Rapid Design of a Student-Centred App for Musculoskeletal Clinical Skills: An Example of a Theoretically Informed Approach to Developing Apps for Learning.

Background and need for innovation: The process to design mobile apps for learning are infrequently reported and focus more on evaluation than process. This lack of clear process for health professional education mobile apps may explain the lack of quality mobile apps to support medical student learning. Goal of innovation: The goal of this project was to develop a student informed ready for production wireframe model of a minimally viable mobile app to support learning of musculoskeletal (MSK) clinical skills. Steps taken for development and implementation of innovation: The Information Systems Research (ISR) framework and Design Thinking were combined for the mobile app design. The process followed the cycles and modes of the combined framework to; systematically review available apps, use a focus group to identify attributes of the app valued by students, define the initial plan for the mobile app, develop an app prototype, and test and refine it with students. Outcomes of innovation: The student focus group data had five themes: 1) interactive usability, 2) environment, 3) clear and concise layout, 4) anatomy and pathology, 5) cultural safety and 'red flags'. The prototyping of the app went through three cycles of student review and improvement to produce a final design ready for app development. Critical reflection on our process: We used a student-centred approach guided by design frameworks to design a minimally viable product mobile app to support learning of MSK clinical skills in ten weeks with a small team. The framework supported nonlinear, iterative, rapid prototyping. Student data converged and diverged with the MSK teaching methods literature. Of note our students requested cultural safety learning in the app design, suggesting mobile apps could support cultural safety learning.

Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial.

BACKGROUND: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app ("Meine Zeit ohne") has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. OBJECTIVE: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants' characteristics, and (3) to study how variations in app use were related to participants' baseline characteristics. METHODS: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection ("congruent use": eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. RESULTS: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. CONCLUSIONS: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users' characteristics. TRIAL REGISTRATION: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-022-06231-x.

Benchmarking mobile applications for the health of people with Diabetes Mellitus.

OBJECTIVE: to map the content and features of mobile applications on the management of Diabetes Mellitus and their usability on the main operating systems. METHOD: benchmarking research. The mapping of apps, content, and resources on the Play Store and App Store platforms was based on an adaptation of the Joanna Briggs Institute's scoping review framework. For the usability analysis, the apps were tested for two weeks and the System Usability Scale instrument was used, with scores between 50-67 points being considered borderline, between 68-84, products with acceptable usability and above 85, excellent user acceptance and, for the analysis, descriptive statistics. RESULTS: the most prevalent contents were capillary blood glucose management, diet, oral drug therapy, and insulin therapy. As for resources, diaries and graphs were the most common. With regard to usability, two apps were considered to have excellent usability; 34, products with acceptable usability; 29, the resource may have some flaws but still has acceptable usability standards and 6, with flaws and no usability conditions. CONCLUSION: the content and resources of mobile applications address the fundamental points for managing Diabetes Mellitus with user-friendly resources, with usability acceptable to users and have the potential to assist in the management of Diabetes Mellitus in patients' daily lives.

Acceptability, Effectiveness, and Roles of mHealth Applications in Supporting Cancer Pain Self-Management: Integrative Review.

BACKGROUND:  Cancer pain remains highly prevalent and persistent throughout survivorship, and it is crucial to investigate the potential of leveraging the advanced features of mobile health (mHealth) apps to empower individuals to self-manage their pain. OBJECTIVE:  This review aims to comprehensively understand the acceptability, users' experiences, and effectiveness of mHealth apps in supporting cancer pain self-management. METHODS:  We conducted an integrative review following Souza and Whittemore and Knafl's 6 review processes. Literature was searched in PubMed, Scopus, CINAHL Plus with Full Text, PsycINFO, and Embase, from 2013 to 2023. Keywords including "cancer patients," "pain," "self-management," "mHealth applications," and relevant synonyms were used in the search. The Johns Hopkins research evidence appraisal tool was used to evaluate the quality of eligible studies. A narrative synthesis was conducted to analyze the extracted data. RESULTS:  A total of 20 studies were included, with the overall quality rated as high (n=15) to good (n=5). Using mHealth apps to monitor and manage pain was acceptable for most patients with cancer. The internal consistency of the mHealth in measuring pain was 0.96. The reported daily assessment or engagement rate ranged from 61.9% to 76.8%. All mHealth apps were designed for multimodal interventions. Participants generally had positive experiences using pain apps, rating them as enjoyable and user-friendly. In addition, 6 studies reported significant improvements in health outcomes, including enhancement in pain remission (severity and intensity), medication adherence, and a reduced frequency of breakthrough pain. The most frequently highlighted roles of mHealth apps included pain monitoring, tracking, reminders, education facilitation, and support coordination. CONCLUSIONS:  mHealth apps are effective and acceptable in supporting pain self-management. They offer a promising multi-model approach for patients to monitor, track, and manage their pain. These findings provide evidence-based insights for leveraging mHealth apps to support cancer pain self-management. More high-quality studies are needed to examine the effectiveness of digital technology-based interventions for cancer pain self-management and to identify the facilitators and barriers to their implementation in real-world practice.

mHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan.

BACKGROUND: Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps. OBJECTIVE: This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development. METHODS: A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security. RESULTS: Of the 152 apps that met the final selection criteria, 88 (57.9%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9%) did not disclose expert consultation, 125 (82.2%) did not disclose evidence-based information, 146 (96.1%) did not disclose author credentials, and 134 (88.2%) did not disclose their information sources. In addition, 105 (69.2%) apps did not disclose adherence to data privacy and security practices. CONCLUSIONS: There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully.

Effect of a Smartphone App (S-Check) on Actual and Intended Help-Seeking and Motivation to Change Methamphetamine Use Among Adult Consumers of Methamphetamine in Australia: Randomized Waitlist-Controlled Trial.

BACKGROUND: Interventions are required that address delays in treatment-seeking and low treatment coverage among people consuming methamphetamine. OBJECTIVE: We aim to determine whether a self-administered smartphone-based intervention, the "S-Check app" can increase help-seeking and motivation to change methamphetamine use, and determine factors associated with app engagement. METHODS: This study is a randomized, 28-day waitlist-controlled trial. Consenting adults residing in Australia who reported using methamphetamine at least once in the last month were eligible to download the app for free from Android or iOS app stores. Those randomized to the intervention group had immediate access to the S-Check app, the control group was wait-listed for 28 days before gaining access, and then all had access until day 56. Actual help-seeking and intention to seek help were assessed by the modified Actual Help Seeking Questionnaire (mAHSQ), modified General Help Seeking Questionnaire, and motivation to change methamphetamine use by the modified readiness ruler. χ2 comparisons of the proportion of positive responses to the mAHSQ, modified General Help Seeking Questionnaire, and modified readiness ruler were conducted between the 2 groups. Logistic regression models compared the odds of actual help-seeking, intention to seek help, and motivation to change at day 28 between the 2 groups. Secondary outcomes were the most commonly accessed features of the app, methamphetamine use, feasibility and acceptability of the app, and associations between S-Check app engagement and participant demographic and methamphetamine use characteristics. RESULTS: In total, 560 participants downloaded the app; 259 (46.3%) completed eConsent and baseline; and 84 (32.4%) provided data on day 28. Participants in the immediate access group were more likely to seek professional help (mAHSQ) at day 28 than those in the control group (n=15, 45.5% vs n=12, 23.5%; χ21=4.42, P=.04). There was no significant difference in the odds of actual help-seeking, intention to seek help, or motivation to change methamphetamine use between the 2 groups on the primary logistic regression analyses, while in the ancillary analyses, the imputed data set showed a significant difference in the odds of seeking professional help between participants in the immediate access group compared to the waitlist control group (adjusted odds ratio 2.64, 95% CI 1.19-5.83, P=.02). For participants not seeking help at baseline, each minute in the app increased the likelihood of seeking professional help by day 28 by 8% (ratio 1.08, 95% CI 1.02-1.22, P=.04). Among the intervention group, a 10-minute increase in app engagement time was associated with a decrease in days of methamphetamine use by 0.4 days (regression coefficient [ß] -0.04, P=.02). CONCLUSIONS: The S-Check app is a feasible low-resource self-administered intervention for adults in Australia who consume methamphetamine. Study attrition was high and, while common in mobile health interventions, warrants larger studies of the S-Check app. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619000534189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377288&isReview=true.

