DESIGN PRINCIPLES FOR APP-BASED HEALTHCARE INTERVENTIONS: A MIXED METHOD APPROACH

Despite the ubiquity of mobile health applications (apps), the practical use and success of the apps have been questionable. Design Principles (DP) can affect chronic health app user satisfaction and have been studied for ensuring favorable app usage. However, there is no consensual definition of DP within the preceding literature, which has a technical rather than an end-user-centric focus and lacks a rigorous theoretical basis. Moreover, different levels of DPs’ application can lead to differential user satisfaction as influenced by the user-contextual environment, warranting a quantitative assessment. Accordingly, the overarching question to be addressed is which DP for the self-management of chronic conditions contributes to better user satisfaction outcomes. The research focuses on Multiple Sclerosis (MS) as a representative condition. This research uses a mixed methods, with a qualitative approach for DP identification and a quantitative approach for the studying the DP-Satisfaction relationship. The DP identification is achieved through - 1) An in depth review of foundational theory for greater validity, 2) A Systematic Literature Review (SLR), for DP themes grounded in theory, and 3) Manually coded user reviews for MS apps. The theoretical underpinnings of the empirical approach are established through a composite theoretical lens, based on technologically, behaviorally, and cognitively oriented frameworks. The DP extracted from theory, SLR, and manual coding methods are found to be largely consistent with each other, namely ‘Communication with Clinicians’, ‘Compatibility, ‘Education’, ‘Notifications’, ‘Tracking’, ‘Social Support’, ‘Ease of Use’, ‘Technical Support’, ‘Usefulness’, ‘Privacy and Security’, and Quality. An ordinal logistic regression analysis is conducted to understand the relationship between DP and User Satisfaction outcomes based on the manually coded DP scores of the user reviews. All DP have a significant impact on User Satisfaction. From a theoretical perspective, the research improves our understanding of key design principles for the self-management of chronic conditions such as MS and the impact of such principles on user satisfaction. From a practical perspective, the findings provide guidance to the user requirement elicitation process, potentially leading to the development of more successful, sustainable, and responsive healthcare interventions

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

The role of mobile technology for fall risk assessment for individuals with multiple sclerosis

Multiple Sclerosis (MS) is a chronic, progressive neurogenerative disease that affects one million people in the United States (Wallin et al., 2019). Common MS symptoms include impaired coordination, poor walking and balance, and fatigue, and these symptoms put people with MS (pwMS) at a higher risk for falls (Cameron & Nilsagard, 2018). Falls are highly prevalent among pwMS and can result in detrimental consequences including bone fractures and even death (Matsuda et al., 2011). To prevent falls and fall related injuries, it is important to first assess for multiple risk factors and then intervene through targeted treatments (Palumbo et al., 2015). Fall risk can be assessed through self-report measures, clinical performance tests, or with technology such as force plates and motion capture systems (Kanekar & Aruin, 2013). However, clinicians have time constraints, technology is expensive, and trained personnel is needed. Moreover, due to the COVID-19 pandemic, access to in-person clinical visits is limited. As a result, pwMS may not receive fall risk screening and remain vulnerable to fall related injuries. Mobile technology offers a solution to increase access to fall risk screening using an affordable, ubiquitous, and portable tool (Guise et al., 2014; Marrie et al., 2019). Therefore, the overarching goal of this study was to develop a usable fall risk health application (app) for pwMS to self-assess their fall risk in the home setting. Four studies were performed: 1) smartphone accelerometry was tested to measure postural control in pwMS; 2) a fall risk algorithm was developed for a mobile health app; 3) a fall risk app, Steady-MS, was developed and its usability was tested; and 4) the feasibility of home-based procedures for using Steady-MS was determined. Results suggest that smartphone accelerometry can assess postural control in pwMS. This information was used to develop an algorithm to measure overall fall risk in pwMS and was then incorporated into Steady-MS. Steady-MS was found to be usable among MS users and feasible to use in the home setting. The results from this project demonstrate that pwMS can independently assess their fall risk with Steady-MS in their homes. For the first time, pwMS are equipped to self-assess their fall risk and can monitor and manage their risk. Home-based assessments also opens the potential to offer individualized and targeted treatments to prevent falls. Ultimately, Steady-MS increases access to home-based assessments to reduce falls and improve functional independence for those with MS

