Mobile health (mHealth) biomedical imaging paradigm

Technology assisted methods for medical diagnosis and biomedical health monitoring are rapidly shifting from classical invasive methods to handheld-based non-invasive approaches. Biomedical imagining is one of the most prominent practices of non-invasive mechanisms in medical applications. This paper considers the medical imaging schemes for Mobile Health (mHealth) applications and studies the feasibility of future mobile systems for accommodating image informatics capabilities.

The Mobile Application Rating Scale (MARS): A new tool to measure the quality of health mobile applications

Smartphone technology provides free or inexpensive access to mental health and wellbeing resources. As a result the use of mobile applications for these purposes has increased significantly in recent years. Yet, there is currently no app quality assessment alternative to the popular ‘star’-ratings, which are often unreliable. This presentation describes the development of the Mobile Application Rating Scale (MARS) a new measure for classifying and rating the quality of mobile applications. A review of existing literature on app and web quality identified 25 published papers, conference proceedings, and online resources (published since 1999), which identified 372 explicit quality criteria. Qualitative analysis identified five broad categories of app quality rating criteria: engagement, functionality, aesthetics, information quality, and overall satisfaction, which were refined into the 23-item MARS. Independent ratings of 50 randomly selected mental health and wellbeing mobile apps indicated the MARS had excellent levels of internal consistency (α = 0.92) and inter-rater reliability (ICC = 0.85). The MARS provides practitioners and researchers with an easy-to-use, simple, objective and reliable tool for assessing mobile app quality. It also provides mHealth professionals with a checklist for the design and development of high quality apps.

Mobile app rating scale: A new tool for assessing the quality of health mobile apps

Background The use of mobile apps for health and well being promotion has grown exponentially in recent years. Yet, there is currently no app-quality assessment tool beyond “star”-ratings. Objective The objective of this study was to develop a reliable, multidimensional measure for trialling, classifying, and rating the quality of mobile health apps. Methods A literature search was conducted to identify articles containing explicit Web or app quality rating criteria published between January 2000 and January 2013. Existing criteria for the assessment of app quality were categorized by an expert panel to develop the new Mobile App Rating Scale (MARS) subscales, items, descriptors, and anchors. There were sixty well being apps that were randomly selected using an iTunes search for MARS rating. There were ten that were used to pilot the rating procedure, and the remaining 50 provided data on interrater reliability. Results There were 372 explicit criteria for assessing Web or app quality that were extracted from 25 published papers, conference proceedings, and Internet resources. There were five broad categories of criteria that were identified including four objective quality scales: engagement, functionality, aesthetics, and information quality; and one subjective quality scale; which were refined into the 23-item MARS. The MARS demonstrated excellent internal consistency (alpha = .90) and interrater reliability intraclass correlation coefficient (ICC = .79). Conclusions The MARS is a simple, objective, and reliable tool for classifying and assessing the quality of mobile health apps. It can also be used to provide a checklist for the design and development of new high quality health apps.

Teleconsultation in sexual and reproductive health for young adults through mobile devices: Experience in Colombia

Background: Sexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia. Objective: To measure the perception of changes in sexual and reproductive risk behavior after the use of a teleconsultation service via mobile devices in a sample of young adults. Methods: A before and after observational study was designed, where a mobile application to inquire about sexual and reproductive health was developed. The perception of changes in sexual and reproductive health risk behaviors in a sample of young adults after the use of the application was measured using the validated survey “Family Health International (FHI) – Behavioral Surveillance Survey (BSS) – Survey for Adults between 15 to 40 Years”. Non-probabilistic convenience recruitment was undertaken through the study´s web page. Participants answered the survey online before and after the use of the mobile application for a six month period (intervention). For the inferential analysis, data was divided into three groups (dichotomous data, discrete quantitative data, and ordinal data), to compare the results of the questions between the first and the second survey. For all tests, a confidence interval of 95% was established. For dichotomous data, the Chi-squared test was used. For quantitative data, we used the Student’s t-test, and for ordinal data, the Mann-Whitney-Wilcoxon test. Results: A total of 257 subjects were registered in the study and met the selection criteria. The pre-intervention survey was answered by 232 subjects, and 127 completely answered the post-intervention survey, of which 54.3% did not use the application, leaving an effective population of 58 subjects for analysis. 53% (n=31) were female, and 47% (n=27) were male. The mean age was 21 years, ranging between 18 and 40 years. The differences between the answers on the first and the second survey were not statistically significant. The main risk behaviors identified in the population were homosexual relations, non-use of condoms, sexual relations with non-regular and commercial partners, the use of psychoactive substances, and ignorance about the symptoms of sexually transmitted diseases and HIV transmission. Conclusions: Although there were no differences between the pre- and post-intervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting educational strategies on this matter and the importance of providing patients with easily accessible tools with reliable health information.

