Applying trans-theoretical model for blood donation among Spanish adults: a cross-sectional study.

BACKGROUND: Relying solely on altruistic appeals may fail to fulfil the increasing demand for blood supplies. Current research has largely been attempted to determine and understand motives that serve as blood donation drivers. The Trans-Theoretical Model of behaviour change (TTM) can be used to conceptualise the process of intentional blood donation behaviour. METHODS: A cross sectional survey of Spanish adults was conducted. The final sample consisted of 504 individuals who were administered a self-report questionnaire including the measures of demographic characteristics, Stages of Change, Processes of Change, Self-efficacy and Decisional Balance. Data were analysed by frequency analysis, MANOVA/ANOVA and correlation analysis. RESULTS: Findings indicated that most of the behavioural and cognitive processes of change, self-efficacy and physical cons differentiated participants across the stages of change of blood donation. In contrast, eligibility cons and pros were less influential in stage transitions. Furthermore, significant correlations were observed between TTM constructs except for the physical cons and the processes of change. CONCLUSIONS: The present study extensively supports and replicates the applicability of the TTM to blood donation behaviour change and offers important implications for the development of effective stage-matched interventions to increase blood donation.

Sizing Prenatal mPHRs using COSMIC Measurement Method.

This paper presents an empirical evaluation of the COSMIC Function Points method (e.g., ISO 19761) through measuring the functional size of 33 prenatal mobile Personal Health Records (mPHRs) apps. This evaluation compares the functional size of each mobile app measured using the COSMIC method to the score of the app obtained in a previous evaluation that relied on functions extraction using a quality assessment questionnaire. It includes as well an investigation of the relationships between the functional sizes of these apps, their ratings in the apps stores, as well as the number of installs. As results, it was noticed that there is a considerable shift between the rankings of the functional sizes and the functionality scores obtained in the opinion-based questionnaire, for most of the apps assessed. Moreover, the study of the relationship between the functional sizes and the ratings, as well as the number of installs indicated that these variables are not linked, since they are impacted by external factors. The findings support the use of the COSMIC method for these apps in regard to measuring the functional size for further updates or improvements, which can also help developers to have an overview about the existing apps on the market and compare between them. Moreover, COSMIC is more effective since it covers all the features and functionalities of prenatal mPHRs.

Evaluating the Privacy Policies of Mobile Personal Health Records for Pregnancy Monitoring.

A mobile personal health record (mPHR) for pregnancy monitoring allows the pregnant woman to track and manage her personal health data. However, owing to the privacy and security issues that may threaten the exchange of this sensitive data, a privacy policy should be established. The aim of this study is to evaluate the privacy policies of 19 mPHRs for pregnancy monitoring (12 for iOS and 7 for Android) using a template covering the characteristics of privacy, security, and standards and regulations. The findings of this study show that none of the privacy policies evaluated entirely comply with the characteristics studied. The developers of mPHRs for pregnancy monitoring are, therefore, requested to improve and pay more attention to the structure and the content of the privacy policies of their apps.

Reusable Software Usability Specifications for mHealth Applications.

One of the key factors for the adoption of mobile technologies, and in particular of mobile health applications, is usability. A usable application will be easier to use and understand by users, and will improve user's interaction with it. This paper proposes a software requirements catalog for usable mobile health applications, which can be used for the development of new applications, or the evaluation of existing ones. The catalog is based on the main identified sources in literature on usability and mobile health applications. Our catalog was organized according to the ISO/IEC/IEEE 29148:2011 standard and follows the SIREN methodology to create reusable catalogs. The applicability of the catalog was verified by the creation of an audit method, which was used to perform the evaluation of a real app, S Health, application created by Samsung Electronics Co. The usability requirements catalog, along with the audit method, identified several usability flaws on the evaluated app, which scored 83%. Some flaws were detected in the app related to the navigation pattern. Some more issues related to the startup experience, empty screens or writing style were also found. The way a user navigates through an application improves or deteriorates user's experience with the application. We proposed a reusable usability catalog and an audit method. This proposal was used to evaluate a mobile health application. An audit report was created with the usability issues identified on the evaluated application.

A systematic review of gamification in e-Health.

