Mobile Health Applications and Medication Adherence of Patients With Hypertension: A Systematic Review and Meta-Analysis.

INTRODUCTION: Current evidence has revealed the beneficial effects of mobile health applications on systolic and diastolic blood pressure. However, there is still no solid evidence of the underlying factors for these outcomes, and hypertension treatment is performed mainly by medication intake. This study aims to analyze the impacts of health applications on medication adherence of patients with hypertension and understand the underlying factors. METHODS: A systematic review and meta-analysis were conducted considering controlled clinical trials published, without year filter, through July 2020. The searches were performed in the electronic databases of Scopus, MEDLINE, and BVSalud. Study characteristics were extracted for qualitative synthesis. The meta-analysis examined medication-taking behavior outcomes using the generic inverse-variance method to combine multiple variables. RESULTS: A total of 1,199 records were identified, of which 10 studies met the inclusion criteria for qualitative synthesis, and 9 met the criteria for meta-analysis with 1,495 participants. The analysis of mean changes revealed significant improvements in medication adherence (standardized mean difference=0.41, 95% CI=0.02, 0.79, I2=82%, p=0.04) as well as the analysis of the values measured after follow-up (standardized mean difference=0.60, 95% CI=0.30, 0.90, I2=77%, p<0.0001). Ancillary improvements were also identified, such as patients' perceived confidence, treatment self-efficacy and self-monitoring, acceptance of technology, and knowledge about the condition and how to deal with health issues. DISCUSSION: There is evidence that mobile health applications can improve medication adherence in patients with hypertension, with broad heterogeneity between studies on the topic. The use of mobile health applications conceivably leads to ancillary improvements inherent to better medication adherence.

Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study.

BACKGROUND: Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. OBJECTIVE: We aim to evaluate the effects of kinesiotherapy with exergaming on older women's epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. METHODS: We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. RESULTS: The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. CONCLUSIONS: Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. TRIAL REGISTRATION: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32729.

Using a mobile health app to improve patients' adherence to hypertension treatment: a non-randomized clinical trial.

Poor adherence to hypertension treatment increases complications of the disease and is characterized by a lack of awareness and acceptance of ongoing treatment. Mobile health (mHealth) apps can optimize processes and facilitate access to health information by combining treatment methods with attractive solutions. In this study, we aimed at verifying the influence of using an mHealth app on patients' adherence to hypertension treatment, also examining how user experience toward the app influenced the outcomes. A total of 49 participants completed the study, men and women, diagnosed with hypertension and ongoing medical treatment. For 12 weeks, the control group continued with conventional monitoring, while the experimental group used an mHealth app. From the experimental group, at baseline, 8% were non-adherent, 64% were partial adherents and 28% were adherent to the treatment. Baseline in the control group indicated 4.2% non-adherents, 58.3% partial adherents, and 37.5% adherents. After follow-up, the experimental group had an increase to 92% adherent, 8% partially adherent, and 0% non-adherent (P < 0.001). In the control group, adherence after follow-up remained virtually the same (P ≥ 0.999). Results of user experience were substantially positive and indicate that the participants in the experimental group had a satisfactory perception of the app. In conclusion, this study suggests that using an mHealth app can empower patients to manage their own health and increase adherence to hypertension treatment, especially when the app provides a positive user experience.

A Bowling Exergame to Improve Functional Capacity in Older Adults: Co-Design, Development, and Testing to Compare the Progress of Playing Alone Versus Playing With Peers.

