A Feasibility Study of Smart-Phone Application on Breast Self-Examination in Korea

Abstract

Background Breast cancer patients who founded in early stage have a good prognosis. Females who practice breast self-examination (BSE) are usually diagnosed at an earlier stage than those who do not.

Aims The purpose of this study was to develop a smart-phone application to encourage BSE, and to evaluate the effects of mobile intervention in terms of improving breast self-examination behavior.

Methods A developed smart-phone application had several functions including a BSE date alarm, a reminder to encourage mother and daughter to practice BSE together, BSE record, and educational video clips. Females aged 19 and over were enrolled and two series of questionnaires were carried out (before and after using the application) between July and September 2012.

Results Forty five subjects (age 29.5 ± 5.9 years) were enrolled in the study. Of 45 participants, 28 (62.2%) had practiced BSE, and only one of these was carried out at the appropriate time, based on the results of the baseline survey. After using the application, the number of participants practicing BSE increased from 28 to 32 (62.2% to 71.1%; p = 0.503). In subgroup analysis (age <30 years), the number of participants using BSE increased from 8 to 18 (36.4% to 81.8%; p = 0.002), and the number of those using it at the appropriate time improved from 1 to 15 (2.2% to 33.3%, p <0.001).

Conclusions In female younger than 30 years, the developed smart-phone application increased BSE practice. To confirm the long-term effect of the mobile application and overcome difference in smart phone usage, further studies must be carried out.

Feasibility of Text Messaging to Improve Oral Anti-Cancer Adherence in older Cancer Patients

Abstract

Background More than 50 oral chemotherapy agents in pill form are on the market, with projections that in 3 years, 25% of cancer treatment will be in pill form. For oral agents to achieve a therapeutically effective level for cancer treatment, patients must strictly adhere to the regimen. However, adherence is often less than 80%, which may be inadequate for treating the cancer. There are more than 285 million wireless subscribers in the US with an estimated 67.5% of adults owning cell phones and 98% of those phones having text messaging capability. A recent review of 12 trials on interventions for disease prevention or management found that text messaging improved health behaviors.

Purpose There are multiple mobile applications and smart phone products to prompt medication adherence, however, few have examined if these prompts improve medication adherence. Adherence is critical among cancer patients who are older and less likely to text message. The cancer medications can be costly, as much as $800 per pill, and only effective if taken as prescribed. Adherence is complicated by complexity of the dosing and the duration of the prescriptions. Therefore, the purpose of this study is to test the feasibility, usability, and satisfaction with text messages to improve symptoms from side effects of treatment and adherence to oral chemotherapy agents.

Methods A 10-week, 2-group, prospective trial will enroll 76 patients from cancer centers to examine a 3-week text message intervention to promote oral agent adherence and management of symptoms from side effects of treatment. Descriptive statistics, generalized linear modeling, and generalized estimating equations will be used for analysis.

Results Enrollment is underway and preliminary findings on characteristics, feasibility of text message intervention and its influence on adherence rates will be presented.

Conclusion Text messages can easily be tailored to a specific oral agent regimen, making this intervention usable for simple or more complex dosing. Further, delivering the text messages on cell phones makes this intervention readily accessible. Likewise, it is the first study to enroll a cohort of patients who are newly prescribed oral agents. Past research has demonstrated that adherence levels begin to decline 2 months after the initiation of therapy. Therefore, this research could inform initiation of care, where patterns of behavior could be established and carried out through the entire treatment regimen. This type of novel intervention also has the potential to transform and impact other ill populations that require adherence to a medication regimen.

A comparison of two text message-based intervention studies for health promotion in Cape Town, South Africa: The lessons learnt

Abstract

According to the World Bank, there are 128 mobile subscriptions per 100 people in South Africa as of 2011. Cellphones are therefore viewed as having considerable potential for health promotion. However, evaluations of interventions and evidence of effectiveness are still limited in developing countries. Two separate trilingual (isiXhosa, Afrikaans and English) short-message-service (SMS) interventions that took place from 2012 to 2013 in Cape Town are evaluated.

The SMS campaigns aimed to increase health knowledge by disseminating health information via SMS. Specifically, each study involved sending SMSes to participants to provide them with information regarding how to control hypertension and how to be healthy during pregnancy, respectively. The hypertension campaign was conducted with hypertensive patients at a Community Health Centre, while the antenatal campaign was with pregnant women attending a Midwife Obstetric Unit. Facility staff guided the preparation and checked the health promotion content of both campaigns.

There were 223 and 206 participants at baseline in the hypertension and antenatal campaigns respectively. Both studies used mixed research methods of a randomised control trial followed by a focus group. Participants were randomised either to be sent SMSes (experiment group) or not (control group). Intervention in the hypertension campaign involved sending 5 SMSes per week for 16 weeks. The pattern of dissemination was different in the antenatal campaign: SMSes were staggered according to the week of pregnancy at the time of recruitment into the study. The total number of SMSes sent to all those in the experiment group was 101.

