@Article{info:doi/10.2196/65826,
author="Ren, Zihan
and Chen, Yawen
and Li, Yufeng
and Fan, Panyu
and Liu, Zhao
and Shen, Biyu",
title="Digital Interventions for Patients With Juvenile Idiopathic Arthritis: Systematic Review and Meta-Analysis",
journal="JMIR Pediatr Parent",
year="2025",
month="Mar",
day="21",
volume="8",
pages="e65826",
keywords="juvenile idiopathic arthritis",
keywords="digital intervention",
keywords="application",
keywords="children health care",
keywords="pediatrics",
abstract="Background: Juvenile idiopathic arthritis (JIA) is a chronic rheumatic condition requiring long-term, multidisciplinary treatment, which consumes significant health care resources and family energy. This study aims to analyze the effectiveness of digital interventions on patient outcomes in individuals with JIA. Objective: This meta-analysis aimed to evaluate the impact of digital interventions on alleviating symptoms and improving overall well-being in children and adolescents with JIA. Methods: A systematic search of 5 databases identified randomized controlled trials assessing the impact of digital interventions on physiological and psychological outcomes in adolescents and children (average age ?19 y). Outcomes included pain, physical activity, health-related quality of life, self-efficacy, and disease-related issues. A total of 2 reviewers independently screened papers and extracted data on intervention functionalities and outcomes, assessing the risk of bias. A meta-analysis using a random-effects model synthesized the results. Results: The review included 11 studies involving 885 patients with JIA. Digital interventions included educational (eg, self-management training), therapeutic (eg, pain management), and behavioral (eg, promoting physical activity) approaches. These were delivered through websites, telephone consultations, video conferences, apps, and interactive games, with durations ranging from 8 to 24 weeks and no clear link observed between intervention length and outcomes. Compared with conventional control groups, digital interventions were significantly effective in alleviating pain (standardized mean difference [SMD] ?0.19, 95\% CI ?0.35 to ?0.04) and enhancing physical activity levels (SMD 0.37, 95\% CI 0.06-0.69). Marginal improvements in health-related quality of life, self-efficacy, and disease-related issues were observed, but these did not reach statistical significance (SMD ?0.04, 95\% CI ?0.19 to 0.11; SMD 0.05, 95\% CI ?0.11 to 0.20; and SMD 0.09, 95\% CI ?0.11 to 0.29, respectively). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach rated the quality of evidence for pain, health-related quality of life, self-efficacy, and disease-related issues as moderate, while the evidence quality for physical activity was assessed as low. Conclusions: Digital interventions can alleviate pain and enhance physical activity in patients with JIA. However, given the limited sample size and high risk of bias in some studies, further high-quality research is needed to improve the treatment and management of JIA. Trial Registration: PROSPERO CRD42023471223; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023471223 ",
doi="10.2196/65826",
url="https://pediatrics.jmir.org/2025/1/e65826"
}


@Article{info:doi/10.2196/65751,
author="Asan, Onur
and Super, Ilse
and Percy, Stephen
and Clouser, N. Katharine",
title="The Effect of COVID-19 on Health Care Utilization Among Children with Medical Complexity: Retrospective Chart Review Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Feb",
day="28",
volume="8",
pages="e65751",
keywords="children with medical complexity",
keywords="pediatric",
keywords="children",
keywords="health care utilization",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual care",
keywords="virtual health",
keywords="COVID-19",
keywords="SARS-COV-2",
keywords="coronavirus",
keywords="respiratory",
keywords="infectious",
keywords="pulmonary",
keywords="pandemic",
keywords="chart review",
keywords="chart review study",
keywords="retrospective chart review",
keywords="retrospective chart review study",
doi="10.2196/65751",
url="https://pediatrics.jmir.org/2025/1/e65751"
}


@Article{info:doi/10.2196/67289,
author="Elkourdi, Farah
and Asan, Onur",
title="Community Caregivers' Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Feb",
day="10",
volume="8",
pages="e67289",
keywords="pediatric care",
keywords="children with medical complexity",
keywords="family-centered care",
keywords="health information technology",
keywords="health care software solutions",
keywords="mobile phone",
keywords="artificial intelligence",
abstract="Background: Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children's needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non--English-speaking immigrant populations. Objective: This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources. Methods: We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity. Results: We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies. Conclusions: The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity. ",
doi="10.2196/67289",
url="https://pediatrics.jmir.org/2025/1/e67289"
}


@Article{info:doi/10.2196/60479,
author="Zvulunov, Alex
and Lenevich, Stepan
and Migacheva, Natalia",
title="Mobile Health App as an Auxiliary Tool in Management of Atopic Dermatitis in Children: Randomized Controlled Trial",
journal="JMIR Dermatol",
year="2025",
month="Jan",
day="22",
volume="8",
pages="e60479",
keywords="atopic dermatitis",
keywords="skin",
keywords="disease management",
keywords="children",
keywords="pediatric",
keywords="feasibility",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="eczema",
keywords="Atopic App",
keywords="dermatology",
abstract="Background: Mobile health apps can boost treatment adherence and support disease management at home. The Atopic App and web-based Atopic School patient education program offer a chance to enhance adherence to atopic dermatitis (AD) management. Objective: We aim to evaluate the feasibility, acceptability, and preliminary efficacy of the Atopic App mobile health intervention in the managing of AD in children. Methods: A randomized controlled study in children with AD divided participants into 3 groups: a control group (no app), an observational group with the app, and an interventional group with investigator supervision. Patients were examined at screening and follow-up visits 1 and 2 at 3-month intervals. Outcome measures included SCORAD (Scoring Atopic Dermatitis) for objective severity and Patient-Oriented Eczema Measure (POEM) for subjective effectiveness. Statistical analysis used paired t tests (2-tailed), the Mann-Whitney U test, and multiple regression. Results: Fifty-eight participants entered this study (38 boys and 20 girls): group 1 (control) comprised 17 patients, while experimental groups 2 and 3 consisted of 20 and 21 patients, respectively. The rates of missed appointments were similar and statistically insignificant across the groups. All groups showed a significant decrease in SCORAD and POEM scores (P<.05). Usage of the app for ?8 days showed a more significant decrease in severity scores compared to those who used it for ?7 days, or did not use it at all. Participants who used the app for ?8 days had a median SCORAD of 6.25 (95\% CI 4.6?14.1; IQR 4-16.3) at visit 1, significantly lower than nonusers (17.9, 95\% CI 13.9?24.0; IQR 13.9-24; P=.03) and those using it ?7 days (13, 95\% CI 9.35?27; IQR 7.2-27; P=.04). Their median POEM of 2 (95\% CI 1.0?4.5; IQR 1-5.3) was also significantly lower than those using the app ?7 days (9, 95\% CI 2?12; IQR 2-12; P=.04) and lower, though not significantly, than nonusers (7, 95\% CI 1?9; IQR 1-9; P=.14). Additionally, using the Atopic App for ?8 days after the screening visit strongly predicted a decrease in both SCORAD and POEM scores (P=.01 and P=.04, respectively). The time since the screening visit significantly predicted increased outcome scores, while prescriptions of topical calcineurin inhibitors, oral antihistamines, and oral antibiotics were weak and insignificant predictors of score changes. Conclusions: Our findings indicate that the Atopic App is helpful tool in managing AD in children, and they underscore the potential of mobile health interventions in the disease management. Trial Registration: ClinicalTrials.gov NCT06412094; https://clinicaltrials.gov/study/NCT06412094 ",
doi="10.2196/60479",
url="https://derma.jmir.org/2025/1/e60479"
}


@Article{info:doi/10.2196/64267,
author="Yakubu, I. Titilola
and Jhajj, Poonamdeep
and Pawer, Samantha
and West, C. Nicholas
and Amed, Shazhan
and Tang, S. Tricia
and G{\"o}rges, Matthias",
title="Exploring the Needs and Preferences of Users and Parents to Design a Mobile App to Deliver Mental Health Peer Support to Adolescents With Type 1 Diabetes: Qualitative Study",
journal="JMIR Diabetes",
year="2025",
month="Jan",
day="20",
volume="10",
pages="e64267",
keywords="peer support",
keywords="type 1 diabetes",
keywords="digital interventions",
keywords="diabetes distress",
keywords="depression",
keywords="mental health",
keywords="focus groups",
keywords="disease management",
keywords="adolescent",
keywords="parent",
keywords="mobile app",
keywords="mHealth",
keywords="type 1",
keywords="diabetes",
keywords="qualitative study",
keywords="physical health",
keywords="psychological",
keywords="emotional health",
keywords="mental health support",
keywords="thematic analysis",
keywords="data collection",
keywords="mobile health",
abstract="Background: Beyond physical health, managing type 1 diabetes (T1D) also encompasses a psychological component, including diabetes distress, that is, the worries, fears, and frustrations associated with meeting self-care demands over the lifetime. While digital health solutions have been increasingly used to address emotional health in diabetes, these technologies may not uniformly meet the unique concerns and technological savvy across all age groups. Objective: This study aimed to explore the mental health needs of adolescents with T1D, determine their preferred modalities for app-based mental health support, and identify desirable design features for peer-delivered mental health support modeled on an app designed for adults with T1D. Methods: A semistructured qualitative focus group study was conducted with adolescents with T1D and parents of adolescents with T1D. Data were collected through pre--focus group surveys, including sociodemographic background, diabetes status, health care experiences, and focus group sessions, including their opinions on peer support and technology. A thematic analysis following an inductive and iterative process was performed to develop themes and subthemes from the collected information. Results: Focus group participants included 10 adolescents (mean 16, SD 1 years; 8/10, 80\% female; who had been living with diabetes for an average of 9, SD 5 years) and 10 parents (mean age 51, SD 7 years; 9/10, 90\% female). Four core themes emerged: (1) experience: navigating adolescence with T1D, (2) empowerment: support systems that enabled better management of their T1D, (3) obstacles: societal barriers that affect adolescents' T1D management, and (4) innovation: adolescent-driven preferences for digital peer support platforms. Conclusions: App-based peer support offers a promising avenue for addressing the mental health needs of adolescents with T1D. Understanding the unique support needs of these adolescents and using this information to suggest design considerations for a mental health peer support app is an important step toward addressing their complex emotional and social challenges. ",
doi="10.2196/64267",
url="https://diabetes.jmir.org/2025/1/e64267"
}


