Relationship between popularity and the likely efficacy: an observational study based on a random selection on top-ranked physical activity apps

Objectives To explore the relationship between popularity of mobile application (apps) for physical activity (PA) and their likely efficacy. The primary objective was to assess the association between app popularity (indicated by user ratings) and likely efficacy (indicated by the number of Behaviour Change Techniques (BCT) present). The secondary objective was to assess the relationship between user ratings and those BCTs that have been shown to be effective in increasing PA. Design Observational study. Methods 400 top-ranked free and paid apps from iTunes and Google Play stores were screened, and were included if the primary behaviour targeted was PA and they had stand-alone functionality. The outcome variable of user rating was dichotomised into high (4, 5 stars) or low (1, 2, 3 stars) rating. Setting iTunes and Google Play app stores. Participants No individual participants but the study used user-led rating system in the app store. Primary and secondary outcome measures BCTs and user rating. Results Of 400 apps, 156 were eligible and 65 were randomly selected, downloaded and assessed by two reviewers. There was no relationship overall between star ratings and the number of BCTs present, nor between star ratings and the presence of BCTs known to be effective in increasing PA. App store was strongly associated with star ratings, with lower likelihood of finding 4 or 5 stars in iTunes compared with Google Play (OR 0.74, 95% CI 0.73 to 0.76, p<0.001). Conclusions The findings of this study suggest that popularity does not necessarily imply the likelihood of effectiveness. Hence, public health impact is unlikely to be achieved by allowing market forces to ‘prescribe’ what is used by the public

Quality of Publicly Available Physical Activity Apps: Review and Content Analysis

BACKGROUND: Within the new digital health landscape, the rise of health apps creates novel prospects for health promotion. The market is saturated with apps that aim to increase physical activity (PA). Despite the wide distribution and popularity of PA apps, there are limited data on their effectiveness, user experience, and safety of personal data. OBJECTIVE: The purpose of this review and content analysis was to evaluate the quality of the most popular PA apps on the market using health care quality indicators. METHODS: The top-ranked 400 free and paid apps from iTunes and Google Play stores were screened. Apps were included if the primary behavior targeted was PA, targeted users were adults, and the apps had stand-alone functionality. The apps were downloaded on mobile phones and assessed by 2 reviewers against the following quality assessment criteria: (1) users' data privacy and security, (2) presence of behavior change techniques (BCTs) and quality of the development and evaluation processes, and (3) user ratings and usability. RESULTS: Out of 400 apps, 156 met the inclusion criteria, of which 65 apps were randomly selected to be downloaded and assessed. Almost 30% apps (19/65) did not have privacy policy. Every app contained at least one BCT, with an average number of 7 and a maximum of 13 BCTs. All but one app had commercial affiliation, 12 consulted an expert, and none reported involving users in the app development. Only 12 of 65 apps had a peer-reviewed study connected to the app. User ratings were high, with only a quarter of the ratings falling below 4 stars. The median usability score was excellent-86.3 out of 100. CONCLUSIONS: Despite the popularity of PA apps available on the commercial market, there were substantial shortcomings in the areas of data safety and likelihood of effectiveness of the apps assessed. The limited quality of the apps may represent a missed opportunity for PA promotion

The Effectiveness of Prompts to Promote Engagement With Digital Interventions: A Systematic Review