Digital innovation in Multiple Sclerosis Management

Due to innovation in technology, a new type of patient has been created, the e-patient, characterized by the use of electronic communication tools and commitment to participate in their own care. The extent to which the world of digital health has changed during the COVID-19 pandemic has been widely recognized. Remote medicine has become part of the new normal for patients and clinicians, introducing innovative care delivery models that are likely to endure even if the pendulum swings back to some degree in a post-COVID age. The development of digital applications and remote communication technologies for patients with multiple sclerosis has increased rapidly in recent years. For patients, eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. For HCPs, eHealth technology may facilitate the assessment of clinical disability, analysis of lab and imaging data, and remote monitoring of patient symptoms, adverse events, and outcomes. It may allow time optimization and more timely intervention than is possible with scheduled face-to-face visits. The way we measure the impact of MS on daily life has remained relatively unchanged for decades, and is heavily reliant on clinic visits that may only occur once or twice each year.These benefits are important because multiple sclerosis requires ongoing monitoring, assessment, and management.The aim of this Special Issue is to cover the state of knowledge and expertise in the field of eHealth technology applied to multiple sclerosis, from clinical evaluation to patient education

The pain experiences of powered wheelchair users

Copyright © 2012 Informa UK, Ltd. This is the author's accepted manuscript. The final published article is available from the link below.Purpose: To explore the experience of pain and discomfort in users of electric-powered indoor/outdoor wheelchairs (EPIOCs) provided by a National Health Service. Methods: EPIOC users receiving their chair between February and November 2002 (N=74) were invited to participate in a telephone questionnaire/interview and 64 (aged 1081 years) agreed. Both specific and open-ended questions examined the presence of pain/discomfort, its severity, minimizing and aggravating factors, particularly in relation to the EPIOC and its use. Results: Most EPIOC users described experiences of pain with 17% reporting severe pain. Over half felt their pain was influenced by the wheelchair and few (25%) considered their chair eased their symptoms. The most common strategy for pain relief was taking medication. Other self-help strategies included changing position, exercise and complementary therapies. Respondents emphasized the provision of backrests, armrests, footrests and cushions which might alleviate or exacerbate pain, highlighting the importance of appropriate assessment for this high dependency group. Conclusions: Users related pain to their underlying medical condition, their wheelchair or a combination of the two. User feedback is essential to ensure that the EPIOC meets health needs with minimal pain. This becomes more important as the health condition of users changes over time