Mobile solutions for front-line health workers in developing countries

We introduce an architecture for low-cost mobile Health (mHealth) applications that run on health-workers’ existing devices. Moreover, we envision extending the phone’s capabilities with an external to attach “sensor” modules, such as pulse oximeter, ECG and phonocardiogram. Our design principles are frugality and simplicity. We propose a comprehensive solution to aid health-workers in their daily tasks, at a low-cost and high penetration rate.

From prototype to exploitation : mobile services for patients with chronic lower back pain

Many research and development projects that are carried out by firms and research institutes are technology-oriented. There is a large gap between research results, for instance in the form of prototypes, and the actual service offerings to customers. This becomes problematic when an organization wants to bring the results from such a project to the market, which will be particularly troublesome when the research results do not readily fit traditional offerings, roles and capabilities in the industry, nor the financial arrangements. In this chapter, we discuss the design of a business model for a mobile health service, starting with a research prototype that was developed for patients with chronic lower back pain, using the STOF model and method. In a number of design sessions, an initial business model was developed that identifies critical design issues that play a role in moving from prototype toward market deployment. The business model serves as a starting-point to identify and commit relevant stakeholders, and to draw up a business plan and case. This chapter is structured as follows. We begin by discussing the need for mobile health business models. Next, the research and development project on mobile health and the prototype for chronic lower back pain patients are introduced, after which the approach used to develop the business model is described, followed by a discussion of the developed mobile health business model for each of the STOF domains. We conclude with a discussion regarding the lessons that were learned with respect to the development of a business model on the basis of a prototype.

Examining the post-adoptive infusion of mobile technology in a healthcare domain: determinants and outcomes

The healthcare industry is beginning to appreciate the benefits which can be obtained from using Mobile Health Systems (MHS) at the point-of-care. As a result, healthcare organisations are investing heavily in mobile health initiatives with the expectation that users will employ the system to enhance performance. Despite widespread endorsement and support for the implementation of MHS, empirical evidence surrounding the benefits of MHS remains to be fully established. For MHS to be truly valuable, it is argued that the technological tool be infused within healthcare practitioners work practices and used to its full potential in post-adoptive scenarios. Yet, there is a paucity of research focusing on the infusion of MHS by healthcare practitioners. In order to address this gap in the literature, the objective of this study is to explore the determinants and outcomes of MHS infusion by healthcare practitioners. This research study adopts a post-positivist theory building approach to MHS infusion. Existing literature is utilised to develop a conceptual model by which the research objective is explored. Employing a mixed-method approach, this conceptual model is first advanced through a case study in the UK whereby propositions established from the literature are refined into testable hypotheses. The final phase of this research study involves the collection of empirical data from a Canadian hospital which supports the refined model and its associated hypotheses. The results from both phases of data collection are employed to develop a model of MHS infusion. The study contributes to IS theory and practice by: (1) developing a model with six determinants (Availability, MHS Self-Efficacy, Time-Criticality, Habit, Technology Trust, and Task Behaviour) and individual performance-related outcomes of MHS infusion (Effectiveness, Efficiency, and Learning), (2) examining undocumented determinants and relationships, (3) identifying prerequisite conditions that both healthcare practitioners and organisations can employ to assist with MHS infusion, (4) developing a taxonomy that provides conceptual refinement of IT infusion, and (5) informing healthcare organisations and vendors as to the performance of MHS in post-adoptive scenarios.

Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial - Cell Phone Intervention for You (CITY).

BACKGROUND: The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population. PURPOSE: To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You (CITY) study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1) a behavioral intervention that is delivered almost entirely via cell phone technology (Cell Phone group); and 2) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone (Personal Coaching group), each compared to 3) a usual care, advice-only control condition. METHODS: A total of 365 community-dwelling overweight/obese adults aged 18-35 years were randomized to receive one of these three interventions for 24 months in parallel group design. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 24 [corrected] months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014. CONCLUSIONS: If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss. ClinicalTrial.gov: NCT01092364.

Mobile healthcare information systems : thru' the ant lens

Deployment of mobile technologies and applications in health care are becoming prevalent worldwide. As mobile innovation and standards in wireless continue to evolve, so does the mobile health care information systems framework. In this paper, we explore this evolving framework by synthesising current technologies, applications, issues and examining this through the actor-network theory (ANT) which seeks to understand socio-technical change by adopting a symmetric treatment of people and technologies.

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.

Patient-oriented computerized clinical guidelines for mobile decision support in gestational diabetes

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients’ self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient’s access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients’ personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients’ acceptance of the whole system.