Gamification is a relatively new trend that focuses on applying game mechanics to non-game contexts in order to engage audiences and to inject a little fun into mundane activities besides generating motivational and cognitive benefits. While many fields such as Business, Marketing and e-Learning have taken advantage of the potential of gamification, the digital healthcare domain has also started to exploit this emerging trend. This paper aims to summarize the current knowledge regarding gamified e-Health applications. A systematic literature review was therefore conducted to explore the various gamification strategies employed in e-Health and to address the benefits and the pitfalls of this emerging discipline. A total of 46 studies from multiple sources were then considered and thoroughly investigated. The results show that the majority of the papers selected reported gamification and serious gaming in health and wellness contexts related specifically to chronic disease rehabilitation, physical activity and mental health. Although gamification in e-Health has attracted a great deal of attention during the last few years, there is still a dearth of valid empirical evidence in this field. Moreover, most of the e-Health applications and serious games investigated have been proven to yield solely short-term engagement through extrinsic rewards. For gamification to reach its full potential, it is therefore necessary to build e-Health solutions on well-founded theories that exploit the core experience and psychological effects of game mechanics.

A Framework for Evaluating the Software Product Quality of Pregnancy Monitoring Mobile Personal Health Records.

Stakeholders' needs and expectations are identified by means of software quality requirements, which have an impact on software product quality. In this paper, we present a set of requirements for mobile personal health records (mPHRs) for pregnancy monitoring, which have been extracted from literature and existing mobile apps on the market. We also use the ISO/IEC 25030 standard to suggest the requirements that should be considered during the quality evaluation of these mPHRs. We then go on to design a checklist in which we contrast the mPHRs for pregnancy monitoring requirements with software product quality characteristics and sub-characteristics in order to calculate the impact of these requirements on software product quality, using the ISO/IEC 25010 software product quality standard. The results obtained show that the requirements related to the user's actions and the app's features have the most impact on the external sub-characteristics of the software product quality model. The only sub-characteristic affected by all the requirements is Appropriateness of Functional suitability. The characteristic Operability is affected by 95% of the requirements while the lowest degrees of impact were identified for Compatibility (15%) and Transferability (6%). Lastly, the degrees of the impact of the mPHRs for pregnancy monitoring requirements are discussed in order to provide appropriate recommendations for the developers and stakeholders of mPHRs for pregnancy monitoring.

An Empirical Study of Neural Network-Based Audience Response Technology in a Human Anatomy Course for Pharmacy Students.

This paper presents an empirical study of a formative neural network-based assessment approach by using mobile technology to provide pharmacy students with intelligent diagnostic feedback. An unsupervised learning algorithm was integrated with an audience response system called SIDRA in order to generate states that collect some commonality in responses to questions and add diagnostic feedback for guided learning. A total of 89 pharmacy students enrolled on a Human Anatomy course were taught using two different teaching methods. Forty-four students employed intelligent SIDRA (i-SIDRA), whereas 45 students received the same training but without using i-SIDRA. A statistically significant difference was found between the experimental group (i-SIDRA) and the control group (traditional learning methodology), with T (87) = 6.598, p < 0.001. In four MCQs tests, the difference between the number of correct answers in the first attempt and in the last attempt was also studied. A global effect size of 0.644 was achieved in the meta-analysis carried out. The students expressed satisfaction with the content provided by i-SIDRA and the methodology used during the process of learning anatomy (M = 4.59). The new empirical contribution presented in this paper allows instructors to perform post hoc analyses of each particular student's progress to ensure appropriate training.

Free blood donation mobile applications.

Blood donation (BD) is a noble act and mobile applications (apps) can help increase awareness about it. This paper analyzes and assesses the characteristics of free apps for BD as regards features and functionality. A search in Google Play, Apple Apps store, Blackberry App World and Windows Mobile App store was carried out to select 169 free BD apps from the 188 apps identified. The results presented in this paper show that the majority of the apps selected have been developed for the Android operating system. Moreover, most of the apps selected are available to help users search for donors. Few of the apps could not be installed and/or accessed. Of those that could be installed: half of them do not require any kind of authentication; a few of them are available in more than one language; half of them have a geographical restriction; around 60 % of them do not notify the user of BD events and requests; one, which is available for Android and iOS, can connect with a laboratory; around 45 % of them allow users to share information via social networks, and the majority of them do not provide BD recommendations. These results are used as a basis to provide app developers with certain recommendations. There is a need for better BD apps with more features in order to increase the number of volunteer donors.

