Developing a Digital Health Metacademy for Continuing Professional Education.

Recently, there is much hype about the Metaverse, especially since COVID-19 has forced many educational programs to adopt online and/or hybrid practices. This study explored the perceptions and experiences of healthcare professionals and digital health practitioners on an in-house developed Metaverse Academy (Metacademy) for Continuing Professional Education (CPE). In a pilot study, majority of participants found the Metacademy a fun and enjoyable place for learning (88.2% each). The most highly rated factors based on the Technology Acceptance Model, were perceived usefulness (18.41±5.38), perceived enjoyment (17.88±3.41) and behavioral intention to use (17.82±2.88). All agreed that the Metacademy was a useful learning tool and had the potential to enhance learning effectiveness (100% each).

An In-House Developed Probiotics Database E-Reference Information for Healthcare Professionals.

Currently available references provide evidence on efficacy of probiotics strains but exclude product-specific information, making it challenging for healthcare professionals (HCPs) to provide suitable probiotic recommendations to consumers. This study describes the development and evaluation of an online probiotics e-reference database to assist HCPs in delivering evidence-based recommendations on probiotics to consumers. The database currently consists of 556 clinical studies collated through PubMed literature search, 753 probiotic products from multiple retail stores in Singapore and 5708 unique product-study links. Users can search for probiotics based on indication, product or strain. Based on a pilot evaluation by 25 pharmacists practising in hospital and retail settings, 84% agreed that the database helped in assessing the efficacy of probiotic products. All (100%) found the database easy to navigate and most (96%) would continue to use the database as an evidence-based e-reference for probiotic information.

The Saltomachy War - A Metaverse Escape Room on the War Against Salt.

Excessive salt intake is a risk factor that leads to cardiovascular diseases. Public education on healthy eating habits and maintaining a healthy lifestyle can enable consumers to make better informed choices. This study developed a Metaverse Escape Room to increase public awareness on the "War Against Salt". Known as "The Saltomachy War" (TSW), 29 participants played the game in teams to solve puzzles across five "worlds" (rooms) to "escape" the game. Median post-game knowledge quiz scores were significantly higher than the pre-game quiz scores (12/15 versus 9/15, p<0.001). All players agreed that the content in TSW was useful in daily life (100%). TSW was easy to navigate (93.1%) and majority were engaged and actively participated in gameplay (96.6%). The storyline was creative and interesting (93.1%). Almost all players liked TSW to be in their curriculum and would recommend TSW to friends and family (96.6% each).

Virtual Reality-Based Intervention to Reduce Preoperative Anxiety in Adults Undergoing Elective Surgery: A Randomized Clinical Trial.

IMPORTANCE: Preoperative anxiety is common among adult patients undergoing elective surgery and is associated with negative outcomes. Virtual reality (VR)-based interventions have been considered simpler, safer, and more effective for reducing anxiety in patients undergoing surgery than conventional care. OBJECTIVE: To examine the effectiveness of a VR-based intervention with preoperative education in reducing preoperative anxiety among adult patients undergoing elective surgery. DESIGN, SETTING, AND PARTICIPANTS: An assessor-blinded prospective randomized clinical trial was conducted to recruit adult patients aged 18 years or older who were scheduled for their first elective surgery procedure under general anesthesia within the next 2 to 4 weeks at a preanesthesia assessment clinic in Hong Kong from July to December 2022. INTERVENTIONS: Participants were randomly assigned to either an intervention group (an 8-minute immersive 360° VR video tour in the operating theater via a head-mounted display console) or a control group (standard care). MAIN OUTCOMES AND MEASURES: The primary outcome of preoperative anxiety was measured using the Amsterdam Preoperative Anxiety and Information Scale (range, 6-30; higher scores indicate greater anxiety), and the secondary outcomes (ie, stress, preparedness, and pain) were assessed by Visual Analog Scale at 3 time points: baseline at beginning of clinical session (T0), at the end of the clinical session immediately after the intervention (T1), and before the surgery (T2). Pain, satisfaction levels, and postoperative length of stay were evaluated after the surgery (T3). Simulation sickness was assessed after the intervention by use of the Simulation Sickness Questionnaire. A generalized estimating equations model was applied to compare changes in outcomes over time. RESULTS: A total of 74 participants (mean [SD] age, 46.34 [14.52] years; 38 men [51.4%] and 36 women [48.6%]) were recruited and randomized to the control group (37 participants) and intervention group (37 participants). Compared with the control group, the VR-based intervention group showed significantly decreased preoperative anxiety at T1 (ß, -5.46; 95% CI, -7.60 to -3.32; P < .001) and T2 (ß, -5.57; 95% CI, -7.73 to -3.41; P < .001), lower stress at T1 (ß, -10.68; 95% CI, -16.00 to -5.36; P < .001) and T2 (ß, -5.16; 95% CI, -9.87 to -0.45; P = .03), and higher preparedness at T1 (ß, 6.60; 95% CI, 0.97 to 12.19; P = .02). Satisfaction levels were significantly increased in the intervention group vs the control group (mean [SD] score, 81.35 [9.24] vs 65.28 [8.16]; difference, 16.07; 95% CI, 12.00 to 20.15; P < .001). No significant differences in pain and postoperative length of stay were found. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that a VR-based intervention is a feasible and effective way to reduce preoperative anxiety in adult patients undergoing elective surgery. Given the promising results of this study, further study in the form of large-scale, multicenter, randomized clinical trials with broader implementation is warranted. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2100051690.

