Mobile health (mHealth) message design strategies for low and middle-income countries (LMICs) have quickly gained acceptance in the field of health education. mHealth initiatives focusing on maternal health are frequently implemented with the aim of providing access to information while improving maternal health practices. Within Ghana, access to relevant health information and hospital care within rural settings remain scarce for the majority of citizens (WHO, 2011). However, with the rapid rate of mobile phone adoption, delivering learning opportunities in conjunction with mobile devices may be promising for many individuals in Ghana. The purpose of this study was to examine message design inputs influencing expecting mothers’ maternal health activity. McGuire’s communication-persuasion theoretical framework informed the mix-methods study. I used participatory rapid appraisal techniques while carrying out the study with research team members. I employed surveys to collect quantitative data. To gather qualitative data I engaged in open-ended survey questions, interviews (one-on-one and focus groups), a journal and team reflections. The findings revealed that participants from two communities in Northern Ghana in rural settings had several inputs in the message design which may influence expecting mothers. These include; information source, design and delivery, power dynamics and personal circumstances, and perceived gains. The findings highlight that for many mHealth projects in LMIC's, there is an urgent need to reexamining the culture attributes of the users' local environment. These findings also address critical aspects of a real world problem with intent to support rural community development in Northern Ghana with goals to alleviate the lack of academic knowledge by providing an insider’s perspectives regarding community insights.

Heart failure (HF) affects many older Canadians with recurrent hospitalizations despite post-discharge strategies to prevent readmission. Self-care is key to the management of HF in the home setting and can potentially lead to better clinical outcomes. Proper HF self-care includes tasks such as daily weight and symptom monitoring, as well as adjusting diuretics based on weight. Patients find HF self-care challenging, with less than 50% of patients regularly weighing themselves. Mobile applications to support self-care have been shown to be effective, however, due to their lack of consideration for barriers such as literacy, numeracy and cognitive impairment within their design, these applications are not usable for many older patients. Previous work supports the use of a paper-based standardized diuretic decision support tool (SDDST) to promote self-care in older individuals with HF. The objective of this study was to use participant (HF patients, informal care-providers) input to convert the paper-based SDDST into a user-centered electronic mobile application. We recruited 12 patients (male and female, age > 60 years) with a confirmed diagnosis of HF, and 7 informal caregivers from the Heart Function Clinic at the Hamilton Health Sciences General site. HF patients were categorized into three groups, 1) adequate self-care patients (6), 2) inadequate self-care patients without a CP (2) or 3) inadequate self-care patients with a CP (4), based on their self-care abilities measured with the Self-Care Heart Failure Index (SCHFI) where a score of > 70 is considered self-care adequate. We conducted semi-structured interviews with HF patients and CPs using Persona-Scenarios. Interviews were analyzed using NVivo, version 10, for emerging themes regarding self-care. Following data analysis, we identified 6 major themes, 1) Usability of technology, 2) Communication, 3) Application customization, 4) Complexity of Self-Care, 5) Usefulness of HF Related Information and 6) Long-Term Use and Cost. Many of the challenges patients and CPs mentioned involved their unfamiliarity with technology. However, by addressing these themes, we were able to develop a series of requirements and modifications to improve the usability of our app design. / Thesis / Master of Science (MSc) / Heart failure (HF) is one of the leading causes of hospitalization and re-hospitalization in older adults. . If patients are able to take care of themselves (self-care) at home they will be less likely to be readmitted to the hospital. However, many patients find self-care difficult, so they do not manage their symptoms. To assist patients in understanding or following their treatment, various mobile health applications have been developed. Unfortunately, older patients do not commonly use these applications because of their complicated design. In this study, we interviewed patients and their informal caregivers to help design our HF self-care app. We gathered information on features they may perceive to be helpful. Our goal was to use their feedback to make the app simpler and more user-oriented, which will make self-care easier.

