Mobile health interventions for improving maternal and child health outcomes in South Africa:a systematic review

Background:Maternal and child health(MCH)remains a significant public health concern globally despite previous efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive breastfeeding,child vaccination and supplements have been rolled out to improve MCH outcomes.However,inadequate maternal healthcare,socioeconomic factors,obstetric haemorrhaging,complications of hypertension during pregnancy,lack of maternal information,poor universal health coverage and uptake of MCH services exacerbate maternal mortality and child mortality rates,especially in resource-constrained areas in many sub-Saharan African countries including South Africa.Objective:This study aimed to review mobile health(mHealth)interventions deployed to improve maternal and child health outcomes.Methods:The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable,prominent electronic databases(Google Scholar,Scopus,PubMed,Embase,CINAHL,Web of Science,etc.).A total of 26 papers were selected and analyzed.Results:The findings revealed several mHealth interventions such as MomConnect,Mobile Alliance for Maternal Action,NurseConnect,ChildConnect,CommCare,Road to Health Application and Philani Mobile Video Intervention for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services.However,inadequate digital infrastructure,digital divide,resistance to change,inadequate funding,language barriers,short message service and data costs,lack of digital skills and support,compatibility,scalability and interoperability issues,legislative and policy compliance,lack of mHealth awareness,data security and privacy concerns hinder uptake and utilisation of mHealth interventions.There is a need to scale up and sustain mHealth interventions and update existing regulatory framework,policies and strategies.Conclusion:mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services.Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues.

Association between glucose levels of children with type 1 diabetes and parental economic status in mobile health application

BACKGROUND The glycemic control of children with type 1 diabetes(T1D)may be influenced by the economic status of their parents.AIM To investigate the association between parental economic status and blood glucose levels of children with T1D using a mobile health application.METHODS Data from children with T1D in China's largest T1D online community,Tang-TangQuan■.Blood glucose levels were uploaded every three months and parental economic status was evaluated based on annual household income.Children were divided into three groups:Low-income(<30000 Yuan),middle-income(30000-100000 Yuan),and high-income(>100000 yuan)(1 Yuan=0.145 United States Dollar approximately).Blood glucose levels were compared among the groups and associations were explored using Spearman’s correlation analysis and multivariable logistic regression.RESULTS From September 2015 to August 2022,1406 eligible children with T1D were included(779 female,55.4%).Median age was 8.1 years(Q1-Q3:4.6-11.6)and duration of T1D was 0.06 years(0.02-0.44).Participants were divided into three groups:Low-income(n=320),middle-income(n=724),and high-income(n=362).Baseline hemoglobin A1c(HbA1c)levels were comparable among the three groups(P=0.072).However,at month 36,the low-income group had the highest HbA1c levels(P=0.036).Within three years after registration,glucose levels increased significantly in the low-income group but not in the middle-income and high-income groups.Parental economic status was negatively correlated with pre-dinner glucose(r=-0.272,P=0.012).After adjustment for confounders,parental economic status remained a significant factor related to pre-dinner glucose levels(odds ratio=13.02,95%CI:1.99 to 126.05,P=0.002).CONCLUSION The blood glucose levels of children with T1D were negatively associated with parental economic status.It is suggested that parental economic status should be taken into consideration in the management of T1D for children.

Impact of mobile health and medical applications on clinical practice in gastroenterology

Mobile health apps (MHAs) and medical apps (MAs) are becoming increasinglypopular as digital interventions in a wide range of health-related applications inalmost all sectors of healthcare. The surge in demand for digital medical solutionshas been accelerated by the need for new diagnostic and therapeutic methods inthe current coronavirus disease 2019 pandemic. This also applies to clinicalpractice in gastroenterology, which has, in many respects, undergone a recentdigital transformation with numerous consequences that will impact patients andhealth care professionals in the near future. MHAs and MAs are considered tohave great potential, especially for chronic diseases, as they can support the selfmanagementof patients in many ways. Despite the great potential associated withthe application of MHAs and MAs in gastroenterology and health care in general,there are numerous challenges to be met in the future, including both the ethicaland legal aspects of applying this technology. The aim of this article is to providean overview of the current status of MHA and MA use in the field ofgastroenterology, describe the future perspectives in this field and point out someof the challenges that need to be addressed.