BACKGROUND: Digital interventions have been effective in improving numerous health outcomes and health behaviors; furthermore, they are increasingly being used in different health care areas, including self-management of long-term conditions, mental health, and health promotion. The full potential of digital interventions is hindered by a lack of user engagement. There is an urgent need to develop effective strategies that can promote users' engagement with digital interventions. One potential method is the use of technology-based reminders or prompts. OBJECTIVE: To evaluate the effectiveness of technology-based strategies for promoting engagement with digital interventions. METHODS: Cochrane Collaboration guidelines on systematic review methodology were followed. The search strategy was executed across 7 electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, the Education Resources Information Center (ERIC), PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Databases were searched from inception to September 13, 2013, with no language or publication type restrictions, using three concepts: randomized controlled trials, digital interventions, and engagement. Gray literature and reference lists of included studies were also searched. Titles and abstracts were independently screened by 2 authors, then the full texts of potentially eligible papers were obtained and double-screened. Data from eligible papers were extracted by one author and checked for accuracy by another author. Bias was assessed using the Cochrane risk of bias assessment tool. Narrative synthesis was performed on all included studies and, where appropriate, data were pooled using meta-analysis. All findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 14 studies were included in the review with 8774 participants. Of the 14 studies, 9 had sufficient data to be included in the meta-analyses. The meta-analyses suggested that technology-based strategies can potentially promote engagement compared to no strategy for dichotomous outcomes (relative risk [RR] 1.27, 95% CI 1.01-1.60, I(2)=71%), but due to considerable heterogeneity and the small sample sizes in most studies, this result should be treated with caution. No studies reported adverse or economic outcomes. Only one study with a small sample size compared different characteristics; the study found that strategies promoting new digital intervention content and those sent to users shortly after they started using the digital intervention were more likely to engage users. CONCLUSIONS: Overall, studies reported borderline positive effects of technology-based strategies on engagement compared to no strategy. However, the results have to be interpreted with caution. More research is needed to replicate findings and understand which characteristics of the strategies are effective in promoting engagement and how cost-effective they are

Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review

Background: Digital health interventions (DHIs) refer to interventions designed to support health-related knowledge transfer and delivered via digital technologies, such as mobile applications (apps). DHIs are a double-edged sword: they have the potential to reduce health inequalities, for example by making treatments available remotely to rural populations underserved by healthcare facilities or by helping to overcome language barriers via in-app translation services. However, if not designed and deployed with care, DHIs also have the potential to increase health inequalities and exacerbate effects of the digital divide. / Objective: The objective of this study was to review ways to mitigate the digital divide through DHI design, deployment and engagement mechanisms sensitive to the needs of digitally-excluded populations. / Methods: This protocol outlines the procedure for a systematic scoping review focussing on features of DHI design and deployment that enable or hinder access to and engagement with DHIs by people from demographic groups likely to be affected by the digital divide. / Results: The review is underway and is anticipated to be completed by the end of September 2021. / Conclusions: The results will have wider implications for researchers and policy makers using DHIs for health improvement peri-pandemic and post-pandemic and will inform best practices in the design and delivery of DHIs. Clinical Trial: A summary of the protocol and any supplementary material will be registered with the Open Science Framework (OSF) and assigned a Digital Object Identifier (DOI) for long-term retrieval

Argument harvesting using chatbots

Much research in computational argumentation assumes that arguments can be obtained in some way. Yet, to improve and apply models of argument, we need methods for acquiring them. Current approaches include argument mining from text, hand coding of arguments by researchers, or generating arguments from knowledge bases. In this paper, we propose a new approach, which we call argument harvesting, that uses a chatbot to enter into a dialogue with a participant to get arguments and counterarguments from him or her. Because it is automated, the chatbot can be used repeatedly in many dialogues, and thereby it can generate a large corpus. We describe the architecture of the chatbot, provide methods for clustering arguments by their similarity and value, and an evaluation of our approach in a case study concerning attitudes of women to participation in sport

Impact of Financial Incentives on Alcohol Consumption Recording in Primary Health Care Among Adults with Schizophrenia and Other Psychoses: A Cross-Sectional and Retrospective Cohort Study

