A mHealth cardiac rehabilitation exercise intervention: findings from content development studies

BACKGROUND: Involving stakeholders and consumers throughout the content and study design ensures interventions are engaging and relevant for end-users. The aim of this paper is to present the content development process for a mHealth (mobile phone and internet-based) cardiac rehabilitation (CR) exercise intervention.

METHODS: An innovative mHealth intervention was developed with patient input using the following steps: conceptualization, formative research, pre-testing, and pilot testing. Conceptualization, including theoretical and technical aspects, was undertaken by experts. For the formative component, focus groups and interviews with cardiac patients were conducted to discuss their perceptions of a mHealth CR program. A general inductive thematic approach identified common themes. A preliminary library of text and video messages were then developed. Participants were recruited from CR education sessions to pre-test and provide feedback on the content using an online survey. Common responses were extracted and compiled. An iterative process was used to refine content prior to pilot testing and conduct of a randomized controlled trial.

RESULTS: 38 CR patients and 3 CR nurses participated in the formative research and 20 CR patients participated in the content pre-testing. Participants perceived the mHealth program as an effective approach to inform and motivate patients to exercise. For the qualitative study, 100% (n = 41) of participants thought it to be a good idea, and 11% of participants felt it might not be useful for them, but would be for others. Of the 20 participants who completed the online survey, 17 out of 20 (85%) stated they would sign up to a program where they could receive information by video messages on a website, and 12 out of 20 (60%) showed interest in a texting program. Some older CR patients viewed technology as a potential barrier as they were unfamiliar with text messaging or did not have mobile phones. Steps to instruct participants to receive texts and view the website were written into the study protocol. Suggestions to improve videos and wording of texts were fed back to the content development team and refined.

CONCLUSIONS: Most participants thought a mHealth exercise program was an effective way to deliver exercise-based CR. The results were used to develop an innovative multimedia exercise intervention. A randomized controlled trial is currently underway.

Learning multi-faceted activities from heterogeneous data with the product space hierarchical Dirichlet processes

Hierarchical Dirichlet processes (HDP) was originally designed and experimented for a single data channel. In this paper we enhanced its ability to model heterogeneous data using a richer structure for the base measure being a product-space. The enhanced model, called Product Space HDP (PS-HDP), can (1) simultaneously model heterogeneous data from multiple sources in a Bayesian nonparametric framework and (2) discover multilevel latent structures from data to result in different types of topics/latent structures that can be explained jointly. We experimented with the MDC dataset, a large and real-world data collected from mobile phones. Our goal was to discover identity–location– time (a.k.a who-where-when) patterns at different levels (globally for all groups and locally for each group). We provided analysis on the activities and patterns learned from our model, visualized, compared and contrasted with the ground-truth to demonstrate the merit of the proposed framework. We further quantitatively evaluated and reported its performance using standard metrics including F1-score, NMI, RI, and purity. We also compared the performance of the PS-HDP model with those of popular existing clustering methods (including K-Means, NNMF, GMM, DP-Means, and AP). Lastly, we demonstrate the ability of the model in learning activities with missing data, a common problem encountered in pervasive and ubiquitous computing applications.

HEART: heart exercise and remote technologies: a randomized controlled trial study protocol.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide. Cardiac rehabilitation (CR) is aimed at improving health behaviors to slow or reverse the progression of CVD disease. Exercise is a central element of CR. Technologies such as mobile phones and the Internet (mHealth) offer potential to overcome many of the psychological, physical, and geographical barriers that have been associated with lack of participation in exercise-based CR. We aim to trial the effectiveness of a mobile phone delivered exercise-based CR program to increase exercise capacity and functional outcomes compared with usual CR care in adults with CVD. This paper outlines the rationale and methods of the trial.

METHODS: A single-blinded parallel two-arm randomized controlled trial is being conducted. A total of 170 people will be randomized at 1:1 ratio either to receive a mHealth CR program or usual care. Participants are identified by CR nurses from two metropolitan hospitals in Auckland, New Zealand through outpatient clinics and existing databases. Consenting participants are contacted to attend a baseline assessment. The intervention consists of a theory-based, personalized, automated package of text and video message components via participants' mobile phones and the Internet to increase exercise behavior, delivered over six months. The control group will continue with usual CR. Data collection occurs at baseline and 24 weeks (post-intervention). The primary outcome is change in maximal oxygen uptake from baseline to 24 weeks. Secondary outcomes include post-intervention measures on self-reported physical activity (IPAQ), cardiovascular risk factors (systolic blood pressure, weight, and waist to hip ratio), health related quality of life (SF-36), and cost-effectiveness.