A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the BRiMS feasibility RCT

This is the final version, also available from NIHR journals library via the DOI in this record.Abstract Background Balance, mobility impairments and falls are common problems for people with multiple sclerosis (MS). Our ongoing research has led to the development of Balance Right in MS (BRiMS), a 13-week home- and group-based exercise and education programme intended to improve balance and encourage safer mobility. Objective This feasibility trial aimed to obtain the necessary data and operational experience to finalise the planning of a future definitive multicentre randomised controlled trial. Design Randomised controlled feasibility trial. Participants were block randomised 1 : 1. Researcher-blinded assessments were scheduled at baseline and at 15 and 27 weeks post randomisation. As is appropriate in a feasibility trial, statistical analyses were descriptive rather than involving formal/inferential comparisons. The qualitative elements utilised template analysis as the chosen analytical framework. Setting Four sites across the UK. Participants Eligibility criteria included having a diagnosis of secondary progressive MS, an Expanded Disability Status Scale (EDSS) score of between ≥ 4.0 and ≤ 7.0 points and a self-report of two or more falls in the preceding 6 months. Interventions Intervention – manualised 13-week education and exercise programme (BRiMS) plus usual care. Comparator – usual care alone. Main outcome measures Trial feasibility, proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls), feasibility of the BRiMS programme (via process evaluation) and economic data. Results A total of 56 participants (mean age 59.7 years, standard deviation 9.7 years; 66% female; median EDSS score of 6.0 points, interquartile range 6.0–6.5 points) were recruited in 5 months; 30 were block randomised to the intervention group. The demographic and clinical data were broadly comparable at baseline; however, the intervention group scored worse on the majority of baseline outcome measures. Eleven participants (19.6%) withdrew or were lost to follow-up. Worsening of MS-related symptoms unrelated to the trial was the most common reason (n = 5) for withdrawal. Potential primary and secondary outcomes and economic data had completion rates of > 98% for all those assessed. However, the overall return rate for the patient-reported falls diary was 62%. After adjusting for baseline score, the differences between the groups (intervention compared with usual care) at week 27 for the potential primary outcomes were MS Walking Scale (12-item) version 2 –7.7 [95% confidence interval (CI) –17.2 to 1.8], MS Impact Scale (29-item) version 2 (MSIS-29vs2) physical 0.6 (95% CI –7.8 to 9) and MSIS-29vs2 psychological –0.4 (95% CI –9.9 to 9) (negative score indicates improvement). After the removal of one outlier, a total of 715 falls were self-reported over the 27-week trial period, with substantial variation between individuals (range 0–93 falls). Of these 715 falls, 101 (14%) were reported as injurious. Qualitative feedback indicated that trial processes and participant burden were acceptable, and participants highlighted physical and behavioural changes that they perceived to result from undertaking BRiMS. Engagement varied, influenced by a range of condition- and context-related factors. Suggestions to improve the utility and accessibility of BRiMS were highlighted. Conclusions The results suggest that the trial procedures are feasible and acceptable, and retention, programme engagement and outcome completion rates were sufficient to satisfy the a priori progression criteria. Challenges were experienced in some areas of data collection, such as completion of daily diaries.National Institute for Health Research (NIHR

Wound Image Quality From a Mobile Health Tool for Home-Based Chronic Wound Management With Real-Time Quality Feedback: Randomized Feasibility Study

BACKGROUND Travel to clinics for chronic wound management is burdensome to patients. Remote assessment and management of wounds using mobile and telehealth approaches can reduce this burden and improve patient outcomes. An essential step in wound documentation is the capture of wound images, but poor image quality can have a negative influence on the reliability of the assessment. To date, no study has investigated the quality of remotely acquired wound images and whether these are suitable for wound self-management and telemedical interpretation of wound status. OBJECTIVE Our goal was to develop a mobile health (mHealth) tool for the remote self-assessment of digital ulcers (DUs) in patients with systemic sclerosis (SSc). We aimed to define and validate objective measures for assessing the image quality, evaluate whether an automated feedback feature based on real-time assessment of image quality improves the overall quality of acquired wound images, and evaluate the feasibility of deploying the mHealth tool for home-based chronic wound self-monitoring by patients with SSc. METHODS We developed an mHealth tool composed of a wound imaging and management app, a custom color reference sticker, and a smartphone holder. We introduced 2 objective image quality parameters based on the sharpness and presence of the color checker to assess the quality of the image during acquisition and enable a quality feedback mechanism in an advanced version of the app. We randomly assigned patients with SSc and DU to the 2 device groups (basic and feedback) to self-document their DU at home over 8 weeks. The color checker detection ratio (CCDR) and color checker sharpness (CCS) were compared between the 2 groups. We evaluated the feasibility of the mHealth tool by analyzing the usability feedback from questionnaires, user behavior and timings, and the overall quality of the wound images. RESULTS A total of 21 patients were enrolled, of which 15 patients were included in the image quality analysis. The average CCDR was 0.96 (191/199) in the feedback group and 0.86 (158/183) in the basic group. The feedback group showed significantly higher (P<.001) CCS compared to the basic group. The usability questionnaire results showed that the majority of patients were satisfied with the tool, but could benefit from disease-specific adaptations. The median assessment duration was <50 seconds in all patients, indicating the mHealth tool was efficient to use and could be integrated into the daily routine of patients. CONCLUSIONS We developed an mHealth tool that enables patients with SSc to acquire good-quality DU images and demonstrated that it is feasible to deploy such an app in this patient group. The feedback mechanism improved the overall image quality. The introduced technical solutions consist of a further step towards reliable and trustworthy digital health for home-based self-management of wounds

