Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review

Background: Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients’ quality of life (QoL) and well-being. Objective: The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients’ user experience with them. Methods: We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores. Results: The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found. Conclusions: Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients’ disease management.European Union's Horizon 2020 No 72201

Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

Background: The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. Objective: This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. Methods: We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Results: Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Conclusions: Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps

Healthcare rule-based expert system framework to help, educate and prepare users

Existe neste momento um grande problema com a abundância de informação relativa a saúde, a desinformação. Este problema tem causado que uma grande percentagem de pessoas faça visitas ao hospital desnecessariamente, ou pior. Como não foi possível encontrar uma aplicação móvel que disponibiliza um conjunto de informação cientificamente correta, disponível para todos, organizada e acessível, foi procurado neste documento resolver este problema. Para isto, um estudo foi conduzido para entender o estado da arte sobre aplicações móveis e sobre o ecossistema de aplicações para a saúde, desta forma endereçando diversos tópicos como acessibilidade, UX/UI e usabilidade. Para combater a desinformação, é importante ser capaz de disponibilizar aos utilizadores informação de confiança e para isso concluiu-se que a melhor e mais confiável informação teria que ser recolhida de especialistas os profissionais de saúde. Um protótipo foi construído que incorpora não só um sistema pericial que, baseado em regras criadas através da informação recolhida dos especialistas, podes disponibilizar um sistema de pesquisa de sintomas, mas também diversas funcionalidades de usabilidade e opções de acessibilidade. Este protótipo abre a possibilidade de desenvolver conjunto de novas funcionalidades e/ou melhorar aquelas já implementadas, como um algoritmo baseado em regras mais dinâmico ou testes de utilizadores mais extensos que permitem uma aplicação móvel mais completa em termos de acessibilidade e usabilidade.There is currently a major problem with the abundance of information regarding health, misinformation. This problem causes a large percentage of people that take unnecessary trips to the hospital or worse. As there is not a suitable mobile app that conveys a set of scientifically correct, easily available, and organized information that is accessible to everyone, in this document we sought to solve this issue. For this, a study was done to understand the state of the art of mobile applications and about the current ecosystem of healthcare apps, addressing several issues such as accessibility, UX/UI and usability. To tackle misinformation, it was important being able to provide reliable information to users, and therefore it was concluded that the best and most reliable information had to be gathered from experts, health professionals. A prototype was built that not only encompasses an expert-system that can, based on rules made with the information gathered from experts, provide a symptom search system, but also incorporates several usability features and accessibility options. This prototype opens the opportunity to develop a range of new features and/or enhance those already implemented, such as an improved and more dynamic rule-based algorithm or extensive user testing that allows for a full- fledged accessible and easy to use mobile application

Accessibility in health mobile applications

Abstract. Nowadays, there is a vast number of mobile devices capable of storing an individual’s entire life. There are applications for everything, from banking to ordering food and clothes, but also different health applications targeted towards different impairments and self-health care management. Self-health care management applications can have a significant impact on individuals with various diseases and impairments. However, it is essential that these applications are accessible to users with different impairments such as motor and vision impairments. The purpose of this study was to examine accessibility concerns in mobile health applications for individuals with multiple sclerosis and evaluate how these concerns were addressed. Multiple sclerosis was chosen as the focus of this study because its symptoms encompass a range of impairments, including vision, motion, hearing, and cognitive limitations. The study was conducted with benchmarking multiple sclerosis applications obtained in Google Play store. Benchmarking focused on accessibility, and measurements and metrics were gathered testing applications with Google Accessibility Scanner and TalkBack screen reader. Measurements were based on web content accessibility guidelines (WCAG) 2 and accessibility guidelines for mobile applications. None of the tested applications followed accessibility guideline requirements based on benchmarking metrics. When examining the metrics from the perspective of impairments, it was found that applications had accessibility concerns related to motor and vision impairments. The applications addressed requirements for hearing impairments in applicable features, while testing cognitive impairment requirements proved challenging with the selected testing tools. In the future, it is recommended to conduct additional accessibility testing for cognitive impairments using methods such as manual accessibility testing and user testing

Are HIV smartphone apps and online interventions fit for purpose?