Towards better reporting of the proportion of days covered method in cardiovascular medication adherence: A scoping review and new tool TEN-SPIDERS.

Although medication adherence is commonly measured in electronic datasets using the proportion of days covered (PDC), no standardized approach is used to calculate and report this measure. We conducted a scoping review to understand the approaches taken to calculate and report the PDC for cardiovascular medicines to develop improved guidance for researchers using this measure. After prespecifying methods in a registered protocol, we searched Ovid Medline, Embase, Scopus, CINAHL Plus and grey literature (1 July 2012 to 14 December 2020) for articles containing the terms "proportion of days covered" and "cardiovascular medicine", or synonyms and subject headings. Of the 523 articles identified, 316 were reviewed in full and 76 were included (93% observational studies; 47% from the USA; 2 grey literature articles). In 45 articles (59%), the PDC was measured from the first dispensing/claim date. Good adherence was defined as 80% PDC in 61 articles, 56% of which contained a rationale for selecting this threshold. The following parameters, important for deriving the PDC, were often not reported/unclear: switching (53%), early refills (45%), in-hospital supplies (45%), presupply (28%) and survival (7%). Of the 46 articles where dosing information was unavailable, 59% reported how doses were imputed. To improve the transparent and systematic reporting of the PDC, we propose the TEN-SPIDERS tool, covering the following PDC parameters: Threshold, Eligibility criteria, Numerator and denominator, Survival, Presupply, In-hospital supplies, Dosing, Early Refills, and Switching. Use of this tool will standardize reporting of the PDC to facilitate reliable comparisons of medication adherence estimates between studies.

Disruptive Technology, Leadership and the Future of Nursing.

Nurses need to take a strategic leadership role in managing disruptive health technologies that can be adopted to improve health and care within the population. While innovative technology developments continue to advance quickly, systematic changes to the health and care systems are not always geared to take advantage of these advances at the same rate. This panel will look at how disruptive technology will impact nursing practice and strategic leadership factors that shape acceptance/resistance to new technologies.

Mobile Health Apps That Act as Surgical Preparatory Guides: App Store Search and Quality Evaluation.