Mobile technology for health care in rural China

With the proliferation of mobile technologies in China,the Chinese mobile medical applications market is growing rapidly.This may be particularly useful for Chinese rural populations who have limited access to quality medical care where mobile technologies can reach across geographic and socioeconomic boundaries and potentially increase access to care and improve health outcomes.

Nursing and mHealth

Innovations in mobile health(mHealth)technology offer applications to promote wellness management and health behavior change outside of formal clinical settings.Nurses can help to move mHealth into mainstream health care by understanding its potential to change the landscape of health intervention delivery,incorporating mHealth into patients'day to day preventive care strategies,and supporting the science of mHealth's effectiveness.

A systematic review of the effect of mobile health on cardiac rehabilitation among coronary heart disease patients

Objective： Mobile health （mHealth） provides an innovative and effective approach to promote prevention and management of coronary heart disease. However, the magnitude of its effects is unclear. The aim of this systematic review was to examine the impact of mHealth-based cardiac rehabilitation outcomes among coronary heart disease patients. Methods： Medline, CINAHL, Embase, PubMed, Google Scholar, NICE, and Cochrane library were searched for randomized controlled trials published between January 2002 and March 2017 which compared mHealth with conventional cardiac rehabilitation programs among coronary heart disease patients. Results： Eight articles were included in this review. The impact of mHealth interventions on physical activity, medicine adherence, smoking cessation, level of anxiety, and quality of life was inconsistent among the articles. Conclusions： Further research is needed to conclusively determine the impact of mHealth interventions on cardiac rehabilitation outcomes. The limitations of the included studies （e.g., inadequate sample size, failure to address the core components of cardiac rehabilitation programs, and lack of theory-based design） should be taken into account when designing future studies.

Mobile Health Applications User Trends in Turkey

Due to the rapid rise of mobile phones around the globe, many consumers, researchers, clinicians, and health services are starting to see their utility in health. As well as a health informatics role in improving the uptake and efficiency of current health services, mobile communication-assisted health care （m-health） also opens opportunities for services that are strikingly new and curative, in particular delivering personal health behaviour change programmes. Herein, we report the preliminary findings of a health-promotion survey titled ＂Mobile Apps User Trend Analysis of Turkish People＂. The survey examines the information needs and media preferences of women and men who research health information and use mobile apps for their healthcare in everyday life. Also this study tries to recover the behaviour of people and what applications they are downloading with respect to health, wellness, and medical mobile applicaitons. In looking the data, it appears that adoption of mHealth is growing at a furious pace. In this context, improvements to health communication have the potential to make a significant role to a promising new medium for health education and communication.

Economic Evaluation of Mobile Mental Health Units in Greece: The Case of Cyclades Islands

