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Posted on Jul 28, 2016 in Original Article | 0 comments

A Qualitative Study Exploring Stakeholder Perceptions of Video Directly Observed Therapy for Monitoring Tuberculosis Treatment in the US-Mexico Border Region

María Luisa Zúñiga, PhD1, Kelly Collins, PhD2, Fátima Muñoz, MD, MPH2, Kathleen Moser, MD, MPH3, Gudelia Rangel, PhD4, Jazmine Cuevas-Mota, MPH2, Maureen Clark, BA2, Jose Luis Burgos, MD, MPH2, Richard S. Garfein, PhD, MPH2

1San Diego State University, School of Social Work, 5500 Campanile Drive, San Diego, CA, USA; 2Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA; 3San Diego County Health and Human Services Agency, San Diego, CA, USA; 4Comisión de Salud Fronteriza, Sección México-Secretaria de Salud, Tijuana, Baja California, México

Corresponding Author: mlzuniga@mail.sdsu.edu

Journal MTM 5:2:12–23, 2016

doi:10.7309/jmtm.5.2.3


Background: Tuberculosis (TB) incidence in the U.S.-Mexico border region exceeds both countries’ national rates. The four U.S. states bordering Mexico account for nearly 40% of total U.S. TB cases. TB treatment monitoring using directly observed therapy (DOT) is a globally-accepted practice; however, it is resource intensive for providers and patients.

Aims: To determine whether Video DOT (VDOT)—a process whereby patients record themselves taking their medication by mobile phone and sending the videos to their TB care provider for observation—could be used to remotely monitor TB treatment adherence.

Methods: We conducted five focus groups with TB patients and four with TB care providers in San Diego, California, U.S. and Tijuana, B.C., Mexico.

Results: VDOT consistently received broad support: U.S. patients valued greater autonomy and Mexican patients valued improved privacy. Groups agreed technology would not be a barrier, but emphasized need for adequate patient training.

Conclusion: Patients and providers in both countries found VDOT conceptually feasible and acceptable.

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Posted on Jul 28, 2016 in Original Article | 0 comments

Mobile and Wearable Device Features that Matter in Promoting Physical Activity

Julie B. Wang, PhD, MPH1,2,3, Janine K. Cataldo, RN, PhD3, Guadalupe X. Ayala, PhD, MPH2, Loki Natarajan, PhD1, Lisa A. Cadmus-Bertram, PhD4, Martha M. White, MS1, Hala Madanat, PhD2, Jeanne F. Nichols, PhD, FACSM5, John P. Pierce, PhD1

1Moores Cancer Center, University of California, San Diego, La Jolla, California, USA; 2Graduate School of Public Health, San Diego State University, San Diego, California, USA; 3Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA; 4Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin; 5Center for Wireless Population Health Systems, University of California, San Diego, La Jolla, California, USA

Corresponding Author: julie.wang@ucsf.edu

Journal MTM 5:2:2–11, 2016

doi:10.7309/jmtm.5.2.2


Background: As wearable sensors/devices become increasingly popular to promote physical activity (PA), research is needed to examine how and which components of these devices people use to increase their PA levels.

Aims: (1) To assess usability and level of engagement with the Fitbit One and daily SMS-based prompts in a 6-week PA intervention, and (2) to examine whether use/ level of engagement with specific intervention components were associated with PA change.

Methods: Data were analyzed from a randomized controlled trial that compared (1) a wearable sensor/ device (Fitbit One) plus SMS-based PA prompts, and (2) Fitbit One only, among overweight/obese adults (N=67). We calculated average scores from Likert-type response items that assessed usability and level of engagement with device features (e.g., tracker, website, mobile app, and SMS-based prompts), and assessed whether such factors were associated with change in steps/day (using Actigraph GT3X+).

Results: Participants reported the Fitbit One was easy to use and the tracker helped to be more active. Those who used the Fitbit mobile app (36%) vs. those who did not (64%) had an increase in steps at 6-week follow-up, even after adjusting for previous web/app use: +545 steps/ day (SE=265) vs. −28 steps/ day (SE=242) (p=.04).