BACKGROUND: Older people often do not meet the recommended levels of exercise required to reduce functional decline. Social interaction is mentioned by this cohort as a reason for joining group-based exercises, which does not occur when exercising alone. This perspective shows that exergames can be used as motivational resources. However, most available exergames are generic, obtained from commercial sources, and usually not specifically designed or adapted for older people. OBJECTIVE: In this study, we aim to co-design and develop a new exergame alongside older participants to (1) tailor the game mechanics and optimize participants' adherence to and enjoyment of exercise; (2) test the participants' functional capacity, motivation, and adherence to the exergaming program; and (3) compare these scores between those who played alone and those who played with peers. METHODS: We conducted a co-design process to develop a new exergame adapted to older people. For user testing, 23 participants were divided into 2 groups to play individually (alone group) or to compete in pairs (with peers group). They played the game twice a week, resulting in 21 exergaming sessions. We assessed the participants' General Physical Fitness Index (GPFI) before and after the user testing. We also administered questionnaires about the gaming experience and exercise adherence with its motivators and barriers. RESULTS: We introduced a new bowling exergame for Xbox with a Kinect motion sensor that can be played in single or multiplayer mode. For the GPFI measurements, the sample was homogeneous in the pretest (with peers group: mean 40.5 [SD 9.6], alone group: mean 33.9 [SD 7.8]; P=.11). After the exergame testing sessions, both groups had significant gains (with peers group: mean 57.5 [SD 8.7], P=.005; alone group: mean 44.7 [SD 10.6]; P=.02). Comparing the posttest between groups, it was found that the group in which participants played with peers had better outcomes than the group in which participants played alone (P=.02). Regarding the gaming experience and exercise adherence, both groups recognized the benefits and expressed enthusiasm toward the exergame. CONCLUSIONS: The findings suggest that the developed exergame helps in improving the functional capacity and adherence to physical exercise among older people, with even better results for those who played with peers. In addition to leading to more appropriate products, a co-design approach may positively influence the motivation and adherence of participants.

"Hey assistant, how can I become a donor?" The case of a conversational agent designed to engage people in blood donation.

BACKGROUND: People have insufficient knowledge and many misconceptions about the blood donation process, which hampers donors recruitment. Therefore, novel strategies and resources are needed to provide information and improve these circumstances. OBJECTIVE: We aimed at an interactive conversational agent to explain about blood donation. METHODS: We used the Dialogflow framework to develop a conversational agent and deployed it publicly. Afterward, we conducted an assessment of user experience (UX) with 50 participants who interacted with the agent. We analyzed participants' opinions, the different UX scales, and their association with participants' demographic variables. RESULTS: The conversational agent is available on the Google Assistant platform in Brazil. It is capable of responding to utterances related to 30 common questions and concerns about donating blood. The user can interact and explore freely and in any order by typing, speaking and selecting interface elements. The agent responds by speaking and displaying visual information, some multimedia content, and suggestions for continuing the dialogue. It enables a conversational sequence in which knowledge is imparted to the user in stages as the dialogue evolves. The overall UX assessed was very satisfactory, and people with specific demographic characteristics were more likely to have better UX. All participants had positive opinions and attitudes towards the conversational agent. CONCLUSIONS: A conversational agent is a creative and captivating strategy of imparting knowledge and engage people regarding blood donation. The findings reaffirm the potential of using this technology for information outreach, especially for socially relevant purposes.

Effects of using a mobile health application on the health conditions of patients with arterial hypertension: A pilot trial in the context of Brazil's Family Health Strategy.

Brazil's Family Health Strategy (FHS) leads public health policies and actions regarding community health, addressing arterial hypertension (AH) in primary care settings. In this scenario, the use of communication technologies becomes appropriate for the monitoring of patients with AH. To preliminary verify the intervention approach and the effects of using an m-Health application on the health conditions of patients with AH for a future study, we conducted a non-randomized, controlled, non-blind trial (N = 39), comparing the use of a mobile health app (m-Health) with conventional AH monitoring over 3 months. During the study, we promoted health information workshops to engage patients from both intervention and control groups. Pre and post-intervention, we compared measurements of systolic and diastolic blood pressure; food frequency questionnaire; Appraisal of Self-Care Agency Scale; blood tests of hemogram, creatinine, uric acid, sodium, potassium, lipid profile, and glycemia. Improvements were identified in both groups due to the workshops, including the reduction in total and non-HDL cholesterol, healthier consumption of salads and sugary drinks, and increased self-care scores. Exclusively in the intervention group, which used the m-Health app, there was a change in systolic and diastolic pressure towards more adequate levels. In addition, the intervention group had improved levels of glucose and HDL cholesterol and reduced consumption of ultra-processed foods. In conclusion, the use of an m-Health app had positive effects on the health conditions of patients with AH under treatment within FHS, especially when combined with health information. On the context of FHS, the use of technology is encouraging supporting better health conditions.