Background: The market of mHealth has been growing steadily over last years, but in China, the market is not very mature, and the low level of popularity negative impact on the development. But it should be noted that the market has great potential with positive development background, the policy support by government, the widely used of smartphone and the Internet and especially the huge demand of mHealth in China.   Purpose: The purpose of the study was to reveals Chinese mHealth industry, to measure and understand the relationship between different factors that influencing the acceptance of mHealth apps in the case of Chinese users.   Method: This study was based on the UTAUT2 Model and a quantitative methodology was followed. The author excluded price value and habit from the original UTAUT and added privacy and security factor. A primary data collection was conducted through a questionnaire in this research. Suitable respondents were those individuals who needed healthcare services, and due to the budget and time limitation, a convenience sampling technique was used.   Conclusion:       The findings show that social influence makes the strongest contribution to explaining users’ acceptance of mHealth app in China. The whole ranking of the factors (from strong to weak) is social influence > privacy and security > facilitating condition > performance expectancy. And except privacy and security, other factors are all positively affect the acceptance of Chinese mHealth app users. Organisations can use these findings to improve the design of mHealth apps in the future.

Introdução: O acompanhamento do parceiro no pré-natal, parto e pós-parto de sua companheira mostram resultados positivos em relação à saúde materna, infantil e também relacionados à saúde do homem. É uma importante estratégia de aproximar os futuros pais dos serviços de saúde e melhorar o vínculo destes com a paternidade. Objetivo: Avaliar se a implementação da tecnologia SMS através do programa PRENACEL para o parceiro como um programa de educação em saúde é um suplemento útil ao acompanhamento pré-natal padrão. Método: Ensaio aleatorizado controlado por conglomerados representados por unidades de saúde. Selecionamos 20 unidades de saúde que foram aleatoriamente alocadas segundo critérios pré estabelecidos, 10 sendo controle e 10 como intervenção. Os parceiros das gestantes que iniciaram o pré-natal antes da 20ª semana de gestação foram a população do estudo. Os parceiros inscritos no PRENACEL receberam periodicamente mensagens curtas de texto via celular com informações sobre gestação e parto. Nas unidades do grupo controle os parceiros receberam, junto com suas companheiras, o pré-natal padrão. Resultados: 186 parceiros foram entrevistados, 62 do grupo PRENACEL, 73 do grupo intervenção, mas que não optaram pelo PRENACEL e 51 do grupo controle. Encontramos um perfil com idade média de 30 anos e a maioria dos entrevistados (51%) se declarou como raça/cor parda. Grande parte dos entrevistados (39,7%) relatou ter em média de 9,3 anos de estudo. A maioria dos homens (57,5%) coabita com a companheira e foi classificada como classe C (63,7%). A adesão ao programa PRENACEL foi de 53,4%. Houve uma maior participação dos parceiros do grupo PRENACEL nas consultas de pré- natal, assim como foi observada uma maior presença destes no momento do parto como acompanhante quando comparado aos demais grupos. Conclusão: O estudo mostrou que uma estratégia de educação em saúde utilizando as tecnologias de comunicação parece ter boa aceitabilidade e um papel promissor no engajamento de homens aos cuidados pré-natal, parto e pós-parto de suas companheiras. / Introduction: The partner accompanying the prenatal care, birth and postpartum care of the woman has presented positive results in relation to mother and child health and also in relation to the health of the man. This is an important strategy to bring future fathers closer to health services and to improve their link with paternity. Aim: To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to standard prenatal monitoring. Method: A parallel cluster randomized trial, with the clusters representing health units. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care. Results: 186 partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (57.5%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. There was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the birth when compared to the other groups. Conclusion: The study showed that a health education strategy using communication technology seems to have good acceptability and a promising role in engaging men in the prenatal care, birth and postpartum care of their partners.