Background: In Greece, the provision of mental health services is limited to people residing in rural and remote areas. The operation of Mobile Mental Health Units (MMHUs) has been introduced in the Cyclades islands. It is an innovative policy intervention that has been shown to be effective and efficient internationally. Objective: The aim was to evaluate the operation of MMHUs in the Cyclades islands based on real-world evidence (RWE), from a societal perspective. Methods: A cost-effectiveness analysis was performed where outcomes and costs were elaborated and classified based on two comparators, 1) with MMHUs’ operation and 2) without MMHUs’ operation. Clinical primary outcomes were based on RWE data and were elaborated for the Disability-Adjusted Life Years (DALYs) values calculation, for a 12 months’ time horizon. Data descriptive statistics were performed with SPSS Statistics 22.0. Direct medical, non-medical and indirect costs were incorporated. Unit costs and monetary values were extracted from published data. Sensitivity analysis was undertaken to test the robustness of the results. Results: The operation of MMHUs in the Cyclades islands led to an incremental cost of €12,250.78 per DALY averted. A substantial higher increase is observed in the direct non-medical costs of the non-MMHUs’ operation where patients had to pay approximately €2,602 per capita annually for their transportation and accommodation due to hospitalization and outpatient care. Informal care expenses are 3 fold increasing in the non-MMHUs’ operation arm. Both direct non-medical and informal care costs correspond to high out of pocket payments totally covered by the patients. The sensitivity analyses demonstrated that the decision does not change when we varied the unit costs by ±10%. Conclusions: The operation of MMHUs appears to be a cost-effective option for treating patients with mental disorders in remote areas and islands in Greece. MMHUs appear to overcome the existing NHS structural inefficiencies by minimizing public expenditures and patients’ income losses by preventing and improving their mental health status.

Mobile health:new technologies,new modes and new era

In the past decade, tremendous developments have been made in mobile communicating technologies, such as fourth generation communication, satellite communication, and wireless network, which, when combined with healthcare, promoted the development of mobile health （mhealth）. Mobile health is defined by the Healthcare Information and Management Systems Society （HIMSS） as the use of small, portable com- puters or telecommunication equipments to meet the needs of consumers for health care or health infor- mation services. It is a combination of the biomedical sensor technology, mobile computing technology and networking technology. The surge in mobile commu- nication technologies has transformed the mode and quality of clinical research and healthcare on a global scale. Consequently, mhealth is the new edge on health- care innovation and heralds the arrival of new era of healthcare.

AB030.Usability of ArtontheBrain:A visual-arts based mobile health solution to promote quality of life in older adults with low vision due to age-related macular degeneration

Background:Taking part in productive and enjoyable recreational activities has been shown improve quality of life for people of all ages and capabilities.However,vision loss can have a significant impact on participation in important leisure activities.This is especially the case for the elderly,whose lowered mobility is further impacted by vision loss.Technology can offer solutions to bridging some barriers caused by these deficits by bringing leisure activities to the user in the form of mobile applications.As such,the purpose of the present study was to evaluate the accessibility and usability of the ArtOnTheBrain application,a visual art based mobile health solution to promote brain health and well-being,by older adults with low vision due to age-related macular degeneration(AMD).Methods:There were a total of 16 participants(age range,65-93 years,M=79,10 males).All had a diagnosis of AMD with visual acuities in the better eye between 20/60 and 20/200.Additionally,all participants had accessed rehabilitation services and most had experience using a computer at home.Using an Apple iPad Air(2013),they were asked to interact with the ArtOnTheBrain website’s Learn(e.g.,Listen to artwork description)and Play(e.g.,complete a word-search game)features with either the Safari or Google Chrome Internet apps.Using the Concurrent Think Aloud method,participants were asked to continuously comment on their activities and experiences with the app and verbalize their internal monologue while being audio and video recorded.These recordings were later transcribed verbatim and analysed using qualitative description and thematic analysis.Results:Participants’behaviours and verbal feedback were divided based on whether they presented as barriers or facilitators.Beginning with barriers,these were mostly related to the accessibility of the visual aspects of the applications interface(i.e.,contrast and font size),whereby participants requested additional control over the magnification options,both for text as well as images of the artwork.The main facilitator was the audio option built into the Learn tab,which allowed participants to listen to the artwork descriptions.Facilitators also included the aesthetics of the app,the perceived boost in confidence in interacting with technology,and the educational and leisure benefits.Conclusions:Older adults with low vision are faced with a decreased ability to engage in leisure activities.The development of technologies aimed at increasing the accessibility of leisure activities for these individuals is an important step in increasing their quality of life.As such,despite some of the accessibility challenges,the majority of participants viewed ArtontheBrain positively.Identifying the barriers and facilitators to its use is an important step in the development of this application in order to optimize its accessibility for older adults with low vision.Future work to be done with this application will be to evaluate the cognitive impact of ArtontheBrain on low vision users.

