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Posted on Apr 21, 2017 in Original Article | 0 comments

Preliminary Validation Study of Consumer-level Activity Monitors and Mobile Applications for Step Counting under Free Living Conditions

Preliminary Validation Study of Consumer-level Activity Monitors and Mobile Applications for Step Counting under Free Living Conditions

Manolis Adamakis, MSc, PhD candidate

Faculty of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece

Corresponding Author:

Journal MTM 6:1:26–33, 2017


Background: The last decade’s technological advances have spurred a continuously increasing interest in objective monitoring of physical activity with the use of wearable devices. Even though an increased accuracy is important in some lines of research, a balance between precision, feasibility and low-cost monitoring technologies is clearly needed.

Aims: The purpose of this study was to compare the accuracy for step counting between one spring-levered pedometer, two piezo-electric pedometers and two free of charge pedometer applications for Android smartphones, under free-living conditions.

Methods: Eleven healthy adults, ranging in BMI from 20.20 to 24.77 kg*m−2, volunteered to participate in the study. They wore the selected criterion pedometer Yamax SW-200 (SW), which is considered the “gold standard”, the Garmin Vivofit (GV), Medisana ViFit (MV), Accupedo application (AC) and Pedometer 2.0 application (PD), for a 24-h period, under free-living settings. Data were analyzed using descriptive and inferential statistics.

Results: All devices and applications demonstrated strong correlations with the SW reference pedometer (IC = 0.86 – 0.94), but often large mean differences Significant differences were observed among the five pedometers (F = 5.21, p = 0.01). Only the PD counted almost similar steps as the SW (F = 0.57, p = 0.47), even though it had high Mean Absolute Percent Error (MAPE). The 3 remaining pedometers significantly overestimated counted steps, with the AC application been the least accurate [F = 11.92, p < 0.01; MAPE = 36.15%].

Conclusions: The results of the present study showed favorable outcomes for the estimation of steps per day for the PD application in healthy and normal weight people. The two piezo-electric pedometers (GV – MV) appeared to give similar values, however these values constantly overestimated step counting compared with the criterion pedometer. Taking into account the free cost and feasibility of the PD application, the results demonstrate good potential for future use in free-living settings.

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Posted on Apr 21, 2017 in Original Article | 0 comments

Development and Feasibility of a Tablet-based Self-monitoring and Management System in Pregnant Women

Development and Feasibility of a Tablet-based Self-monitoring and Management System in Pregnant Women

Hiroshi Kobayashi, MD, PhD1, Yuno Osanai2, Toshiyuki Sado, MD, PhD1, Katsuhiko Naruse, MD, PhD1, Michiyuki Horiguchi3

1Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan; 2ShinIng. Inc., Otaru, Japan; 3Rastec, Co. Ltd., Nara, Japan

Corresponding Author:

Journal MTM 6:1:19–25, 2017


Objectives: Many health telemedicine applications (apps) have been released in the clinical-care setting. There is limited information regarding the utility of ICT-based maternity data collection and a comprehensive home-based model of care for high risk pregnant women. The aim of our study was to assess the feasibility of a tablet-based real-time bidirectional telecommunication of self-reported maternal condition in normal and high risk pregnant women.

Methods: The study included eighteen pregnant women (13 normal pregnant women [the Cohort 1 study] and 5 high risk pregnant women [the Cohort 2 study]) who expressed their interest in participating in the study. Participants were supplied with a tablet computer installed with the “MaternityCare” service program. Each user recorded physical information (body weight and blood pressure) and answered the multiple questions on obstetrical symptoms daily for 30 days.

Results: The median value of individual compliance with practice (individual patient-level reporting rates) was 76.7% in the Cohort 1 study and 100% in the Cohort 2 study. Self-reporting data were transmitted on 65.8% for the Cohort 1 study, and 218.9% for the Cohort 2 study of subject days (subject day =1 subject × 1 day). 66.7% (10/15) of participants affirmed applications’ ease of use, and 60% (9/15) desired to implement the app into practice after the study.

Discussion: In conclusion, high risk pregnant women had a positive attitude about home-based self-monitoring and expressed a strong desire to receive this app. A dynamic, real-time, bidirectional and interactive mobile maternity health system with a tablet app may support information sharing, quick consultation and initiation of the prophylaxis and treatment at the patient, pre-hospital healthcare provider and physician levels.

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Posted on Apr 21, 2017 in Original Article | 0 comments

Meta-analysis of Mobile Phone Reminders on HIV Patients’ Retention to Care

Meta-analysis of Mobile Phone Reminders on HIV Patients’ Retention to Care

SoSon Jong, RN, PhD1, Yvette Cuca, PhD1, Lisa M. Thompson, FNP, PhD2

1School of Nursing, University of California, San Francisco; 2School of Nursing, Global Health Sciences, University of California, San Francisco

Corresponding Author:

Journal MTM 6:1:5–18, 2017


Aims: This research aims to systematically review the current clinical evidence of the efficacy of mobile phone reminders on retention to care among HIV patients. This study also seeks to determine an effect size of the intervention and presents implications for future studies.

Background: Use of mobile technologies is an innovative and affordable approach to HIV prevention and care, particularly in resource limited settings. Approximately two-thirds of people who are initially diagnosed with HIV are lost to follow-up before starting HIV treatment in low and middle-income countries, posing serious global health concerns. While mobile text message reminders for HIV medication adherence have shown positive health outcomes, it is not well understood whether the reminders can also improve patients’ retention to care.

Methods: The authors conducted a meta-analysis of literature in the following databases: PubMed, CINAHL, ProQuest, and Web of Science. Of the 667 peer-reviewed research articles reviewed, nine studies were included in the final analysis. Stata version 13 was used for the analysis.

Results: Nine studies (5 randomized controlled and 4 before and after studies) from 7 countries included 3,004 HIV patients. Random-effect meta-analysis (I-squared=94.1%) found that HIV patients who received mobile phone reminders for their follow-up appointments were two times more likely to return to care than those who didn’t receive reminders (pooled odd ratio (OR)=2.04, 95% CI: 0.97–4.27). Our sub-group analysis of 5 randomized controlled studies showed a significant effect of mobile phone reminders (OR=2.04, 95% CI: 1.11–3.74). Six studies in Africa showed that HIV patients (mostly women) receiving mobile phone reminders were three times more likely to return to care than those who received no reminders (OR=2.92, 95% CI: 1.13–7.53).

Conclusion: Mobile phone reminders are an effective intervention to improve retention to HIV care. Women with HIV living in resource limited settings benefit significantly from the intervention. Also, mobile phone reminders using text messages are as effective as phone calls to improve retention to HIV care.

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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:

Journal MTM 5:2:12–23, 2016


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:

Journal MTM 5:2:2–11, 2016


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:

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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