UA Open Access Publishing Fund / Background: Internet and mobile health (mHealth) apps hold promise for expanding the reach of evidence-based health interventions. Research in this area is rapidly expanding. However, these studies may experience problems with recruitment and retention. Web-based and mHealth studies are in need of a wide-reaching and low-cost method of recruitment that will also effectively retain participants for the duration of the study. Online recruitment may be a low-cost and wide-reaching tool in comparison to traditional recruitment methods, although empirical evidence is limited. Objective: This study aims to review the literature on online recruitment for, and retention in, mHealth studies. Methods: We conducted a review of the literature of studies examining online recruitment methods as a viable means of obtaining mHealth research participants. The data sources used were PubMed, CINAHL, EbscoHost, PyscINFO, and MEDLINE. Studies reporting at least one method of online recruitment were included. A narrative approach enabled the authors to discuss the variability in recruitment results, as well as in recruitment duration and study design. Results: From 550 initial publications, 12 studies were included in this review. The studies reported multiple uses and outcomes for online recruitment methods. Web-based recruitment was the only type of recruitment used in 67% (8/12) of the studies. Online recruitment was used for studies with a variety of health domains: smoking cessation (58%; 7/12) and mental health (17%; 2/12) being the most common. Recruitment duration lasted under a year in 67% (8/12) of the studies, with an average of 5 months spent on recruiting. In those studies that spent over a year (33%; 4/12), an average of 17 months was spent on recruiting. A little less than half (42%; 5/12) of the studies found Facebook ads or newsfeed posts to be an effective method of recruitment, a quarter (25%; 3/12) of the studies found Google ads to be the most effective way to reach participants, and one study showed better outcomes with traditional (eg in-person) methods of recruitment. Only one study recorded retention rates in their results, and half (50%; 6/12) of the studies recorded survey completion rates. Conclusions: Although online methods of recruitment may be promising in experimental research, more empirical evidence is needed to make specific recommendations. Several barriers to using online recruitment were identified, including participant retention. These unique challenges of virtual interventions can affect the generalizability and validity of findings from Web-based and mHealth studies. There is a need for additional research to evaluate the effectiveness of online recruitment methods and participant retention in experimental mHealth studies.

Background: The health benefits of regular physical activity are well known and include the prevention of chronic diseases such as obesity, type 2 diabetes, and cardiovascular diseases. Still, only 20% of U.S. adults report meeting the Physical Activity Guidelines for Americans. With approximately 43% of U.S. jobs considered sedentary, there is a need for effective workplace physical activity interventions. MapTrek is a mobile health game designed to increase daily physical activity in a low-cost, scalable, and enjoyable way. Objective: The purpose of the present study was to test the efficacy of MapTrek for increasing daily steps and moderate-intensity steps over 10 weeks in a sample of sedentary office workers. Methods: Participants included 144 full-time sedentary office workers ages 21-65 who reported sitting at least 75% of their workday. Each participant received a Fitbit Zip to wear daily throughout the intervention. Participants were randomized to either a: 1) Fitbit only group or 2) Fitbit + MapTrek group. Physical activity outcomes and intervention compliance were measured with the Fitbit activity monitor. Results: The Fitbit + MapTrek group significantly increased daily steps (+2,091.5 steps/day) and active minutes (+11.2 minutes/day) compared to the Fitbit only arm. Conclusions: These data support MapTrek as an effective approach for increasing physical activity at a clinically meaningful level in sedentary office workers.

In this study we present feasibility of a mobile monitoring and reporting system that would provide an accurate unbiased screening tool to systematically analyze opioid adherence in Sickle cell disease patients. In addition, the software simultaneously measures pain. The Mobile Applications Rating Scale: a new and validated tool for assessing the quality of health mobile apps for engagement, functionality, aesthetics, information quality, subjective quality, relevance and overall impact was administered post usage to evaluate the application. A total of 28 patients were recruited to review and test the software at one sitting. The majority of the population found the application to be relevant for their care. Patients were also asked to report on the completeness of information within the app, the majority (96%) reported on the application’s completeness while 4% estimated the information to be minimal or overwhelming. The quality of information as it pertains to sickle cell patients was overwhelimingly reported to be relevant (91.7%); only 8.3% found the application to be poorly relevant to sickle cell disease. The application’s performance was positively rated while the ease of its use positively rated at 91.7%. Most participants (85.7%) found the application to be interesting to use while 74% found it entertaining. All users found the application’s navigation to be logical and accurate with consistent and intuitive gestural design. We conclude that surveyed patients believe it is feasible to use a smartphone application specifically targeted to monitor opioid use and behavior in patients with sickle cell disease (SCD)-associated pain