Empirical studies on usability of mHealth apps: a systematic literature review.

The release of smartphones and tablets, which offer more advanced communication and computing capabilities, has led to the strong emergence of mHealth on the market. mHealth systems are being used to improve patients' lives and their health, in addition to facilitating communication between doctors and patients. Researchers are now proposing mHealth applications for many health conditions such as dementia, autism, dysarthria, Parkinson's disease, and so on. Usability becomes a key factor in the adoption of these applications, which are often used by people who have problems when using mobile devices and who have a limited experience of technology. The aim of this paper is to investigate the empirical usability evaluation processes described in a total of 22 selected studies related to mHealth applications by means of a Systematic Literature Review. Our results show that the empirical evaluation methods employed as regards usability could be improved by the adoption of automated mechanisms. The evaluation processes should also be revised to combine more than one method. This paper will help researchers and developers to create more usable applications. Our study demonstrates the importance of adapting health applications to users' need.

Compliance of blood donation apps with mobile OS usability guidelines.

The aim of this paper is to employ the guidelines of Android, iOS, Blackberry and Windows Phone to analyze the usability compliance of free blood donation (BD) apps. An analysis process based on a systematic review protocol is used to select free BD apps. An assessment is conducted using a questionnaire composed of 13 questions concerning the compliance of free BD apps with Android, Blackberry, iOS and Windows Phone usability guidelines. A total of 133 free BD apps have been selected from the 188 BD apps identified. Around 63% of the free BD apps selected have a good compliance with mobile OS usability recommendations. Around 72% of Android, 57% of Windows Phone, 33% of iOS and 33% of Blackberry BD apps have a high usability score. The aspect of BD app behavior should be improved along with some style components: the use of pictures to explain ideas and the adaptation of the app to both horizontal and vertical orientations. Structure patterns should also be used to improve the structure aspect of a BD app. Usability is a quality aspect that should be improved in current BD apps. Our study provides smartphone users with a list of usable free BD apps and BD app developers with recommendations.

Examining the benefits of learning based on an audience response system when confronting emergency situations.

This article presents an empirical study on the effectiveness of the use of an audience response system called SIstema De Respuesta inmediata de la Audiencia on a nursing course. A total of 130 students of mixed gender, age, and computer experience and educational background on a third-year course in nursing administration and management participated in the study. The benefits of an audience response system as regards learning how to confront emergency situations were studied. The innovative aspect of the proposal is twofold: (1) the use of a smartphone to respond to the questions and (2) the analysis of the students' response time when confronting critical situations while managing nursing resources. A positive impact on the students' performance was revealed in their final assessments. Our findings show that SIstema De Respuesta inmediata de la Audiencia increases student participation and aids in identifying and correcting misconceptions. The students found SIstema De Respuesta inmediata de la Audiencia to be very motivating and wanted it to be used in additional lectures. Further research is required to study the effectiveness of SIstema De Respuesta inmediata de la Audiencia for it to be widely used in other disciplines.

Mobile PHRs compliance with Android and iOS usability guidelines.

Mobile Personal Health Records (PHRs) have achieved a particularly strong market share since the appearance of more powerful mobile devices and popular worldwide mobile application markets such as Apple's App Store and Android's Google Play. However, Android and Apple have a set of recommendations on design and usability targeted towards developers who wish to publish apps in their stores: Android Design Guidelines and iOS Human Interface Guidelines. This paper aims to evaluate compliance with these guidelines by assessing the usability recommendations of a set of 24 selected mobile PHR applications. An analysis process based on a well-known Systematic Literature Review (SLR) protocol was used. The results show that the 24 mobile PHR applications studied are not suitably structured. 46 % of these applications do not use any of the recommended patterns, using instead lists or springboards, which are deprecated patterns for top-level menus. 70 % of the PHRs require a registration to be able to test the application when these interactions should be delayed. Our study will help both PHR users to select user-friendly mobile PHRs and PHR providers and developers to identify the good usability practices implemented by the applications with the highest scores.

[A guide to good practice for information security in the handling of personal health data by health personnel in ambulatory care facilities]. / Guía de buenas prácticas de seguridad informática en el tratamiento de datos de salud para el personal sanitario en atención primaria.