@Article{info:doi/10.2196/63384,
author="Zhu, Wenqing
and Gu, Shuneng
and Li, Jian
and Lin, Jin
and Hu, Chanling
and Liu, Rui",
title="Transformative Gamified Binocular Therapy for Unilateral Amblyopia in Young Children: Pilot Prospective Efficacy and Safety Study",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="16",
volume="13",
pages="e63384",
keywords="amblyopia",
keywords="binocular treatment",
keywords="digital therapy",
keywords="game",
keywords="stereoacuity",
keywords="visual acuity",
abstract="Background: Amblyopia is a common cause of visual impairment in children. Compliance with traditional treatments for amblyopia is challenging due to negative psychosocial impacts. Recent shifts in amblyopia treatment have moved from suppressing the dominant eye to enhancing binocular visual function. Binocular digital therapy has become a promising approach. Objective: The aim of this study was to evaluate the effects of binocular gamified digital therapy on visual acuity and stereoacuity (SA) in children with unilateral amblyopia. Methods: This pilot prospective study enrolled 11 children aged 4-6 years with unilateral amblyopia. Following at least 8 weeks of refractive correction, participants underwent binocular gamified digital therapy for 60 minutes per day, 5 days a week. The therapy used a roguelike shooting game delivered under binocular conditions through two independent channels with a real-time artificial intelligence visual engine. Assessments of distance visual acuity (DVA), near visual acuity (NVA), and SA were conducted at baseline and again at 4, 8, and 12 weeks. Results: At 12 weeks, the following significant improvements were noted: amblyopic eye DVA improved by 1.0 line (P=.01; d=0.77), binocular DVA improved by 0.7 lines (P=.006; d=1.00), and SA improved by 0.3 logarithm (log) arcseconds (P=.01; d=0.97). At 8 weeks, improvements included amblyopic eye DVA by 0.9 lines (P=.046; d=1.00) and SA by 0.28 log arcseconds (P=.02; d=0.90). No significant adverse events were observed, although one participant developed progressive esotropia. Conclusions: Binocular gamified digital therapy is effective and safe for improving visual outcomes in children aged 4-6 years with unilateral amblyopia. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300072066; https://www.chictr.org.cn/showproj.html?proj=198625 ",
doi="10.2196/63384",
url="https://games.jmir.org/2025/1/e63384"
}


@Article{info:doi/10.2196/58563,
author="Skovslund Nielsen, Eva
and Kalles{\o}e, Karen
and Bennedsen Gehrt, Tine
and Bjerre-Nielsen, Ellen
and Lalouni, Maria
and Frostholm, Lisbeth
and Bonnert, Marianne
and Rask, Ulrikka Charlotte",
title="Trajectories of Change, Illness Understanding, and Parental Worries in Children and Adolescents Undergoing Internet-Delivered Cognitive-Behavioral Therapy for Functional Abdominal Pain Disorders: Protocol for a Single-Case Design and Explorative Pilot Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="7",
volume="14",
pages="e58563",
keywords="functional abdominal pain disorders",
keywords="abdominal pain",
keywords="internet-based intervention",
keywords="cognitive behavioral therapy",
keywords="interoception",
keywords="attentional bias",
keywords="parental distress",
keywords="single case study",
keywords="children",
keywords="adolescents",
keywords="youth",
keywords="study protocol",
keywords="quality of life",
keywords="treatment",
keywords="medication",
keywords="psychological treatment",
keywords="psychology",
abstract="Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. FAPDs are associated with diminished quality of life, school absence, increased health care use, and comorbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of effect mechanisms and identification of possible additional treatment targets could refine treatment. Objective: This protocol paper aims to describe a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms of effect. Methods: Children (8-12 years), adolescents (13-17 years) with FAPDs, and their respective parents will be included for 10 weeks for ICBT. First, detailed trajectories of effect are examined through a randomized single-case design study involving 6 children and 6 adolescents (substudy 1). Following this, an open-ended explorative pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (substudy 2). Finally, spanning across these 2 substudies, including all parents from substudies 1 and 2, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (substudy 3). Results: Recruitment of participants began in June 2022 and is finalized for substudy 1 and ongoing for substudies 2 and 3. Recruitment is expected to be completed by January 2025, with final data collection during April 2025. Conclusions: The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people. Trial Registration: ClinicalTrials.gov NCT05237882; https://clinicaltrials.gov/study/NCT05237882; ClinicalTrials.gov NCT05486585; https://clinicaltrials.gov/study/NCT05486585; OSF Registries osf.io/c49k7; https://osf.io/c49k7 International Registered Report Identifier (IRRID): DERR1-10.2196/58563 ",
doi="10.2196/58563",
url="https://www.researchprotocols.org/2025/1/e58563"
}


@Article{info:doi/10.2196/58693,
author="Boulton, Ann Kelsie
and Hilton, Makana
and Sutton, Emilia
and Guastella, John Adam",
title="Apps and Digital Resources for Child Neurodevelopment, Mental Health, and Well-Being: Review, Evaluation, and Reflection on Current Resources",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="1",
volume="27",
pages="e58693",
keywords="digital tools",
keywords="neurodevelopmental conditions",
keywords="mental health",
keywords="digital health",
keywords="implementation",
keywords="digital interventions",
keywords="child neurodevelopment",
keywords="digital technology",
keywords="mobile phone",
abstract="Background: An increase in the prevalence of neurodevelopmental conditions worldwide, alongside resource constraints within clinical services, has led to increased interest in health information technologies, such as apps and digital resources. Digital tools are often viewed as a solution to bridge this divide and to increase supports for families. There is, however, a paucity of research that has evaluated digital health tools, their potential benefits for child neurodevelopment and associated concerns (eg, mental health, well-being), and their benefit for families. Objective: This study conducted the first review of existing mobile apps and digital resources targeted at supporting the needs of children with developmental concerns or neurodevelopmental conditions. Methods: We identified 3435 separate resources, of which 112 (43 apps and 69 digital resources) met the criteria. These resources were categorized according to their purpose or target and were then reviewed based on their engagement, information quality, and evidence base using the Adapted Mobile App Rating Scale. Results: The most common condition of concern targeted by apps and digital resources was autism (19/112, 17\% resources), with retrieved resources focusing on supporting challenging behaviors, promoting speech, language, and social development, and providing options for alternative and assistive communication. Other common areas of concern targeted by apps and digital resources included language and communication (16/112, 14.3\%) and attention-deficit/hyperactivity disorder (11/112, 9.8\%). Results showed that reviewed resources were engaging, with high levels of accessibility and functionality. Resources had various functions, including developmental or behavioral tasks targeted at children, assistive communication support, scheduling support, journaling, and advice, activities, and strategies for parents. The information quality of resources, such as credibility of source and evidence base was, however, mostly low. Apps and digital resources with good credibility and an existing evidence base were largely developed in partnership with research, health, or government institutions, and were rated significantly higher on overall quality compared with apps and digital resources not developed in partnership with such institutions (apps; t41=--4.35, P<.001; digital resources; t67=--4.95, P<.001). Conclusions: The lack of evidence base across resources means that it is extremely difficult to provide recommendations to families with respect to apps or digital resources that may support their needs. Frameworks for the development of new tools are discussed, highlighting the novel approaches required to demonstrate the efficacy of tools for improving outcomes for children and families. Such a framework requires collaboration with multiple stakeholders (software developers, researchers, regulatory bodies, clinicians, children, and families) and engagement across multiple levels of expertise (app development, implementation, and dissemination within services, policy, and clinical regulations), to harness the potential of digital health for improving outcomes and promoting support in child neurodevelopment, which at this juncture remains largely underdeveloped. ",
doi="10.2196/58693",
url="https://www.jmir.org/2025/1/e58693"
}


@Article{info:doi/10.2196/51606,
author="Marelli, Ariane
and Rozenblum, Ronen
and Bolster-Foucault, Clara
and Via-Dufresne Ley, Alicia
and Maynard, Noemie
and Amaria, Khush
and Galuppi, Barb
and Strohm, Sonya
and Nguyen, Linda
and Dawe-McCord, Claire
and Putterman, Connie
and Kovacs, H. Adrienne
and Gorter, Willem Jan",
title="Development of MyREADY Transition BBD Mobile App, a Health Intervention Technology Platform, to Improve Care Transition for Youth With Brain-Based Disabilities: User-Centered Design Approach",
journal="JMIR Pediatr Parent",
year="2024",
month="Oct",
day="1",
volume="7",
pages="e51606",
keywords="patient-centered care",
keywords="patient engagement",
keywords="mobile app",
keywords="health IT",
keywords="health care transition",
keywords="mobile phone",
abstract="Background: Transition from pediatric to adult health care varies and is resource intensive. Patient-centered health information technology (HIT) interventions are increasingly being developed in partnership with patients. Objective: This study aims to develop an internet-based mobile app intervention for patients with brain-based disabilities to improve transition in care readiness. Methods: The app was designed for patients aged 15 to 17 years with brain-based disabilities having the ability to use a mobile app. A multidisciplinary team, an industry partner, and a patient and family advisory council was assembled. We hypothesized that existing tools could be migrated into the app to address education, empowerment, and navigation. We used cognitive learning theory to support chapters targeting transition in care skill sets. We used the agile iterative methodology to engage stakeholders. Results: We developed a novel MyREADY Transition HIT platform. An electronic mentor supported cognitive learning with messaging, quizzes, rewards, and videos. We used gaming to guide navigation through a fictitious health care city. Adapting existing tools was achieved by the patient and family advisory council requesting personalization. Our iterative design required time-consuming back-end technology management. Developing the platform took 24 months instead of our grant-approved 12 months, impacting the onset of the planned trial within the allotted budget. Conclusions: A novel patient-centered HIT platform to improve health care transition was successfully developed in partnership with patients and industry. Careful resource management was needed to achieve timely delivery of the end product, flagging the cautious planning required to deliver HIT tools in time for the much-needed trials informing their clinical application. Trial Registration: ClinicalTrials.gov NCT03852550; https://clinicaltrials.gov/study/NCT03852550 ",
doi="10.2196/51606",
url="https://pediatrics.jmir.org/2024/1/e51606"
}


@Article{info:doi/10.2196/56816,
author="Butler, Sonia
and Sculley, Dean
and Santos, Derek
and Giron{\`e}s, Xavier
and Singh-Grewal, Davinder
and Coda, Andrea",
title="Development and Delivery of an Integrated Digital Health Care Approach for Children With Juvenile Idiopathic Arthritis: Usability Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Sep",
day="17",
volume="7",
pages="e56816",
keywords="phone app",
keywords="smart watch",
keywords="juvenile idiopathic arthritis",
keywords="pain",
keywords="medication adherence",
keywords="physical activity",
keywords="integrated care",
keywords="medication",
keywords="development",
keywords="usability study",
keywords="chronic inflammatory disorder",
keywords="children",
keywords="child",
keywords="usability",
keywords="survey",
keywords="thematic analysis",
keywords="gamification",
keywords="modules",
keywords="web-based platform",
keywords="support",
abstract="Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder with no cure. Most children are prescribed several medications aimed at controlling disease activity, managing symptoms, and reducing pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long-term adherence, ongoing monitoring by a pediatric rheumatologist, and involvement of an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, which aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics among children with JIA. Methods: As part of this pediatric cross-sectional study, 12 children were asked to wear a smartwatch for 2 weeks, which was synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain level assessment. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a postintervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data underwent thematic analysis. Results: Twelve children aged 10 to 18 years (mean 14.2, SD 3.1 years; female: n=8, 66.7\%) and 1 parent for each child (n=12; female: n=8, 66.7\%) were enrolled in the study. Based on the highest and lowest agreement areas of the survey, most children and parents liked the smartwatch and web-based platform; they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers that hindered uptake were identified in the phone app and medication module. Children required a unique in-app experience, and their suggestive improvements included more personalization within the app; simplification by removing all links not relevant to antirheumatic medications; flexibility in response times; improved conferment through gamification; additional comment fields for the input of more data, such as medication side effects or pain-related symptoms; more detailed graphical illustrations of the physical activity module, including a breakdown of metrics; and importantly, interconnections between modules, because medication adherence, pain levels, and physical activity can each influence the other. They were, overall, improving usefulness for children and parents. Conclusions: The usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a unique in-app experience through more personalization, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions are needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care. Trial Registration: ANZCTR ACTRN12616000665437; https://tinyurl.com/mwwfje8r ",
doi="10.2196/56816",
url="https://pediatrics.jmir.org/2024/1/e56816"
}