A deeper understanding of human physiology, combined with improvements in sensing technologies, is fulfilling the vision of affective computing, where applications monitor and react to changes in affect. Further, the proliferation of commodity mobile devices is extending these applications into the natural environment, where they become a pervasive part of our daily lives. This work examines one such pervasive affective computing application with significant implications for long-term health and quality of life adaptive just-in-time interventions (AJITIs). We discuss fundamental components needed to design AJITIs based for one kind of affective data, namely stress. Chronic stress has significant long-term behavioral and physical health consequences, including an increased risk of cardiovascular disease, cancer, anxiety and depression. This dissertation presents the state-of-the-art of Just-in-time interventions for stress. It includes a new architecture. that is used to describe the most important issues in the design, implementation, and evaluation of AJITIs. Then, the most important mechanisms available in the literature are described, and classified. The dissertation also presents a simulation model to study and evaluate different strategies and algorithms for interventions selection. Then, a new hybrid mechanism based on value iteration and monte carlo simulation method is proposed. This semi-online algorithm dynamically builds a transition probability matrix (TPM) which is used to obtain a new policy for intervention selection. We present this algorithm in two different versions. The first version uses a pre-determined number of stress episodes as a training set to create a TPM, and then to generate the policy that will be used to select interventions in the future. In the second version, we use each new stress episode to update the TPM, and a pre-determined number of episodes to update our selection policy for interventions. We also present a completely online learning algorithm for intervention selection based on Q-learning with eligibility traces. We show that this algorithm could be used by an affective computing system to select and deliver in mobile environments. Finally, we conducts posthoc experiments and simulations to demonstrate feasibility of both real-time stress forecasting and stress intervention adaptation and optimization.

Busy families of Nova Scotia and similar populations find it challenging to make healthy nutrition and exercise choices due to time constraints (Chircop et al, under review; Jabs et al, 2007; Devine et al, 2006). Smartphone application technology can provide health behavior change interventions in a mobile and fast format (Breton, Bernard, Fuemmeler, Lorien & Abroms, 2011). Using focus groups, this research addressed parent’s perceptions on how smartphone application technology can support nutrition and physical activity habits within their family and what, if any, barriers exist in adopting this form of health behavior intervention. Findings revealed this population believes smartphone health applications can improve family nutrition and physical activity as long as barriers are minimized and requirements for adoption are met. Diffusion of Innovations theory was used to understand the adoption rate within the target population. Thoughts on future work efforts for related health behaviour interventions is discussed.

There are currently a great deal of available health applications available on various app-stores around the globe and more is being added each day. With that vast amount of available options, which health applications are trustworthy and offers the functionality that the users are looking for? With the current regulations and classification processes, it is difficult to know if mHealth services offers the high standards that it should. This thesis investigates the need for mHealth services tobe subject of an evaluation process, by a health organization or a government agency, to ensure that quality standards are high. We discover the current “state-of-the-art” of mHealth and the privacy-and usability aspects of mHealth, we find outif evaluated and approved mHealth applications are believed to be more attractive to use than the non-evaluated counterparts, and lastly, we identify what aspects is important to evaluate of mHealth applications. To provide answers to the thesis, we perform a literature review and distribute a survey to a small group of potential users of mHealth services. The literature review provides information about the current state of mHealth around the globe. Moreover, the literature review also reveals that both usability, but especially privacy, is of major importance when creating mHealth services. We also discover that there are voices from field experts that suggests mHealth services to be subject of an evaluation process, similar to what we suggest in this thesis. With the survey, we identify the respondents’ current utilization of mHealth services. We also find out what aspects they believe is important and if their trust and utilization of an evaluated and approved mHealth service would be affected compared to a non-evaluated counterpart. The respondents of the survey is parents of young children, a group that is likely in need of medical attention in one way or another and still has the technical experience that is required to answer the survey.

Sedan cigaretten introducerades under 1800-talet har rökningens vara eller inte vara debatterats ständigt. Riskerna med rökning har lett till att fler och fler åtgärder införts för att försvåra tillgången till tobak, och möjligheterna att röka överallt har kraftigt begränsats. I samarbete med företaget Deversify och deras produkt Smoketrack avser examensarbetet att skapa en digital plattform i syfte med att erbjuda hjälp till ett rökfritt liv.  Arbetet behandlar vilka funktioner en applikation ska innehålla, och processen som ledde fram till det, för att i kombination med produkten Smoketrack uppmuntra till rökavvänjning. Arbetet har utförts genom en designprocess bestående av intervjuer och användartester samt litteraturdata. Resultatet av arbetet gestaltas genom en mobilapplikation med fokus på en community för sina medlemmar.