DISCUSSION: This manuscript presents the protocol for a randomized controlled trial of a mHealth exercise-based CR program. Results of this trial will provide much needed information about physical and psychological well-being, and cost-effectiveness of an automated telecommunication intervention. If effective, this intervention has enormous potential to improve the delivery of CR and could easily be scaled up to be delivered nationally (and internationally) in a very short time, enhancing the translational aspect of this research. It also has potential to extend to comprehensive CR (nutrition advice, smoking cessation, medication adherence).

Image-encounters with the techno-mediated other: Regarding post-election Iran on Youtube

In June 2009 large-scale public demonstrations on the streets of Tehran followed Mahmoud Ahmadinejad’s controversial claiming of victory in the Republic’s most recent election. As the scale of the unrest rapidly escalated, foreign journalists were expelled from the country and unprecedented numbers of Iranian journalists were imprisoned (Sreberny and Khiabany 176). Observers outside of Iran learned of the events as Iranians on the streets embraced image production and distribution as a central component of their protest. Evading the attempts of the regime to control media coverage of the post-election violence, Iranians uploaded rough footage, still images, and blog entries, seeking to make real their experiences for the international community. A stream of citizen-produced footage of mass demonstrations, beatings and deaths was relayed to the world at large via Internet-based social networking channels and mobile phones. This paper takes a series of images from the mediated turmoil in Iran as a prism through which to consider the problem of what it is that such images make real for distant observers.

Text message-based diabetes self-management support (SMS4BG): study protocol for a randomised controlled trial.

BACKGROUND: Addressing the increasing prevalence, and associated disease burden, of diabetes is a priority of health services internationally. Interventions to support patients to effectively self-manage their condition have the potential to reduce the risk of costly and debilitating complications. The utilisation of mobile phones to deliver self-management support allows for patient-centred care at the frequency and intensity that patients desire from outside the clinic environment. Self-Management Support for Blood Glucose (SMS4BG) is a novel text message-based intervention for supporting people with diabetes to improve self-management behaviours and achieve better glycaemic control and is tailored to individual patient preferences, demographics, clinical characteristics, and culture. This study aims to assess whether SMS4BG can improve glycaemic control in adults with poorly controlled diabetes. This paper outlines the rationale and methods of the trial. METHODS/DESIGN: A two-arm, parallel, randomised controlled trial will be conducted across New Zealand health districts. One thousand participants will be randomised at a 1:1 ratio to receive SMS4BG, a theoretically based and individually tailored automated text message-based diabetes self-management support programme (intervention) in addition to usual care, or usual care alone (control). The primary outcome is change in glycaemic control (HbA1c) at 9 months. Secondary outcomes include glycaemic control at 3 and 6 months, self-efficacy, self-care behaviours, diabetes distress, health-related quality of life, perceived social support, and illness perceptions. Cost information and healthcare utilisation will also be collected as well as intervention satisfaction and interaction. DISCUSSION: This study will provide information on the effectiveness of a text message-based self-management support tool for people with diabetes. If found to be effective it has the potential to provide individualised support to people with diabetes across New Zealand (and internationally), thus extending care outside the clinic environment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12614001232628 .

Mobile technology platforms for flexible access to information resources : considerations in the use of ebook readers, smart phones, netbooks and iPads

Smart phones are everywhere, people are taking eBook readers on holiday, the iPad has queues of people wanting to buy one, and some netbooks can fit in a pocket. The technology is attractive and increasingly affordable – how can it help an individual in their access to and use of texts, journals, databases, clinical sources, the web and day-to-day information? The Library has been investigating and trialling mobile devices during 2010, and has received interesting feedback from staff and students on the effectiveness of the technology in the University and personal environments. Each device has its strengths and weaknesses depending on the needs of the individual or activity it is supporting – productivity, research, study, clinical or recreational. The presentation will explore these issues along with some of the practical implications at Deakin, and international experiences in academic environments.

Wireless haptic rendering for mobile platforms

Computer haptics has so far been performed on a personal computer (PC). Off the shelf haptic devices provide only PC interfaces and software drivers for control and communication. The new wave of high capable tablet PCs and high end smart phones introduced new platforms for haptic applications. The major problem was to communicate wirelessly to provide user convenience and support mobility which is an essential feature for these platforms. In this paper we provide a wireless layered communication protocol and a hardware setup that enables off the shelf haptic devices to communicate wirelessly with a mobile device. The layers in the protocol enable the change of any hardware components without affecting the data flow. However, the adoption of the wireless interface instead of the wired one comes with the price of speed. Haptic refresh loops require a relatively high refresh rate of 1000 Hz compared to graphics loop which require between 30 and 60 only. An interpolation algorithm was demonstrated to compensate the latency and secure a stable user experience. The introduced setup was tested against portable environments and the users could perform similar functionalities to what are available on a wired setup to a PC.