The Impact of User Engagement With Exposure Components on Posttraumatic Stress Symptoms in an mHealth Mobile App: Secondary Analysis of a Randomized Controlled Trial.

Background: Mobile mental health apps are a cost-effective option for managing mental health problems, such as posttraumatic stress disorder (PTSD). The efficacy of mobile health (mHealth) apps depends on engagement with the app, but few studies have examined how users engage with different features of mHealth apps for PTSD. Objective: This study aims to examine the relationship between app engagement indices and PTSD symptom reduction using data from an unblinded pilot randomized controlled trial of "Renew" (Vertical Design), an exposure-based app for PTSD with and without coaching support. Because exposure is an effective approach for treating PTSD, we expected that engagement with exposure activities would be positively related to symptom reduction, over and above overall app usage. Methods: Participants were veterans (N=69) with clinically significant PTSD symptoms who were recruited online using Facebook advertisements and invited to use the Renew app as often as they wanted over a 6-week period. Participants completed screening and assessments online but provided informed consent, toured the app, and completed feedback interviews via telephone. We assessed users' self-reported PTSD symptoms before and after a 6-week intervention period and collected app usage data using a research-instrumented dashboard. To examine overall app engagement, we used data on the total time spent in the app, the number of log-in days, and the number of points that the user gained in the app. To examine engagement with exposure components, we used data on total time spent completing exposure activities (both in vivo and imaginal), the number of in vivo exposure activities completed, and the number of characters written in response to imaginal exposure prompts. We used hierarchical regression analyses to test the effect of engagement indices on change in PTSD symptoms. Results: Usage varied widely. Participants spent an average of 166.09 (SD 156.52) minutes using Renew, over an average of 14.7 (SD 10.71) mean log-in days. Engagement with the exposure components of the app was positively associated with PTSD symptom reduction (F6,62=2.31; P=.04). Moreover, this relationship remained significant when controlling for overall engagement with the app (ΔF3,62=4.42; P=.007). The number of characters written during imaginal exposure (ß=.37; P=.009) and the amount of time spent completing exposure activities (ß=.36; P=.03) were significant contributors to the model. Conclusions: To our knowledge, this is the first study to show a relationship between symptom improvement and engagement with the active therapeutic components of an mHealth app (ie, exposure) for PTSD. This relationship held when controlling for overall app use, which suggests that it was engagement with exposure, specifically, that was associated with symptom change. Future work to identify ways of promoting greater engagement with self-guided exposure may help improve the effectiveness of mHealth apps for PTSD.

Reporting quality of published reviews of commercial and publicly available mobile health apps (mHealth app reviews): a scoping review protocol.

INTRODUCTION: Reviews of commercial and publicly available smartphone (mobile) health applications (mHealth app reviews) are being undertaken and published. However, there is variation in the conduct and reporting of mHealth app reviews, with no existing reporting guidelines. Building on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we aim to develop the Consensus for APP Review Reporting Items (CAPPRRI) guidance, to support the conduct and reporting of mHealth app reviews. This scoping review of published mHealth app reviews will explore their alignment, deviation, and modification to the PRISMA 2020 items for systematic reviews and identify a list of possible items to include in CAPPRRI. METHOD AND ANALYSIS: We are following the Joanna Briggs Institute approach and Arksey and O'Malley's five-step process. Patient and public contributors, mHealth app review, digital health research and evidence synthesis experts, healthcare professionals and a specialist librarian gave feedback on the methods. We will search SCOPUS, CINAHL Plus, AMED, EMBASE, Medline, APA PsycINFO and the ACM Digital Library for articles reporting mHealth app reviews and use a two-step screening process to identify eligible articles. Information on whether the authors have reported, or how they have modified the PRISMA 2020 items in their reporting, will be extracted. Data extraction will also include the article characteristics, protocol and registration information, review question frameworks used, information about the search and screening process, how apps have been evaluated and evidence of stakeholder engagement. This will be analysed using a content synthesis approach and presented using descriptive statistics and summaries. This protocol is registered on OSF (https://osf.io/5ahjx). ETHICS AND DISSEMINATION: Ethical approval is not required. The findings will be disseminated through peer-reviewed journal publications (shared on our project website and on the EQUATOR Network website where the CAPPRRI guidance has been registered as under development), conference presentations and blog and social media posts in lay language.