abstract: For the past decade, mobile health applications are seeing greater acceptance due to their potential to remotely monitor and increase patient engagement, particularly for chronic disease. Sickle Cell Disease is an inherited chronic disorder of red blood cells requiring careful pain management. A significant number of mHealth applications have been developed in the market to help clinicians collect and monitor information of SCD patients. Surveys are the most common way to self-report patient conditions. These are non-engaging and suffer from poor compliance. The quality of data gathered from survey instruments while using technology can be questioned as patients may be motivated to complete a task but not motivated to do it well. A compromise in quality and quantity of the collected patient data hinders the clinicians' effort to be able to monitor patient's health on a regular basis and derive effective treatment measures. This research study has two goals. The first is to monitor user compliance and data quality in mHealth apps with long and repetitive surveys delivered. The second is to identify possible motivational interventions to help improve compliance and data quality. As a form of intervention, will introduce intrinsic and extrinsic motivational factors within the application and test it on a small target population. I will validate the impact of these motivational factors by performing a comparative analysis on the test results to determine improvements in user performance. This study is relevant, as it will help analyze user behavior in long and repetitive self-reporting tasks and derive measures to improve user performance. The results will assist software engineers working with doctors in designing and developing improved self-reporting mHealth applications for collecting better quality data and enhance user compliance. / Dissertation/Thesis / Masters Thesis Computer Science 2017

Background: Successful recruitment of participants to mobile health (mHealth) studies presents unique challenges over in-person studies. It is important to identify recruitment strategies that maximize the limited recruitment resources available to researchers. Objective: The objective of this study was to describe a case study of a unique recruitment process used in a recent mHealth software app designed to increase smoking cessation among weight-concerned women smokers. The See Me Smoke-Free app was deployed to the Google Play Store (Alphabet, Inc., Google, LLC), where potential participants could download the app and enroll in the study. Users were invited in-app to participate in the study, with no in-person contact. The recruitment activities relied primarily on earned (free) and social media. Methods: To determine the relationship between recruitment activities and participant enrollment, the researchers explored trends in earned and social media activity in relation to app installations, examined social media messaging in relation to reach or impressions, and described app users' self-reported referral source. The researchers collected and descriptively analyzed data regarding recruitment activities, social media audience, and app use during the 18-week recruitment period (March 30, 2015-July 31, 2015). Data were collected and aggregated from internal staff activity tracking documents and from Web-based data analytics software such as SumAll, Facebook Insights (Facebook, Inc.), and Google Analytics (Alphabet, Inc., Google, LLC). Results: Media coverage was documented across 75 publications and radio or television broadcasts, 35 of which were local, 39 national, and 1 international. The research team made 30 Facebook posts and 49 tweets, yielding 1821 reaches and 6336 impressions, respectively. From March 30, 2015 to July 31, 2015, 289 unique users downloaded the app, and 151 participants enrolled in the study. Conclusions: Research identifying effective online recruitment methods for mHealth studies remains minimal, and findings are inconsistent. We demonstrated how earned media can be leveraged to recruit women to an mHealth smoking cessation trial at low cost. Using earned media and leveraging social media allowed us to enroll 3 times the number of participants that we anticipated enrolling. The cost of earned media resides in the staff time required to manage it, particularly the regular interaction with social media. We recommend communication and cooperation with university public affairs and social media offices, as well as affiliate programs in journalism and communications, so that earned media can be used as a recruitment strategy for mHealth behavior change interventions. However, press releases are not always picked up by the media and should not be considered as a stand-alone method of recruitment. Careful consideration of an intervention's broad appeal and how that translates into potential media interest is needed when including earned media as part of a comprehensive recruitment plan for mHealth research.

US asthma prevalence increased by five million in the last decade and health care spending for the disease increased from $53 billion to $56 billion. Children are more likely than adults to have an asthma attack and its estimated that 1-in-10 youth has asthma. Despite initiatives to promote adherence to practice guidelines, childhood asthma emergency room) visits, and hospitalizations remain steady while the number of asthma deaths have increased over a 17-year period. Preliminary studies find the majority of adolescents prefer smartphones as a means of education and guidance. A modified Technology Acceptance Model (TAM) survey was comprised of 15 statements that explored providers' acceptance of smartphone applications (apps) as an adjunct strategy for management of asthma among adolescents in the outpatient setting. Current insight in adolescent asthma demonstrates multifaceted disparities in care stemming from biological and developmental transitions unique to adolescents. The quantitative, descriptive design of the project assessed two factors integral to the TAM related to provider acceptance and perception: 1) Perceived use (PU), and 2) Perceived ease of use (PEU). The survey sample consisted of 18 providers. Overwhelmingly, the majority of providers surveyed favored use of a smartphone app for adolescent asthma and believed apps had the potential to improve the quality of adolescent asthma management. Most participants agreed; smartphone apps might help accomplish benchmarks for adolescent asthma management. Numerous studies demonstrate adolescents’ preference for technological interventions for self-management of their asthma symptoms. The survey results reinforce the willingness of providers to accept asthma smartphone apps as a potential adjunct management strategy for adolescent asthma. Additional studies involving providers are required to further explore provider attitudes of acceptance and rejection relating to smartphone apps for chronic health conditions.