messaging, and smartphone pain apps for management of persons with pain. Also presented are findings on the utility of activity trackers and use of telehealth to deliver cognitive behavioral therapy. Finally, barriers, study gaps, and future challenges of incorporating mobile technology for chronic pain are discussed. Although the future of mHealth technology and telemedicine in clinical practice is promising, this critical review highlights the need for rigorous studies to establish an association of the use of mHealth technology with improved quality of life, functional autonomy, and decreased hospital use.
Pain is the most common and distressing symptom for patients in all clinical settings. The dearth of health informatics tools to support acute and chronic pain management may be contributing to the ...chronic pain and opioid abuse crises. The purpose of this study is to qualitatively evaluate the content and functionality of mobile pain management apps.
The Apple App Store and the Google Play Store were searched to identify pain management apps. The inclusion criteria were as follows: (1) that apps include a pain diary function allowing users to record pain episodes, (2) are available in either Apple App Store or Google Play Store, and (3) are available in the English language. We excluded apps if they were limited to only specific forms of pain or specific diseases.
A total of 36 apps met the inclusion criteria. Most of the apps served as pain diary tools to record the key characteristics of pain. The pain diary features of the apps were grouped into nine categories: the recordings of pain intensity, pain location, pain quality, pain's impacts on daily life, other features of pain, other related symptoms, medication, patients' habits and basic information, and other miscellaneous functions. The apps displayed various problems in use. The problem of not involving healthcare professionals in app development has not been resolved. Approximately 31% of apps including a pain diary function engaged clinicians in app development. Only 19% involved end-users in development and then only in an ad-hoc way. Only one third of the apps supported the cross-platforms, none of the apps supported clinician access to graphical pain data visualization, none secured HIPAA compliance, and none endorsed the PEG tool for primary care physicians' chronic pain management.
Most of the 36 pain management apps demonstrated various problems including user interface and security. Many apps lacked clinician and end-user involvement in app development impacting the clinical utility of these apps. We could not find any pain apps suitable for clinical usage despite high demand from clinicians due to the US opioid crisis.
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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.
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.
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.
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.
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.
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Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, ...risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction.
The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction.
This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care.
A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group.
The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction.
ClinicalTrials.gov NCT02914301; https://clinicaltrials.gov/ct2/show/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517).
In Search of a Few Good Apps Powell, Adam C; Landman, Adam B; Bates, David W
JAMA : the journal of the American Medical Association,
05/2014, Volume:
311, Issue:
18
Journal Article
Peer reviewed
The article reports that mHealth apps are mobile device applications intended to improve health outcomes, deliver health care services, or enable health research. These apps can be used to ...inexpensively promote wellness and manage chronic diseases; their appeal has increased with health reform and the increasing focus on value. The number of apps has increased substantially
Mobile health (mHealth) apps can be prescribed as an effective self-management tool for patients. However, it is challenging for doctors to navigate 350,000 mHealth apps to find the right ones to ...recommend. Although medical professionals from many countries are using mHealth apps to varying degrees, current mHealth app use by Australian general practitioners (GPs) and the barriers and facilitators they encounter when integrating mHealth apps in their clinical practice have not been reported comprehensively.
The objectives of this study were to (1) evaluate current knowledge and use of mHealth apps by GPs in Australia, (2) determine the barriers and facilitators to their use of mHealth apps in consultations, and (3) explore potential solutions to the barriers.
We helped the Royal Australian College of General Practitioners (RACGP) to expand the mHealth section of their annual technology survey for 2017 based on the findings of our semistructured interviews with GPs to further explore barriers to using mHealth apps in clinical practice. The survey was distributed to the RACGP members nationwide between October 26 and December 3, 2017 using Qualtrics Web-based survey tool.
