It is widely supported that there are significant, positive relationships between the occurrence of some mental health symptoms and physical illnesses. Research indicates that the burden experienced by those with a physical and mental illness are magnified compared to individuals who do not experience an illness. More specifically, one of the burdens experienced by individuals is the monetary burden of affording the necessary health services to properly manage their illness. This study attempts to reveal a difference between mental health symptom count for individuals who do and do not experience difficulty affording health care for their physical problems. The first hypothesis states that the indication of medical problems will be associated with greater mental health symptoms. The second hypothesis states that the relationship between medical concerns and mental health symptoms will be moderated by difficulty affording health services. Lastly, the third hypothesis states that the indication of unhealthy behaviors, such as smoking and irregular exercise, will be associated with greater mental health symptoms. All data used in this study is archived data that was gathered by the Institute for Rural Health’s Mobile Health Units during free community health fairs from September 2012 to February 2014. The first hypothesis was supported because the incidence rate of mental health symptom count was increased with the presence of some physical problems. These findings supported previous research that indicated that the presence of physical illness increases the chance of developing a mental illness. The study results revealed that the second hypothesis was not supported since difficulty affording health services did not have a significant effect on the relationship between indicated physical illnesses and mental health symptom count. Previous research reports that there is monetary burden for individuals who experience a physical or mental illness when accessing appropriate health services. This research aimed to explore if that burden would significantly affect the relationship of those illnesses. Lastly, the third hypothesis was supported because mental health symptom count incidence rate was found to increase for individuals partaking in negative health behaviors, such as smoking, and decrease for individuals partaking in positive health behaviors, such as exercising.

Aims: Untreated opioid use disorder (OUD) is associated with overdose, premature death and infectious disease, including human immunodeficiency virus (HIV) and Hepatitis C (HCV). While prior studies have shown that educational interventions are associated with improvements in HIV and HCV knowledge and reductions in risk behaviors, those examined to date have typically been time- and resource-intensive. We recently developed an HIV+HCV Education intervention which aims to improve HIV and HCV knowledge in a single visit using an automated iPad platform. In this project, we examined its ability, using a within-subject evaluation, to improve knowledge of HIV and HCV transmission and risks among adults with OUD. Methods: Participants were 25 adults with OUD who were enrolled in a 12-week randomized trial evaluating the efficacy of an Interim Buprenorphine Treatment (IBT) for reducing illicit opioid use while awaiting entry into community-based opioid treatment. Participants completed a baseline HIV+HCV knowledge assessment (Pre-Test) followed by corrective feedback, both administered via iPad. They then completed an interactive HIV flipbook and animated HCV video, also on iPad, followed by a second administration of the knowledge assessment (Post-Test). Finally, to evaluate whether any changes in knowledge persisted over time, the HIV+HCV assessment was administered again at 4 and 12 weeks following study intake. Results: At baseline (Pre-Test), participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. After completing the educational intervention, participants answered 86% of items correctly on both the HIV and HCV assessments (p’s<.001). These improvements in knowledge also persisted throughout the three-month study, with scores at Week 4 and 12 timepoints significantly greater than baseline (p’s<.001). Conclusion: An HIV+Hepatitis Education intervention delivered via a portable, automated iPad platform may produce significant and persistent improvements in HIV and HCV knowledge among adults with OUD. These data provide additional support for the use of mobile educational interventions for enhancing HIV and HCV knowledge in individuals at elevated risk for infectious disease. Support: This trial was supported by NIDA R34 DA3730385 (Sigmon) with additional support by NIDA T32 DA007242 (Higgins).