Collaborating with Young Adults Diagnosed with Schizophrenia:A Participatory Design Study to Shape the Healthcare System

Introduction: Disengagement from mental health services in young adults with schizophrenia has been associated with dissatisfaction and unmet needs. Striving to improve engagement, we invited service users recently diagnosed with schizophrenia to be co-designers of a smartphone technology that will be responsive to their needs. Aim: This paper reports the first phase of a three-phased participatory design process. The objective was to identify needs of support in young adults recently diagnosed with schizophrenia and to generate ideas of how the needs could be accommodated using smartphone technology. Methods: Participatory design guided the research process and a qualitative approach was used to generate and analyse the data. Data were generated by means of participant observations (n = 45 hours) and interviews (n = 6) with young adults from a first episode psychosis program in Denmark. Findings: Low levels of knowledge and high levels of uncertainties are characteristic of young adults recently diagnosed with schizophrenia, bringing about a vast need of support in order for them to gain power over their new life situation. Our study suggests that the smartphone may be used to foster empowerment by guiding the young adult’s actions in situ, providing comprehensive and easily understood information on the go, allowing for recovery tracking, and notification of mental health changes, providing medication overview and giving easy access to healthcare providers. Conclusion: Young adults recently diagnosed with schizophrenia require comprehensive support in order to become empowered to confidently manage their new life situation. The smartphone holds this potential by offering flexible collaboration and timely access to self-management

Receiving antenatal care via mobile clinic: Lived experiences of Jordanian mothers

Objective To understand the perceptions of pregnant Jordanian women who received antenatal care via mobile clinic,and to contribute new insights into the experiences of these mothers and how they evaluated the services that were available.Methods Ten Jordanian mothers who had received antenatal care at a mobile clinic discussed their experiences in semi-structured,audiotaped interviews in a study that adopted a qualitative research design.The analysis was done using interpretative phenomenological analysis.Results Three main themes were identified:Being informed about the medical campaign or missing the opportunity of being informed;The experience of receiving antenatal care was wonderful,although there was only one thing lacking;and they safeguard our life and take any opportunity to educate us.Conclusion Data indicate that the mothers were largely satisfied with most facets of the antenatal care services they had received at the mobile clinics.However,while services are generally well received,there are clear opportunities for ameliorating the quality of services provided.For mothers living in remote,deprived areas,outreach is not just an‘optional extra’but rather an essential service.

Intelligent health in the IS area:A literature review and research agenda

As the global demand for healthcare services continues to grow,improving the efficiency and effectiveness of the healthcare ecosystem has become a pressing concern.Information systems are transforming the healthcare delivery process,shifting the focus of healthcare services from passive disease treatment to proactive health prevention and the healthcare management model from hospital-centric to patient-centric.This study focuses on reviewing research in IS journals on the topic of e-health and is dedicated to constructing a theoretical model of intelligent health to provide a research basis for future discussions in this field.In addition,as the innovation of intelligent healthcare services has led to changes in its elements(e.g.,an increase in the number of stakeholders),there is an urgent need to sort out and analyze the existing research.

基于SWOT-CLPV分析的上海市老年人移动医疗服务利用现状及策略研究

目的了解上海市老年人移动医疗服务利用现状,为解决老年人“数字鸿沟”问题提出相应策略。方法对上海市461名老年人进行问卷调查,了解其知晓和利用移动医疗服务的现状,在此基础上采用SWOT-CLPV[优势(strengths),劣势(weaknesses),机会(opportunities),威胁(threats)-抑制性(control),杠杆作用(leverage),问题性(problem),脆弱性(vulnerability)]分析法进一步分析老年人利用移动医疗服务的优势、劣势、机会和威胁并找出主要的影响因素。结果知晓移动医疗服务的老年人比例为79.61%,其中每次就医都使用的仅有2.72%,能够独立使用的只有27.76%,总体上,老年人移动医疗服务利用现状不理想。SWOT-CLPV分析显示,老年人利用移动医疗服务的主要劣势是老年人自身条件以及使用基础和移动医疗功能受限,主要威胁是老年群体需求受到外界忽略。结论目前老年人对移动医疗服务的了解和利用并不充分,需加强家庭和社会对老年人利用移动医疗服务的支持,建立强有力的法律法规以提高数字化技术的适老化。