An Electronic Health Platform for Monitoring Health Conditions of Patients With Hypertension in the Brazilian Public Health System: Protocol for a Nonrandomized Controlled Trial.

BACKGROUND: Chronic noncommunicable diseases such as arterial hypertension have a high impact in the context of public health. Previous studies have shown improvements in blood pressure due to simple lifestyle changes, which were supported by electronic health (eHealth) solutions. OBJECTIVE: The aim of this study is to develop an eHealth platform and assess the effects of its use on the health conditions of patients with hypertension, with assistance from health professionals in the public health system of a Brazilian city. METHODS: The platform will include a server that centralizes all the data and business rules, a website dashboard for health professionals, and a mobile app for patients. We will analyze the effects of its use through a controlled, nonrandomized, nonblind, prospective, monocentric clinical trial. We will enroll 68 participants diagnosed with arterial hypertension and under medical follow-up and categorize them into two groups. The participants of the intervention group will use the platform as a monitoring method, whereas the participants of the control group will use conventional methods. In both groups, we will assess and compare the evolution of blood pressure and treatment adherence before, during, and after the intervention. RESULTS: The project was funded at the end of 2018. We have been developing the software since 2019 with plans to complete it in 2020, and we will enroll patients between 2020 and 2021. We expect to submit the first results for publication in 2020. CONCLUSIONS: For the primary outcome, we expect a reduction and stabilization of blood pressure. For the secondary outcomes, we hope to see improvements in treatment adherence, physical activities and dietary practices, and acceptance of the eHealth platform. In public health, the technology that favors disease control also helps reduce complications and, consequently, treatment costs. The platform might encourage the adaptation of medical assistance to incorporate this technology into patient monitoring. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/15299.

Development and Assessment of a Mobile Health Application for Monitoring the Linkage Among Treatment Factors of Type 1 Diabetes Mellitus.

Background: In the daily routine of type 1 diabetes mellitus (T1DM), the patients deal with many data and consider many variables to perform actions, decisions, and regimen adjustments. There is a need to apply filtering techniques to extract relevant information and provide appropriate data visualization methods to assist in clinical tasks and decision making. Objective: To present Soins DM, a mobile health tool, for monitoring the linkage among treatment factors of T1DM with an interactive data visualization approach. Methods: First, we performed a literature review, a commercial search, and ideation. Next, we created a prototype and an online survey for its feedback, with participation of 76 individuals. Afterward, the mobile app and its website version were built. Eventually, we conducted a pilot experiment with 4 patients, an online experiment for satisfaction assessment with 97 patients, and an online assessment by 9 health professionals. Results: Prototyping and feedback facilitated the design refinement. Soins DM enables the recording of data from routines of glycemia, insulin applications, meals, and physical exercises. From these logs, the app builds two different ways of interactive data visualization, a timeline and an integrated chart, providing personalized feedback on bad glycemia with its possible causes. The assessments revealed overall satisfaction with the app's characteristics. Conclusions: Soins DM is a novel application with interactive visualization and personalized feedback for easy identification of the linkage among treatment factors of T1DM. The test scenario with patients and health professionals indicates Soins DM as a useful and reliable tool.

Diabetes Mellitus m-Health Applications: A Systematic Review of Features and Fundamentals.