34.53% and 46.60% of the participants were lost to follow-up (LTFU) in the hypertension and antenatal campaign respectively. There was no differential LTFU in either study. At the end of the antenatal campaign, there were no significant differences in the level of knowledge (assessed by nine questions) between the experiment and the control group (all p > 0.05). Similar results emerged in the hypertension campaign. Despite no significant improvements in knowledge, both campaigns’ participants (experiment group) reported high levels of behavioural change. Participants in both focus groups remarked that the SMSes acted as reminders or “light bulbs”.

SMSes appear to be more effective at improving motivation than increasing knowledge, although objective measures to verify behavioural change could not be obtained in either campaign. Further research is needed to investigate how health knowledge can be improved via mHealth interventions, particularly in populations of low socioeconomic status where high rates of LTFU are a reality.

There’s an App for That! Promoting Antiretroviral Medication Adherence in Rural Georgia: The Music for Health Project

Consistent high levels of adherence to antiretroviral drug therapy (ART) are needed to sustain undectable viral loads (VL) in persons living with HIV/AIDS (PLWH). The result is improved health and prevention of HIV transmission. Rural dwelling PLWH encounter barriers such as low health care resources, transportation, poverty, stigma, and depression that contribute to adherence challenges. The goal of the Music for Health smartphone app is to use technology to improve adherence to ART. The app consists of a music program called the LIVE Network that includes animated music videos specially developed and tailored for PLWH, a manual with web links, and a pill count survey. The program is designed to educate, motivate, and increase self-confidence in rural PLWH to adhere to ART. We are conducting a randomized controlled clinical trial to study the efficacy of this app compared to an equivalent educational app in 240 rural PLWH in Georgia. Eligibility criteria include: HIV infected, initiating ART for the first time or changing a regimen due to side effects or ART drug resistance, ≥18 years of age, English speaking, and willing to complete study activities. Once randomized at baseline, each participant will receive a smartphone loaded with the appropriate app and will have a supervised listening/viewing session. They will receive regular text message reminders to use the app and for monthly unannounced pill counts. Pill counts will also be collected via smart phone. All participants will be followed up at 3, 6, 9 months using computerized interviews, hair samples for ART drug levels, and lab values extracted from medical records. The app was pre-tested in 3 focus groups conducted in 3 different rural counties. Nine men and 4 women participated; 10 (77%) were African American. All reviewed the app and provided feedback. Only one person did not own a mobile phone and 7 (54%) owned a smart phone. After coaching all were able to use the smart phone and app. All songs and videos were rated ≥ 7 on a scale of 0 to 10 and 5 songs had a median score of 10. Participants found the songs relevant and many thought songs addressed a situation they were currently experiencing: “This is my first year living with HIV, so songs like that I can relate to… dealing with issues and questions that I have in my own head… that I don’t talk to people about.” Videos were edited to incorporate changes requested by the participants. Study recruitment will begin in 2014. If successful this app could transform the delivery of HIV adherence self-management care by overcoming barriers in this vulnerable group.

Virtual Validity: mHealth Simulation Games, Diagnostic Indicators, and Behavior Change

Abstract

Risky decisions (e.g., having unprotected sex; using methamphetamine) are often context dependent, automatic, and affectively based, but the contextual triggers that contribute to those risks may not be well understood by the individual him or herself. Virtual game simulations, designed to capture real-life situations, for example for PTSD sufferers, (Rizzo et al., 2009; McLay et al., 2011) are used by clinicians to diagnose then, personalize therapy. Because Read et al. (2006) have designed interactive virtual date environments (VE) to simulate the risk challenges MSM typically encounter in real life, could MSM’s virtual decisions be used to diagnose men’s risks in everyday life? However, to date, no tests of a simulation game’s virtual validity (link between game and real-world risk-taking) have been conducted: That was this project’s goal. We tested the hypothesis that decisions made within the VE would be correlated with real-life risky choices made in the past 3 months (e.g., unprotected sex, alcohol use, methamphetamine use). High-risk men who have sex with men of color (18-30yr old MSM of Latino & African-American descent) were recruited online via hook-up/social networking sites on both mobile apps and through the Internet. Participants reported past risky behaviors and then made a series of automatically recorded choices in an online VE. We found that those who drank alcohol in the past 90 days were likely to choose to drink alcohol in the VE, p(116)=.332, P=.000. Similarly, those who took methamphetamine in the last 90 days, were also likely to choose to take methamphetamine in the VE, p(116)=.866, P=.000. Those who were the insertive partner most in real-life (over 60% of the time), chose to be the insertive partner in the VE, and those who were the receptive partner most in real-life (over 60% of the time), chose to be the receptive partner in the VE, Anal Sex Position p(90)=.747, P=.000. Finally, those who chose to have unprotected anal intercourse (UAI) in the VE, were more likely to have engaged in risky anal sex in the past 90 days, UAI (Time 1) p (116)=.612, P=.000. These findings suggest the potential value of VE for unobtrusively diagnosing, predicting, and understanding the circumstances under which real-life risk-taking might take place. These findings suggest virtual simulation games could be used in apps and over the web to diagnose MSM’s real-life risky choices, potentially yielding more behavior change, even for those with contextual challenges they don’t understand.