Contents analysis of telemedicine applications in South Korea: An analysis of possibility of inducing selective or unnecessary medical care.

The use of telemedicine and telehealth has rapidly increased since the start of the COVID-19 pandemic, however, could lead to unnecessary medical service. This study analyzes the contents of telemedicine apps (applications) in South Korea to investigate the use of telemedicine for selective or unnecessary medical treatments and the presence of advertising for the hospital. This study analyzed 49 telemedicine mobile apps in Korea; a content analysis of the apps' features and quality using a Mobile Application Rating Scale was done. The study analyzed 49 mobile telemedicine apps and found that 65.3% of the apps provide immediate telemedicine service without reservations, with an average rating of 4.35. 87% of the apps offered selective care, but the overall quality of the apps was low, with an average total quality score of 3.27. 73.9% of the apps were able to provide selective care for alopecia or morning-after pill prescription, 65.2% of the apps for weight loss, and 52.2% of the apps for erectile dysfunction, with the potential to encourage medical inducement or abuse. Therefore, before introducing telemedicine, it is helpful to prevent the possibility of abuse of telemedicine by establishing detailed policies for methods and scope of telemedicine.

A Nurse-Led App-Based Home Exercise Program After Total Knee Arthroplasty: A Quasi-Experimental Study.

PURPOSE: Reduced activity because of pain is a major health issue associated with total knee arthroplasty. This study evaluated the effectiveness of a nurse-led app-based home exercise program for patients who underwent total knee arthroplasty. METHODS: A nonequivalent control group of pretest-posttest design was used. Data from 45 patients were collected. The control group received individualized face-to-face exercise education, whereas the experimental group received training on the use of app-based home exercise education, including exercise videos and app push notifications to encourage exercise after discharge. Pain, range of motion, exercise self-efficacy, and quality of life were measured at baseline and 3 and 12 weeks after surgery. Nursing care satisfaction was evaluated 12 weeks after surgery. RESULTS: There were significant overall reductions in pain intensity ( p = .001), improvements in limited range of motion ( p < .001), and increases in exercise self-efficacy ( p = .034) and quality of life ( p = .033) in the experimental group ( n = 22) compared with those in the control group ( n = 23). Nursing care satisfaction was significantly higher in the experimental group than in the control group ( p < .001). CONCLUSIONS: Rehabilitation nurses can offer app-based home exercise education with push notifications to alleviate pain, enhance range of motion, improve exercise self-efficacy, and increase nursing care satisfaction for patients who have had a knee arthroplasty.

Self-efficacy with Pelvic floor muscle training mediates the effect of an App-based intervention on improving postpartum urinary incontinence severity among pregnant women: A causal mediation analysis from a randomised controlled trial.

BACKGROUND: A pragmatic randomised controlled trial has confirmed the effectiveness of Urinary Incontinence for Women (UIW) app-based intervention in improving postpartum urinary incontinence (UI) severity among pregnant women. However, the causal mechanisms underlying this intervention effect remain unclear. OBJECTIVE: To examine the mediating role of self-efficacy with pelvic floor muscle training (PFMT) on the effect of the UIW app-based intervention in improving postpartum UI severity. METHODS: This was a secondary causal mediation analysis of a single-center, 2-arm, unblinded pragmatic randomised controlled trial. Singleton pregnant women without UI before pregnancy aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and randomised to receive the UIW app intervention plus oral PFMT instructions (n = 63) or oral PFMT instructions alone (n = 63). The primary outcome was postpartum changes in UI severity at 6 weeks. Changes in self-efficacy with PFMT 2 months after randomisation were a hypothesised mediator. Causal mediation analysis was used to estimate the average causal mediation effect (ACME), average direct effect (ADE), average total effect (ATE), and proportion mediated. A sensitivity analysis was conducted to examine the robustness of the ACME in relation to potential unmeasured confounding. RESULTS: Data from 103 participants were analyzed. The ATE of UIW app-based intervention on postpartum UI severity was 2.91 points (95 % confidence intervals [CI] 1.69 to 4.12), with ADE of 1.97 points (95 % CI 0.63 to 3.41) and the ACME 0.94 points (95 % CI 0.27 to 1.72). The proportion of ATE mediated by self-efficacy with PFMT was 0.32 (95 % CI 0.08 to 0.67). Sensitivity analysis revealed the robust ACME with respect to the potential effects of unmeasured confounding. CONCLUSION: An increase in self-efficacy with PFMT partially mediated the effect of the UIW app intervention on improvements in postpartum UI severity. TRIAL REGISTRATION: The original trial was prospectively registered in the Chinese Clinical Trial Registry under the reference number ChiCTR1800016171 on 16/05/2018. Further details can be accessed at: http://www.chictr.org.cn/showproj.aspx?proj=27455.