BACKGROUND: Mobile health (mHealth) apps are becoming increasingly common in surgical practices for training, education, and communication. Factors leading to increased delays, morbidity, and mortality in surgery include inadequate preoperative patient preparation due to a failure to identify patients and procedure details, and missing instruments and equipment required for the procedure. Many apps are available for supporting preoperative, intraoperative, and postoperative care. However, there is a lack of studies that assess the quality of apps that act as surgical preparatory guides. OBJECTIVE: The aim of this study is to evaluate the quality of apps that act as surgical preparatory guides for operating room personnel through an in-house quality assessment tool. METHODS: The quality assessment tool comprises 35 questions categorized into 5 sections: (1) engagement (customization, interactivity, target audience; 19 points), (2) functionality (performance, ease of use, navigation; 12 points), (3) aesthetics (layout, visual appeal; 6 points), (4) information (quality and quantity of information, visual information, credibility; 29 points), and (5) privacy and security (4 points). An app search was conducted in the Australian Apple and Google Play stores using the following keywords: "surgical apps", "surgical preferences", "surgeon preferences", "operating room", and "perioperative procedures". The overall total scores and scores for each section were reported as medians and IQRs, expressed as raw scores and percentages. RESULTS: A total of 5 unique apps were evaluated on both iOS and Android platforms. The median overall score across all apps was 35/70 (50%; IQR 38.6%-64.3%). ScrubUp (48/70, 69%) and MySurgeon (42/70, 60%) had the highest overall scores, followed by PrefCard (35/70, 50%) and Scrubnote (28/70, 40%). The lowest scoring app was BrainPadd (26/70, 37%). The sections with the highest median scores, in decreasing order, were privacy and security (4/4, 100%; IQR 75%-100%), aesthetics (5/6, 83%; IQR 75%-91.7%), engagement (15/19, 79%; IQR 57.9%-86.8%), functionality (7/12, 58%; IQR 29.2%-75%), and information (5/29, 17%; IQR 15.5%-34.5%). Most apps scored well (4/4, 100%) on privacy and security, except for Scrubnote (2/4, 50%). ScrubUp received a perfect score for aesthetics (6/6, 100%). MySurgeon (17/19, 90%) had the highest engagement score, while ScrubUp and MySurgeon had the highest functionality scores (9/12, 75% each). All apps scored below 50% for the information section, with ScrubUp having the highest score of 13/29 (45%). CONCLUSIONS: ScrubUp and MySurgeon had the highest quality scores and can be used as adjuncts to hospital protocols by operating room personnel for their surgical preparation. Developers are encouraged to develop appropriate apps for surgical preparation based on relevant guidelines and standards, as well as the quality evaluation criteria in our tool. Operating room personnel can also use this tool as a guide to select and assess their preferred apps in their practices.

Development of a Probiotics Practice E-Reference Database for Health Care Professionals.

PURPOSE: Currently available references provide evidence on the efficacy of probiotics strains but exclude product-specific information, making it challenging for health care professionals (HCPs) to provide consumers with suitable recommendations on probiotics. An online probiotics e-reference database was developed to assist HCPs in delivering evidence-based recommendations on probiotics to consumers. The usability and applicability of the database in health care practice were evaluated. METHODS: Information on the efficacy of probiotics and probiotic products was collated using a PubMed literature search, and from local pharmacies and online supplement stores. A web database was compiled using various programming scripts and uploaded onto a web server. The database was beta-tested using an online self-administered questionnaire for community-based pharmacists, and responses were analyzed using descriptive statistics. FINDINGS: The database comprised 584 clinical study excerpts, 449 probiotic products, and 1879 unique product-study links. Users can search for suitable probiotics based on their indication profile or for a specific probiotic product. Information provided includes the probiotic constituents, dosage regimen, and indications of the product, with supporting clinical evidence. Overall, all participants of the beta-test indicated that they were satisfied with the database and were willing to use it again (both, 13 participants [100%]). In addition, all participants indicated that they found the database intuitive to use and smooth functioning, without inconsistencies (both, 13 [100%]). The majority also indicated that they found the information provided to be clear, comprehensive, and useful in health care practice (12 [92.3%] each). IMPLICATIONS: The probiotics e-reference database is an integrated resource that is user-friendly, and provides HCPs with ready access to clear and comprehensive information on probiotic products and clinical studies, so that HCPs can provide consumers with relevant and evidence-based recommendations on probiotics.

Quality evaluation of stress, anxiety and depression apps for COVID-19.