Το mHealth, η χρήση δηλαδή φορητών τεχνολογιών για την βελτίωση των παρεχόμενων υπηρεσιών υγείας, είναι σήμερα ένα από τα πιο ταχέως αναπτυσσόμενα πεδία της ηλεκτρονικής υγείας (eHealth). Ο αριθμός των επαγγελματιών υγείας που υιοθετούν έξυπνα κινητά τηλέφωνα (smartphones) για την εκτέλεση πληθώρας λειτουργιών αυξάνεται συνεχώς, εξαιτίας των δυνατοτήτων και της φορητότητας που αυτά παρέχουν. Ταυτόχρονα, τα σφάλματα στη φαρμακευτική αγωγή είναι από τα πιο συνηθισμένα ιατρικά λάθη με επιπτώσεις τόσο στην υγεία του ασθενούς όσο και στις δαπάνες στην υγεία. Η χορήγηση φαρμάκων είναι μια πολύπλοκη διαδικασία, καθώς απαιτεί από τον ειδικό της υγείας την ανάλυση πληθώρας παραγόντων και την ανάκτηση, επεξεργασία και διαχείριση μεγάλου όγκου πληροφορίας. Σύμφωνα με τη βιβλιογραφία, η χρήση τεχνολογιών πληροφορικής για την υποβοήθηση των επαγγελματιών υγείας στη λήψη αποφάσεων κατά τη συνταγογράφηση, μπορεί να συμβάλει σημαντικά στη μείωση των σφαλμάτων φαρμακευτικής αγωγής. Στο πλαίσιο της παρούσας διπλωματικής εργασίας, προχωρήσαμε στη διερεύνηση και αξιολόγηση των σημαντικότερων εφαρμογών έξυπνων κινητών συσκευών για το φάρμακο, με στόχο την εξαγωγή χρήσιμων συμπερασμάτων για τα χαρακτηριστικά και τις λειτουργίες που ενσωματώνουν. Ένα από τα βασικά συμπεράσματα της έρευνας ήταν η απουσία αντίστοιχης εφαρμογής για τα φάρμακα που είναι εγκεκριμένα από τον Εθνικό Οργανισμό Φαρμάκων (ΕΟΦ). Ως εκ τούτου, προχωρήσαμε στο σχεδιασμό και την ανάπτυξη εφαρμογής για τον έλεγχο ασυμβασιών μεταξύ φαρμάκων, η οποία παρέχει επιπλέον τη δυνατότητα προβολής πληροφοριών συνταγολογίου για τα φάρμακα του ΕΟΦ. Ο σχεδιασμός της εφαρμογής έγινε λαμβάνοντας υπόψη τις ανάγκες και τις απαιτήσεις μελλοντικών χρηστών, όπως οι επαγγελματίες υγείας και οι ασθενείς, προκειμένου να διασφαλιστεί η λειτουργικότητα και η ευχρηστία της. Η εν λόγω εφαρμογή προορίζεται για έξυπνες κινητές συσκευές που διαθέτουν λειτουργικό σύστημα Android, ενώ η πληροφορία που ενσωματώνει βασίζεται αποκλειστικά στο εθνικό συνταγολόγιο του ΕΟΦ. / Mobile Health or mHealth, namely the use of mobile and wireless technologies in order to improve health services and achieve health goals, is today one of the most rapidly expanding fields of electronic health (eHealth). The number of health professionals that adopt smartphones to perform multiple tasks, during their everyday medical practice, is increasing constantly. This is due to the fact that smartphones provide advanced computing capabilities and high portability. Simultaneously, medication errors are among the most common medical errors which have negative impact both for the health of the patient and the expenditure on health sector. Drug prescribing is quite a complex procedure, considering the fact that requires the health expert to analyze multiple factors and retrieve, process, manage and digest large volume of information. According to the literature, the use of information technologies to assist health professionals in decision-making when prescribing drugs, can contribute significantly to the reduction of medication errors. In the context of our work, we explored and evaluated the major smartphone applications for drugs, aiming to the extraction of useful conclusions about the features and functions that they incorporate. One of the research key findings was the absence of a corresponding application for the drugs that are approved by the National Drug Organization of Greece. Therefore, we design and develop an application for checking drug-drug interactions which additionally provides the ability to view national formulary information about drugs. The analysis and design of the application was implemented in collaboration with future users, such as health professionals and patients, in order to ensure that will meet their needs and requirements and at the same time will remain user friendly. This application is intended for Android smart mobile devices (e.g. smartphones, tablet PCs) and the information that integrates is solely based on the national formulary of the National Drug Organization of Greece.