基于结构方程模型的老年人移动医疗服务使用意愿影响因素及路径分析:以上海市为例

目的 了解上海市老年人移动医疗服务使用意愿的影响因素,为制定有针对性的干预策略提供依据。方法对上海市406名老年人进行问卷调查,运用SPSS 26.0和AMOS 26.0进行描述统计、单因素秩和检验、相关分析和结构方程模型检验。结果 上海市老年人移动医疗服务使用意愿得分为(3.72±0.87)分。不同年龄段、文化程度、职业、收入水平和居住方式老年人的使用意愿差异分别有统计学意义(P <0.05)。社会影响、绩效期望、便利条件、努力期望和健康态度会对使用意愿产生直接或间接的正向影响,总效应分别为0.246、0.330、0.633、0.160和0.093。抵触改变和技术焦虑对使用意愿有间接的负向影响,总效应分别为-0.043和-0.054。各路径间的效应均有统计学意义(P <0.05)。结论 上海市老年人移动医疗服务使用意愿有待提升,应重点关注使用意愿较低的群体,从各维度影响因素入手提高老年人的使用意愿。

Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough?

Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the &#x0201c;sixth&#x0201d; major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A &#x0201c;two way&#x0201d; relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.

Attitudes towards acceptance of an innovative home-based and remote sensing rehabilitation protocol among cardiovascular patients in Shantou, China

Background Cardiac rehabilitation （CR） protocols have diversified to include home-based cardiac tele-rehabilitation （HBCTR） as an alternative to hospital-based or center-based CR. To adopt the use of home-based cardiac tele-rehabilitation, it is necessary to assess cardiac patients＇ attitudes towards acceptance of such e-health technology, especially in China where knowledge of such technology is deficient. Methods Interviews were conducted in the First Affiliated Hospital of Shantou University Medical College, Shantou, China. After percutaneous coronary interventional （PCI） surgery, patients completed the survey. Results Among the 150 patients, only 13% had ever heard of HBCTR. After an introduction of our HBCTR program, 60% of patients were willing to participate in the program. From our multivariate analysis of questionnaire data, age （OR： 0.92, 95% CI： 0.864）.98; P = 0.007）, average family monthly income （OR： 0.13, 95% CI： 0.05-0.341 P 〈 0.001）, education level （OR： 0.24, 95% CI： 0.10-0.59; P = 0.002） and physical exercise time （OR： 0.19, 95% CI： 0.06-0.56; P = 0.003） were independent predictors for acceptance of HBCTR. From the reasons for participation, patients selected： enhanced safety and independ ence （28.3%）, ability to self-monitor physical conditions daily （25 A%）, and having automatic and emergency alert （23.1%）. Reasons for refusal were： too cumbersome operation （34.3%） and unnecessary protocol （19.4%）. Conclusions Most patients lacked knowledge about HBCTR but volunteered to participate after they have learned about the program. Several personal and life-style factors influenced their acceptance of the program. These indicate that both improvement of technology and better understanding of the program will enhance active participation.