BACKGROUND: The increasing number of diabetes mellitus (DM) m-health applications (apps) reveals a panorama of different approaches to the subject, demonstrating dynamism and heterogeneity. Available applications have various functions, capabilities, and data collection techniques. OBJECTIVE: We systematically reviewed the literature to identify and analyze studies regarding the diversity of applications aimed at DM monitoring and treatment. We aimed to investigate app functionalities, the basis for their design, and how they were tested. MATERIALS AND METHODS: We conducted a systematic literature review in Association for Computing Machinery (ACM), Institute of Electrical and Electronics Engineers (IEEE), ScienceDirect, Springer, and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases. The search considered studies published until April 2017, without language restrictions. RESULTS: After removal of duplicates, 679 studies were screened and assessed for eligibility, when 39 studies met the inclusion criteria. We present tables summarizing the functionalities, features, fundamental techniques, and methods. CONCLUSIONS: There is a variety of approaches used in the DM apps, with comprehensive, customizable, and adjusted functionalities for different purposes. Most apps are digital logbooks for collecting data on various daily tasks from DM treatment. The researchers are interested in guidelines of medical organizations, evaluations from health professionals and patients, and other methods to verify accuracy and reliability.

Alz Memory – um aplicativo móvel para treino de memória em pacientes com Alzheimer / Alz Memory – a mobile app to stimulate memory of Alzheimer’s disease patients / Alz Memory – una aplicación móvil para estimular la memoria de los pacientes con enfermedad de Alzheimer

O Alzheimer é uma demência caracterizada pelo prejuízo cognitivo, que tem como principal característica o declínio da memória no primeiro estágio da doença. Sabe-se que o Alzheimer ainda não possui cura, mas existem tratamentos para retardar o seu avanço, como o treino de memória. Este artigo tem como objetivo apresentar o Alz Memory, um jogo desenvolvido para estimular a memória de pacientes com Alzheimer, com vistas a minimizar os efeitos da doença sobre ela. Para o desenvolvimento do aplicativo foram utilizados: a linguagem HTML5, as folhas de estilo CSS3, o JavaScript, a biblioteca jQuery e o framework PhoneGap. Os resultados da avaliação preliminar de usabilidade realizada permitiram identificar que os aspectos facilidade de uso, tamanho das letras e imagens, funcionalidades do aplicativo, navegação, controle do usuário, cores e motivação para o uso de outras tecnologias, considerados para o desenvolvimento do jogo, são válidos...

The Alzheimer’s disease is a dementia characterized by cognitive decline, whose main characteristic ismemory decline in the first stage of it. It is known that Alzheimer’s does not have a cure, but there are treatments as the memory training to retard the advance of memory loss. This article aims to present the Alz Memory, a game developed for Alzheimer’s patients to memory training in order to minimize the effects of the disease on the memory. To develop the application were used: HTML5 language, style sheet languagein CSS3, JavaScript, JQuery library and PhoneGap framework. The results of the preliminary evaluation of usability have identified aspects as the ease of use, size of letters and images, application functionality, navigation, user control, colors and motivation for the use of other technologies which were considered important to the development of the game are good...

La enfermedad de Alzheimer es una demencia caracterizada por deterioro cognitivo, que tiene como principal característica la disminución de la memoria en su primera etapa. Se sabe que el alzhéimer no tiene cura, pero existen tratamientos para frenar su avance, como el entrenamiento de la memoria. Este artículo tiene como objetivo presentar el Alz Memory, un juego desarrollado para estimular la memoria de los pacientes de Alzheimer, con el fin de minimizar los efectos de la enfermedad sobre aquella. Para el desarrollo dela aplicación fueron utilizados: lenguaje HTML5, hojas de estilo CSS3, JavaScript, biblioteca jQuery y elframework PhoneGap. Los resultados de la evaluación preliminar de usabilidad realizada identificaron que los aspectos facilidad de uso, tamaño de las letras e imágenes, funcionalidad de la aplicación, navegación, control de usuario, colores y motivación para el uso de otras tecnologías, considerados para el desarrollo del juego, son valiosos...