The usability and effectiveness of mobile health technology-based lifestyle and medical intervention apps supporting health care during pregnancy: Systematic review

Background: A growing number of mobile health (mHealth) technology-based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation. Objective: This study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others. Methods: We performed a systematic review searching the following electronic databases for studies on mHealth technology-based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. Results: Our search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness.

Development of a 3G Authentication Based Mobile Access of Health Records: A Mobile Telemedicine Application

As our country progresses in its aim to be a developed country by the Year 2020, the field of Information and Communications Technology or ICT is fast becoming the forerunner for the vision. The Internet is used in almost all aspects of life. As for the communications sector, according to Global Mobile Subscriber Database December 2002 report, there are 8,814,700 mobile subscribers in Malaysia with an Annual Growth of 16.6%. Withthe adoption of 3G-communication technology in the coming years, compelling high speed services, reaching up to 2 Mb/s together with improved security features would soon be possible. Through these years in the mobile industry, the health sector has always been neglected. Reason being, the technology could not support the application and it is not so much of a revenue generating business compared to mobile games or sports news. With globalization where the society is always on the move across borders, together with degrading environment conditions and the need for time, instant health services are becoming crucial. Looking into these conditions of mobile adoption and health status, the author intends to develop a solution for a mobile telemedicine application. Kevin Hung (2003) defines telemedicine as the utilization of telecommunication technology for medical diagnosis, treatment and patient care. Thus, the main aim of this project was to develop an application that could be used for medical purposes. This project integrates the latest mobile telecommunication technologies together with medical services with the idea of providing a highly secured personalize medical system and database query as mobile handsets are becoming a necessity to individuals. This would make updating and retrieving medical health records hassle free, anytime and anywhere. This project has also laid the groundwork for future expansion by incorporating the basic audio and video streaming features. This report accounts for all the concepts, design works and results of the mobile telemedicine application that has been developed successfully

Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme

BACKGROUND: Diabetes self-management involves adherence to healthy daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. OBJECTIVE: The objective of our study was to identify and classify barriers to adoption of remote health for management of type 2 diabetes. METHODS: The following 6 electronic databases were searched for articles published from 2010 to 2015: MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier). The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of 2 to review and extract data from identified papers. Information collected included study characteristics, outcomes, dropout rates, technologies used, and barriers identified. RESULTS: A total of 53 publications on 41 studies met the specified criteria. Lack of data accuracy due to input bias (32%, 13/41), limitations on scalability (24%, 10/41), and technology illiteracy (24%, 10/41) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations, whereas limitations on scalability were more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. In total, 40.5% (60/148) of identified barrier instances impeded patient engagement, which is manifest in the large dropout rates cited (up to 57%). CONCLUSIONS: The barriers identified represent major challenges in the design of remote health interventions for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high dropout rates, and new interventions are needed to identify and assist those at the greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financial sustainability

Provisioning Quality of Service of Wireless Telemedicine for E-Health Services: A Review

In general, on-line medical consultation reduces time required for medical consultation and induces improvement in the quality and efficiency of healthcare services. The scope of study includes several key features of present day e-health applications such as X-ray, ECG, video, diagnosis images and other common applications. Moreover, the provision of Quality of Service (QoS) in terms of specific medical care services in e-health, the priority set for e-health services and the support of QoS in wireless networks and techniques or methods aimed at IEEE 802.11 to secure the provision of QoS has been assessed as well. In e-health, medical services in remote places which include rustic healthcare centres, ships, ambulances and home healthcare services can be supported through the applications of e-health services such as medical databases, electronic health data and the transferring of text, video, sound and images. Given this, a proposal has been made for a multiple service wireless networking with multiple sets of priorities. In relation to the terms of an acceptable QoS level by the customers of e-health services, prioritization is an important criterion in a multi-traffic network. The requirement for QoS in medical networking of wireless broadband has paved the way for bandwidth prerequisites and the live transmission or real-time medical applications. The proposed wireless network is capable of handling medical applications for both normal and life-threatening conditions as characterized by the level of emergencies. In addition, the allocation of bandwidth and the system that controls admittance designed based on IEEE 802.16 especially for e-health services or wireless telemedicine will be discussed in this study. It has been concluded that under busy traffic conditions, the proposed architecture can used as a feasible and reliable infrastructure network for telemedicine

An Integrated and Distributed Framework for a Malaysian Telemedicine System (MyTel)