Validating the CorrectWearing of Protection Mask by Taking a Selfie:Design of a Mobile Application“CheckYourMask”to Limit the Spread of COVID-19

In a context of a virus that is transmissive by sputtering,wearing masks appear necessary to protect the wearer and to limit the propagation of the disease.Currently,we are facing the 2019-2020 coronavirus pandemic.Coronavirus disease 2019(COVID-19)is an infectious disease with first symptoms similar to the flu.The symptom of COVID-19 was reported first in China and very quickly spreads to the rest of the world.The COVID-19 contagiousness is known to be high by comparison with the flu.In this paper,we propose a design of a mobile application for permitting everyone having a smartphone and being able to take a picture to verify that his/her protection mask is correctly positioned on his/her face.Such application can be particularly useful for people using face protection mask for the first time and notably for children and old people.The designed method exploits Haar-like feature descriptors to detect key features of the face and a decision-making algorithm is applied.Experimental results show the potential of this method in the validation of the correct mask wearing.To the best of our knowledge,our work is the only one that currently proposes a mobile application design“CheckYourMask”for validating the correct wearing of protection mask.

Mobile medical applications’state quo and underlying barriers:review of literature

Objective:To explore the current development and challenges regarding mobile medical applications(mmAPPs),so as to provide reference for application function elevation and quality improvement.Methods:We retrieved literature databases like Web of Science,PubMed,China National Knowledge Infrastructure,Wanfang,China Biomedical Network,time limit was from January 1,2010 to December 31,2021,and restricted to the Chinese or English language.Results:This study concluded with the following six aspects:Domestic and foreign development of mmAPP,reminder function,barriers and challenges(low quality;slow update rate;lack of standard evaluation tool or criterion),privacy and safety concerns,adverse drug event report state(low report rate-related reasons,different countries’report policies),and current hindrances in the progression(economic worries;personal education level;acceptance and study of technology;rural districts,and low-income countries).Conclusions:We should focus on the application’s quality elevation rather than quantity,pay more attention to patients’adverse drug event reports,privacy and safety,and place emphasis on rural districts and low-income countries.

Assessment of a Downloadable Application with Avatar Guidance for PT-Prescribed Home Exercise after Total Knee Arthroplasty: A 30-Day Usability and Feasibility Study

Objective: To explore the usability and feasibility of a downloadable application (APP) compared to paper handouts (CONTROL) in guiding 30 days of PT-prescribed home exercise after total knee arthroplasty (TKA), and to compare functional outcomes at 30 days postoperatively between APP and CONTROL. Design: Randomized controlled usability and feasibility study. Setting: Rehabilitation laboratories at two regional medical centers. Participants: Individuals with knee osteoarthritis undergoing unilateral TKA (APP group: N = 26;mean age, 67.0 ± 8.2 y;CONTROL group: N = 31;mean age, 64.7 ± 7.7 y). Interventions: This study assessed the user experience of a downloadable app to guide 30 days of home exercises and instruction after TKA and compared exploratory outcomes to a group using paper handouts. Main Outcome Measures: The System Usability Scale (SUS) score was used to assess patient usability experience. Raw SUS scores were dichotomized (≥72% or <72%) to determine app usability against a 75% a priori criterion for mean APP group score. Feasibility for app use was similarly evaluated in the APP group only through a priori criteria applied to computing device ownership and study use, to the absence of technology-based barriers to participation, and to completion of app-based testing. Exploratory measures compared change from baseline to 30 days for functional and patient-reported outcomes between APP and CONTROL. Results: The APP group’s mean SUS score of 79.2% at 30 days exceeded the 75% threshold for good usability. The app met the predetermined a priori feasibility criteria for absence of technology-based barriers to participation (75% of participants) and completion of app-based testing (91.3% of participants). Personal computing devices were used by 71.4% of APP participants, which was below the 75% a priori feasibility criterion. No differences between the APP and CONTROL groups were observed for functional or patient-reported outcomes. Conclusions: The app-based platform met the a priori criteria for usability for 79% of APP participants. Our findings suggest that app-based, avatar-guided home exercise after TKA has acceptable usability and feasibility. The app-guided patient assessment capability also demonstrates preliminary feasibility for guiding and administering functional and self-reported outcomes assessments.