BACKGROUND: COVID-19 has caused increased stress, anxiety and depression with increased barriers to treatment. Mobile apps offer a potential solution, but there is no information on the quality of such apps recommended for COVID-19. This study aims to evaluate the quality of stress, anxiety and depression apps recommended for COVID-19. METHODS: A search was conducted to identify relevant apps on the iOS and Android platforms. 44 apps were evaluated using the Mobile App Rating Scale (MARS), and the American Psychiatric Association's app evaluation model for data privacy and security. RESULTS: Overall quality scores of iOS and Android apps were 3.69 ± 0.43 and 3.66 ± 0.47. Thirty percent had good/excellent overall scores. In general, the iOS and Android versions of the apps scored best for functionality (4.21 ± 0.48, 4.12 ± 0.53), followed by aesthetics (3.84 ± 0.50, 3.78 ± 0.56), information (3.39 ± 0.54, 3.40 ± 0.60), and engagement (3.31 ± 0.81, 3.34 ± 0.84). Over half (59%) shared personal information with third parties and 14% were compliant with data protection standards. LIMITATIONS: Only free apps available in Singapore were evaluated. Our results are time sensitive due to addition, removal, and update of apps in the app stores, thus our results should be extrapolated with caution to apps from other countries and paid apps. CONCLUSION: Apps that addressed all three conditions had the highest overall quality scores. The top ranked apps (Sanvello, Woebot, Happify, Youper, Bloom) were of good quality, but majority were of acceptable quality and had room for improvement. App developers are encouraged to use our findings to improve and develop better quality apps.

Assessing the quality of COVID-19 vaccine videos on video-sharing platforms.

BACKGROUND: Video-sharing platforms are a common source for health information such as Coronavirus Disease 2019 (COVID-19) vaccines. It is important that they provide good quality, evidence-based information. However, to date, the quality of information surrounding COVID-19 vaccines on video-sharing platforms has not been established. OBJECTIVE: This study developed an assessment tool to evaluate the quality of Coronavirus Disease 2019 (COVID-19) vaccine videos on YouTube, Facebook Watch and TikTok. METHODS: Assessment of quality was based on understandability, actionability, accuracy, comprehensiveness and reliability. Videos were searched using the keywords "COVID-19 vaccine", "Coronavirus vaccine" and "SARS-CoV-2 vaccine". Seventy-two videos were evaluated. Descriptive statistics, Kruskal-Wallis and Wilcoxon-rank sum tests were used for analysis. RESULTS: YouTube had the highest median composite score compared to TikTok (36.8% versus 27.5%, p = 0.001). YouTube also had the highest median reliability score (37.5%), but those of Facebook Watch (35.0%) and TikTok (35.0%) were only marginally lower. Median accuracy scores of all platforms were 100%, but their median comprehensiveness scores were low (YouTube 12.5%; Facebook Watch 6.3%; TikTok 6.3%, p = 0.004). Median actionability scores (0%) were the lowest for all platforms. TikTok had the highest median understandability score compared to YouTube and Facebook Watch (96.9% versus 80.0 each, p < 0.001). CONCLUSION: The overall quality of videos on all video-sharing platforms were low. All platforms provided accurate COVID-19 vaccine information, but TikTok videos were the most understandable. Most videos did not provide full details about COVID-19 vaccines, thus viewers would need to watch several videos before making a better-informed decision.

Trends in lipid-modifying agent use in 83 countries.

BACKGROUND AND AIMS: Lipid-modifying agents (LMAs) are increasingly used to reduce lipid levels and prevent cardiovascular events but the magnitude of their consumption in different world regions is unknown. We aimed to describe recent global trends in LMA consumption and to explore the relationship between country-level LMA consumption and cholesterol concentrations. METHODS: This cross-sectional and ecological study used monthly pharmaceutical sales data from January 2008 to December 2018 for 83 countries from the IQVIA Multinational Integrated Data Analysis System and total and non-high-density lipoprotein (non-HDL) cholesterol concentrations from the NCD Risk Factor Collaboration. Compound annual growth rate (CAGR) was used to assess changes in LMA consumption over time. RESULTS: From 2008 to 2018, use of LMAs increased from 7468 to 11,197 standard units per 1000 inhabitants per year (CAGR 4.13%). An estimated 173 million people used LMAs in 2018. Statins were the most used class of LMA and their market share increased in 75% of countries between 2008 and 2018. From 2013 to 2018, consumption of low-density lipoprotein lowering therapies increased (statins 3.99%; ezetimibe 4.01%; proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors 104.47%). Limited evidence supports a clear relationship between country-level changes in LMA consumption and mean total and non-HDL cholesterol concentrations in 2008 versus 2018. CONCLUSIONS: Since 2008, global access to LMAs, especially statins, has improved. In line with international lipid guideline recommendations, recent trends indicate growth in the use of statins, ezetimibe, and PCSK9 inhibitors. Country-level patterns of LMA use and total and non-HDL cholesterol varied considerably.

