Background - Mobile health (mHealth) interventions to promote medication adherence have shown promise; among patients primarily diagnosed with Coronary Heart Disease (CHD), however, there is a lack of evidence for nurse-led mHealth interventions, in this particular group in Iran. Aim - To refine and evaluate a pre-developed nurse-led mHealth intervention to promote cardiovascular medication adherence in Iranian adult, male and female Cardiac Rehabilitation (CR) outpatients. Methods - A quantitative-dominant mixed methods study was conducted drawing upon the Medical Research Council’s (MRC) Framework on the development and evaluation of complex interventions. Phase 1 comprised of a self-completion CHD patients’ survey (n=123) and three focus groups with cardiac nurses (n=23) within three public university-affiliated hospitals in Tehran, which in turn informed Phase 2 (the exploratory trial phase). The automated Short Message Service (SMS) medication reminder was designed based on the dimensions of adherence suggested by the World Health Organisation (WHO) and Bandura’ Self-efficacy Theory. The intervention was refined according to the findings from Phase 1 and then piloted in an Iranian CR setting. Seventy eight CHD patients who were 18 years or older, and had mobile phone access were recruited and randomised to receive either daily SMS reminders (n=39) or usual care (n=39) for 12 weeks. The primary outcome was the effect on cardiovascular medication adherence as measured by the self-reported Morisky Medication Adherence Scale; secondary outcomes explored the feasibility of the mHealth intervention, intervention effect on medication adherence selfefficacy, cardiac ejection fraction, cardiac functional capacity, hospital readmission/ death rate and health-related quality of life. Patient acceptability was assessed through completion of a post-intervention survey. Results - Feasibility was evidenced by high ownership of mobile phones in CHD patients, high application of SMS messaging, positive patients’ perception about the intervention, suboptimal cardiovascular medication adherence and patients’ high interest in receiving SMS reminders for their medications. Participants in the intervention group showed higher self-reporting of medication adherence compared to the usual care group χ2 (2) = 23.447; P < 0.001. The Relative Risk (RR) was indicated that it was 2.19 times more likely for the control group to be less adherent to their medications than the intervention group (RR = 2.19; 95% Confidence Interval (CI) 1.5 - 3.19). All secondary outcomes improved in the intervention group at the end of the study. Acceptability was evidenced by participants who received the intervention reporting that they perceived the SMS reminders useful. Conclusion - The SMS medication reminder intervention was well accepted and feasible with significantly higher reporting of medication adherence in Iranian CHD patients. Effect sizes were established for use in future follow-up evaluations of the mHealth intervention.

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.

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.

Philosophiae Doctor - PhD / Short Message Service (SMS) is one of the most popularly used services for communication between mobile phone users. In recent times it has also been proposed as a means for information access. However, there are several challenges to be overcome in order to process an SMS, especially when it is used as a query in an information retrieval system.SMS users often tend deliberately to use compacted and grammatically incorrect writing that makes the message difficult to process with conventional information retrieval systems. To overcome this, a pre-processing step known as normalization is required. In this thesis an investigation of SMS normalization algorithms is carried out. To this end,studies have been conducted into the design of algorithms for translating and normalizing SMS text. Character-based, unsupervised and rule-based techniques are presented. An investigation was also undertaken into the design and development of a system for information access via SMS. A specific system was designed to access information related to a Frequently Asked Questions (FAQ) database in healthcare, using a case study. This study secures SMS communication, especially for healthcare information systems. The proposed technique is to encipher the messages using the secure shell (SSH) protocol.

The General Data Protection Regulation grants data subjects the legal rights of transparency and intervenability. Ex post transparency provides users of data services with insight into how their personal data have been processed, and potentially clarifies what consequences will or may arise due to the processing of their data. Technological artefacts, ex post transparency-enhancing tools (TETs) convey such information to data subjects, provided the TETs are designed to suit the predisposition of their audience. Despite being a prerequisite for transparency, however, many of the TETs available to date lack usability in that their capabilities do not reflect the needs of their final users. The objective of this thesis is therefore to systematically apply the concept of human-centred design to ascertain design principles that demonstrably lead to the implementation of a TET that facilitates ex post transparency and supports intervenability. To this end, we classify the state of the art of usable ex post TETs published in the literature and discuss the gaps therein. Contextualising our findings in the domain of fitness tracking, we investigate to what extent individualisation can help accommodate the needs of users of online mobile health services. We introduce the notion of privacy notifications as a means to inform data subjects about incidences worthy of their attention and examine how far privacy personas reflect the preferences of distinctive groups of recipients. We suggest a catalogue of design guidelines that can serve as a basis for specifying context-sensitive requirements for the implementation of a TET that leverages privacy notifications to facilitate ex post transparency, and which also serve as criteria for the evaluation of a future prototype. / <p>Paper 2 ingick som manuskript i avhandlingen, nu publicerad.</p>

Digital transformation is evolving, and it is driving at the helm of the digital evolution. The amount of information accessible to us has revolutionized the way we gather information. Mobile technology and the immediate and ubiquitous access to information has changed how we engage with services including healthcare. Digital technology and digital transformation have afforded people the ability to self-manage in different ways than face-to-face and paper-based methods through different technologies. This study focuses on exploring the use of the most commonly used digital health technologies in the healthcare sector and how it affects physicians’ daily routine practice. The study presents findings from a qualitative methodology involving semi-structured, personal interviews with physicians from Sweden and a physician from Spain. The interviews capture what physicians feel towards digital transformation, digital health technologies and how it affects their work. In a field where a lack of information regarding how physicians work is affected by digital health technologies, this study reveals a general aspect of how reality looks for physicians. A new way of conducting medicine and the changed role of the physician is presented along with the societal implications for physicians and the healthcare sector. The findings demonstrate that physicians’ role, work and the digital transformation in healthcare on a societal level are important in shaping the future for the healthcare industry and the role of the physician in this future. / Den digitala transformationen växer och den drivs vid rodret för den digitala utvecklingen. Mängden information som är tillgänglig för oss har revolutionerat hur vi samlar in information. Mobila tekniker och den omedelbara och allmänt förekommande tillgången till information har förändrat hur vi tillhandahåller oss tjänster inklusive inom vården. Digital teknik och digital transformation har gett människor möjlighet att kontrollera sig själv och sin egen hälsa på olika sätt än ansikte mot ansikte och pappersbaserade metoder genom olika tekniker. Denna studie fokuserar på att utforska användningen av de vanligaste digitala hälsoteknologierna inom hälso- och sjukvårdssektorn och hur det påverkar läkarnas dagliga rutin. Studien presenterar resultat från en kvalitativ metod som involverar semistrukturerade, personliga intervjuer med läkare från Sverige och en läkare från Spanien. Intervjuerna fångar vad läkare tycker om digital transformation, digital hälsoteknik och hur det påverkar deras arbete. I ett fält där brist på information om hur läkare arbetar påverkas av digital hälsoteknik avslöjar denna studie en allmän aspekt av hur verkligheten ser ut för läkare. Ett nytt sätt att bedriva medicin och läkarens förändrade roll presenteras tillsammans med de samhälleliga konsekvenserna för läkare och vårdsektorn. Resultaten visar att läkarnas roll, arbete och den digitala transformationen inom hälso- och sjukvården på samhällsnivå är viktiga för att utforma framtiden för vårdindustrin och läkarens roll i framtiden.