The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities.

Security and privacy in electronic health records: a systematic literature review.

OBJECTIVE: To report the results of a systematic literature review concerning the security and privacy of electronic health record (EHR) systems. DATA SOURCES: Original articles written in English found in MEDLINE, ACM Digital Library, Wiley InterScience, IEEE Digital Library, Science@Direct, MetaPress, ERIC, CINAHL and Trip Database. STUDY SELECTION: Only those articles dealing with the security and privacy of EHR systems. DATA EXTRACTION: The extraction of 775 articles using a predefined search string, the outcome of which was reviewed by three authors and checked by a fourth. RESULTS: A total of 49 articles were selected, of which 26 used standards or regulations related to the privacy and security of EHR data. The most widely used regulations are the Health Insurance Portability and Accountability Act (HIPAA) and the European Data Protection Directive 95/46/EC. We found 23 articles that used symmetric key and/or asymmetric key schemes and 13 articles that employed the pseudo anonymity technique in EHR systems. A total of 11 articles propose the use of a digital signature scheme based on PKI (Public Key Infrastructure) and 13 articles propose a login/password (seven of them combined with a digital certificate or PIN) for authentication. The preferred access control model appears to be Role-Based Access Control (RBAC), since it is used in 27 studies. Ten of these studies discuss who should define the EHR systems' roles. Eleven studies discuss who should provide access to EHR data: patients or health entities. Sixteen of the articles reviewed indicate that it is necessary to override defined access policies in the case of an emergency. In 25 articles an audit-log of the system is produced. Only four studies mention that system users and/or health staff should be trained in security and privacy. CONCLUSIONS: Recent years have witnessed the design of standards and the promulgation of directives concerning security and privacy in EHR systems. However, more work should be done to adopt these regulations and to deploy secure EHR systems.

Free Web-based personal health records: an analysis of functionality.

This paper analyzes and assesses the functionality of free Web-based PHRs as regards health information, user actions and connection with other tools. A systematic literature review in Medline, ACM Digital Library, IEEE Digital Library and ScienceDirect was used to select 19 free Web-based PHRs from the 47 PHRs identified. The results show that none of the PHRs selected met 100% of the 28 functions presented in this paper. Two free Web-based PHRs target a particular public. Around 90 % of the PHRs identified allow users throughout the world to create their own profiles without any geographical restrictions. Only half of the PHRs selected provide physicians with user actions. Few PHRs can connect with other tools. There was considerable variability in the types of data included in free Web-based PHRs. Functionality may have implications for PHR use and adoption, particularly as regards patients with chronic illnesses or disabilities. Support for standard medical document formats and protocols are required to enable data to be exchanged with other stakeholders in the health care domain. The results of our study may assist users in selecting the PHR that best fits their needs, since no significant connection exists between the number of functions of the PHRs identified and their popularity.

Are personal health records safe? A review of free web-accessible personal health record privacy policies.

BACKGROUND: Several obstacles prevent the adoption and use of personal health record (PHR) systems, including users' concerns regarding the privacy and security of their personal health information. OBJECTIVE: To analyze the privacy and security characteristics of PHR privacy policies. It is hoped that identification of the strengths and weaknesses of the PHR systems will be useful for PHR users, health care professionals, decision makers, and designers. METHODS: We conducted a systematic review using the principal databases related to health and computer science to discover the Web-based and free PHR systems mentioned in published articles. The privacy policy of each PHR system selected was reviewed to extract its main privacy and security characteristics. RESULTS: The search of databases and the myPHR website provided a total of 52 PHR systems, of which 24 met our inclusion criteria. Of these, 17 (71%) allowed users to manage their data and to control access to their health care information. Only 9 (38%) PHR systems permitted users to check who had accessed their data. The majority of PHR systems used information related to the users' accesses to monitor and analyze system use, 12 (50%) of them aggregated user information to publish trends, and 20 (83%) used diverse types of security measures. Finally, 15 (63%) PHR systems were based on regulations or principles such as the US Health Insurance Portability and Accountability Act (HIPAA) and the Health on the Net Foundation Code of Conduct (HONcode). CONCLUSIONS: Most privacy policies of PHR systems do not provide an in-depth description of the security measures that they use. Moreover, compliance with standards and regulations in PHR systems is still low.