Simulazione agent-based di un sistema di m-Health per il self-management del diabete di tipo 1

L'obiettivo della tesi è dimostrare l'utilità e i vantaggi che può fornire il Self-Management del diabete mellito di tipo 1 in un sistema di mobile Health a partire da un modello computazionale Agent-Based. Viene quindi affrontata in maniera approfondita la tematica del mobile Health ed il suo sviluppo nei paesi a basso/medio reddito, illustrando i risultati ottenuti dalla ricerca scientifica fino ad oggi, ed il concetto di Self-Management di malattie croniche, un processo di cura caratterizzato dalla partecipazione autonoma del paziente stesso, fornendo una panoramica degli approcci computazionali sviluppati. Viene quindi studiato il diabete mellito in ogni sua caratteristica, seguito dall'illustrazione di diverse applicazioni per la gestione autonoma della suddetta patologia tutt'ora in commercio. Nel caso di studio vengono effettuate diverse simulazioni, tramite la piattaforma di simulazione MASON, per realizzare varie dinamiche della rete fisiologica di un paziente al fine di stabilire feedback qualitativi per il Self-Management della patologia.

Ray's Night Out

Research Background: The proliferation of technologically-based interventions and mHealth in particular have led to a need for innovative, relevant and engaging ways of presenting health messages to young people using technology. ‘Ray’s Night Out’ is a mobile health application co-designed with young people by an interdisciplinary team of researchers at Queensland University of Technology. Research Questions: The design, research, development and evaluation of ‘Ray’s Night Out’ addressed a number of research questions from across the fields of Psychology and Interactive and Visual Design. The specific design research questions addressed were: How can a mobile intervention be best designed to promote young people’s safety and wellbeing and minimise harm when consuming alcohol on a typical night out? Specifically, how can principles of interactive and visual design be effectively applied to develop innovative digital health communication solutions that empower young people as active participants in improving their health and wellbeing? Research Contribution: Innovation The mobile app, as a digital artifact, represents a new way of engaging young people in the issue of alcohol consumption and the pacing and self-care behaviours through unique interaction, visual and interface designs which resulted from the participant-led and iterative design research process. The design of the specific interactive and visual features of the app informed by participatory design data and by health research present a novel approach to preventing young people in crossing the ‘stupid line’ on a typical night out. Research Significance: The significance of the design research component within the larger interdisciplinary practices that have informed ‘Ray’s Night Out’ (e.g. field of psychology, reported through journal articles and other related outcomes), is the unique visual and interactive presentation of participant data and health concepts within the app interface and interaction design which improves and increases young people’s engagement with the health messages it contains. The global quality standard is further demonstrated by the launch on Apple iTunes: https://itunes.apple.com/us/app/rays-night-out/id978589497?mt=8 This demonstrates the application meets the high professional requirements for global release and international standards set by Apple AppStore.

'Music eScape': mHealth application

Research Background Young people’s avid use of mobile technologies in daily life has led to an increase in the design and research on mHealth (mobile health) interventions targeting young people. ‘Music eScape’ is a mobile based mood regulation app that uses an innovative approach to promoting young people’s wellbeing using music. Research Question The design, research, development and evaluation of ‘Music eScape’ addressed a number of research questions from across the fields of Psychology and Interactive and Visual Design. The specific design research question addressed was: How can interaction and visual design be utilized to promote and enable young people to effectively regulate their mood using music and how can the new design further promote their experience of empowerment, control and agency over actively directing their mood journey? Research Contribution Innovation and New Knowledge Through its unique visual interface design and interactivity, the application presents a novel approach to promoting young people’s wellbeing using music and a specific function that allows users to ‘draw’ their mood journey in order to generate a playlist. The mobile app is the first to contain a function that enables users to plan their mood journey and exercise a sense of agency, intentional choice and control over the mood shift and by extension, their wellbeing. The feature ‘drawing’ interface was designed by Oksana Zelenko using participatory design research and Russell’s circumplex model of affect (1980) to inform the key visual design concept and underpinning interaction design. Research Significance The significance of the design research component within the larger interdisciplinary practices that have informed ‘Music eScape’ (e.g. field of psychology, reported through journal articles and other related outcomes), is the unique visual and interactive presentation of participant data and music therapy research within the app interface and interaction design which improves and increases young people’s engagement with the health messages it contains. The industry quality standard is further demonstrated by the launch on Apple iTunes. This demonstrates the application meets the high professional requirements for national release and meets international standards. The app also creates a new benchmark for the quality of health apps on the market as it marks the industry release of a trialled evidence-based mHealth intervention co-designed with young people.

Beyond Wearables : Experiences and Trends in Design of Portable Medical Devices

The use of Portable Medical Devices (PMDs) has become increasingly widespread over the last few years. A combination of factors; including advances in technology, the pressure to reduce public health costs and the desire to make health solutions accessible to a wider patient base are contributing to the growth in the PMD market. Design has a clear role to play in the current and future context of the PMD landscape. In this paper, we identify emerging trends in the design of PMDs; including changes in the form, purpose and mode of use, and explore how these trends are likely to fundamentally impact the nature of healthcare and the patient experience from an experience design perspective. We conclude by identifying a research opportunity for design within the healthcare and PMD context.