Use of virtual reality in the supportive care management of paediatric patients with cancer.

Paediatric patients with cancer undergo multiple treatments and procedures that can be invasive and painful. Virtual reality technologies could support the management of paediatric cancer. This Review focuses on the physiological and psychological efficacy of virtual reality in supportive care management. Virtual reality has shown potential in reducing pain scores, pulse rates, and distress scores, but has no significant effect on other indicators, such as anxiety, fear, and depression. Several virtual reality characteristics might affect its effectiveness when used in the paediatric cancer setting. Virtual reality games with high fidelity (eg, fully-isolating head-mounted display, stereo sound, and controllers) components provide a higher level of immersion, presence, and narrative engagement, which could better manage pain. Personalising the virtual reality experience to the patient and procedure would also improve accessibility and comfort. Clinicians should work closely with virtual reality developers to ensure that the virtual reality applications used are appropriate for their patients.

Mobile Health Apps That Help With COVID-19 Management: Scoping Review.

BACKGROUND: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. OBJECTIVE: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, literature searches were conducted on Google Search, Google Scholar, and PubMed using the country's name as keywords and "coronavirus," "COVID-19," "nCOV19," "contact tracing," "information providing apps," "symptom tracking," "mobile apps," "mobile applications," "smartphone," "mobile phone," and "mHealth." Countries most affected by COVID-19 and those that first rolled out COVID-19-related apps were included. RESULTS: A total of 46 articles were reviewed from 19 countries, resulting in a total of 29 apps. Among them, 15 (52%) apps were on contact tracing, 7 (24%) apps on quarantine, 7 (24%) on symptom monitoring, and 1 (3%) on information provision. More than half (n=20, 69%) were from governmental sources, only 3 (10%) were from private organizations, and 3 (10%) from universities. There were 6 (21%) apps available on either Android or iOS, and 10 (34%) were available on both platforms. Bluetooth was used in 10 (34%) apps for collecting data, 12 (41%) apps used GPS, and 12 (41%) used other forms of data collection. CONCLUSIONS: This review identifies that the majority of COVID-19 apps were for contact tracing and symptom monitoring. However, these apps are effective only if taken up by the community. The sharing of good practices across different countries can enable governments to learn from each other and develop effective strategies to combat and manage this pandemic.

Development of a 3D-printed Medication Label for the Blind and Visually Impaired.

This study explored the potential of three-dimensional printing (3DP) technology in producing a three-dimensional (3D) medication label for blind and visually impaired (BVI) patients to ease their drug administration. Different variations of label wordings, dosing instructions, and medication identifiers were designed with reference to guidelines by the American Foundation for the Blind. Shapes and symbols were used as dosing instructions and medication identifiers to the patient's medical conditions. Prototype designs were created with common graphics computer-assisted drafting software and 3D-printed using acrylonitrile butadiene styrene as the polymer filament. Feedback was then obtained from five people with normal vision and four BVI persons. The initial prototype comprised four components, namely, medication name and strength, patient's name, dosing instruction, and medication identifier. A revised label comprising the latter two components was developed after feedback by BVI persons. Words were in all uppercase and regular font type, with a 5-mm center-to-center letter spacing. Elevation heights of the letters alternated between 1 mm and 1.5 mm. A half sphere represented the medication dose unit, while vertical lines and a horizontal center line with alternating elevation of arrowheads represented the frequency of administration and the medication's consumption in relation to food, respectively. Symbols based on target organs were used as medication identifiers. With rapid advancements in 3DP technologies, there is tremendous potential for producing 3D labels in patients' medication management.