@Article{info:doi/10.2196/53805,
author="Liu, Ming
and Wu, Xiaoqian
and Li, Ziyu
and Tan, Dongmei
and Huang, Cheng",
title="Assessment of Eye Care Apps for Children and Adolescents Based on the Mobile App Rating Scale: Content Analysis and Quality Assessment",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="13",
volume="12",
pages="e53805",
keywords="Mobile apps",
keywords="Eye care",
keywords="Myopia",
keywords="MARS",
keywords="Children",
keywords="Adolescent",
keywords="Quality Assessment",
keywords="Content Analysis",
keywords="mhealth",
keywords="China",
abstract="Background: In China, the current situation of myopia among children and adolescents is very serious. Prevention and control of myopia are inhibited by the lack of medical resources and the low awareness about eye care. Nevertheless, mobile apps provide an effective means to solve these problems. Since the health app market in China is still immature, it has become particularly important to conduct a study to assess the quality of eye-care apps to facilitate the development of better eye-care service strategies. Objective: This study aimed to evaluate the quality, functionality, medical evidence, and professional background of eye-care apps targeting children and adolescents in the Chinese app stores. Methods: A systematic search on iOS and Android app stores was performed to identify eye-care apps for children and adolescents. The general characteristics, development context, and functional features of the apps were described. Quality assessment of the apps was completed by 2 independent researchers using the Mobile App Rating Scale. Results: This study included 29 apps, of which 17 (59\%) were developed by commercial organizations and 12 (41\%) had a design with relevant scientific basis. The main built-in functions of these apps include self-testing (18/29, 62\%), eye exercises (16/29, 55\%), and eye-care education (16/29, 55\%). The mean overall quality of eye-care apps was 3.49 (SD 0.33), with a score ranging from 2.89 to 4.39. The overall Mobile App Rating Scale score exhibited a significant positive correlation with the subscale scores (r=0.81-0.91; P<.001). In addition, although most apps provided basic eye-care features, there are some deficiencies. For example, only a few apps were developed with the participation of medical organizations or professional ophthalmologists, and most of the apps were updated infrequently, failing to provide the latest eye-care information and technology in a timely manner. Conclusions: In general, the quality of eye-care apps for children and teenagers in Chinese app stores is good. These apps fulfill users' needs for eye-care services to a certain extent, but they still suffer from insufficient medical background, low user engagement, and untimely updates. In order to further improve the effectiveness of eye-care apps, cooperation with medical institutions and professional ophthalmologists should be strengthened to enhance the scientific and authoritative nature of the apps. At the same time, interactive features and regular updates should be added to enhance user participation and the continuity of the apps. This study provides a reference for future development or improvement of eye-care apps, which can help promote myopia prevention and control. ",
doi="10.2196/53805",
url="https://mhealth.jmir.org/2024/1/e53805"
}


@Article{info:doi/10.2196/49868,
author="van Tilburg, Leendert Mark
and Spin, Ivar
and Pisters, F. Martijn
and Staal, Bart J.
and Ostelo, WJG Raymond
and van der Velde, Miriam
and Veenhof, Cindy
and Kloek, JJ Corelien",
title="Barriers and Facilitators to the Implementation of Digital Health Services for People With Musculoskeletal Conditions in the Primary Health Care Setting: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="27",
volume="26",
pages="e49868",
keywords="eHealth",
keywords="primary health care",
keywords="musculoskeletal problems",
keywords="implementation science",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Objective: This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Methods: PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct. Results: Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (--) of and facilitators (+) to implementation were identified in all 5 CFIR domains: ``digital health characteristics'' (ie, commercial neutral [+], privacy and safety [--], specificity [+], and good usability [+]), ``outer setting'' (ie, acceptance by stakeholders [+], lack of health care guidelines [--], and external financial incentives [--]), ``inner setting'' (ie, change of treatment routines [+ and --], information incongruence (--), and support from colleagues [+]), ``characteristics of the healthcare professionals'' (ie, health care professionals' acceptance [+ and --] and job satisfaction [+ and --]), and the ``implementation process'' (involvement [+] and justification and delegation [--]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers. Conclusions: Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context. ",
doi="10.2196/49868",
url="https://www.jmir.org/2024/1/e49868",
url="http://www.ncbi.nlm.nih.gov/pubmed/39190440"
}


@Article{info:doi/10.2196/55123,
author="Keikhosrokiani, Pantea
and Polus, Manria
and Guardado Medina, Sharon
and Isomursu, Minna",
title="The Effectiveness of Medical Adherence Mobile Health Solutions for Individuals With Epilepsy: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="6",
volume="13",
pages="e55123",
keywords="digital care pathway",
keywords="epilepsy",
keywords="mHealth",
keywords="mobile health",
keywords="effectiveness",
keywords="systematic review",
keywords="management",
keywords="medical adherence",
keywords="patient outcomes",
keywords="digital health",
keywords="design",
keywords="eHealth solutions",
keywords="health care professionals",
abstract="Background: Epilepsy requires continuous management and treatment to optimize patient outcomes. The advancement of digital health has led to the development of various mobile health (mHealth) tools designed to enhance treatment adherence among individuals with epilepsy. These solutions offer crucial support through features such as reminders, educational resources, personalized feedback, assistance with managing costs, shared decision-making, and access to supportive communities. To design effective medication adherence mHealth solutions, it is essential to evaluate the effectiveness of existing mHealth tools, understand the unique circumstances of different patients, and identify the roles of health care professionals within the digital care pathway. Existing studies on epilepsy primarily focus on self-management, whereas the effectiveness and usability of medical adherence mHealth solutions often remain overlooked. Furthermore, the involvement of health care professionals in digital care pathways for epilepsy as well as the impact of adherence mHealth solutions on the patient experience have not been adequately explored. Objective: This study aims to assess the effectiveness of current mHealth solutions designed to improve medical adherence among patients with epilepsy. Furthermore, the study will examine the experiences of patients using mHealth solutions for maintaining medical adherence in epilepsy care. Finally, this review intends to determine the roles of health care professionals within mHealth systems aimed at supporting adherence to medication among patients with epilepsy. Methods: A systematic literature review has been selected as the appropriate method to address the research questions, adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion and exclusion criteria have been carefully selected, and both qualitative and quantitative analyses will be used to analyze the results. The expected results will mainly focus on the comparison, classification, and analysis of the effectiveness of current medical adherence mHealth tools. Moreover, the patient experiences using available medical adherence mHealth tools for epilepsy will be assessed. Finally, the role of health care professionals in the epilepsy digital care pathway will be explored, with emphasis on medical adherence. Results: The initial search, full-text screening, and data extraction have been carried out. Thirty-three papers were included in the final stage of the review. The study is expected to be completed by October 2024. Conclusions: To enhance the digital care pathway for epilepsy, a medical adherence mHealth solution should be personalized, manage medications, include an alarm system, track seizures, support consultations, and offer updated treatment plans. This study aims to understand how findings from the research questions can improve mHealth solutions for individuals with epilepsy. Insights from this research on the effectiveness of current mHealth adherence solutions will provide guidance for developing future mHealth systems, making them more efficient and effective in managing epilepsy. Trial Registration: PROSPERO CRD4202347400; https://tinyurl.com/48mfx22e International Registered Report Identifier (IRRID): DERR1-10.2196/55123 ",
doi="10.2196/55123",
url="https://www.researchprotocols.org/2024/1/e55123"
}


@Article{info:doi/10.2196/50527,
author="Mazzocato, Pamela
and Luckhaus, Linnea Jamie
and Malmqvist Castillo, Moa
and Burnett, Johan
and Hager, Andreas
and Oates, Gabriela
and Wannheden, Carolina
and Savage, Carl",
title="A Patient-Driven Mobile Health Innovation in Cystic Fibrosis Care: Comparative Cross-Case Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="31",
volume="26",
pages="e50527",
keywords="chronic illness",
keywords="implementation",
keywords="adoption",
keywords="spread",
keywords="patient-driven innovation",
keywords="mHealth",
keywords="mobile health",
keywords="innovation",
keywords="health care provider",
keywords="motivation",
keywords="interdependency",
keywords="adaptability",
abstract="Background: Patient-driven innovation in health care is an emerging phenomenon with benefits for patients with chronic conditions, such as cystic fibrosis (CF). However, previous research has not examined what may facilitate or hinder the implementation of such innovations from the provider perspective. Objective: The aim of this study was to explain variations in the adoption of a patient-driven innovation among CF clinics. Methods: A comparative multiple-case study was conducted on the adoption of a patient-controlled app to support self-management and collaboration with health care professionals (HCPs). Data collection and analysis were guided by the nonadoption, abandonment, spread, scale-up, and sustainability and complexity assessment tool (NASSS-CAT) framework. Data included user activity levels of patients and qualitative interviews with staff at 9 clinics (n=8, 88.9\%, in Sweden; n=1, 11.1\%, in the United States). We calculated the maximum and mean percentage of active users at each clinic and performed statistical process control (SPC) analysis to explore how the user activity level changed over time. Qualitative data were subjected to content analysis and complexity analysis and used to generate process maps. All data were then triangulated in a cross-case analysis. Results: We found no evidence of nonadoption or clear abandonment of the app. Distinct patterns of innovation adoption were discernable based on the maximum end-user activity for each clinic, which we labeled as low (16\%-23\%), middle (25\%-47\%), or high (58\%-95\%) adoption. SPC charts illustrated that the introduction of new app features and research-related activity had a positive influence on user activity levels. Variation in adoption was associated with providers' perceptions of care process complexity. A higher perceived complexity of the value proposition, adopter system, and organization was associated with lower adoption. In clinics that adopted the innovation early or those that relied on champions, user activity tended to plateau or decline, suggesting a negative impact on sustainability. Conclusions: For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and providers' perspectives on what generates value is essential. ",
doi="10.2196/50527",
url="https://www.jmir.org/2024/1/e50527",
url="http://www.ncbi.nlm.nih.gov/pubmed/39083342"
}


@Article{info:doi/10.2196/57950,
author="Lau, Nancy
and Palermo, M. Tonya
and Zhou, Chuan
and Badillo, Isabel
and Hong, Shannon
and Aalfs, Homer
and Yi-Frazier, P. Joyce
and McCauley, Elizabeth
and Chow, J. Eric
and Weiner, J. Bryan
and Ben-Zeev, Dror
and Rosenberg, R. Abby",
title="Mobile App Promoting Resilience in Stress Management for Adolescents and Young Adults With Cancer: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="30",
volume="13",
pages="e57950",
keywords="adolescents",
keywords="young adult",
keywords="cancer",
keywords="mHealth",
keywords="psychosocial intervention",
keywords="stress management",
keywords="coping",
keywords="resilience",
keywords="health-related quality of life",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers. Objective: This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate. Methods: This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ?60\% enrollment and ?70\% retention (ie, percentage of participants who completed the study), and ``feasibility, acceptability, and appropriateness'' as defined by cut-off scores ?4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics. Results: Since September 2023, we have enrolled 20 participants and recruitment is ongoing. Conclusions: Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes. Trial Registration: ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902 International Registered Report Identifier (IRRID): DERR1-10.2196/57950 ",
doi="10.2196/57950",
url="https://www.researchprotocols.org/2024/1/e57950"
}