Sexual health is an under-explored area of Human-Computer Interaction (HCI), particularly sexually transmitted infections such as HIV. Due to the stigma associated with these infections, people are often motivated to seek information online. With the rise of smartphone and web apps, there is enormous potential for technology to provide easily accessible information and resources. However, using online information raises important concerns about the trustworthiness of these resources and whether they are fit for purpose. We conducted a review of smartphone and web apps to investigate the landscape of currently available online apps and whether they meet the diverse needs of people seeking information on HIV online. Our functionality review revealed that existing technology interventions have a one-size-fits-all approach and do not support the breadth and complexity of HIV-related support needs. We argue that technology-based interventions need to signpost their offering and provide tailored support for different stages of HIV, including prevention, testing, diagnosis and management

mHealth: providing a mindfulness app for women with chronic pelvic pain in gynaecology outpatient clinics: qualitative data analysis of user experience and lessons learnt

OBJECTIVES: To determine whether a pre-existing smartphone app to teach mindfulness meditation is acceptable to women with chronic pelvic pain (CPP) and can be integrated into clinical practice within the National Health Service (NHS) CPP pathways, and to inform the design of a potential randomised clinical trial. DESIGN: A prestudy patient and public involvement (PPI) group to collect feedback on the acceptability of the existing app and study design was followed by a three-arm randomised feasibility trial. In addition, we undertook interviews and focus groups with patients and staff to explore app usability and acceptability. We also obtained participant comments on the research process, such as acceptability of the study questionnaires. SETTING: Two gynaecology clinics within Barts Health NHS, London, UK. PARTICIPANTS: Patients with CPP lasting ≥6 months with access to smartphone or personal computer and understanding of basic English. INTERVENTION: The intervention was mindfulness meditation content plus additional pain module delivered by a smartphone app. Active controls received muscle relaxation content from the same app. Passive (waiting list) controls received usual care. MAIN OUTCOME MEASURES: Themes on user feedback, app usability and integration, and reasons for using/not using the app. RESULTS: The use of the app was low in both active groups. Patients in the prestudy PPI group, all volunteers, were enthusiastic about the app (convenience, content, portability, flexibility, ease of use). Women contributing to the interview or focus group data (n=14), from a 'real world' clinic (some not regular app users), were less positive, citing as barriers lack of opportunities/motivation to use the app and lack of familiarity and capabilities with technology. Staff (n=7) were concerned about the potential need for extra support for them and for the patients, and considered the app needed organisational backing and peer acceptance. CONCLUSION: The opinions of prestudy PPI volunteers meeting in their private time may not represent those of patients recruited at a routine clinic appointment. It may be more successful to codesign/codevelop an app with typical users than to adapt existing apps for use in real-world clinical populations. TRIAL REGISTRATION NUMBER: ISRCTN10925965

Empirical study of user experience on mobile data collection for chronic low back pain

The majority of all IS implementation projects fails. McFarlan (1981) identified risk factors associated with organizational IT projects and created a model to predict project risk. The McFarlan Risk Model (MRM) provides a useful approach for the diagnosis and mitigation of IT project risks but can be improved in its predictive ability. In this paper, we suggest to augment the model, beyond its original three dimensions. Based on recent literature, which points to the importance of culture, specifically corporate culture, we develop an extension to McFarlan’s model and assess the added value of this extended model through the evaluation of two business cases. Expert evaluations using the Extended McFarlan Risk Model (EMRM) indicate higher predictive power in the differentiation of project success and failure, based on differences in the model’s culture dimension

My Crohn’s disease on real-time information - User experience improvement through cross-platform applications