Doctors' Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study.

BACKGROUND: Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients' mobile app adoption behavior; however, they offer limited insights into doctors' personal preferences among a variety of choices of mobile apps. OBJECTIVE: This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? METHODS: We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. RESULTS: In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees' perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors' affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. CONCLUSIONS: Our findings contribute to a nuanced understanding of doctors' adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns.

Use of Mobile Technologies to Streamline Pretriage Patient Flow in the Emergency Department: Observational Usability Study.

BACKGROUND: In emergency departments (EDs), triage nurses are under tremendous daily pressure to rapidly assess the acuity level of patients and log the collected information into computers. With self-service technologies, patients could complete data entry on their own, allowing nurses to focus on higher-order tasks. Kiosks are a popular working example of such self-service technologies; however, placing a sufficient number of unwieldy and fixed machines demands a spatial change in the greeting area and affects pretriage flow. Mobile technologies could offer a solution to these issues. OBJECTIVE: The aim of this study was to investigate the use of mobile technologies to improve pretriage flow in EDs. METHODS: The proposed stack of mobile technologies includes patient-carried smartphones and QR technology. The web address of the self-registration app is encoded into a QR code, which was posted directly outside the walk-in entrance to be seen by every ambulatory arrival. Registration is initiated immediately after patients or their proxies scan the code using their smartphones. Patients could complete data entry at any site on the way to the triage area. Upon completion, the result is saved locally on smartphones. At the triage area, the result is automatically decoded by a portable code reader and then loaded into the triage computer. This system was implemented in three busy metropolitan EDs in Shanghai, China. Both kiosks and smartphones were evaluated randomly while being used to direct pretriage patient flow. Data were collected during a 20-day period in each center. Timeliness and usability of medical students simulating ED arrivals were assessed with the After-Scenario Questionnaire. Usability was assessed by triage nurses with the Net Promoter Score (NPS). Observations made during system implementation were subject to qualitative thematic analysis. RESULTS: Overall, 5928 of 8575 patients performed self-registration on kiosks, and 7330 of 8532 patients checked in on their smartphones. Referring effort was significantly reduced (43.7% vs 8.8%; P<.001) and mean pretriage waiting times were significantly reduced (4.4, SD 1.7 vs 2.9, SD 1.0 minutes; P<.001) with the use of smartphones compared to kiosks. There was a significant difference in mean usability scores for "ease of task completion" (4.4, SD 1.5 vs 6.7, SD 0.7; P<.001), "satisfaction with completion time" (4.5, SD 1.4 vs 6.8, SD 0.6; P<.001), and "satisfaction with support" (4.9, SD 1.9 vs 6.6, SD 1.2; P<.001). Triage nurses provided a higher NPS after implementation of mobile self-registration compared to the use of kiosks (13.3% vs 93.3%; P<.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps. CONCLUSIONS: This study suggests patient-carried smartphones as a useful tool for ED self-registration. With increased usability and a tailored queueing model, the proposed system is expected to minimize pretriage waiting for patients in the ED.

Validity of the TBApp mobile application for self-care management for people with tuberculosis.