Personalizing symptom monitoring and contact tracing efforts through a COVID-19 web-app.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has sparked attention in many countries, especially those that have experienced a steep spike in the number of identified cases. The continued spread of the coronavirus suggests that this situation may be here to stay for a while. Contact tracing is a time-consuming and resource-intensive process, which taps on the already lean healthcare resource in certain countries. Furthermore, the massive infodemic on COVID-19 on the Internet has also resulted in widespread circulation of misinformation online. This outbreak has evoked irrational fear and anxiety from the public, which has resulted in destabilizing of societal norms, such as panic buying and hoarding of daily necessities, and can potentially pose serious health risks to the public. The aim of this paper is to present a COVID-19 Symptom Monitoring and Contact Tracking Record (CoV-SCR) web-app as a bottom-up, proactive approach to supplement the current management strategies for COVID-19. MAIN TEXT: The CoV-SCR web-app ( http://bit.ly/covscrapp ) enables individuals to keep a personal record of their close contacts and monitor their symptoms on a daily basis, so that they can provide relevant and accurate details when they see the doctor and during the contact tracing process. Individuals can record their temperature and rate their symptoms on a 5-point severity scale, as well as record details of their travel and contact history for the last 14 days. The recorded information will be sent to their e-mail address for potential symptom monitoring and contact tracing purposes. In addition, this web-app consolidates evidence-based information on the coronavirus from credible sources, such as the World Health Organization, countries' health authorities, and PubMed literature. CONCLUSIONS: A COVID-19 Symptom Monitoring and Contact Tracking web-app has been developed to facilitate contact tracing efforts through public engagement. This app serves an additional purpose of providing information about COVID-19 from reliable resources.

Students' perceptions of an in-house developed pharmacy serious game for professional skills training.

Background: An in-house three-dimensional (3D) multiplayer online role-playing game was developed for professional skills training of pharmacy students. Students play the game in a post-apocalyptic world to save humankind from zombies. They solve virtual patient encounters through visual and motion-capture technologies. Their gaming perceptions and experiences were investigated. Method: A self-administered questionnaire obtained participants' demographics, gaming interests, perceptions of game effectiveness, preferences on gaming elements and gameplay experience through the Game Engagement Questionnaire (GEQ). Pre-gameplay and post-gameplay assessments were tracked to assess student learning. Descriptive statistics and paired sample t-tests were used for analysis. Results: Fifty-five students were recruited. Two-thirds of the gameplay group (67.9%) liked the post-apocalyptic fantasy settings and heroic storyline (66.0%). Three quarters liked the modern setting (73.1%), authentic plots (73.5%) and plot animations (72.3%). Participants felt the game was effective in training health communication and patient history-taking skills (81.8%). Participants' test scores for counselling increased from 66.1%±7.6% (pre-gameplay) to 70.3%±8.0% (post-gameplay, p=0.004). The highest scoring GEQ dimension was sensory and imaginative immersion (2.92±0.74). Conclusion: Students found the game useful for pharmacy professional skills training. With proper implementation, this game can become a useful tool to enhance student learning and gear them towards clinical practices.

Design Considerations in the Development of App-Based Oral Anticancer Medication Management Systems: a Qualitative Evaluation of Pharmacists' and Patients' Perspectives.

Smartphone apps can potentially help in enhancing oral anticancer medication (OAM) adherence. Patient adoption and efficacy of such apps depends on inclusion of user-centred and evidence-based features. The objective of this study was to identify important design considerations from the perspectives of patients taking OAMs, caregivers and oncology pharmacists. The study employed a qualitative study design. Data were collected using in-depth interviews with patients (n = 15), caregivers (n = 3) and pharmacists (n = 16). Interviews were audio-recorded, transcribed verbatim and inductive thematic analysis approach was used in data analysis. Monitoring medication-related problems, medication information, replacement of or integration with current systems and accessibility of app content on devices other than smartphones were the key themes identified in the analysis. Flexible input methods for monitored data, glanceability of monitored reports/information, near real-time adherence enhancing and symptom management interventions and customisable reminder options were design considerations identified under the monitoring medication-related problems theme. Participants suggested the provision of focused and easily understandable medication information with a potential for personalisation. Integration of app-based adherence systems with patients' electronic medical records with added mechanisms for alerts in the dispensing system was also suggested as a key design requirement to improve quality of patient care and facilitate adoption by clinicians. Finally, smartphones were the most favoured platform with optional accessibility of app content on other devices. In conclusion, important design considerations were identified through a user-centred design approach. The findings will help developers and clinicians in the design of new app-based systems and evaluation of existing ones.

User acceptance of an app-based adherence intervention: Perspectives from patients taking oral anticancer medications.