A review of the current status of mobile apps in education - implication for emerging countries business education strategies

Mobile applications (in short: mobile apps) are software applications designed to run on mobile devices such as smart phones and tablet computers. These technologies have come a long way since the opening of the Apple App Store in 2008, especially in their applications for business, information, communication, health and gaming. Most mobile devices are capable of processing and disseminating information in an efficient way. Smart devices, such as the iPhone or iPad, are equipped with innovative functionalities and unique features for easy delivery of content, information sharing, and collaborative work over the Internet. This is the basis for the use of these technologies in the education industry.

iTeach we learn via mobile apps : "a case study in a business course"

Mobile smart phones and Mobile applications (apps) can be seen as an added opportunity for education and for teachers in particular, this can be true if educational institutions are willing to enable this type of delivery mechanism. With the recent development of app technologies in today’s society and the shift towards mobile technologies (devices and applications), it seems hard to imagine better devices and tools that can grant students easy and on demand access to learning content. These smart devices and technologies are multitasking and can offer variety of educational apps that teachers and students are able to integrate into their daily learning activities and can carry with them anywhere. In this paper mobile apps and their integration in education are discussed, a case study on the use of three mobile apps (e-Lecture-Producer, Dropbox and QR Code) in an educational setting in a Business e-commerce course is described. Results and outcomes are discussed based on the results from the case study.

Mobile devices in social contexts

The development of mobile devices has occurred with unprecedented pace since the late nineties, and the increase of generic services has proliferated in most developed countries, driven by the expanding technological capabilities and performance of mobile platforms. This dissertation investigates how consumer objectives, orientation and behavior can aid in explaining the adoption and use of a new type of mobile devices: "app phones". This dissertation focuses its effort on two focal influences of adoption and use; social influences and competing forces. Through a qualitative case study and field study this dissertation explores early adoption and use of iPhones. The case study is a one-shot cross-sectional case study that investigates five individuals, related through the same social network, and their decision to adopt an iPhone prior to its release in Denmark. This adoption decision engenders high switching costs as adopters lack references to imitate and need skills to unlock and jailbreak their iPhones to make them work on Danish networks. The specific purpose of the case study is to explore how social influences impact mobile users' early adoption decisions, as it is well known in the literature that people with similar characteristics, tastes, and beliefs often associate in the same social networks and, hence, influence each other. The field study is cross-sectional with multiple snapshots and explores fifteen individuals part of the same university study, who recieves an iPhone for a period of seven months short after its release in Denmark. The specific purpose of the field study is to explore how competing forces of iPhone usage influence assimilation, i.e. the degree to which the iPhone is used, over time. The dissertation is reported through four articles and is directed at both academic researchers and practitioners. The study emphasizes the importance of social influences and competing forces in the investigation of adoption and use of certain mobile devices.

Remote monitoring system enabling cloud technology upon smart phones and inertial sensors for human kinematics

Stroke is a common neurological condition which is becoming increasingly common as the population ages. This entails healthcare monitoring systems suitable for home use, with remote access for medical professionals and emergency responders. The mobile phone is becoming the easy access tool for self-evaluation of health, but it is hindered by inherent problems including computational power and storage capacity. This research proposes a novel cloud based architecture of a biomedical system for a wearable motion kinematic analysis system which mitigates the above mentioned deficiencies of mobile devices. The system contains three subsystems: 1. Bio Kin WMS for measuring the acceleration and rotation of movement 2. Bio Kin Mobi for Mobile phone based data gathering and visualization 3. Bio Kin Cloud for data intensive computations and storage. The system is implemented as a web system and an android based mobile application. The web system communicates with the mobile application using an encrypted data structure containing sensor data and identifiable headings. The raw data, according to identifiable headings, is stored in the Amazon Relational Database Service which is automatically backed up daily. The system was deployed and tested in Amazon Web Services.

Mobile phone app aimed at improving iron intake and bioavailability in premenopausal women: a qualitative evaluation

BACKGROUND: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women.

OBJECTIVE: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron.

METHODS: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated.

RESULTS: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app's functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app's components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app.

CONCLUSIONS: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women.