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

Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.Fil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miranda, Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Leveraging Digital Technologies for Management of Peripartum Depression to Mitigate Health Disparities

Health disparities are adverse, preventable differences in health outcomes that affect disadvantaged populations. Examples of health disparities can be seen in the condition of peripartum depression (PPD), a mood disorder affecting approximately 10-15% of peripartum women. For example, Hispanic and African-American women are less likely to start or continue PPD treatment. Digital health technologies have emerged as practical solutions for PPD care and self-management. However, existing digital solutions lack an incorporation of behavior theory and distinctive information needs based on women’s personal, social, and clinical profiles. Bridging this gap, I adapt Digilego, an integrative digital health development framework consisting of: a) mixed-methods user needs analysis, (b) behavior and health literacy theory mapping, and (c) content and feature engineering specifications for future programmatic development, to address health disparities. This enhanced framework is then used to design and develop a digital platform (MomMind) for PPD prevention among women in their peripartum period. This platform contains a digital journal, social forum, a library repository of PPD patient education materials, and a repository of PPD self-monitoring surveys. In line with the existing Digilego digital health framework, throughout my iterative process of design and development, I gather design insights from my target population (n=19) and their health providers (n=9) using qualitative research methods (e.g., interviews) and secondary analysis of peer interactions in two PPD online forums (n=55,301 posts from 9,364 users spanning years 2008-2022). These multimodal needs gathering efforts allowed me to a) compile women’s information and technology needs, and b) utilize them as a guide for MomMind intervention development and evaluation. One key MomMind strength is its grounding in theory-driven behavior change techniques (e.g., shaping knowledge) and patient engagement features (e.g., electronic questionnaires) as facilitated by Digilego. Also, I extend Digilego by incorporating literacy domains (e.g., health literacy) and cognitive processes (e.g., understanding) from the eHealth literacy framework into my content engineering approach. After an in-house usability assessment, I conducted a pilot acceptability evaluation of MomMind using cross-sectional acceptability surveys and PPD health literacy surveys administered pre-and-post use of MomMind. Interviews were also conducted to assess participant’s personal opinions and feedback. The study sample included n=30 peripartum women, of whom 16 (53.3%) were Hispanic and 17 (56.7%) were in low-income ranges. A total of 29/30 (96.6%) participants approved of MomMind, 28/30 (93.3%) deemed it a good fit, and 29/30 (96.67%) deemed it easy to use. Participants showed statistically significant improvement (

Improving neonatal health in Nepal: Major challenges to achieving millennium development goal 4

Background: Globally, more than 40% of all under-five child deaths occur during the neonatal period. Neonatal mortality in Nepal is 33 per 1,000 live births, eight times that of developed regions. So there is an urgent need for neonatal care to prevent these deaths, in order to achieve the fourth Millennium Development Goal by 2015. Objective: The objective of this article was to review the major challenges in improving neonatal health in Nepal and to identify possible keys to achieving Millennium Development Goal 4. Methodology: Key literature searches were conducted of electronic databases and relevant web-sites. Furthermore, personal contact with the local population in Nepal and hand searching of key journals was performed. Results: In Nepal, there exist harmful cultural practices during pregnancy and after childbirth. Under utilization of basic maternal and neonatal healthcare, limited health infrastructure with a shortage of trained health care professionals, poverty, illiteracy, women's low status in the society and political instability are major challenges facing neonatal health in Nepal. Conclusions: In order to improve neonatal health in Nepal, it is imperative to focus on biomedical, nursing and social interventions, in addition to family centred care. Health promotion regarding the practices to be adopted during pregnancy and after childbirth, improving health infrastructure and integrating skilled delivery personnel into local health services are important measures. Longer-term solutions could include: improving mother's nutrition and women's position in society, increasing the proportions of girls attending school, as well as involving men in neonatal health matters

Iodine and pregnancy – a qualitative study focusing on dietary guidance and information

Iodine is essential for thyroid hormones synthesis and normal neurodevelopment; however, ~60% of pregnant women do not meet the WHO (World Health Organization) recommended intake. Using a qualitative design, we explored the perceptions, awareness, and experiences of pregnancy nutrition, focusing on iodine. Women in the perinatal period (n = 48) were interviewed and filled in a food frequency questionnaire for iodine. Almost all participants achieved the recommended 150 μg/day intake for non-pregnant adults (99%), but only 81% met the increased demands of pregnancy (250 μg/day). Most were unaware of the importance, sources of iodine, and recommendations for iodine intake. Attitudes toward dairy products consumption were positive (e.g., helps with heartburn; easy to increase). Increased fish consumption was considered less achievable, with barriers around taste, smell, heartburn, and morning sickness. Community midwives were the main recognised provider of dietary advice. The dietary advice received focused most often on multivitamin supplements rather than food sources. Analysis highlighted a clear theme of commitment to change behaviour, motivated by pregnancy, with a desired focus on user-friendly documentation and continued involvement of the health services. The study highlights the importance of redirecting advice on dietary requirements in pregnancy and offers practical suggestions from women in the perinatal period as the main stakeholder group