@Article{info:doi/10.2196/48964,
author="Bear, Alice Holly
and Ayala Nunes, Lara
and Ramos, Giovanni
and Manchanda, Tanya
and Fernandes, Blossom
and Chabursky, Sophia
and Walper, Sabine
and Watkins, Edward
and Fazel, Mina",
title="The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="30",
volume="26",
pages="e48964",
keywords="adolescent mental health",
keywords="marginalized groups",
keywords="smartphone apps",
keywords="engagement",
keywords="implementation science",
keywords="mobile app",
keywords="smartphone",
keywords="mobile health",
keywords="mHealth",
keywords="mental health",
keywords="challenges",
keywords="acceptability",
keywords="young",
keywords="effectiveness",
keywords="mobile phone",
abstract="Background: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. Objective: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. Methods: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. Results: The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement. Conclusions: Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in ``real-world'' settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. Trial Registration: PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=254241 ",
doi="10.2196/48964",
url="https://www.jmir.org/2024/1/e48964",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078699"
}


@Article{info:doi/10.2196/54322,
author="Ladune, Raphaelle
and Hayotte, Meggy
and Vuillemin, Anne
and d'Arripe-Longueville, Fabienne",
title="Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="30",
volume="8",
pages="e54322",
keywords="cystic fibrosis",
keywords="decisional balance",
keywords="digital app",
keywords="acceptability",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: Cystic fibrosis (CF) is a genetic disease affecting the respiratory and digestive systems, with recent treatment advances improving life expectancy. However, many people with CF lack adequate physical activity (PA). PA can enhance lung function and quality of life, but barriers exist. The Cystic Fibrosis Decisional Balance of Physical Activity questionnaire assesses the decisional balance for PA in adults with CF, but it is not optimal for clinical use. A digital app might overcome this limitation by improving the efficiency of administration, interpretation of results, and communication between patients and health care professionals. Objective: This paper presents the development process and reports on the acceptability of a web app designed to measure and monitor the decisional balance for PA in people with CF. Methods: This study comprised two stages: (1) the co-design of a digital app and (2) the evaluation of its acceptability among health care professionals and people with CF. A participatory approach engaged stakeholders in the app's creation. The app's acceptability, based on factors outlined in the Unified Theory of Acceptance and Use of Technology 2, is vital for its successful adoption. Participants volunteered, gave informed consent, and were aged >18 years and fluent in French. Data collection was performed through qualitative interviews, video presentations, surveys, and individual semistructured interviews, followed by quantitative and qualitative data analyses. Results: In total, 11 health care professionals, 6 people with CF, and 5 researchers were involved in the co-design phase. Results of this phase led to the coconstruction of an app named MUCO\_BALAD, designed for people with CF aged ?18 years, health care professionals, and researchers to monitor the decisional balance for PA in people with CF. In the acceptability evaluation phase, the sample included 47 health care professionals, 44 people with CF, and 12 researchers. The analysis revealed that the acceptability measures were positive and that app acceptability did not differ according to user types. Semistructured interviews helped identify positive and negative perceptions of the app and the interface, as well as missing functionalities. Conclusions: This study assessed the acceptability of an app and demonstrated promising qualitative and quantitative results. The digital tool for measuring the decisional balance in PA for people with CF is encouraging for health care professionals, people with CF, and researchers, according to the valuable insights gained from this study. ",
doi="10.2196/54322",
url="https://formative.jmir.org/2024/1/e54322",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078689"
}


@Article{info:doi/10.2196/52540,
author="Santos-Silva, Catarina
and Ferreira-Cardoso, Henrique
and Silva, S{\'o}nia
and Vieira-Marques, Pedro
and Valente, Carlos Jos{\'e}
and Almeida, Rute
and A Fonseca, Jo{\~a}o
and Santos, Cristina
and Azevedo, In{\^e}s
and J{\'a}come, Cristina",
title="Feasibility and Acceptability of Pediatric Smartphone Lung Auscultation by Parents: Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Apr",
day="8",
volume="7",
pages="e52540",
keywords="respiratory sounds",
keywords="respiratory",
keywords="respiration",
keywords="lung",
keywords="lungs",
keywords="pulmonary",
keywords="breathing",
keywords="sound",
keywords="sounds",
keywords="wheeze",
keywords="crackle",
keywords="child",
keywords="children",
keywords="pediatric",
keywords="pediatrics",
keywords="parent",
keywords="parents",
keywords="parenting",
keywords="asthma",
keywords="auscultation",
keywords="smartphone",
keywords="mobile applications",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="crackles",
keywords="wheezes",
keywords="wheezing",
keywords="participation",
keywords="patient participation",
keywords="willingness",
keywords="adoption",
keywords="acceptance",
keywords="usability",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="smartphones",
keywords="intent",
keywords="ease of use",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="mobile phone",
abstract="Background: The use of a smartphone built-in microphone for auscultation is a feasible alternative to the use of a stethoscope, when applied by physicians. Objective: This cross-sectional study aims to assess the feasibility of this technology when used by parents---the real intended end users. Methods: Physicians recruited 46 children (male: n=33, 72\%; age: mean 11.3, SD 3.1 y; children with asthma: n=24, 52\%) during medical visits in a pediatric department of a tertiary hospital. Smartphone auscultation using an app was performed at 4 locations (trachea, right anterior chest, and right and left lung bases), first by a physician (recordings: n=297) and later by a parent (recordings: n=344). All recordings (N=641) were classified by 3 annotators for quality and the presence of adventitious sounds. Parents completed a questionnaire to provide feedback on the app, using a Likert scale ranging from 1 (``totally disagree'') to 5 (``totally agree''). Results: Most recordings had quality (physicians' recordings: 253/297, 85.2\%; parents' recordings: 266/346, 76.9\%). The proportions of physicians' recordings (34/253, 13.4\%) and parents' recordings (31/266, 11.7\%) with adventitious sounds were similar. Parents found the app easy to use (questionnaire: median 5, IQR 5-5) and were willing to use it (questionnaire: median 5, IQR 5-5). Conclusions: Our results show that smartphone auscultation is feasible when performed by parents in the clinical context, but further investigation is needed to test its feasibility in real life. ",
doi="10.2196/52540",
url="https://pediatrics.jmir.org/2024/1/e52540"
}


@Article{info:doi/10.2196/47295,
author="Robinson, Billy
and Proimos, Eleni
and Zou, Daniel
and Gong, Enying
and Oldenburg, Brian
and See, Katharine",
title="Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Structured Search and Evaluation",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="10",
volume="12",
pages="e47295",
keywords="asthma",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="mobile",
keywords="chronic disease",
keywords="systematic review",
keywords="smartphone",
keywords="review methodology",
keywords="respiratory",
keywords="compliance",
keywords="guideline",
keywords="guidelines",
keywords="review of apps",
keywords="evaluation",
keywords="quality",
keywords="best practices",
keywords="apps",
keywords="mobile phone",
abstract="Background: Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Few studies have systematically evaluated asthma mobile health (mHealth) apps for quality and functionality; however, none have systematically assessed these apps for their content alignment with international best practice guidelines. Objective: This review aims to conduct a systematic search and evaluation of current mHealth apps in the Australian marketplace for their functionality, quality, and consistency with best practice guidelines. Methods: The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. We developed a checklist based on these recommendations and a modified version of a previously developed framework. App stores were reviewed to identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included the assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, and an app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System. Finally, the mHealth apps were assessed for their content alignment with the GINA guidelines using the checklist we developed. Results: Of the 422 apps initially identified, 53 were suitable for further analysis based on inclusion and exclusion criteria. The mean number of behavioral change techniques for a single app was 3.26 (SD 2.27). The mean MARS score for all the reviewed apps was 3.05 (SD 0.54). Of 53 apps, 27 (51\%) achieved a total MARS score of ?3. On average, the reviewed apps achieved 5.1 (SD 2.79) functionalities on the 11-point IMS functionality scale. The median number of functionalities identified was 5 (IQR 2-7). Overall, 10 (22\%) of the 45 apps with reviewer consensus in this domain provided general knowledge regarding asthma. Of 53 apps, skill training in peak flow meters, inhaler devices, recognizing or responding to exacerbations, and nonpharmacological asthma management were identified in 8 (17\%), 12 (25\%), 11 (28\%), and 14 (31\%) apps, respectively; 19 (37\%) apps could track or record ``asthma symptoms,'' which was the most commonly recorded metric. The most frequently identified prompt was for taking preventive medications, available in 9 (20\%) apps. Five (10\%) apps provided an area for patients to store or enter their asthma action plan. Conclusions: This study used a unique checklist developed based on the GINA guidelines to evaluate the content alignment of asthma apps. Good-quality asthma apps aligned with international best practice asthma guidelines are lacking. Future app development should target the currently lacking key features identified in this study, including the use of asthma action plans and the deployment of behavioral change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases. Trial Registration: PROSPERO CRD42021269894; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=269894 International Registered Report Identifier (IRRID): RR2-10.2196/33103 ",
doi="10.2196/47295",
url="https://mhealth.jmir.org/2024/1/e47295",
url="http://www.ncbi.nlm.nih.gov/pubmed/38198204"
}


@Article{info:doi/10.2196/47524,
author="Tsimicalis, Argerie
and Stinson, Jennifer
and Thorstad, Kelly
and Rauch, Frank
and Hamdy, Reggie
and Chougui, Khadidja
and Addab, Sofia
and Palomo, Telma
and Bernstein, Mitchell
and Dahan-Oliel, Noemi
and Veilleux, Louis-Nicolas
and Massochin Nunes Pinto, Laura
and Passos dos Santos, Raissa",
title="The Design, Development, and Usability Testing of an eHealth Program for Youths With Osteogenesis Imperfecta: Protocol for a 2-Phase User-Centered Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="23",
volume="12",
pages="e47524",
keywords="eHealth program",
keywords="osteogenesis imperfecta",
keywords="self-management",
keywords="youth",
keywords="transition of care",
abstract="Background: Innovative approaches are needed to address the self-management needs of youths with osteogenesis imperfecta (OI) transitioning into adult-oriented health care systems. Using a sequentially phased research approach, the goal is to design, develop, and test the usability of an innovative eHealth program called ``Teens Taking Charge: Managing OI Online,'' hereafter named ``Teens OI.'' This program seeks to optimize self-management, facilitate a successful transition to adult care, and address a critical gap in the quality of care for youths with OI. Objective: The study objectives are to (1) design and develop an English and French version of the Teens OI and (2) test the usability of the Teens OI in terms of efficiency, effectiveness, and satisfaction from the perspectives of youths with OI and their parents. Methods: A user-centered design is presently in progress to design and develop Teens OI. A ``Website Design and Development Council'' (ie, Council) has been convened, with 20 youths and parent dyads recruited and global experts surveyed at an international meeting. With unanimous support from the Council, usability testing of the Teens OI will ensue in 4 iterative cycles with 32 youth-parent dyads. All sociodemographic and usability metrics will be descriptively analyzed. All recorded interview and focus group data are analyzed using content analysis techniques involving an iterative process of data reduction, data display, conclusion drawing, and verification. Results: As of December 2022, an 8-person, interdisciplinary Teens OI council, comprising 4 health care professionals, 3 youths and young adults with OI, and 1 parent, has been convened to oversee the design and development of Teens OI. Two cycles of interviews have been conducted with 10 youths with OI with or without their parents (n=6) from December 2021 to September 2022. Data analysis has been in progress since April 2022. Aim 2 is ethically approved and will commence following the completion of content development, expected by late July 2023. Preliminary analysis indicates that the following topics need to be prioritized for the youths: mental health, pain, accessibility, medical care, education, community, and parental care. Conclusions: The proposed study will design and develop a self-management and transitional care program for youths with OI in partnership with patients, caregivers, and health care professionals. This study leverages youths' openness to adopt eHealth technologies to meet their needs and has the potential to actively engage them to autonomously manage their lifelong conditions, and facilitate a successful transition to adult health care. Finally, the proposed study will also address a critical gap in the quality of care and the growing concern that the OI population transitioning from pediatric to adult care is at risk of various adverse events associated with the transition. International Registered Report Identifier (IRRID): DERR1-10.2196/47524 ",
doi="10.2196/47524",
url="https://www.researchprotocols.org/2023/1/e47524",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351933"
}


