Background: Lifestyle programmes require a structured approach to be effective. Maintaining fidelity of coach-based interventions is challenging. Mobile devices may assist by supporting the use of an algorithm based approach.

Aims: To describe the development and challenges associated with a mobile technology approach to supporting a coach-based lifestyle programme for the prevention of gestational diabetes mellitus (GDM) in pregnancy.

Methods: Narrative approach to system design, with a survey of 12 lifestyle coaches involved in the pan-European multicentre DALI (Randomised controlled trial for the prevention of gestational diabetes mellitus (GDM) with vitamin D And Lifestyle Intervention) study.

Results: A mobile device based programme was associated with more technical issues than a web-based approach, particularly in relation to upgrades to improve usability and utility. Even after multiple upgrades, a paper approach was preferred by some coaches, and by most for aspects of the intervention that required greater coach-participant interaction (eg goal setting). Coaches generally preferred the mobile device approach for obtaining pre-existing data, structured data entry and for intervention prompts.

Conclusion: Mobile technology can facilitate coach-delivered lifestyle interventions. However, more work is required to minimise intrusion into the behavioural intervention.

Background: There is incredible potential for telemedicine to advance postoperative care. Work in high-income nations shows the potential to use mobile phones to monitor postoperative recovery progress. However, there is little information about the attitudes of people in low resource countries, like Myanmar, toward the adoption of mHealth in postoperative care.

Aims: This study presents survey results collected in Myanmar to better understand cultural attitudes of this population towards adopting mHealth technologies to improve postoperative patient care.

Methods: A thirteen-question survey was developed, focused on demographic questions and attitudes towards physicians, the internet, and willingness to perform tasks on their mobile phones. Respondents were selected in a sample of convenience in urban and rural public spaces.

Results: Of the 125 people approached, 112 agreed to participate in the survey. A wide range of ages (18-78), genders (55.4% female), locations (22.3% rural, 77.7% urban) and ethnicities (67% Burmese) were represented. 85.7% were willing to make contact with a surgeon in a hypothetical postoperative setting via mobile phone. 83.0% were willing to fill out a survey about their postoperative state and 69.6% were willing to send a picture of their wound with their surgeon via mobile phone. A majority of respondents had a very high level of trust in physicians in general, most already owned a mobile phone with access to the internet and used it to look up health information.

Conclusion: Our results indicate that Myanmar could provide a promising location for the implementation of mHealth technologies to improve post-operative care.

Keywords: mobile health, telecare, health information on the Web, ehealth, assistive technologies

Background: Despite the prevalence of hepatitis C virus (HCV) and the availability of effective treatments, HCV screening remains suboptimal, in part due to primary care physicians’ (PCPs) unawareness of and discomfort discussing HCV risk factors. Patient-facing text message campaigns may overcome these barriers by empowering patients to initiate screening discussions with their PCPs.

Aims: The objectives were to evaluate a patient-facing text message campaign in terms of (1) feasibility, (2) acceptability, and (3) impact on patient-PCP discussions about HCV screening.

Methods: Primary care patients were recruited to receive either an HCV text message, which contained HCV information and a prompt to discuss HCV with their PCPs, or a calcium control text message. Forty minutes before their appointments, participants were sent their assigned text message. Participants were then called for an evaluation of the text message campaign.

Results: Of 185 patients called, 38 enrolled and completed the study. Participants who were sent an HCV text message (n=25) were significantly more likely to initiate a conversation with their PCPs about HCV screening than participants sent a calcium control text message (n=13) (p=0.008). Thirty-two (82%) participants liked receiving a health-related text message (88% in the HCV group; 70% in the control group).

Conclusions: A patient-facing HCV text message campaign shows promise as a novel method to activate primary care patients to initiate HCV screening discussions with their PCPs. This campaign may help educate patients about the importance of HCV screening, overcome physician barriers to screening, and, ultimately, help control the HCV epidemic.

Keywords: hepatitis C, text messaging, physician-patient relations, preventive health services, primary health care

Methods: Dilated screening eye exams were performed by ophthalmic technicians in four remote districts of Nepal. Anterior and posterior segment photographs captured with a Paxos Scope ophthalmic camera system attached to an iPod Touch 6^th generation device were uploaded to a secure cloud database for review by an ophthalmologist in Kathmandu. The ophthalmic technicians’ referral decisions based on slit-lamp exam were compared to the ophthalmologist’s recommendation based on the transmitted images.

Results: Using the transmitted images, the ophthalmologist recommended referral for an additional 20% of the 346 total subjects screened who would not have been referred by the ophthalmic technician. Of those subjects, 34% were referred to the retina clinic. Conversely, among the 101 patients referred by the technician, the ophthalmologist concurred with the appropriateness of referral in more than 97% of cases but thought eight (2.8%) of those patients had variants of normal eye pathology.

Conclusion: An ophthalmologist who reviewed data and photos gathered with the mobile device teleophthalmology system identified a significant number of patients whose need for referral was not identified by the screening technician. Posterior segment pathology was most frequently found by the remote reader and not by the technician performing dilated slit lamp examinations. These results are promising for further clinical implementation of handheld mobile devices as tools for teleophthalmic screening in resource-limited settings.

Keywords: telemedicine, rural population, ophthalmology, referral and consultation, global health