Wearable technologies to measure clinical outcomes in multiple sclerosis: A scoping review

Wearable technology refers to any sensor worn on the person, making continuous and remote monitoring available to many people with chronic disease, including multiple sclerosis (MS). Daily monitoring seems an ideal solution either as an outcome measure or as an adjunct to support rater-based monitoring in both clinical and research settings. There has been an increase in solutions that are available, yet there is little consensus on the most appropriate solution to use in either MS research or clinical practice. We completed a scoping review (using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines) to summarise the wearable solutions available in MS, to identify those approaches that could potentially be utilised in clinical trials, by evaluating the following: scalability, cost, patient adaptability and accuracy. We identified 35 unique products that measure gait, cognition, upper limb function, activity, mood and fatigue, with most of these solutions being phone applications

Self-Tracking by People Living with Multiple Sclerosis: Supporting Experiences of Agency in a Chronic Neurological Condition

Multiple sclerosis is a complex neurological condition. It disrupts the central nervous system leading to an individual range of physical, cognitive, and mental impairments. Research has focused on the tracking of primary disease indicators and disability outcome measures to assess the progression of this condition. However, there is little knowledge on how technologies could support the needs of people with multiple sclerosis (MS) in self-tracking their health and wellbeing. Drawing on qualitative research and design methods this thesis provides two contributions. Firstly, it improves understanding of self-tracking in MS self-management. Interview participants reported regaining a sense of control over MS through intertwining individual self-care practices with different self-tracking tools, including paper notebooks and fitness wearables. They associated experiences of control with their agency to document their health in holistic ways, involving symptom monitoring and life journaling. However, participants criticised that self-tracking apps can impede their capacities, in particular when the user experience is focused on predefined health indicators and the optimisation of health behaviour. These findings highlight the need to support people’s individual self-care intentions and agentive capacities through customisable self- tracking approaches. Secondly, this thesis contributes the design of Trackly, a technology probe that supports people in defining and colouring pictorial trackers, such as body shapes. We identify benefits and challenges of customisable and pictorial self-tracking through a field study of Trackly in MS self-management. Having been able to support their individual self-care intentions with Trackly, participants reported a spectrum of interrelated experiences of agency, including ownership, identity, awareness, mindfulness, and control. Overall, this thesis provides a qualitative account and design perspective that demonstrate how adapting self-tracking technologies to individual care needs supported experiences of agency. These findings are particularly relevant to the design of technologies aimed at leveraging personally meaningful self-care and quality of life

Managing Fatigue with Technology for Individuals with Multiple Sclerosis

OBJECTIVE: The purpose of this study was to investigate whether the use of a mobile health application (mHealth app) in conjunction with energy conservation management techniques will result in a decrease in fatigue for adults with multiple sclerosis. METHOD: Using a quantitative, exploratory, pre-posttest design, we examined outcomes associated with the use of the mHealth app, Pace My Day, by seven participants during one chosen task over two weeks. The app reinforced the use of energy conservation management techniques during the chosen task. Outcome measures included Modified Fatigue Impact Scale (MFIS) and Canadian Occupational Performance Measure (COPM). RESULTS: There was a significant decrease in the MFIS scores indicating a decrease in fatigue over the two-week period t (6) =5.75, p=0.001. Additionally, there was a significant increase in satisfaction with performance of the chosen task as measured by the COPM over the two-week period t (6) =-3.359, p=0.015. CONCLUSION: The use of a mHealth app to support energy conservation management education was found to significantly reduce levels of fatigue and increase self-perceived performance and satisfaction with task execution