AIMS: Lack of financial incentive is a frequently cited barrier to alcohol screening in primary care. The Quality and Outcomes Framework (QOF) pay for performance scheme has reimbursed UK primary care practices for alcohol screening in people with schizophrenia since April 2011. This study aimed to determine the impact of financial incentives on alcohol screening by comparing rates of alcohol recording in people with versus those without schizophrenia between 2000 and 2013. METHODS: Cross-sectional and retrospective cohort study. Alcohol data were extracted from The Health Improvement Network (THIN) database of UK primary care records using (a) Read Codes for level of alcohol consumption, (b) continuous measures of drinking (e.g. units a week) and (c) Read Codes for types of screening test. RESULTS: A total of 14,860 individuals (54% (8068) men and 46% (6792) women) from 409 general practices aged 18-99 years with schizophrenia were identified during April 2011-March 2013. Of these, 11,585 (78%) had an alcohol record, of which 99% (8150/8257) of Read Codes for level of consumption were eligible for recompense in the QOF. There was an 839% increase in alcohol recording among people with schizophrenia over the 13-year period (rate ratio per annum increase 1.19 (95% CI 1.18-1.20)) compared with a 62% increase among people without a severe mental illness (rate ratio per annum increase 1.04 (95% CI 1.03-1.05)). CONCLUSION: Financial incentives offered by the QOF appear to have a substantial impact on alcohol screening among people with schizophrenia in UK primary care. SHORT SUMMARY: Alcohol screening among people with schizophrenia increased dramatically in primary health care following the introduction of the UK pay for performance incentive scheme (Quality and Outcomes Framework) for severe mental illness, with an 839% rise (>8-fold increase) compared with a 62% increase among people without a over the 13-year study period (2000-2013)

Parasitic Cape honeybee workers, Apis mellifera capensis, evade policing

Relocation of the Cape honeybee, Apis mellifera capensis, by bee-keepers from southern to northern South Africa in 1990 has caused widespread death of managed African honeybee, A. m. scutellata, colonies. Apis mellifera capensis worker bees are able to lay diploid, female eggs without mating by means of automictic thelytoky (meiosis followed by fusion of two meiotic products to restore egg diploidy), whereas workers of other honeybee subspecies are able to lay only haploid, male eggs. The A. m. capensis workers, which are parasitizing and killing A. m. scutellata colonies in northern South Africa, are the asexual offspring of a single, original worker in which the small amount of genetic variation observed is due to crossing over during meiosis (P. Kryger, personal communication). Here we elucidate two principal mechanisms underlying this parasitism. Parasitic A. m. capensis workers activate their ovaries in host colonies that have a queen present (queenright colonies), and they lay eggs that evade being killed by other workers (worker policing)—the normal fate of worker-laid eggs in colonies with a queen. This unique parasitism by workers is an instance in which a society is unable to control the selfish actions of its members

Unintended consequences of patient online access to health records: a qualitative study in UK primary care

Background: Health systems around the world are seeking to harness digital tools to promote patient autonomy and increase the efficiency of care. One example of this policy in England is online patient access to full medical records in primary care. Since April 2019, all NHS England patients have had the right to access their full medical record prospectively, and full record access has been the “default position” since April 2020. / Aim: To identify and understand the unintended consequences of online patient access their medical record. / Design and Setting: Qualitative interview study in 10 general practices in South West and North West England. / Method: Semi-structured individual interviews with 13 patients and 16 general practice staff with experience of patient online access to health records. / Results: Online access generated unintended consequences that negatively impacted patients’ understanding of their health care, for example patients discovering surprising information or information that was difficult to interpret. Online access impacted GPs’ documentation practices, such as when GPs pre-emptively attempted to minimise potential misunderstandings to aid patient understanding of their health care, in other cases, negatively impacting the quality of the records and patient safety when GPs avoided documenting their speculations or concerns. Contrary to assumptions that practice workload would be reduced, online access introduced extra work, such as managing and monitoring access and taking measures to prevent possible harm to patients. / Conclusion: The unintended consequences described by both staff and patients show that to achieve the intended consequences set out in NHS policy additional work is necessary to prepare records for sharing and prepare patients about what to expect. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access now that it is the default position