The overall aim of the research was to produce a validated framework for a Malaysian integrated and distributed telemedicine system. The framework was constructed so that it was capable of being useful in retrieving and storing a patient's lifetime health record continuously and seamlessly during the downtime of the computer system and the unavailability of a landline telecommunication network. The research methodology suitable for this research was identified including the verification and validation strategies. A case study approach was selected for facilitating the processes and development of this research. The empirical data regarding the Malaysian health system and telemedicine context were gathered through a case study carried out at the Ministry of Health Malaysia (MOHM). The telemedicine approach in other countries was also analysed through a literature review and was compared and contrasted with that in the Malaysian context. A critical appraisal of the collated data resulted in the development of the proposed framework (MyTel) a flexible telemedicine framework for the continuous upkeep o f patients' lifetime health records. Further data were collected through another case study (by way of a structured interview in the outpatient clinics/departments of MOHM) for developing and proposing a lifetime health record (LHR) dataset for supporting the implementation of the MyTel framework. The LHR dataset was developed after having conducted a critical analysis of the findings of the clinical consultation workflow and the usage o f patients' demographic and clinical records in the outpatient clinics. At the end of the analysis, the LHR components, LHR structures and LHR messages were created and proposed. A common LHR dataset may assist in making the proposed framework more flexible and interoperable. The first draft of the framework was validated in the three divisions of MOHM that were involved directly in the development of the National Health JCT project. The division includes the Telehealth Division, Public and Family Health Division and Planning and Development Division. The three divisions are directly involved in managing and developing the telehealth application, the teleprimary care application and the total hospital information system respectively. The feedback and responses from the validation process were analysed. The observations and suggestions made and experiences gained advocated that some modifications were essential for making the MyTel framework more functional, resulting in a revised/ final framework. The proposed framework may assist in achieving continual access to a patient's lifetime health record and for the provision of seamless and continuous care. The lifetime health record, which correlates each episode of care of an individual into a continuous health record, is the central key to delivery of the Malaysian integrated telehealth application. The important consideration, however, is that the lifetime health record should contain not only longitudinal health summary information but also the possibility of on-line retrieval of all of the patient's health history whenever required, even during the computer system's downtime and the unavailability of the landline telecommunication network

The e-Health Development Framework in Spain

Telemedicine and Information Society, Research DivisionThis document sets out to identify the strategic lines, framework for action and status quo. Moreover, it seeks to pinpoint recommendations designed to foster the development of e-health in this country and meet any potential demand in a European context arising from an institutional commitment to lend impetus to the Information Society in Health, in the shape of the «Strategic Initiative for the Development of the Information Society» (Iniciativa estratégica para el Desarrollo de Sociedad de la Información - Info XXI) and the National Research, Development and Innovation Plan (2000-2003).Telemedicine and Information Society, Research Division" Introducción, General, Objetivo y alcance del documento, Justificación, Realización del documento, Contenido, Sobre la e-Salud y su campo de aplicaciones, General, Definiendo la e-Salud, De las infraestructuras a las aplicaciones, El espacio de las aplicaciones de la e-Salud, El marco europeo y el contexto global, La e-Salud en la iniciativa de e-Europa, El contexto global, Escenario de la e-Salud en España, Aspectos generales, Los grandes grupos de usuarios de e-Salud Los consumidores (ciudadanos en general), Los pacientes, Los profesionales sanitarios, Las organizaciones sanitarias, Análisis de situación, Factores impulsores, Barreras, Discusión por categorías de usuarios, Planteando una estrategia de acción en e-Salud, Resumen de situación, Visión del papel de la e-Salud, Perspectivas de evolución. Contexto de desarrollo, Identificación de los temas de fondo Propuesta de actuaciones, General, Elementos de actuación, Medidas Generales, Acciones de Investigación y Desarrollo, Acciones de Formación y Docencia, Acciones de Transferencia de Tecnología e Innovación, Referencias/Bibliografía

M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

Mobile virtual communities for telemedicine: research challenges and opportunities

Today’s mobile devices have become increasingly powerful with enhanced features such as increased CPU power and memory, internet connectivity in multiple ways (multi-homing) and interfacing with external peripheral devices (for instance GPS receiver, medical sensors). The proliferation of these mobile devices combined with an increasing willingness of users to share information available on and around mobile device (e.g. location, user activity) has given rise to Mobile Virtual Communities (MVC). This way, social interaction is now feasible anywhere and anytime. In another paradigm referred to as telemedicine, information and communication technologies are being investigated and employed in areas such as health maintenance and alleviation, cure and prevention of diseases. In general, (mobile) virtual communities have been explored in the telemedicine domain where they were found to be promising in many cases. However, evidence for their effectiveness has yet to be established. With this background and based on our expertise with MVCs and telemedicine, we address a number of aspects including: 1) basic concepts in telemedicine and MVC and analysis of effectiveness and success factors of MVCs in the telemedicine domain; 2) a prototype architecture addressing mobility issues for the MVC in the telemedicine domain; and 3) reflection on the opportunities and research challenges involved in using MVCs in the telemedicine domain