A total of 1014 RACGP members responded (response rate 4.6% 1014/21,884, completion rate 61.2% 621/1014). The median years practiced was 20.7 years. Two-thirds of the GPs used apps professionally in the forms of medical calculators and point-of-care references. A little over half of the GPs recommended apps for patients either daily (12.9%, 80/621), weekly (25.9%, 161/621), or monthly (13.4%, 83/621). Mindfulness and mental health apps were recommended most often (32.5%, 337/1036), followed by diet and nutrition (13.9%, 144/1036), exercise and fitness (12.7%, 132/1036), and women's health (10%, 104/1036) related apps. Knowledge and usage of evidence-based apps from the Handbook of Non-Drug Interventions were low. The prevailing barriers to app prescription were the lack of knowledge of effective apps (59.9%, 372/621) and the lack of trustworthy source to access them (15.5%, 96/621). GPs expressed their need for a list of safe and effective apps from a trustworthy source, such as the RACGP, to overcome these barriers. They reported a preference for online video training material or webinar to learn more about mHealth apps.
Most GPs are using apps professionally but recommending apps to patients sparingly. The main barriers to app prescription were the lack of knowledge of effective apps and the lack of trustworthy source to access them. A curated compilation of effective mHealth apps or an app library specifically aimed at GPs and health professionals would help solve both barriers.
Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, ...improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded.
The aim of this paper is to reach a better understanding of people's perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools.
A systematic review was carried out on qualitative studies published in English, on patients' perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method.
A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients' point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools.
Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information.
Background
Reducing the transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a global priority. Contact tracing identifies people who were recently in contact with an ...infected individual, in order to isolate them and reduce further transmission. Digital technology could be implemented to augment and accelerate manual contact tracing. Digital tools for contact tracing may be grouped into three areas: 1) outbreak response; 2) proximity tracing; and 3) symptom tracking. We conducted a rapid review on the effectiveness of digital solutions to contact tracing during infectious disease outbreaks.
Objectives
To assess the benefits, harms, and acceptability of personal digital contact tracing solutions for identifying contacts of an identified positive case of an infectious disease.
Search methods
An information specialist searched the literature from 1 January 2000 to 5 May 2020 in CENTRAL, MEDLINE, and Embase. Additionally, we screened the Cochrane COVID‐19 Study Register.
Selection criteria
We included randomised controlled trials (RCTs), cluster‐RCTs, quasi‐RCTs, cohort studies, cross‐sectional studies and modelling studies, in general populations. We preferentially included studies of contact tracing during infectious disease outbreaks (including COVID‐19, Ebola, tuberculosis, severe acute respiratory syndrome virus, and Middle East respiratory syndrome) as direct evidence, but considered comparative studies of contact tracing outside an outbreak as indirect evidence.
The digital solutions varied but typically included software (or firmware) for users to install on their devices or to be uploaded to devices provided by governments or third parties. Control measures included traditional or manual contact tracing, self‐reported diaries and surveys, interviews, other standard methods for determining close contacts, and other technologies compared to digital solutions (e.g. electronic medical records).
Data collection and analysis
Two review authors independently screened records and all potentially relevant full‐text publications. One review author extracted data for 50% of the included studies, another extracted data for the remaining 50%; the second review author checked all the extracted data. One review author assessed quality of included studies and a second checked the assessments. Our outcomes were identification of secondary cases and close contacts, time to complete contact tracing, acceptability and accessibility issues, privacy and safety concerns, and any other ethical issue identified. Though modelling studies will predict estimates of the effects of different contact tracing solutions on outcomes of interest, cohort studies provide empirically measured estimates of the effects of different contact tracing solutions on outcomes of interest. We used GRADE‐CERQual to describe certainty of evidence from qualitative data and GRADE for modelling and cohort studies.
Main results
We identified six cohort studies reporting quantitative data and six modelling studies reporting simulations of digital solutions for contact tracing. Two cohort studies also provided qualitative data. Three cohort studies looked at contact tracing during an outbreak, whilst three emulated an outbreak in non‐outbreak settings (schools). Of the six modelling studies, four evaluated digital solutions for contact tracing in simulated COVID‐19 scenarios, while two simulated close contacts in non‐specific outbreak settings.