Conclusions: Level of engagement with the Fitbit One, particularly the mobile app, was associated with increased steps. Mobile apps can instantly display summaries of PA performance and could optimize self-regulation to activate change. More research is needed to determine whether such modalities might be cost-effective in future intervention research and practice.


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Posted on Jul 28, 2016 in Original Article | 0 comments

An integrated mHealth model for type 2 diabetes patients using mobile tablet devices

Sora Park, PhD1, Sally Burford, PhD1, Leif Hanlen, PhD2, Paresh Dawda, MBBS/DRCOG3, Paul Dugdale, PhD/FAFPHM4, Christopher Nolan, MBBS/PhD5, John Burns, Adjunct Professor6

1News & Media Research Centre, University of Canberra, ACT, Australia; 2Data61, University of Canberra, Australian National University, ACT, Australia; 3Ochre Health Medical Centre, ACT, Australia; 4College of Medicine, Biology & Environment, Australian National University, ACT, Australia; 5College of Medicine, Biology & Environment, Australian National University, Canberra Hospital, ACT, Australia; 6University of Canberra, ACT, Australia

Corresponding Author: sora.park@canberra.edu.au

Journal MTM 5:2:24–32, 2016

doi: 10.7309/jmtm.5.2.4


Background: Ease of use, proximity to the user and various health maintenance applications enable mobile tablet devices to improve patient self-management. With mobile phones becoming prevalent, various mobile health (mHealth) programs have been devised, to improve patient care and strengthen healthcare systems.

Aims: This study explored how mHealth programs can be developed for type 2 diabetes patients through a co-design participatory workshop between practitioners and researchers. The aim was to design a mHealth pilot program from the input.

Methods: A co-design workshop was conducted with 15 participants, including general practitioners, specialists, nurses and a multidisciplinary research team. Participants generated 31 statements in response to a trigger question and engaged in a structured discussion. Thematic cluster analysis was conducted on the statements and discussions.

Results: Through the analysis, patients’ self-management and health system integration emerged as the main topics. Further analysis revealed that there were two distinct areas of patient self-management; ‘compelled’ and ‘empowered’.

Conclusion: With the results, a loose-knit mHealth pilot program was developed wherein patients with various levels of conditions and digital skills could be incorporated. In order to encourage sustainable changes, practitioners proposed that mobile devices must be situated in the patients’ everyday settings and that digital training should be provided.


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Posted on Jul 28, 2016 in Original Article | 0 comments

Scope of Mobile Phones in Mental Health Care in Low Resource Settings

M Sood, Additional Prof.1, RK Chadda, Prof.1, K Sinha Deb, Assistant Prof.1, R Bhad, Senior Resident1, A Mahapatra, Senior Resident1, R Verma, Assistant Prof.1, AK Mishra, Assistant Prof.1

1Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India

Corresponding Author: soodmamta@gmail.com

Journal MTM 5:2:33–37, 2016

doi: 10.7309/jmtm.5.2.5


Introduction: Mobile apps are used as an aid in the mental health services in many high income countries. The present study was conducted to assess frequency of mobile phone use amongst patients with mental illness.

Methods: Patients attending psychiatric outpatient department of a public funded tertiary care hospital in India were assessed for use of mobile phone and its possible utility in mental health service delivery using a semi structured questionnaire.

Results: The study had 350 subjects, out of whom 307 (87.7%) reported using mobile phone on a regular basis. Mobile phone was used for phone calls, sending and receiving short text messages (SMS) recreation, and accessing social networking sites. Most of the users agreed that the mobile phone could be used as an aid in mental health service delivery, and expressed willingness to receive educational messages.

Conclusion: Patients with mental illness attending psychiatric outpatient services in India use mobile phones and are willing to use as a treatment aid.