Introdução: O acompanhamento do parceiro no pré-natal, parto e pós-parto de sua companheira mostram resultados positivos em relação à saúde materna, infantil e também relacionados à saúde do homem. É uma importante estratégia de aproximar os futuros pais dos serviços de saúde e melhorar o vínculo destes com a paternidade. Objetivo: Avaliar se a implementação da tecnologia SMS através do programa PRENACEL para o parceiro como um programa de educação em saúde é um suplemento útil ao acompanhamento pré-natal padrão. Método: Ensaio aleatorizado controlado por conglomerados representados por unidades de saúde. Selecionamos 20 unidades de saúde que foram aleatoriamente alocadas segundo critérios pré estabelecidos, 10 sendo controle e 10 como intervenção. Os parceiros das gestantes que iniciaram o pré-natal antes da 20ª semana de gestação foram a população do estudo. Os parceiros inscritos no PRENACEL receberam periodicamente mensagens curtas de texto via celular com informações sobre gestação e parto. Nas unidades do grupo controle os parceiros receberam, junto com suas companheiras, o pré-natal padrão. Resultados: 186 parceiros foram entrevistados, 62 do grupo PRENACEL, 73 do grupo intervenção, mas que não optaram pelo PRENACEL e 51 do grupo controle. Encontramos um perfil com idade média de 30 anos e a maioria dos entrevistados (51%) se declarou como raça/cor parda. Grande parte dos entrevistados (39,7%) relatou ter em média de 9,3 anos de estudo. A maioria dos homens (57,5%) coabita com a companheira e foi classificada como classe C (63,7%). A adesão ao programa PRENACEL foi de 53,4%. Houve uma maior participação dos parceiros do grupo PRENACEL nas consultas de pré- natal, assim como foi observada uma maior presença destes no momento do parto como acompanhante quando comparado aos demais grupos. Conclusão: O estudo mostrou que uma estratégia de educação em saúde utilizando as tecnologias de comunicação parece ter boa aceitabilidade e um papel promissor no engajamento de homens aos cuidados pré-natal, parto e pós-parto de suas companheiras. / Introduction: The partner accompanying the prenatal care, birth and postpartum care of the woman has presented positive results in relation to mother and child health and also in relation to the health of the man. This is an important strategy to bring future fathers closer to health services and to improve their link with paternity. Aim: To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to standard prenatal monitoring. Method: A parallel cluster randomized trial, with the clusters representing health units. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care. Results: 186 partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (57.5%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. There was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the birth when compared to the other groups. Conclusion: The study showed that a health education strategy using communication technology seems to have good acceptability and a promising role in engaging men in the prenatal care, birth and postpartum care of their partners.

Introduction: There is an increased acceptance and demand for online and mobile health (mHealth) interventions to support physical and mental health problems. However, the uptake and engagement of these interventions is relatively low and the evidence base for these interventions requires continual updating in line with technological advances. A systematic review was conducted, focusing on anxiety and depression, to explore the existing evidence base of both physical health and mental health mobile applications. The first research paper explores the acceptability of mHealth interventions for both mental health and physical health problems. The final research paper explores use and strategies when searching for mental health information online. Additionally, perceived quality, sentiment and barriers to online health information was explored. Methods: Studies were identified by searching for articles published between January 2008 and January 2016. Databases included: PsycINFO, MEDLINE, CINAHL PLUS and the Cochrane Central Register of Controlled Trials for 2016. In the research articles, 218 people completed an online survey in January 2016 exploring, online health seeking for mental health and physical health problems, and acceptability of mHealth interventions. Sentiment of online health resources was explored by extracting 432 individual tweets from Twitter. Results: The systematic review revealed twenty-seven studies for inclusion; 10 with a physical health focus and 17 with a mental health focus. Targeted depression applications have the superior evidence base; however, no firm conclusions can be made regarding interventions that targeted physical health, or those measuring anxiety. The first research paper found that face-to-face therapy would more likely meet expectations for treatment of both physical and mental health problems compared to mHealth interventions. Computerised interventions were more likely to meet expectations than mobile applications. Expectations of treatment were higher for the treatment of mental health problems than physical health problems. The second research paper found that a large proportion of the public use the internet to search for information on mental health, with half citing it as their primary source for mental health information. The online survey found that the quality of mental health information available on the internet was rated favourably, compared to mobile applications. Overall, the sentiment towards specific online mental health resources was generally positive. Conclusions: Research into online and mHealth interventions has developed considerably in recent years in line with advances in technology. These interventions have the potential to be an effective treatment of common mental health problems. The systematic review highlighted that depression applications are more established and effective than applications targeting anxiety. The first research paper suggests that mHealth interventions fall short of public expectations for treatment of health problems. The final research paper reflects that the perceived quality of online mental health information is rated favourably. However, many barriers still limit uptake. Future research could focus on continually developing and evaluating evidence based online and mHealth interventions and the outcome of this study suggests that incorporating them more widely into existing care systems, alongside face to face interventions could increase the public’s confidence in these interventions.