Reducing hospital institutionalization of citizen with chronic diseases is a major priority of western countries priorities. The more complex the health condition, the harder it is to coordinate clinical care. To improve the disease management and control, most patients need to use mobile applications that are available in online stores or web services because of the difficulty that a personal mobile phone has to get real time access to clinical data outside of a hospital. In terms of IBD - Inflammatory Bowel Disease - existing mobile phone solutions are very complex, because visually the interfaces communicates with the user through inadequate use of symbols in clinical features, which are inconsistent and have poor legibility. They also presents a lack of visual optimization between multiplatform systems. This increases the user's learning curve in terms of how to interpret and interact with these systems, generating an opportunity for these patients with abilities to innovate through the creation and development of solutions that solve their own problems related to the management and coordination of the disease. This thesis aims to analysis IBD patients behaviour related to disease management, identify the type of problems, both functional and communication, which occur in existing IBD m-Health and e-Health systems, and introduces two topics – communication and design studies – in the "User Innovator" model of Von Hippel (1976) which consists of users, that are, for example, patients with chronic diseases, and who innovate by creating solutions to solve personal problems because of unfavourable healthcare conditions. To validate in the design process the three perspectives – design, innovation and patient – were considered, and the framework “Human-social Interaction Model for e-Health Interfaces” was created, enabling a sustainable approach to research, with inputs from personal experience being used, introducing relevant feedback for the final goal of the preliminary studies, when creating the interface for mobile phone application particularly for Crohn’s disease, one of the IBD, with a new healthcare user experience. To reach the objective, a set of studies were conducted that were divided into two stages. The first, a literature review of the relationship between semiotics and interactive communication; the meaning of symbolic representation in interactive projects; new design research guidelines that define interfaces and features and that are more approachable for users; user perspectives towards technology for health supporting and controlling; the design and communication space on technological projects; the challenge for users/ patients who try to create systems to solve personal problems. The second part, presents the practical research that includes a survey of 279 participants with IBD; the empirical analysis of six case studies – mobile applications and multiplatform: context, features, design principles lifting, and usability testing A/B with the design features and principles of design on two of the six systems being compared. The results from the thesis challenge the concepts of mobile interface usability in health, providing users with a structured interpretation of medical information design and a guideline for designers with chronic diseases that would like to create solutions to monitor health problems.Reduzir a institucionalização hospitalar de cidadãos com doenças crónicas é uma das prioridades para os países ocidentais. Quanto maior for a complexidade das condições de saúde, mais difícil se torna a coordenação dos cuidados clínicos. Para melhorar o controle e a gestão da doença, a maioria destes pacientes recorre às aplicações para telemóvel disponíveis em lojas online e aos serviços na web pois, é difícil obter permissão para aceder a dados clínicos em tempo real no telemóvel pessoal a partir do hospital. No contexto da DII – Doença Inflamatória do Intestino – as soluções existentes apresentam níveis de complexidade visual elevados pois, a interface comunica com o utilizador através de símbolos clínicos inadequados em funcionalidades convencionais – fraca legibilidade e inconsistência; Apresenta também, fraca coerência visual entre sistemas multiplataforma. Estes cenários promovem no utilizador, um aumento da curva de aprendizagem relativamente à forma como estes interagem com os sistemas criando assim, uma abertura para o desenvolvimento de soluções pelos que têm habilidade para inovar através da criação e desenvolvimento de sistemas que resolvem os seus problemas com a gestão e coordenação da doença. Esta tese tem como objetivo analisar o comportamento dos pacientes com DII relativamente à gestão da sua doença. Identificar que tipo de problemas – funcionais e de comunicação – existem nas soluções atuais para telemóvel e web no contexto da DII, introduzindo novos temas – estudos em comunicação e design – no modelo "User Innovator" de Von Hippel (1976) que consiste em, utilizadores, como por exemplo, pacientes com doenças crónicas, que inovam ao criarem soluções para resolver os problemas pessoais, tais como, condições de saúde adversas. Para validar no processo de design a integração das três áreas – design, inovação e paciente – criamos a framework “Human-social Interaction Model for e-Health Interfaces” que nos permitiu uma abordagem sustentável à investigação, quando foram aplicados inputs provenientes de experiência pessoal das três perspectivas introduzindo feedback relevante para o objetivo final dos estudos preliminares, também quando criada a interface para dispositivos móveis focada na doença de Crohn, uma das DII, com uma nova experiência de utilizador na área da saúde. Para atingir o objectivo, realizou-se um conjunto de estudos que se encontram divididos em dois momentos: o primeiro, com revisão de literatura sobre a relação da semiótica com a comunicação interativa; o significado da representação simbólica em projetos interativos; as novas linhas de reflexão do Design que definem interfaces e funcionalidades mais próximas do utilizador; a perspectiva dos utilizadores perante a tecnologia como meio de suporte e controle da saúde; o espaço do design e da comunicação em projetos tecnológicos; o desafio para utilizadores/ pacientes que tentam criar sistemas para solucionar problemas pessoais. A segunda parte apresenta a investigação de campo com, um inquérito a 279 participantes com DII; análise empírica de seis casos de estudo – aplicações para telemóvel e multiplataforma: contexto, funcionalidades, levantamento de princípios do design, e testes de usabilidade A/B onde comparamos em dois dos seis sistemas, a articulação entre as funcionalidades e os princípios do design. Os resultados obtidos desafiam a usabilidade das interfaces para telemóvel no contexto da saúde, proporcionando aos utilizadores uma interpretação mais coerente do ponto de vista formal do design de informação médica e um caminho para designers com doenças crónicas que pretendem criar soluções para resolver problemas de monotorização da saúde