@Article{info:doi/10.2196/40856,
author="Gutierrez, Robert
and McCrady, Allison
and Masterson, Chelsea
and Tolman, Sarah
and Boukhechba, Mehdi
and Barnes, Laura
and Blemker, Silvia
and Scharf, Rebecca",
title="Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND): Protocol for a Multimodal Feasibility Study",
journal="JMIR Res Protoc",
year="2022",
month="Oct",
day="27",
volume="11",
number="10",
pages="e40856",
keywords="mHealth",
keywords="ubiquitous computing",
keywords="neuromuscular disorders",
keywords="inertial measurement unit",
keywords="motor function",
keywords="specific torque",
keywords="cross-sectional area",
keywords="echogenicity",
abstract="Background: Neuromuscular diseases, such as spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD), may result in the loss of motor movements, respiratory failure, and early mortality in young children and in adulthood. With novel treatments now available, new evaluation methods are needed to assess progress that is not currently captured in existing motor scale tests. Objective: With our feasibility study, our interdisciplinary team of investigators aims to develop a novel, multimodal paradigm of measuring motor function in children with neuromuscular diseases that will revolutionize the way that clinical trial end points are measured, thereby accelerating the pipeline of new treatments for childhood neuromuscular diseases. Through the Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND) study, we hypothesize that the novel objective measures of upper extremity muscle structure and function proposed herein will be able to capture small changes and differences in function that cannot be measured with current clinical metrics. Methods: U-EXTEND introduces a novel paradigm in which concrete, quantitative measures are used to assess motor function in patients with SMA and DMD. Aim 1 will focus on the use of ultrasound techniques to study muscle size, quality, and function, specifically isolating the biceps and pronator muscles of the upper extremities for follow-ups over time. To achieve this, clinical investigators will extract a set of measurements related to muscle structure, quality, and function by using ultrasound imaging and handheld dynamometry. Aim 2 will focus on leveraging wearable wireless sensor technology to capture motion data as participants perform activities of daily living. Measurement data will be examined and compared to those from a healthy cohort, and a motor function score will be calculated. Results: Data collection for both aims began in January 2021. As of July 2022, we have enrolled 44 participants (9 with SMA, 20 with DMD, and 15 healthy participants). We expect the initial results to be published in summer 2022. Conclusions: We hypothesize that by applying the described tools and techniques for measuring muscle structure and upper extremity function, we will have created a system for the precise quantification of changes in motor function among patients with neuromuscular diseases. Our study will allow us to track the minimal clinically important difference over time to assess progress in novel treatments. By comparing the muscle scores and functional scores over multiple visits, we will be able to detect small changes in both the ability of the participants to perform the functional tasks and their intrinsic muscle properties. International Registered Report Identifier (IRRID): DERR1-10.2196/40856 ",
doi="10.2196/40856",
url="https://www.researchprotocols.org/2022/10/e40856",
url="http://www.ncbi.nlm.nih.gov/pubmed/36301603"
}


@Article{info:doi/10.2196/28238,
author="Ho, Y. Teresa C.
and McGrath, Colman
and Yiu, Y. Cynthia K.
and Lee, M. Gillian H.",
title="Apps for Promoting Children's Oral Health: Systematic Search in App Stores and Quality Evaluation",
journal="JMIR Pediatr Parent",
year="2022",
month="Jun",
day="6",
volume="5",
number="2",
pages="e28238",
keywords="apps",
keywords="oral health",
keywords="evidence-based",
keywords="oral hygiene",
keywords="children",
abstract="Background: Increasingly, mobile apps are being used to promote oral care. Many of them are aimed at children. Objective: This study aimed to systematically search and evaluate apps that promote oral care and hygiene for children. Methods: A broad search strategy (13 keywords) was developed to identify apps from Apple's App Store and the Google Play Store in April 2019. After reviewing the apps' titles and summaries, potentially relevant apps were downloaded for viewing. The quality of the apps that met the inclusion criteria was assessed by the Health on the Net Foundation Code of Conduct (HONcode) criteria for medical and health websites and the Scientific Basis of Oral Self-care (SBOSC). Results: More than 3000 Apps were identified and 54 relevant apps informed the review. The quality of the apps according to the HONcode criteria was generally low. The mean HONcode score was 1.8/8.0. One-quarter of the apps had a HONcode score of 0 (14/54, 26\%). The SBOSC score of the apps was evaluated based on a 6-point scale. The mean SBOSC score was 1.5/6.0; 19\% (10/54) of the apps had a score of 0. There was a significant and positive correlation between HONcode and SBOSC scores (r=0.37; P<.01). More recently uploaded apps had significantly higher HONcode scores (P<.05). Conclusions: There are many apps aiming to promote oral self-care among children. The quality and scientific basis of these apps are low. Newer apps are of higher quality in terms of scientific basis. There is a need to ensure high-quality and evidence-based apps are available. The effectiveness of apps in terms of oral care and clinical outcomes among children needs to be evaluated. ",
doi="10.2196/28238",
url="https://pediatrics.jmir.org/2022/2/e28238",
url="http://www.ncbi.nlm.nih.gov/pubmed/35666565"
}


@Article{info:doi/10.2196/35408,
author="Egan, Lyra
and Gardner, Anne Lauren
and Newton, Nicola
and Champion, Katrina",
title="eHealth Interventions Targeting Poor Diet, Alcohol Use, Tobacco Smoking, and Vaping Among Disadvantaged Youth: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="13",
volume="11",
number="5",
pages="e35408",
keywords="eHealth",
keywords="adolescent",
keywords="health promotion",
keywords="diet",
keywords="alcohol",
keywords="smoking",
keywords="vaping",
keywords="socioeconomic status",
keywords="remoteness",
keywords="rural",
keywords="disadvantage",
abstract="Background: Chronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas. Objective: This is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping. Methods: A systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25\% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool. Results: As of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022. Conclusions: This systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations. Trial Registration: PROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=294119 International Registered Report Identifier (IRRID): PRR1-10.2196/35408 ",
doi="10.2196/35408",
url="https://www.researchprotocols.org/2022/5/e35408",
url="http://www.ncbi.nlm.nih.gov/pubmed/35560002"
}


@Article{info:doi/10.2196/34117,
author="Sonney, Jennifer
and Cho, E. Emily
and Zheng, Qiming
and Kientz, A. Julie",
title="Refinement of a Parent--Child Shared Asthma Management Mobile Health App: Human-Centered Design Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Feb",
day="17",
volume="5",
number="1",
pages="e34117",
keywords="parent--child shared management",
keywords="school-age children",
keywords="asthma",
keywords="participatory design",
keywords="mHealth",
keywords="prototype",
keywords="usability",
keywords="family health informatics",
abstract="Background: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent--child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). Objective: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. Methods: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent--child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. Results: Twelve parent--child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. Conclusions: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming. ",
doi="10.2196/34117",
url="https://pediatrics.jmir.org/2022/1/e34117",
url="http://www.ncbi.nlm.nih.gov/pubmed/35175214"
}


@Article{info:doi/10.2196/35455,
author="Zanoni, C. Brian
and Archary, Moherndran
and Sibaya, Thobekile
and Goldstein, Madeleine
and Bergam, Scarlett
and Denton, David
and Cordero, Vincente
and Peng, Cynthia
and Psaros, Christina
and Marconi, C. Vincent
and Haberer, E. Jessica",
title="Mobile Phone--Based Intervention Among Adolescents Living With Perinatally Acquired HIV Transitioning from Pediatric to Adult Care: Protocol for the Interactive Transition Support for Adolescents Living With HIV using Social Media (InTSHA) Study",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="21",
volume="11",
number="1",
pages="e35455",
keywords="adolescent",
keywords="mHealth",
keywords="South Africa",
keywords="HIV",
keywords="Social media",
keywords="InTSHA",
keywords="protocol",
keywords="transition support",
keywords="support",
keywords="WhatsApp",
keywords="caregiver",
keywords="health care provider",
abstract="Background: Adolescents living with perinatally acquired HIV often have poor retention in care and viral suppression during the transition from pediatric to adult-based care. Objective: The aim of this study is to evaluate a mobile phone--based intervention, Interactive Transition Support for Adolescents Living With HIV using Social Media (InTSHA), among adolescents living with perinatally acquired HIV as they transition from pediatric to adult care in South Africa. Methods: InTSHA uses encrypted, closed group chats delivered via WhatsApp (Meta Platforms Inc) to develop peer support and improve communication between adolescents, their caregivers, and health care providers. The intervention is based on formative work with adolescents, caregivers, and health care providers and builds on several existing adolescent support programs as well as the Social-ecological Model of Adolescent and Young Adult Readiness for Transition (SMART). The final InTSHA intervention involves 10 modules conducted weekly through moderated WhatsApp group chats with adolescents and separately with their caregivers. We will randomly assign 80 South African adolescents living with perinatally acquired HIV who are aware of their HIV status and aged between 15 and 19 years to receive either the intervention (n=40) or standard of care (n=40). Results: We will measure acceptability of the intervention as the primary outcome and evaluate feasibility and preliminary effectiveness for retention in care and viral suppression after completion of the intervention and at least 6 months after randomization. In addition, we will measure secondary outcomes evaluating the impact of the InTSHA intervention on peer support, self-esteem, depression, stigma, sexual education, connection to health care providers, and transition readiness. Enrollment began on April 15, 2021. As of December 31, 2021 a total of 78 out of expected 80 participants have been enrolled. Conclusions: If successful, the intervention will be evaluated in a fully powered randomized controlled trial with a larger number of adolescents from urban and rural populations to further evaluate the generalizability of InTSHA. Trial Registration: ClinicalTrials.gov NCT03624413; https://clinicaltrials.gov/ct2/show/NCT03624413 International Registered Report Identifier (IRRID): DERR1-10.2196/35455 ",
doi="10.2196/35455",
url="https://www.researchprotocols.org/2022/1/e35455",
url="http://www.ncbi.nlm.nih.gov/pubmed/35060907"
}