Technology has taken over tasks that were originally carried out by professionals in all different kinds of industries and sectors ranging from self-check in at airports to money transfer via mobile devices. In the healthcare sector the internet has become one main information resource for health-related issues and with the introduction of mobile devices such as smartphones the mHealth market has evolved. With help of mHealth applications (mHealth apps) patients can actively participate in maintaining their health and take over tasks usually fulfilled by health professionals. Despite the advantages of mHealth apps in practice, the download numbers are decreasing and the academic world has not paid much attention to the end-users point of view. The purpose of this paper is to identify factors influencing end-users in their intention to use mHealth apps. In order to answer this research question a quantitative research design has been chosen. The data is collected with help of an online self-completion questionnaire and statistical analysis with the software SPSS. Time and Perceived Usefulness were two out of five factors that had an influence on the end-users intention to use mHealth apps. A key finding of this study is that the mHealth app market is still in its early stage and end-users lack knowledge about it. This paper contributes to theory as well as to practice by providing new research directions for the academic world and insights for app developers and marketers to adapt their marketing strategies in order to meet the customers’ needs.

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

Background: Diabetic foot neuropathy (DFN) is one of the most important complications of diabetes mellitus; its early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is concerning. Delivering messages to remind patients to perform thermometry and foot care might be helpful to guarantee regular foot monitoring. This trial was designed to compare the incidence of diabetic foot ulcers (DFUs) between participants who receive thermometry alone and those who receive thermometry as well as mHealth (SMS and voice messaging) over a year-long study period. Methods/design: This is an evaluator-blinded, randomized, 12-month trial. Individuals with a diagnosis of type 2 diabetes mellitus, aged between 18-80 years, having a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Foot), have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent will be eligible to participate in the study. Recruitment will be performed in diabetes outpatient clinics at two Ministry of Health tertiary hospitals in Lima, Peru. Interventions: participants in both groups will receive education about foot care at the beginning of the study and they will be provided with a thermometry device (TempStat (TM)). TempStat (TM) is a tool that captures a thermal image of the feet, which, depending on the temperature of the feet, shows different colors. In this study, if a participant notes a single yellow image or variance between one foot and the contralateral foot, they will be prompted to notify a nurse to evaluate their activity within the previous 2 weeks and make appropriate recommendations. In addition to thermometry, participants in the intervention arm will receive an mHealth component in the form of SMS and voice messages as reminders to use the thermometry device, and instructions to promote foot care. Outcomes: the primary outcome is foot ulceration, evaluated by a trained nurse, occurring at any point during the study. Discussion: This study has two principal contributions towards the prevention of DFU. First, the introduction of messages to promote self-management of diabetes foot care as well as using reminders as a strategy to improve adherence to daily home-based measurements. Secondly, the implementation of a thermometry-based strategy complemented by SMS and voice messages in an LMIC setting, with wider implications for scalability.