BACKGROUND: Widespread adoption by patients is imperative for the success of app-based interventions for enhancing adherence to oral anticancer medications. Patients' attitudes and beliefs should be evaluated to understand determinants of their acceptance and adoption of such interventions. OBJECTIVE: To identify factors that influence cancer patients' intention to adopt an app-based system for enhancing oral anticancer medication adherence. METHODS: This study was conducted as part of the usability evaluation of an app-based system for enhancing adherence. We followed the grounded theory approach employing audio-recorded face-to-face interviews for data collection from patients taking oral anticancer medications (n = 15) and caregivers of such patients (n = 3). Data analysis involved verbatim transcription of all interviews, coding of the transcripts and field notes, detailed memo writing, and constant comparative evaluation of emergent categories. RESULTS: A conceptual framework of facilitating and hindering factors for users' adoption intention for an oral anticancer medication adherence app was developed. Findings suggest that facing difficulties in maintaining adherence and patients' perceived superiority of the app over their current methods facilitate adoption intention. In contrast, having to pay, lack of language options and users' perception of low competence in using an app were the hindrance factors. CONCLUSION: This study showed that adoption of adherence apps could be explained by technology acceptance constructs, such as performance expectancy. Adoption intention was also facilitated by patients perceived vulnerabilities in maintaining adherence to their medications, which was a health behaviour construct. Implementation of app-based programs should address patients' perceived vulnerabilities and relative advantage of the app over their current methods. Clinicians and app developers should also consider the financial, technological and language barriers for end users.

Herbopolis - A mobile serious game to educate players on herbal medicines.

BACKGROUND: Use of herbal medicines is common. There is a need for education in this area. Mobile games are useful educational tools for motivating learning. A mobile game on herbal medicines can potentially enhance players' herb-related knowledge. Our objective was to develop a mobile game to motivate players to learn more about herbal medicines. METHODS: Game development comprised of storyboarding, user interface design, database development, server development and distribution. A pilot usability study was conducted for the game prototype. Data was gathered through user registration, background data collection and a post-game survey containing a quiz on herbs encountered in the game. Mann-Whitney U test, chi-squared test and Spearman's correlation coefficient were used for data analysis. RESULTS: "Herbopolis" is an in-house developed mobile game of the simulation genre. Players are tasked to manage a city specializing in the production and sale of herbal products. Nineteen out of 24 participants downloaded and played the game, and completed the post-game survey. Heuristic evaluations for usability, playability and educability were generally positive. Strong positive associations were observed between player level (r = 0.810, p < 0.001) and gameplay time (r = 0.757, p < 0.001) with quiz scores. Female players scored higher in the quiz (p = .044), played for more days (p = .010) and attained higher levels (p = .010) than male players. CONCLUSION: Players are motivated to learn about herb-related information through playing "Herbopolis". Our results support its use for improving knowledge on herbal medicines. Future game iterations to improve robustness and performance will likely to improve its reception and effectiveness in learning.

MedAd-AppQ: A quality assessment tool for medication adherence apps on iOS and android platforms.

BACKGROUND: With the recent proliferation of smartphone medication adherence applications (apps), it is increasingly more difficult for patients and clinicians to identify the most useful app. OBJECTIVE: To develop a quality assessment tool for medication adherence apps, and evaluate the quality of such apps from the major app stores. METHODS: In this study, a Medication Adherence App Quality assessment tool (MedAd-AppQ) was developed and two evaluators independently assessed apps that fulfilled the following criteria: availability in English, had at least a medication reminder feature, non-specific to certain disease conditions (generic apps), free of technical malfunctions and availability on both the iPhone Operating System (iOS) and Android platforms. Descriptive statistics, Mann-Whitney U test, Pearson product moment correlation and Spearman rank-order correlation were used for statistical analysis. RESULTS: MedAd-AppQ was designed to have 24 items (total 43 points) categorized under three sections: content reliability (11 points), feature usefulness (29 points) and feature convenience (3 points). The three sections of MedAd-AppQ were found to have inter-rater correlation coefficients of 0.801 (p-value < .001) or higher. Based on analysis of 52 apps (27 iOS and 25 Android), quality scores ranged between 7/43 (16.3%) and 28/43 (65.1%). There was no significant difference between the quality scores of the Android and iOS versions. None of the apps had features for self-management of side effects. Only two apps in each platform provided disease-related and/or medication information. CONCLUSIONS: MedAd-AppQ can be used to reliably assess the quality of adherence apps. Clinicians can use the tool in selecting apps for use by patients. Developers of adherence apps should consider features that provide therapy-related information and help patients in medications and side-effects management.