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Posted on Mar 28, 2016 in Original Article | 0 comments

Smartphone use in Paediatric Practice: a national survey

Adamos Hadjipanayis, Prof.1, Alexios Klonis, Dr2, Omar Assem Abdel-Mannan, Dr3, Alastair G Sutcliffe, Dr4

1Assistant Professor of Paediatrics, Faculty of Medicine, European University Cyprus, Cyprus; 2School of Clinical Medicine, University of Cambridge, United Kingdom; 3Academic Clinical Fellow, General and Adolescent Paediatric Unit, Institute of Child Health, United Kingdom; 4Professor of General Paediatrics, Institute of Child Health, UCL, United Kingdom

Corresponding Author: Adamos@paidiatros.com

Journal MTM 5:1:3–8, 2016

doi:10.7309/jmtm.5.1.2


Introduction: Smartphones have become universal among the general public since their launch in 2007. Alongside this, the use of smartphones and mobile medical applications (apps) by clinicians has risen exponentially.

Objectives: The aim of this study is to present the current prevalence of smartphone ownership among Cypriot paediatricians and the patterns of their use in everyday clinical practice.

Study design: A standardized telephone survey was conducted by trained interviewers on a random sample of all 225 currently registered and active paediatricians across all districts of Cyprus.

Results: From a total of 78 randomly selected eligible participants, 75 (96%) paediatricians agreed to participate in the study. The majority of physicians reported that they owned a smartphone (n =53, 71%) and the rest (n=22, 29%) used a Symbian phone as their primary device. Of those who owned a smartphone, 40% (n=21) reported using at least one app related to their clinical work. The mean number of applications used by these users was 3.5. The majority (44/53, 83%) responded that they did not use their smartphone as a tool for managing patient appointments, while 9 out of the 53 (17%) responded positively. Over 80% of participants used their smartphone to take or receive a picture or a video from their patients for professional purposes.

Conclusion: This study found a high level of smartphone ownership and usage among medical Cypriot paediatricians, corroborating with previous literature for other specialties in other countries. Despite the benefits they offer, more rigorous validation practices regarding mobile medical apps need to be established to ensure they are used safely and appropriately.


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Posted on Mar 27, 2016 in Original Article | 0 comments

Smartphone Use and Perceptions among Medical Students and Practicing Physicians

Andrew Buchholz, DO MPH, LT, MC, USN1, Brittany Perry, DO2, Lucia Beck Weiss, MS3, Danielle Cooley, DO3

1Naval Medical Center Portsmouth, Directorate for Mental Health, Portsmouth, VA, USA; 2Alfred I. DuPont Hospital for Children, Wilmington, DE, USA; 3Rowan University School of Osteopathic Medicine, Department of Family Medicine, Stratford, NJ, USA

Corresponding Author: andrew.c.buchholz.mil@mail.mil

Journal MTM 5:1:27–32, 2016

doi:10.7309/jmtm.5.1.5


Background: Smartphones have become mainstream, including in the healthcare setting. However, little formal research has been performed to examine mobile medical technology.

Aims: To examine smartphone use and perceptions among medical students and physicians in a statewide medical university.

Methodology: An IRB approved 23-item survey eliciting smartphone use and perceptions was developed by the research team and an e-mail invitation for participation was sent to all medical students, resident and attending physicians in three medical schools.

Results: A total of 544 surveys were submitted; 347 were completed and analyzed. 93.9% of respondents had smartphones, with no significant difference between students and physicians. Of those with the technology, 82.9% stated they have used it at least once in a clinical setting. Respondents perceived fast access to information to be the greatest benefit to mobile medical technology (96.6%), as well as simplified access (75.5%). Greatest perceived barriers to using this technology were uncertainty about available applications (39.4%) and inexperience (23.4%). There was no significant difference between students and physicians with regard to either category. Concerning patient-centered applications, assistance with lifestyle modification (78.8%) and increased adherence to treatment plans (73.8%) were agreed upon as potential benefits. Greatest perceived barriers to recommending this technology were added cost to the patient (52.6%) and concerns about patient self-diagnosis (47.7%), with no significant difference found between students and physicians.

Conclusion: These data demonstrate smartphone usage is prominent in the healthcare setting and indicates strong agreement regarding its benefits and barriers. Implementing smartphone education into medical curricula may be beneficial to healthcare providers.


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