Impact of Social Networking Sites on Post-Partum Depression in Women: An Analysis in the Context of Bangladesh

Postpartum Depression (PPD) refers to moderate or severe depression in a woman after childbirth. It is strikingly common in new mothers from all regions of the world with a prevalence of around 10-15%. PPD can have severe adverse effects on maternal and child health, such as suicidal tendency of the mother, infanticide as well as poor cognitive and developmental growth of the child. Despite this, few women seek medical attention due to ignorance, negligence and financial limitations; the latter is especially true for those who live in developing countries. Nowadays, social networking sites (SNS) e.g., Facebook can act as accessible and effective tools for the prevention and treatment of PPD. In this paper, we analyze the opinions and awareness level of Bangladeshi people about PPD and impact of using SNS during postpartum period on reducing PPD based on our survey (N = 93). We also discuss possible SNS-based interventions and design implications that can effectively and feasibly reduce PPD in women in developing countries

Behavior Change Apps for Gestational Diabetes Management : Exploring Desirable Features

Publisher Copyright: © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.Gestational diabetes mellitus (GDM) has considerable and increasing health effects as it raises both the mother’s and offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and engaging insufficient physical activity. While telemedicine interventions requiring weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control amongst women with GDM, apps without extensive input from health care professionals are limited and have not shown to be effective. We aimed to improve the efficacy of GDM self-management apps by exploring desirable features in a review. We derived six desirable features from the multidisciplinary literature and we evaluated the state of implementation of these features in existing GDM apps. The results showed that features for increasing competence to manage GDM and for providing social support were largely lacking.Peer reviewe

Smartphone usage and preferences among postpartum HIV-positive women in South Africa

Introduction. In South Africa, HIV-positive women receiving antiretroviral therapy (ART) often are lost to care postpartum and strategies to support long-term engagement in care are needed. Mobile health (mHealth) interventions are emerging as potential strategies for supporting long-term engagement in the prevention of mother-to-child transmission (PMTCT) of HIV care continuum. Smartphone technology and mobile data are getting cheaper and more accessible, however little research has been done to explore the potential for smartphone-based interventions in the PMTCT cascade in low-resource settings. This study explored smartphone use and the acceptability and feasibility of mHealth interventions among postpartum women who were attending the Gugulethu Community Health Centre in Cape Town, South Africa. Methods. This mini-dissertation is composed of three parts. Part A, the protocol, outlines the study methodology and the ethical considerations of the proposed study. Part B, the structured literature review, synthesises available data on uses of mobile phone-based applications to support the PMTCT continuum as well as end-user perceptions and preference for mHealth interventions for PMTCT. The review considered published quantitative and qualitative studies that were conducted in sub-Saharan Africa, the most comparable settings to the study population. Part C, the journal ready manuscript, presents the results of six focus group discussions (FGDs) conducted with 27 HIV-positive, postpartum women who were using a smartphone. Questions assessed the respondent’s general smartphone use, as well as their exposure to and perceptions of mHealth interventions. Results. The review shows that, despite a range of evidence on short message service (SMS) and/or voice call interventions, smartphone-based interventions have not been a focus of prior research to support the PMTCT continuum of care or maternal lifelong ART. Results are promising for SMS and/or voice call to enhance maternal retention, infant HIV testing and infant ART initiation. The review found evidence of acceptability and feasibility of mHealth interventions offered directly to women, or also including their partners and health workers as support systems to address PMTCT challenges. The primary research found little turnover in phones and phone numbers, and about half the women shared their devices with family and friends. Respondents reported high familiarity with smartphone applications such as WhatsApp and Facebook, with WhatsApp cited as the preferred method of smartphone communication. Women had access to reliable data sources such as data bundles, airtime and Wi-Fi, with data bundles perceived as the most cost-effective method to access the internet. Nearly all women were familiar with MomConnect, a national mHealth text support service in South Africa, and most described it positively. Women expressed interest in future HIV mHealth applications including complementary health information on physical activity, nutrition, mental health and basic social services. Conclusions. In the context of rapidly increasing access to smartphones, even in low-resource settings, these findings suggest that future smartphone mHealth interventions may be appropriate to support the PMTCT continuum of care in low-income settings of South Africa. These results call for further studies to evaluate the feasibility and effectiveness of smartphone interventions in similar settings

Scottish government equality outcomes:pregnancy and maternity evidence review

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