@Article{info:doi/10.2196/25129,
author="Bezabih, Mequanint Alemitu
and Gerling, Kathrin
and Abebe, Workeabeba
and Abeele, Vanden Vero",
title="Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="10",
volume="9",
number="12",
pages="e25129",
keywords="HIV",
keywords="adolescents",
keywords="ART adherence",
keywords="eHealth",
keywords="health theories",
keywords="behavior change techniques",
keywords="motivational design principles",
abstract="Background: eHealth systems provide new opportunities for the delivery of antiretroviral therapy (ART) adherence interventions for adolescents. They may be more effective if grounded in health behavior theories and behavior change techniques (BCTs). Prior reviews have examined the effectiveness, feasibility, and acceptability of these eHealth systems. However, studies have not systematically explored the use of health behavior theories and BCTs in the design of these applications. Objective: The purpose of this review was to explore whether health behavior theories and BCTs were considered to ground designs of eHealth systems supporting adolescents' (10-24 years) ART adherence. More specifically, we examined which specific theories and BCTs were applied, and how these BCTs were implemented as design features. Additionally, we investigated the quality and effect of eHealth systems. Methods: A systematic search was performed on IEEE Xplore, ACM, ScienceDirect, PubMed, Scopus, and Web of Science databases from 2000 to 2020. Theory use and BCTs were coded using the Theory Coding Scheme and the Behavior Change Technique Taxonomy version 1 (BCTTv1), respectively. Design features were identified using the lenses of motivational design for mobile health (mHealth). The number of BCTs and design features for each eHealth system and their prevalence across all systems were assessed. Results: This review identified 16 eHealth systems aiming to support ART adherence among adolescents. System types include SMS text message reminders (n=6), phone call reminders (n=3), combined SMS text message and phone call reminders (n=1), electronic adherence monitoring devices (n=3), smartphone apps (n=1), smartphone serious games (n=1), gamified smartphone apps (n=1), leveraging existing social media (n=2), web-based applications (n=1), videoconferencing (n=1), and desktop applications (n=1). Nine were grounded in theory, of which 3 used theories extensively. The impact of adolescent developmental changes on ART adherence was not made explicit. A total of 42 different BCTs and 24 motivational design features were used across systems. Ten systems reported positive effects on 1 or more outcomes; however, of these ten systems, only 3 reported exclusively positive effects on all the outcomes they measured. As much as 6 out of 16 reported purely no effect in all the outcomes measured. Conclusions: Basic applications (SMS text messaging and phone calls) were most frequent, although more advanced systems such as mobile apps and games are also emerging. This review indicated gaps in the use of theory and BCTs, and particularly the impact of developmental changes on ART adherence was not adequately considered. Together with adopting a developmental orientation, future eHealth systems should effectively leverage health theories and consider developing more advanced systems that open the door to using BCTs more comprehensively. Overall, the impact of eHealth systems on adolescent ART adherence and its mediators is promising, but conclusive evidence on effect still needs to be provided. ",
doi="10.2196/25129",
url="https://mhealth.jmir.org/2021/12/e25129",
url="http://www.ncbi.nlm.nih.gov/pubmed/34890353"
}


@Article{info:doi/10.2196/29003,
author="Park, Jihyun
and Park, Mi-Jeong
and Seo, Young-Gyun",
title="Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="17",
volume="23",
number="11",
pages="e29003",
keywords="ICT",
keywords="eHealth",
keywords="mHealth",
keywords="weight loss",
keywords="obesity",
keywords="BMI",
keywords="meta-analysis",
keywords="randomized controlled trial",
keywords="children",
keywords="adolescents",
keywords="mobile phone",
abstract="Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=?1.26 kg/m2, 95\% CI ?2.24 to ?0.28), lifestyle modification comparator (WMD=?1.75, 95\% CI ?2.76 to ?0.74), intervention involving both boys and girls (WMD=?1.30, 95\% CI ?2.14 to ?0.46), and intervention involving obesity only (WMD=?1.92, 95\% CI ?3.75 to ?0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. ",
doi="10.2196/29003",
url="https://www.jmir.org/2021/11/e29003",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787572"
}


@Article{info:doi/10.2196/30093,
author="Veludhandi, Anirudh
and Ross, Diana
and Sinha, B. Cynthia
and McCracken, Courtney
and Bakshi, Nitya
and Krishnamurti, Lakshmanan",
title="A Decision Support Tool for Allogeneic Hematopoietic Stem Cell Transplantation for Children With Sickle Cell Disease: Acceptability and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="28",
volume="5",
number="10",
pages="e30093",
keywords="decision support tool",
keywords="sickle cell disease",
keywords="mobile application",
keywords="mHealth",
keywords="pediatrics",
keywords="transplant",
keywords="mobile phone",
abstract="Background: Individuals living with sickle cell disease (SCD) may benefit from a variety of disease-modifying therapies, including hydroxyurea, voxelotor, crizanlizumab, L-glutamine, and chronic blood transfusions. However, allogeneic hematopoietic stem cell transplantation (HCT) remains the only nonexperimental treatment with curative intent. As HCT outcomes can be influenced by the complex interaction of several risk factors, HCT can be a difficult decision for health care providers to make for their patients with SCD. Objective: The aim of this study is to determine the acceptability and usability of a prototype decision support tool for health care providers in decision-making about HCT for SCD, together with patients and their families. Methods: On the basis of published transplant registry data, we developed the Sickle Options Decision Support Tool for Children, which provides health care providers with personalized transplant survival and risk estimates for their patients to help them make informed decisions regarding their patients' management of SCD. To evaluate the tool for its acceptability and usability, we conducted beta tests of the tool and surveys with physicians using the Ottawa Decision Support Framework and mobile health app usability questionnaire, respectively. Results: According to the mobile health app usability questionnaire survey findings, the overall usability of the tool was high (mean 6.15, SD 0.79; range 4.2-7). According to the Ottawa Decision Support Framework survey findings, acceptability of the presentation of information on the decision support tool was also high (mean 2.94, SD 0.63; range 2-4), but the acceptability regarding the amount of information was mixed (mean 2.59, SD 0.5; range 2-3). Most participants expressed that they would use the tool in their own patient consults (13/15, 87\%) and suggested that the tool would ease the decision-making process regarding HCT (8/9, 89\%). The 4 major emergent themes from the qualitative analysis of participant beta tests include user interface, data content, usefulness during a patient consult, and potential for a patient-focused decision aid. Most participants supported the idea of a patient-focused decision aid but recommended that it should include more background on HCT and a simplification of medical terminology. Conclusions: We report the development, acceptability, and usability of a prototype decision support tool app to provide individualized risk and survival estimates to patients interested in HCT in a patient consultation setting. We propose to finalize the tool by validating predictive analytics using a large data set of patients with SCD who have undergone HCT. Such a tool may be useful in promoting physician-patient collaboration in making shared decisions regarding HCT for SCD. Further incorporation of patient-specific measures, including the HCT comorbidity index and the quality of life after transplant, may improve the applicability of the decision support tool in a health care setting. ",
doi="10.2196/30093",
url="https://formative.jmir.org/2021/10/e30093",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709190"
}


@Article{info:doi/10.2196/26991,
author="Stampe, Kathrine
and Kishik, Sharon
and M{\"u}ller, Dueholm Sune",
title="Mobile Health in Chronic Disease Management and Patient Empowerment: Exploratory Qualitative Investigation Into Patient-Physician Consultations",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="15",
volume="23",
number="6",
pages="e26991",
keywords="compliance",
keywords="empowerment",
keywords="mHealth",
keywords="patient-physician consultation",
keywords="power",
abstract="Background: Chronic diseases often present severe consequences for those affected. The management and treatment of chronic diseases largely depend on patients' lifestyle choices and how they cope with the disease in their everyday lives. Accordingly, the ability of patients to self-manage diseases is a highly relevant topic. In relation to self-management, studies refer to patient empowerment as strengthening patients' voices and enabling them to assert control over their health and treatment. Mobile health (mHealth) provides cost-efficient means to support self-management and foster empowerment. Objective: There is a scarcity of research investigating how mHealth affects patient empowerment during patient-physician consultations. The objective of this study is to address this knowledge gap by investigating how mHealth affects consultations and patient empowerment. Methods: We relied on data from an ethnographic field study of 6 children and adolescents diagnosed with juvenile idiopathic arthritis. We analyzed 6 patient-physician consultations and drew on Michel Foucault's concepts of power and power technology. Results: Our results suggest that the use of mHealth constitutes practices that structure the consultations around deviations and noncompliant patient behavior. Our analysis shows how mHealth is used to discipline patients and correct their behavior. We argue that the use of mHealth during consultations may unintentionally lead to relevant aspects of patients' lives related to the disease being ignored; thus, inadvertently, patients' voices may be silenced. Conclusions: Our results show that concrete uses of mHealth may conflict with extant literature on empowerment, which emphasizes the importance of strengthening the patients' voices and enabling patients to take more control of their health and treatment. We contribute to the state-of-the-art knowledge by showing that the use of mHealth may have unintended consequences that do not lead to empowerment. Our analysis underscores the need for further research to investigate how mHealth impacts patient empowerment during consultations. ",
doi="10.2196/26991",
url="https://www.jmir.org/2021/6/e26991",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128817"
}


@Article{info:doi/10.2196/25811,
author="Kan, Kristin
and Shaunfield, Sara
and Kanaley, Madeleine
and Chadha, Avneet
and Boon, Kathy
and Foster, C. Carolyn
and Morales, Luis
and Labellarte, Patricia
and Vojta, Deneen
and Gupta, S. Ruchi",
title="Parent Experiences With Electronic Medication Monitoring in Pediatric Asthma Management: Qualitative Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Apr",
day="23",
volume="4",
number="2",
pages="e25811",
keywords="pediatric asthma",
keywords="digital health",
keywords="outpatient care",
keywords="asthma management",
keywords="pediatric",
keywords="asthma",
keywords="parents",
keywords="caregivers",
keywords="Bluetooth sensors",
keywords="inhaler",
abstract="Background: Electronic medication monitoring (EMM) is a digital tool that can be used for tracking daily medication use. Previous studies of EMM in asthma management have been conducted in adults or have examined pediatric interventions that use EMM for less than 1 year. To understand how to improve EMM-enhanced interventions, it is necessary to explore the experiences of parents of children with asthma, recruited from outpatient practices, who completed a 12-month intervention trial. Objective: The objective of our study was to use qualitative inquiry to answer the following questions: (1) how did using an EMM-enhanced intervention change parents'/caregivers' experiences of managing their child's asthma, and (2) what do parents recommend for improving the intervention in the future? Methods: Parents were recruited from the intervention arm of a multicomponent health intervention enhanced by Bluetooth-enabled sensors placed on inhaler medications. Semistructured interviews were conducted with 20 parents of children aged 4-12 years with asthma. Interviews were audio-recorded, transcribed, and inductively analyzed using a constant comparative approach. Results: Interview participants reflected an even mix of publicly and privately insured children and a diverse racial-ethnic demographic. Parents discussed 6 key themes related to their experience with the EMM-enhanced intervention for the management of their child's asthma: (1) compatibility with the family's lifestyle, (2) impact on asthma management, (3) impact on the child's health, (4) emotional impact of the intervention, (5) child's engagement in asthma management with the intervention, and (6) recommendations for future intervention design. Overall, parents reported that the 12-month EMM intervention was compatible with their daily lives, positively influenced their preventive and acute asthma management, and promoted their child's engagement in their own asthma management. While parents found the intervention acceptable and generally favorable, some parents identified compatibility issues for families with multiple caregivers and frustration when the technology malfunctioned. Conclusions: Parents generally viewed the intervention as a positive influence on the management of their child's asthma. However, our study also highlighted technology challenges related to having multiple caregivers, which will need to be addressed in future iterations for families. Attention must be paid to the needs of parents from low socioeconomic households, who may have more limited access to reliable internet or depend on other relatives for childcare. Understanding these family factors will help refine how a digital tool can be adopted into daily disease management of pediatric asthma. ",
doi="10.2196/25811",
url="https://pediatrics.jmir.org/2021/2/e25811",
url="http://www.ncbi.nlm.nih.gov/pubmed/33890861"
}