Missing data techniques in classification for cardiovascular dysautonomias diagnosis.

Missing data (MD) is a common and inevitable problem facing data mining (DM)-based decision systems in e-health since many medical historical datasets contain a huge number of missing values. Therefore, a pre-processing stage is usually required to deal with missing values before building any DM-based decision system. The purpose of this paper is to evaluate the impact of MD techniques on classification systems in cardiovascular dysautonomias diagnosis. We analyzed and compared the accuracy rates of four classification techniques: random forest (RF), support vector machines (SVM), C4.5 decision tree, and Naive Bayes (NB), using two MD techniques: deletion or imputation with k-nearest neighbors (KNN). A total of 216 experiments were therefore carried out using three missingness mechanisms (MCAR: missing completely at random, MAR: missing at random and NMAR: not missing at random), two MD techniques (deletion and KNN imputation), nine MD percentages from 10 to 90% over a dataset collected from the autonomic nervous system (ANS) unit of the University Hospital Avicenne in Morocco. The results obtained suggest that using KNN imputation rather than deletion enhances the accuracy rates of the four classifiers. Moreover, the MD percentages have a negative impact on the performance of classification techniques regardless of the MD mechanisms and MD techniques used. In fact, the accuracy rates of the four classifiers decrease as the MD percentage increases. Graphical abstract.

A mapping study of ensemble classification methods in lung cancer decision support systems.

Achieving a high level of classification accuracy in medical datasets is a capital need for researchers to provide effective decision systems to assist doctors in work. In many domains of artificial intelligence, ensemble classification methods are able to improve the performance of single classifiers. This paper reports the state of the art of ensemble classification methods in lung cancer detection. We have performed a systematic mapping study to identify the most interesting papers concerning this topic. A total of 65 papers published between 2000 and 2018 were selected after an automatic search in four digital libraries and a careful selection process. As a result, it was observed that diagnosis was the task most commonly studied; homogeneous ensembles and decision trees were the most frequently adopted for constructing ensembles; and the majority voting rule was the predominant combination rule. Few studies considered the parameter tuning of the techniques used. These findings open several perspectives for researchers to enhance lung cancer research by addressing the identified gaps, such as investigating different classification methods, proposing other heterogeneous ensemble methods, and using new combination rules. Graphical abstract Main features of the mapping study performed in ensemble classification methods applied on lung cancer decision support systems.

Mobile health applications for postnatal care: Review and analysis of functionalities and technical features.

BACKGROUND: Providing a continuum of care from antenatal, childbirth and postnatal period results in reduced maternal and neonatal morbidity and mortality. Timely, high quality postnatal care is crucial for maximizing maternal and newborn health. In this vein, the use of postnatal mobile applications constitutes a promising strategy. METHODS: A Systematic Literature Review (SLR) protocol was adopted to perform the selection, data extraction and functional evaluation of the available postnatal apps on iOS and Android platforms. The analysis of the functionalities and technical features of the apps selected was performed according to a 37-items assessment questionnaire developed on the basis of the scientific literature of postnatal care and a preliminary analysis of available postnatal apps RESULTS: A total of 48 postnatal apps were retrieved from the app repositories of the iOS and Android platforms. The results of the functional content analysis show that the postnatal apps selected relatively achieved low scores owing to the complexity and the ramification of the postnatal care. CONCLUSIONS: The present study helps in identifying areas related to the postnatal care that require further endeavors to be properly addressed. It also provides directions for developers to leverage the advancement and innovation on mobile technology to build complete and well-suited postnatal apps.

Systematic mapping study of data mining-based empirical studies in cardiology.

Data mining provides the methodology and technology to transform huge amount of data into useful information for decision making. It is a powerful process to extract knowledge and discover new patterns embedded in large data sets. Data mining has been increasingly used in medicine, particularly in cardiology. In fact, data mining applications can greatly benefits all parts involved in cardiology such as patients, cardiologists and nurses. This article aims to perform a systematic mapping study so as to analyze and synthesize empirical studies on the application of data mining techniques in cardiology. A total of 142 articles published between 2000 and 2015 were therefore selected, studied and analyzed according to the four following criteria: year and channel of publication, research type, medical task and empirical type. The results of this mapping study are discussed and a list of recommendations for researchers and cardiologists is provided.