Modelling studies
Two modelling studies provided low‐certainty evidence of a reduction in secondary cases using digital contact tracing (measured as average number of secondary cases per index case ‐ effective reproductive number (R eff)). One study estimated an 18% reduction in R eff with digital contact tracing compared to self‐isolation alone, and a 35% reduction with manual contact‐tracing. Another found a reduction in R eff for digital contact tracing compared to self‐isolation alone (26% reduction) and a reduction in R eff for manual contact tracing compared to self‐isolation alone (53% reduction). However, the certainty of evidence was reduced by unclear specifications of their models, and assumptions about the effectiveness of manual contact tracing (assumed 95% to 100% of contacts traced), and the proportion of the population who would have the app (53%).
Cohort studies
Two cohort studies provided very low‐certainty evidence of a benefit of digital over manual contact tracing. During an Ebola outbreak, contact tracers using an app found twice as many close contacts per case on average than those using paper forms. Similarly, after a pertussis outbreak in a US hospital, researchers found that radio‐frequency identification identified 45 close contacts but searches of electronic medical records found 13. The certainty of evidence was reduced by concerns about imprecision, and serious risk of bias due to the inability of contact tracing study designs to identify the true number of close contacts.
One cohort study provided very low‐certainty evidence that an app could reduce the time to complete a set of close contacts. The certainty of evidence for this outcome was affected by imprecision and serious risk of bias. Contact tracing teams reported that digital data entry and management systems were faster to use than paper systems and possibly less prone to data loss.
Two studies from lower‐ or middle‐income countries, reported that contact tracing teams found digital systems simpler to use and generally preferred them over paper systems; they saved personnel time, reportedly improved accuracy with large data sets, and were easier to transport compared with paper forms. However, personnel faced increased costs and internet access problems with digital compared to paper systems.
Devices in the cohort studies appeared to have privacy from contacts regarding the exposed or diagnosed users. However, there were risks of privacy breaches from snoopers if linkage attacks occurred, particularly for wearable devices.
Authors' conclusions
The effectiveness of digital solutions is largely unproven as there are very few published data in real‐world outbreak settings. Modelling studies provide low‐certainty evidence of a reduction in secondary cases if digital contact tracing is used together with other public health measures such as self‐isolation. Cohort studies provide very low‐certainty evidence that digital contact tracing may produce more reliable counts of contacts and reduce time to complete contact tracing. Digital solutions may have equity implications for at‐risk populations with poor internet access and poor access to digital technology.
Stronger primary research on the effectiveness of contact tracing technologies is needed, including research into use of digital solutions in conjunction with manual systems, as digital solutions are unlikely to be used alone in real‐world settings. Future studies should consider access to and acceptability of digital solutions, and the resultant impact on equity. Studies should also make acceptability and uptake a primary research question, as privacy concerns can prevent uptake and effectiveness of these technologies.
Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health ...professionals remain relatively low.
This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists.
To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web.
The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol.
In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice.
Summary
Background
There are thousands of medical applications for mobile devices targeting use by healthcare professionals. However, several factors related to the structure of the existing market ...for medical applications create significant barriers preventing practitioners from effectively identifying mobile medical applications for individual professional use.
Aims
To define existing market factors relevant to selection of medical applications and describe a framework to empower clinicians to identify, assess and utilise mobile medical applications in their own practice.
Materials and Methods
Resources available on the Internet regarding mobile medical applications, guidelines and published research on mobile medical applications.
Results
Mobile application stores (e.g. iTunes, Google Play) are not effective means of identifying mobile medical applications. Users of mobile devices that desire to implement mobile medical applications into practice need to carefully assess individual applications prior to utilisation.
Discussion
Searching and identifying mobile medical applications requires clinicians to utilise multiple references to determine what application is best for their individual practice methods. This can be done with a cursory exploration of mobile application stores and then moving onto other available resources published in the literature or through Internet resources (e.g. blogs, medical websites, social media). Clinicians must also take steps to ensure that an identified mobile application can be integrated into practice after carefully reviewing it themselves.
Conclusion
Clinicians seeking to identify mobile medical application for use in their individual practice should use a combination of app stores, published literature, web‐based resources, and personal review to ensure safe and appropriate use.
Linked Comment: Citrome and Karagianis. Int J Clin Pract 2014; 68: 141–2.
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