@Article{info:doi/10.2196/25513,
author="Thornton, Louise
and Gardner, Anne Lauren
and Osman, Bridie
and Green, Olivia
and Champion, Elizabeth Katrina
and Bryant, Zachary
and Teesson, Maree
and Kay-Lambkin, Frances
and Chapman, Cath
and ",
title="A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="12",
volume="5",
number="4",
pages="e25513",
keywords="mHealth",
keywords="mobile phone",
keywords="chronic disease",
keywords="adolescents",
keywords="health promotion",
abstract="Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. ",
doi="10.2196/25513",
url="https://formative.jmir.org/2021/4/e25513",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843590"
}


@Article{info:doi/10.2196/20217,
author="Benavides, Carmen
and Ben{\'i}tez-Andrades, Alberto Jos{\'e}
and Marqu{\'e}s-S{\'a}nchez, Pilar
and Arias, Natalia",
title="eHealth Intervention to Improve Health Habits in the Adolescent Population: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="18",
volume="9",
number="2",
pages="e20217",
keywords="adolescent behaviors",
keywords="BMI",
keywords="diet",
keywords="healthy habits",
keywords="intervention",
keywords="leader",
keywords="physical activity",
keywords="social network analysis",
keywords="adolescent",
keywords="social network",
keywords="behavior",
abstract="Background: Technology has provided a new way of life for the adolescent population. Indeed, strategies aimed at improving health-related behaviors through digital platforms can offer promising results. However, since it has been shown that peers are capable of modifying behaviors related to food and physical exercise, it is important to study whether digital interventions based on peer influence are capable of improving the weight status of adolescents. Objective: The purpose of this study was to assess the effectiveness of an eHealth app in an adolescent population in terms of improvements in their age- and sex-adjusted BMI percentiles. Other goals of the study were to examine the social relationships of adolescents pre- and postintervention, and to identify the group leaders and study their profiles, eating and physical activity habits, and use of the web app. Methods: The BMI percentiles were calculated in accordance with the reference guidelines of the World Health Organization. Participants' diets and levels of physical activity were assessed using the Mediterranean Diet Quality Index (KIDMED) questionnaire and the Physical Activity Questionnaire for Adolescents (PAQ-A), respectively. The variables related to social networks were analyzed using the social network analysis (SNA) methodology. In this respect, peer relationships that were considered reciprocal friendships were used to compute the ``degree'' measure, which was used as an indicative parameter of centrality. Results: The sample population comprised 210 individuals in the intervention group (IG) and 91 individuals in the control group (CG). A participation rate of 60.1\% (301/501) was obtained. After checking for homogeneity between the IG and the CG, it was found that adolescents in the IG at BMI percentiles both below and above the 50th percentile (P50) modified their BMI to approach this reference value (with a significance of P<.001 among individuals with an initial BMI below the P50 and P=.04 for those with an initial BMI above the P50). The diet was also improved in the IG compared with the CG (P<.001). After verifying that the social network had increased postintervention, it was seen that the group leaders (according to the degree SNA measure) were also leaders in physical activity performed (P=.002) and use of the app. Conclusions: The eHealth app was able to modify behaviors related to P50 compliance and exert a positive influence in relation to diet and physical exercise. Digital interventions in the adolescent population, based on the improvement in behaviors related to healthy habits and optimizing the social network, can offer promising results that help in the fight against obesity. ",
doi="10.2196/20217",
url="http://mhealth.jmir.org/2021/2/e20217/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33599616"
}


@Article{info:doi/10.2196/25413,
author="Tiase, L. Victoria
and Sward, A. Katherine
and Del Fiol, Guilherme
and Staes, Catherine
and Weir, Charlene
and Cummins, R. Mollie",
title="Patient-Generated Health Data in Pediatric Asthma: Exploratory Study of Providers' Information Needs",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="26",
volume="4",
number="1",
pages="e25413",
keywords="information needs",
keywords="asthma",
keywords="symptom management",
keywords="mobile health",
keywords="patient-generated health data",
keywords="pediatrics",
keywords="adolescents",
abstract="Background: Adolescents are using mobile health apps as a form of self-management to collect data on symptoms, medication adherence, and activity. Adding functionality to an electronic health record (EHR) to accommodate disease-specific patient-generated health data (PGHD) may support clinical care. However, little is known on how to incorporate PGHD in a way that informs care for patients. Pediatric asthma, a prevalent health issue in the United States with 6 million children diagnosed, serves as an exemplar condition to examine information needs related to PGHD. Objective: In this study we aimed to identify and prioritize asthma care tasks and decisions based on pediatric asthma guidelines and identify types of PGHD that might support the activities associated with the decisions. The purpose of this work is to provide guidance to mobile health app developers and EHR integration. Methods: We searched the literature for exemplar asthma mobile apps and examined the types of PGHD collected. We identified the information needs associated with each decision in accordance with consensus-based guidelines, assessed the suitability of PGHD to meet those needs, and validated our findings with expert asthma providers. Results: We mapped guideline-derived information needs to potential PGHD types and found PGHD that may be useful in meeting information needs. Information needs included types of symptoms, symptom triggers, medication adherence, and inhaler technique. Examples of suitable types of PGHD were Asthma Control Test calculations, exposures, and inhaler use. Providers suggested uncontrolled asthma as a place to focus PGHD efforts, indicating that they preferred to review PGHD at the time of the visit. Conclusions: We identified a manageable list of information requirements derived from clinical guidelines that can be used to guide the design and integration of PGHD into EHRs to support pediatric asthma management and advance mobile health app development. Mobile health app developers should examine PGHD information needs to inform EHR integration efforts. ",
doi="10.2196/25413",
url="http://pediatrics.jmir.org/2021/1/e25413/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33496674"
}


@Article{info:doi/10.2196/14774,
author="Su, Pen-Hua
and Yang, Chen
and Chao, Mei-Chyn
and Chiang, Chung-Lin",
title="Monitoring Adherence Rate to Growth Hormone Therapy and Growth Outcomes in Taiwanese Children Using Easypod Connect: Observational Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="15",
volume="4",
number="1",
pages="e14774",
keywords="growth hormone",
keywords="adherence",
keywords="easypod",
keywords="eHealth",
abstract="Background: Adherence to growth hormone therapy is difficult to detect reliably. Devices such as easypod have been developed for electronic recording of injections. The easypod connect observational study (ECOS) was an open-label, observational, multinational, phase IV study conducted in 24 countries around the world. The final results from ECOS in the Taiwanese cohort are reported in this paper. Objective: This study aimed to evaluate the adherence and long-term outcomes of growth hormone therapy in pediatric subjects using the easypod electromechanical device. Methods: Subjects (aged 2-18 years or >18 years without fusion of growth plates) who received Saizen (recombinant human growth hormone, somatropin) via the easypod device were enrolled in this study. The primary objective was to assess the level of adherence in subjects receiving Saizen via easypod. Results: In Taiwan, a total of 35 and 13 children fulfilled the criteria of full analysis set and complete analysis set, respectively. The mean (SD) age of the complete analysis set was 12.08 (2.72) years. All subjects were growth hormone--na{\"i}ve, with 38\% (5/13) females. The mean adherence rates of 13 subjects were 87.6\% at 3 months and 84.3\% at 6 months, that of 8 subjects was 81.0\% at 9 months, and that of 4 subjects was 91.6\% at 1 year. After 1 year of treatment, subjects had a median (Q1:Q3) change in height SD score of 0.30 (0.06:0.48), median height velocity of 6.50 (4.33:8.24) cm/year, and median change in height velocity SD score of 1.81 (--0.04:3.52). Conclusions: With the easypod device, patients with inadequate adherence and poor response to treatment can be identified. Adherence to growth hormone therapy administered via easypod was generally high in the first year of treatment but the adherence gradually decreased over time. Overall, growth outcomes after 1 year indicated a positive growth response to growth hormone treatment. Future efforts should be focused on personalized management of adherence by using the easypod system. ",
doi="10.2196/14774",
url="https://pediatrics.jmir.org/2021/1/e14774",
url="http://www.ncbi.nlm.nih.gov/pubmed/33448936"
}


@Article{info:doi/10.2196/15833,
author="Butler, Sonia
and Sculley, Dean
and Santos, Santos Derek
and Fellas, Antoni
and Giron{\`e}s, Xavier
and Singh-Grewal, Davinder
and Coda, Andrea",
title="Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review",
journal="JMIR Pediatr Parent",
year="2020",
month="Dec",
day="1",
volume="3",
number="2",
pages="e15833",
keywords="juvenile idiopathic arthritis",
keywords="child",
keywords="adolescence",
keywords="eHealth",
keywords="mHealth",
keywords="systematic review",
keywords="mobile phone",
keywords="pain",
keywords="physical activity",
keywords="self-management",
keywords="quality of life",
abstract="Background: Considering the changing landscape of internet use and rising ownership of digital technology by young people, new methods could be considered to improve the current model of juvenile idiopathic arthritis (JIA) management. Objective: This systematic review aims to evaluate the usability of eHealth and mobile health (mHealth) interventions currently available for young people living with JIA. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to oversee this review. We systematically searched 15 databases for 252 potential studies; 2 authors independently screened all quantitative studies reporting the use of eHealth and mHealth interventions for young people (aged 1-18 years) diagnosed with JIA. Studies were excluded if they did not report outcome measures or were reviews, commentaries, or qualitative studies. Study methodological quality was scored using the Down and Black (modified) checklist. A narrative descriptive methodology was used to quantify the data because of heterogeneity across the studies. Results: A total of 11 studies were included in this review, reporting 7 eHealth and mHealth interventions for young people (aged 4-18 years) living with JIA, targeting health issues such as pain, health-related quality of life, physical activity, and chronic disease self-management. The usability of the interventions was facilitated through training and ongoing support. The engagement was promoted by a combination of persuasive influences, and barriers preventing adherence were removed through personal reminders and flexible program schedules to cater to JIA and non-JIA illnesses or other commonly seen activities in childhood. The feedback obtained was that most young people and their parents liked the interventions. Conclusions: The results of this review need to be considered cautiously because of the lack of rigorous testing and heterogeneity, which limits the detailed descriptions of data synthesis. Further research is needed to consider gender differences, associated costs, and the effectiveness of the interventions on health outcomes to better support young people living with JIA. ",
doi="10.2196/15833",
url="http://pediatrics.jmir.org/2020/2/e15833/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33258786"
}