OBJECTIVES: to describe the validity process of the TBApp mobile application for self-care management for people with tuberculosis linked to Primary Health Care. METHODS: methodological research developed with ten expert judges, carried out virtually. The application was assessed in relation to content and technology quality in seven domains (objectivity; structure and appearance; relevance; functionality; reliability; usability; and efficiency), using an instrument with a Likert scale. RESULTS: TBApp was considered valid, relevant, functional, reliable and effective by expert judges. The objectives, structure and presentation and relevance domains presented an overall Content Validity Index of 0.93, and the functionality, reliability, usability and efficiency domains presented characteristics and sub-characteristics values greater than 0.80. CONCLUSIONS: TBApp is a creative and innovative tool that can be used by people with TB and disseminated in the scientific community.

Mobile Health App and Web Platform (eDOL) for Medical Follow-Up of Patients With Chronic Pain: Cohort Study Involving the French eDOL National Cohort After 1 Year.

BACKGROUND: Chronic pain affects approximately 30% of the general population, severely degrades quality of life and professional life, and leads to additional health care costs. Moreover, the medical follow-up of patients with chronic pain remains complex and provides only fragmentary data on painful daily experiences. This situation makes the management of patients with chronic pain less than optimal and may partly explain the lack of effectiveness of current therapies. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs could better characterize patients, chronic pain, pain medications, and daily impact to help medical management. OBJECTIVE: This cohort study aimed to assess the ability of our mHealth tool (eDOL) to collect extensive real-life medical data from chronic pain patients after 1 year of use. The data collected in this way would provide new epidemiological and pathophysiological data on chronic pain. METHODS: A French national cohort of patients with chronic pain treated at 18 pain clinics has been established and followed up using mHealth tools. This cohort makes it possible to collect the determinants and repercussions of chronic pain and their evolutions in a real-life context, taking into account all environmental events likely to influence chronic pain. The patients were asked to complete several questionnaires, body schemes, and weekly meters, and were able to interact with a chatbot and use educational modules on chronic pain. Physicians could monitor their patients' progress in real time via an online platform. RESULTS: The cohort study included 1427 patients and analyzed 1178 patients. The eDOL tool was able to collect various sociodemographic data; specific data for characterizing pain disorders, including body scheme; data on comorbidities related to chronic pain and its psychological and overall impact on patients' quality of life; data on drug and nondrug therapeutics and their benefit-to-risk ratio; and medical or treatment history. Among the patients completing weekly meters, 49.4% (497/1007) continued to complete them after 3 months of follow-up, and the proportion stabilized at 39.3% (108/275) after 12 months of follow-up. Overall, despite a fairly high attrition rate over the follow-up period, the eDOL tool collected extensive data. This amount of data will increase over time and provide a significant volume of health data of interest for future research involving the epidemiology, care pathways, trajectories, medical management, sociodemographic characteristics, and other aspects of patients with chronic pain. CONCLUSIONS: This work demonstrates that the mHealth tool eDOL is able to generate a considerable volume of data concerning the determinants and repercussions of chronic pain and their evolutions in a real-life context. The eDOL tool can incorporate numerous parameters to ensure the detailed characterization of patients with chronic pain for future research and pain management. TRIAL REGISTRATION: ClinicalTrials.gov NCT04880096; https://clinicaltrials.gov/ct2/show/NCT04880096.

A Chatbot-Delivered Stress Management Coaching for Students (MISHA App): Pilot Randomized Controlled Trial.

BACKGROUND: Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for students with stress remains limited. OBJECTIVE: This study aims to develop a conversational agent-delivered stress management coaching intervention for students called MISHA and to evaluate its effectiveness, engagement, and acceptance. METHODS: In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited on the web. Using a 1:1 randomization ratio, participants (N=140) were allocated to either the intervention or waitlist control group. Treatment effectiveness on changes in the primary outcome, that is, perceived stress, and secondary outcomes, including depression, anxiety, psychosomatic symptoms, and active coping, were self-assessed and evaluated using ANOVA for repeated measure and general estimating equations. RESULTS: The per-protocol analysis revealed evidence for improvement of stress, depression, and somatic symptoms with medium effect sizes (Cohen d=-0.36 to Cohen d=-0.60), while anxiety and active coping did not change (Cohen d=-0.29 and Cohen d=0.13). In the intention-to-treat analysis, similar results were found, indicating reduced stress (ß estimate=-0.13, 95% CI -0.20 to -0.05; P<.001), depressive symptoms (ß estimate=-0.23, 95% CI -0.38 to -0.08; P=.003), and psychosomatic symptoms (ß estimate=-0.16, 95% CI -0.27 to -0.06; P=.003), while anxiety and active coping did not change. Overall, 60% (42/70) of the participants in the intervention group completed the coaching by completing the postintervention survey. They particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated the lowest, the target group fitting was perceived as high. CONCLUSIONS: Findings indicate that MISHA is feasible, acceptable, and effective in reducing perceived stress among students in Switzerland. Future research is needed with different populations, for example, in students with high stress levels or compared to active controls. TRIAL REGISTRATION: German Clinical Trials Register DRKS 00030004; https://drks.de/search/en/trial/DRKS00030004.

Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study.

BACKGROUND: Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app-based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. OBJECTIVE: Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. METHODS: A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks' postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). RESULTS: The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). CONCLUSIONS: This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations.

Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis.

BACKGROUND: Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China. OBJECTIVE: In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement. METHODS: We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators. RESULTS: The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9%, SD 24.2%) lagged behind general PI protection (mean 90.4%, SD 14.7%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9%, SD 24.2%). Although most apps (n=41, 79%) committed to supervising subcontractors, only a quarter (n=13, 25%) required users' explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2%, SD 29.3%) and incident management (mean 71.8%, SD 36.6%), half of the assessed apps (n=27, 52%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77%) and instances of PI deletion or anonymization (n=41, 79%), but fewer (n=20, 38.5%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42%) or to refuse advertisement based on automated decision-making (n=13, 25%). Significant deficiencies remained in regular compliance audits (mean 11.5%, SD 37.8%), impact assessments (mean 13.5%, SD 15.2%), and PI officer disclosure (mean 48.1%, SD 49.3%). CONCLUSIONS: Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps' privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages.

Effectiveness of Mobile-Based Progressive and Fixed Physical Activity on Depression, Stress, Anxiety, and Quality of Life Outcomes Among Adults in South Korea: Randomized Controlled Trial.

BACKGROUND: Depression acts as a significant obstacle to the overall well-being of individuals. Given the significant consequences, timely recognition and proactive steps to manage symptoms of depression become essential. Such actions not only reduce personal distress but also play a crucial role in reducing its far-reaching impact on society as a whole. OBJECTIVE: In response to this concern, the objective of this study was to explore the use of mobile-based interventions as a possible remedy. More specifically, this study aimed to investigate the effectiveness of 2 types of physical activity (PA), progressive and fixed, within a mobile-based app on depression, perceived stress, anxiety, physical health, and psychological health, aiming to contribute to the optimization of mental health benefits. METHODS: Participants (N=60; mean age 25.29, SD 6.10 years) were recruited using a combination of web-based and offline methods, and the study lasted for 8 weeks. The baseline and posttest questionnaires were administered to all participants. The participants were randomly assigned to 1 of the 3 groups: progressive group (n=20; performing mobile-based progressive PA), fixed group (n=20; performing mobile-based fixed intensity PA), and control group C (n=20). Data analysis involved comparing scores between the experimental and control groups using a one-way ANOVA, paired sample t tests (2-tailed), and repeated measures ANOVA with a 3 (group)×2 (time) design. RESULTS: The findings revealed significant improvements in mental health indicators among participants engaged in both fixed and progressive PA groups compared with the control group. However, the fixed PA group demonstrated more significant reductions in symptoms. Specifically, the progressive PA group showed significant reductions in depression (F1,36=6.941; P=.01; ηp2=0.16) and perceived stress (F1,36=5.47; P=.03; ηp2=0.13), while the fixed PA group exhibited significant reductions in depression (F1,37=5.36; P=.03; ηp2=0.12), perceived stress (F1,37=7.81; P=.008; ηp2=0.17), and general anxiety disorder (F1,37=5.45; P=.03; ηp2=0.13) compared with the control group. CONCLUSIONS: This study underscores the potential of mobile-based PA in improving mental health outcomes. The findings offer significant insights for mental health professionals and researchers aiming to optimize mental well-being through innovative mobile therapies. TRIAL REGISTRATION: Clinical Research Information Service KCT0009100; https://tinyurl.com/mr33fmur.