mHealth Acceptance and Usage among South Asian Adults in the U.S.

Background: Modifiable lifestyle factors such as physical inactivity and unhealthy diet contribute to the increased risk of cardiovascular diseases (CVD) and diabetes (DM) in South Asians (SAs) (Volgman et al., 2018). Interventions using mobile health (mHealth) have demonstrated feasibility and potential efficacy for ethnic minorities (Bender et al., 2018), and have the potential to be of preventive and therapeutic value in reducing the burden of CVD and DM in SAs living in the US. However, there is a gap in knowledge regarding the usage and acceptance of mHealth among SAs. Purpose: The objectives were to examine the overall usage of mHealth and examine factors associated with the acceptance, usage, non-usage, and discontinuation of mHealth technology among SA adults living in the US. Methods: The study utilized a cross-sectional research design. A total of 134 South Asian adults were recruited to the study. Self-reported measures included demographics, health status, motivations for using mHealth, factors associated with technology acceptance and usage, reasons for non-usage and discontinuation of mHealth applications (apps) and smart and connected devices using the survey developed by Paré, Leaver, & Bourget (2018). Correlation analyses were conducted using Pearson’s and Spearman’s correlation tests. Chi-square and Kruskal-Wallis analyses were conducted to compare group differences among current users, past users, and non-users of mHealth technology. Results: About 62.4% of the participants were current users of mobile health apps, and 43.1% were current users of smart and connected devices. Users were on an average between the ages 35-54 years, female, healthy, employed, university educated, with an annual family income of over $80,000. There was a statistically significant difference in age (χ2 (2) = 9.638, p = .007) and employment (χ2 (4, N = 105) = 12.262, p = 0.019) between the current users, past users, and non-users of smart devices. Non-users of smart devices were more likely to be students, and between 18-34 years of age. The mean scores for the scales of perceived ease of use, perceived usefulness, confirmation of expectations, user satisfaction, and intent to continue using mHealth technology ranged from 3.5 – 4.2 (somewhat agree to strongly agree) for mobile health apps and from 4.1 to 4.4 (somewhat agree to strongly agree) for smart and connected devices. Conclusions: mHealth technology was used, accepted, and appreciated by more than half of the South Asian adults that we surveyed. The results from this study may help in selecting and utilizing the most accepted mHealth technology for designing interventions for South Asian adults living in the US to lower the risk of CVD and DM

Multivalent Vaccine Formulation with BmVAL-1 and BmALT-2 Confer Significant Protection against Challenge Infections with Brugia malayi in Mice and Jirds

Purpose: Lymphatic filariasis is a mosquito borne infection affecting 120 million people in 83 different countries. Despite several setbacks, mass drug administration is fully underway in several parts of the world to eradicate this infection by year 2020. Even though drug alone is highly efficient in treating this infection, long term sustainable prophylaxis needs effective vaccine. Unfortunately there are no vaccines available to control this infection in human and animals despite the fact that several potential candidate vaccine antigens have been identified by several laboratories. Brugia malayi Vespid venom Allergen homologue-Like protein (BmVAL-1) and B. malayi Abundant Larval Transcript (BmALT-2) are two of the most promising vaccine candidates. In this study we have evaluated various vaccination regimens consisting of DNA and protein antigens and evaluated the potential of monovalent and multivalent vaccine formulations in mice and jird animal models. Methods: Mice and jirds were vaccinated with monovalent DNA preparations of BmVAL-1 or BmALT-2 in pVAX-1 vector or monovalent protein preparations of rBmVAL-1 and rBmALT-2 in alum using a homologous or heterologous prime boost approach. These vaccine regimens were then compared with a multivalent vaccine formulation consisting of DNA or hybrid protein formulation of the two antigens. Challenge experiments were performed with B. malayi L3 in mice and jirds to evaluate the degree of protection and immunological parameters were determined in mice and human to elucidate the characteristics of the protective immune responses. Results: Results presented in this study show that vaccination with monovalent BmVAL-1 vaccine confers from 39% (DNA vaccine) protection to 54% (DNA prime and protein boost) protection in mice. Similar degree of protection was observed in jirds (50% to 52% protection). Monovalent BmAT-2 afforded 51% to 75% protection in mice and 58% to 79% protection in jirds. When we tested a multivalent formulation of BmVAL-1 and BmALT-2, there was 57% to 82% protection in mice and 77% to 85% protection in jirds. Heterologous prime boost approach using the multivalent vaccine gave the highest degree of protection in both mice and jirds. Serological analysis in mice showed that BmVAL-1 vaccination induced an IgG1, IgG2a and IgG3 antibody response, whereas, BmALT-2 vaccination predominantly induced an IgG1 and IgG3 antibody response. Cytokine responses of antigen responding cells in the spleen secreted predominantly IFN-y and IL-5 in response to BmVAL-1 and IL-4 and IL-5 in response to BmALT-2. Conclusion: In conclusion, results presented in this study show that a multivalent vaccine formulation of BmVAL-1 and BmALT-2 when given as a prime boost regimen gave significant protection against lymphatic filariasis caused by B. malayi in mice and jirds. Since putatively immune EN subjects also carry protective antibodies against BmVAL-1 and BmALT-2, there is a great potential for developing this multivalent formulation as a prophylactic vaccine against B. malayi for human and veterinary use

Benefits of, Barriers to, and Needs for an Artificial Intelligence–Powered Medication Information Voice Chatbot for Older Adults: Interview Study With Geriatrics Experts

BackgroundOne of the most complicated medical needs of older adults is managing their complex medication regimens. However, the use of technology to aid older adults in this endeavor is impeded by the fact that their technological capabilities are lower than those of much of the rest of the population. What is needed to help manage medications is a technology that seamlessly integrates within their comfort levels, such as artificial intelligence agents. ObjectiveThis study aimed to assess the benefits, barriers, and information needs that can be provided by an artificial intelligence–powered medication information voice chatbot for older adults. MethodsA total of 8 semistructured interviews were conducted with geriatrics experts. All interviews were audio-recorded and transcribed. Each interview was coded by 2 investigators (2 among ML, PR, METR, and KR) using a semiopen coding method for qualitative analysis, and reconciliation was performed by a third investigator. All codes were organized into the benefit/nonbenefit, barrier/nonbarrier, and need categories. Iterative recoding and member checking were performed until convergence was reached for all interviews. ResultsThe greatest benefits of a medication information voice-based chatbot would be helping to overcome the vision and dexterity hurdles experienced by most older adults, as it uses voice-based technology. It also helps to increase older adults’ medication knowledge and adherence and supports their overall health. The main barriers were technology familiarity and cost, especially in lower socioeconomic older adults, as well as security and privacy concerns. It was noted however that technology familiarity was not an insurmountable barrier for older adults aged 65 to 75 years, who mostly owned smartphones, whereas older adults aged >75 years may have never been major users of technology in the first place. The most important needs were to be usable, to help patients with reminders, and to provide information on medication side effects and use instructions. ConclusionsOur needs analysis results derived from expert interviews clarify that a voice-based chatbot could be beneficial in improving adherence and overall health if it is built to serve the many medication information needs of older adults, such as reminders and instructions. However, the chatbot must be usable and affordable for its widespread use