@Article{info:doi/10.2196/16898,
author="Xu, Xiaomeng
and Griva, Konstadina
and Koh, Mark
and Lum, Elaine
and Tan, Shin Woan
and Thng, Steven
and Car, Josip",
title="Creating a Smartphone App for Caregivers of Children With Atopic Dermatitis With Caregivers, Health Care Professionals, and Digital Health Experts: Participatory Co-Design",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="29",
volume="8",
number="10",
pages="e16898",
keywords="atopic dermatitis",
keywords="eczema",
keywords="mobile phone",
keywords="telehealth",
abstract="Background: Smartphone apps could support patients and caregivers in disease self-management. However, as patients' experiences and needs might not always align with clinical judgments, the eliciting and engaging of perspectives of all stakeholders in the smartphone app design process is of paramount importance. Objective: The aims of this study are to better understand the needs of and challenges facing caregivers and health care professionals (HCPs) who care for children with atopic dermatitis (AD) and to explore the desirable features and content of a smartphone app that would support AD self-management. Methods: This study adopted a qualitative participatory co-design methodology involving 3 focus group discussions: workshop one focused on caregivers; workshop two engaged with HCPs; and in the last workshop, caregivers and digital health experts were asked to design the wireframe prototype. The participants completed a sociodemographic questionnaire, a technology acceptance questionnaire, and a workshop evaluation form. Results: Twelve caregivers participated in the first workshop, and 10 HCPs participated in the second workshop. Eight caregivers and 4 digital health experts attended the third workshop. Three superordinate themes that reflected caregivers' and HCPs' challenges and needs were identified: empowerment by education, confusion over treatment, and emotional impact. Workshop participants also raised a series of suggestions on the features and contents of the AD self-management app, which informed the last co-design workshop, and described their needs and challenges. In the last workshop, the participants developed a wireframe prototype of the app following the identified requirements and recommendations. Conclusions: The co-design approach was found to be a successful way of engaging with the participants, as it allowed them to express their creativity and helped us to articulate the root of the clinical problems. The co-design workshop was successful in creating and generating new ideas and solutions for smartphone app development. ",
doi="10.2196/16898",
url="http://mhealth.jmir.org/2020/10/e16898/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118949"
}


@Article{info:doi/10.2196/21038,
author="Sezgin, Emre
and Noritz, Garey
and Hoffman, Jeffrey
and Huang, Yungui",
title="A Medical Translation Assistant for Non--English-Speaking Caregivers of Children With Special Health Care Needs: Proposal for a Scalable and Interoperable Mobile App",
journal="JMIR Res Protoc",
year="2020",
month="Oct",
day="14",
volume="9",
number="10",
pages="e21038",
keywords="medical translation",
keywords="mobile app",
keywords="special health care needs",
keywords="pediatrics",
keywords="caregiver-provider communication",
abstract="Background: Communication and comprehension of medical information are known barriers in health communication and equity, especially for non--English-speaking caregivers of children with special health care needs. Objective: The objective of this proposal was to develop an interoperable and scalable medical translation app for non--English-speaking caregivers to facilitate the conversation between provider and caregiver/patient. Methods: We employed user-centered and participatory design methods to understand the problems and develop a solution by engaging the stakeholder team (including caregivers, physicians, researchers, clinical informaticists, nurses, developers, nutritionists, pharmacists, and interpreters) and non--English-speaking caregiver participants. Results: Considering the lack of interpreter service accessibility and advancement in translation technology, our team will develop and test an integrated, multimodal (voice-interactive and text-based) patient portal communication and translation app to enable non--English-speaking caregivers to communicate with providers using their preferred languages. For this initial prototype, we will focus on the Spanish language and Spanish-speaking families to test technical feasibility and evaluate usability. Conclusions: Our proposal brings a unique perspective to medical translation and communication between caregiver and provider by (1) enabling voice entry and transcription in health care communications, (2) integrating with patient portals to facilitate caregiver and provider communications, and (3) adopting a translation verification model to improve accuracy of artificial intelligence--facilitated translations. Expected outcomes include improved health communications, literacy, and health equity. In addition, data points will be collected to improve autotranslation services in medical communications. We believe our proposed solution is affordable, interoperable, and scalable for health systems. ",
doi="10.2196/21038",
url="http://www.researchprotocols.org/2020/10/e21038/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33051177"
}


@Article{info:doi/10.2196/18506,
author="Iio, Misa
and Miyaji, Yumiko
and Yamamoto-Hanada, Kiwako
and Narita, Masami
and Nagata, Mayumi
and Ohya, Yukihiro",
title="Beneficial Features of a mHealth Asthma App for Children and Caregivers: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="24",
volume="8",
number="8",
pages="e18506",
keywords="children",
keywords="caregivers",
keywords="asthma",
keywords="mobile app",
keywords="proposed beneficial features",
abstract="Background: mHealth and uHealth apps are available for children with asthma and their caregivers. However, previous studies on mHealth apps for children older than 7 years old with asthma are limited, and most studies on asthma apps do not consider interactions involving communication between children and caregivers. Therefore, a prototype mHealth child asthma app was developed for children and their caregivers, with features of tailored feedback messages in continuing self-management and interactions between children and caregivers. Objective: The aim of this study was to identify the beneficial features of a prototype mHealth app developed for children with asthma and their caregivers. Methods: Children diagnosed with persistent asthma by allergy specialists at the National Center for Child Health and Development were recruited. The features of a prototype mHealth app for children with asthma and their caregivers were investigated using semistructured interviews after they tried the app. Data were analyzed using thematic analysis. Content-characteristic words were named and grouped together as categories to explore themes. Results: We recruited 27 children with asthma aged 2 to 12 years and 26 their caregivers. Findings on the good aspects of the app for children older than 7 years old and caregivers suggested 4 themes (confirmation of asthma knowledge, child-caregiver interaction, design of the app, and child's interest), and 6 categories were identified. Findings on the good aspects of app for children 7 to 12 years old and caregivers suggested 5 themes (new knowledge, manga as a Japanese-style comic, child's interest, trigger of self-management, and design and operability), and 11 categories were identified. Findings on the beneficial features of app suggested 6 themes (asthma knowledge, elements for continuous, universal design, notification, monitoring, and functions), and 12 categories were identified. Conclusions: Children with asthma and their caregivers perceived that the good aspects of the app were learning asthma knowledge with fun, including manga; interaction between child and caregiver; and easy-to-read design, such as colors. They wanted not only the asthma knowledge but also the universal design and enhanced elements, monitoring, and notification functions of the app. ",
doi="10.2196/18506",
url="http://mhealth.jmir.org/2020/8/e18506/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32831181"
}


@Article{info:doi/10.2196/15295,
author="Nichols, Michelle
and Miller, Sarah
and Treiber, Frank
and Ruggiero, Kenneth
and Dawley, Erin
and Teufel II, Ronald",
title="Patient and Parent Perspectives on Improving Pediatric Asthma Self-Management Through a Mobile Health Intervention: Pilot Study",
journal="JMIR Form Res",
year="2020",
month="Jul",
day="3",
volume="4",
number="7",
pages="e15295",
keywords="asthma",
keywords="mobile health",
keywords="ecological momentary assessment",
keywords="adolescents",
keywords="medication adherence",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Asthma is a common chronic pediatric disease that can negatively impact children and families. Self-management strategies are challenging to adopt but critical for achieving positive outcomes. Mobile health technology may facilitate self-management of pediatric asthma, especially as adolescents mature and assume responsibility for their disease. Objective: This study aimed to explore the perceptions of youths with high-risk asthma and their caregivers on the use of a smartphone app, Smartphone Asthma Management System, in the prevention and treatment of asthma symptoms, possible use of the app to improve self-management of asthma outside traditional clinical settings, and the impact of asthma on everyday life to identify potential needs for future intervention development. Methods: Key informant interviews were completed with parent-child dyads post participation in an asthma management feasibility intervention study to explore the perceptions of users on a smartphone app designed to monitor symptoms and medication use and offer synchronous and asynchronous provider encounters. A thematic qualitative analysis was conducted inductively through emergent findings and deductively based on the self-determination theory (SDT), identifying 4 major themes. Results: A total of 19 parent-child dyads completed the postintervention interviews. The major themes identified included autonomy, competence, relatedness, and the impact of asthma on life. The participants also shared their perceptions of the benefits and challenges associated with using the app and in the self-management of asthma. Both children and parents conveyed a preference for using technology to facilitate medication and disease management, and children demonstrated a strong willingness and ability to actively engage in their care. Conclusions: Our study included support for the app and demonstrated the feasibility of enhancing the self-management of asthma by youth in the community. Participant feedback led to intervention refinement and app improvements, and the use of the SDT allowed insight into motivational drivers of behavioral change. The use of mobile apps among high-risk children with asthma and their parents shows promise in improving self-management, medication adherence, and disease awareness and in reducing overall disease morbidity. ",
doi="10.2196/15295",
url="https://formative.jmir.org/2020/7/e15295",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442127"
}


@Article{info:doi/10.2196/18400,
author="Fedele, A. David
and Cushing, C. Christopher
and Koskela-Staples, Natalie
and Patton, R. Susana
and McQuaid, L. Elizabeth
and Smyth, M. Joshua
and Prabhakaran, Sreekala
and Gierer, Selina
and Nezu, M. Arthur",
title="Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="6",
volume="8",
number="5",
pages="e18400",
keywords="asthma",
keywords="mobile health",
keywords="adherence",
keywords="adolescence",
keywords="self-regulation",
keywords="problem-solving",
keywords="adolescent",
keywords="youth",
abstract="Background: Adolescents diagnosed with persistent asthma commonly take less than 50\% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents' difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents' objectively measured ICS adherence data indicate suboptimal rates of medication use. Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17--year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93\%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT's emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process. ",
doi="10.2196/18400",
url="https://mhealth.jmir.org/2020/5/e18400",
url="http://www.ncbi.nlm.nih.gov/pubmed/32374273"
}


@Article{info:doi/10.2196/12411,
author="Kosse, C. Richelle
and Bouvy, L. Marcel
and Belitser, V. Svetlana
and de Vries, W. Tjalling
and van der Wal, S. Piet
and Koster, S. Ellen",
title="Effective Engagement of Adolescent Asthma Patients With Mobile Health--Supporting Medication Adherence",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="27",
volume="7",
number="3",
pages="e12411",
keywords="adolescent",
keywords="asthma",
keywords="medication adherence",
keywords="pharmacists",
keywords="telemedicine",
abstract="Background: Mobile health (mHealth) apps have the potential to support patients' medication use and are therefore increasingly used. Apps with broad functionality are suggested to be more effective; however, not much is known about the actual use of different functionalities and the effective engagement. Objective: The aim of this study was to explore the use and the effective engagement of adolescents (aged 12 to 18 years) with the Adolescent Adherence Patient Tool (ADAPT). Methods: The ADAPT intervention consisted of an app for patients, which was connected to a management system for their pharmacist. The aim of the ADAPT intervention was to improve medication adherence and, therefore, the app contained multiple functionalities: questionnaires to monitor symptoms and adherence, medication reminders, short movies, pharmacist chat, and peer chat. For this study, data of the ADAPT study and a cluster randomized controlled trial were used. Adolescents with asthma had 6 months' access to the ADAPT intervention, and all app usage was securely registered in a log file. Results: In total, 86 adolescents (mean age 15.0, SD 2.0 years) used the ADAPT app 17 times (range 1-113) per person. Females used the app more often than males (P=.01) and for a longer period of time (P=.03). On average, 3 different functionalities were used, and 13\% of the adolescents used all functionalities of the app. The questionnaires to monitor symptoms and adherence were used by most adolescents. The total app use did not affect adherence; however, activity in the pharmacist chat positively affected medication adherence (P=.03), in particular, if patients sent messages to their pharmacist (P=.01). Conclusions: mHealth apps for adolescents with asthma should contain different functionalities to serve the diverging needs and preferences of individual patients. Suggested key functionalities to promote use and effectiveness in adolescents with asthma are questionnaires to monitor symptoms and a health care provider chat. ",
doi="10.2196/12411",
url="http://mhealth.jmir.org/2019/3/e12411/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30916664"
}