abstract: Advancements in mobile technologies have significantly enhanced the capabilities of mobile devices to serve as powerful platforms for sensing, processing, and visualization. Surges in the sensing technology and the abundance of data have enabled the use of these portable devices for real-time data analysis and decision-making in digital signal processing (DSP) applications. Most of the current efforts in DSP education focus on building tools to facilitate understanding of the mathematical principles. However, there is a disconnect between real-world data processing problems and the material presented in a DSP course. Sophisticated mobile interfaces and apps can potentially play a crucial role in providing a hands-on-experience with modern DSP applications to students. In this work, a new paradigm of DSP learning is explored by building an interactive easy-to-use health monitoring application for use in DSP courses. This is motivated by the increasing commercial interest in employing mobile phones for real-time health monitoring tasks. The idea is to exploit the computational abilities of the Android platform to build m-Health modules with sensor interfaces. In particular, appropriate sensing modalities have been identified, and a suite of software functionalities have been developed. Within the existing framework of the AJDSP app, a graphical programming environment, interfaces to on-board and external sensor hardware have also been developed to acquire and process physiological data. The set of sensor signals that can be monitored include electrocardiogram (ECG), photoplethysmogram (PPG), accelerometer signal, and galvanic skin response (GSR). The proposed m-Health modules can be used to estimate parameters such as heart rate, oxygen saturation, step count, and heart rate variability. A set of laboratory exercises have been designed to demonstrate the use of these modules in DSP courses. The app was evaluated through several workshops involving graduate and undergraduate students in signal processing majors at Arizona State University. The usefulness of the software modules in enhancing student understanding of signals, sensors and DSP systems were analyzed. Student opinions about the app and the proposed m-health modules evidenced the merits of integrating tools for mobile sensing and processing in a DSP curriculum, and familiarizing students with challenges in modern data-driven applications. / Dissertation/Thesis / M.S. Electrical Engineering 2013

Background: The One Drop vertical bar Mobile app supports manual and passive (via HealthKit and One Drop's glucose meter) tracking of self-care and glycated hemoglobin A(1c) (HbA(1c)). Objective: We assessed the HbA(1c) change of a sample of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the One Drop vertical bar Mobile app on iPhone and Apple Watch, and tested relationships between self-care tracking with the app and HbA(1c) change. Methods: In June 2017, we identified people with diabetes using the One Drop vertical bar Mobile app on iPhone and Apple Watch who entered two HbA(1c) measurements in the app 60 to 365 days apart. We assessed the relationship between using the app and HbA(1c) change. Results: Users had T1D (n=65) or T2D (n=191), were 22.7% (58/219) female, with diabetes for a mean 8.34 (SD 8.79) years, and tracked a mean 2176.35 (SD 3430.23) self-care activities between HbA(1c) entries. There was a significant 1.36% or 14.9 mmol/mol HbA(1c) reduction (F=62.60, P<.001) from the first (8.72%, 71.8 mmol/mol) to second HbA(1c) (7.36%, 56.9 mmol/mol) measurement. Tracking carbohydrates was independently associated with greater HbA(1c) improvement (all P<.01). Conclusions: Using One Drop vertical bar Mobile on iPhone and Apple Watch may favorably impact glycemic control.

Magister Commercii - MCom / Introduction: Diabetes mellitus is a global health problem with a high mortality rate. Self-management is an essential part of diabetes management and it includes self-care behaviour tasks such as healthy eating, being active and taking prescribed medication. In the current digital age, the use of technology for self- management of the disease is an important consideration. As a first step towards this, individuals have to first accept and use the technology. However, the literature indicates low levels of technology use amongst diabetic patients in environments with low socio- economic indicators and amongst minority groups. Previous studies suggest that there are many factors that influence technology acceptance such as economic, social and cultural factors. Mobile health (m-health) received recognition in healthcare literature in recent years and are known for delivering effective and efficient interventions to patients with chronic conditions such as diabetes. An investigation into m-health acceptance for diabetes management is vital as it impacts the achievement of development goals, including the United Nations’ SDG 3. This research posits that the culture of patients is a possible reason for the low acceptance and use of technology. Research based on the proliferation of culture as a determinant for diabetes self-management at an individual level is limited, especially in the South African context. The main research question pursued in the study reported in this thesis is How does culture influence m-health acceptance of diabetic patients in disadvantaged communities? Research design and methodology: Using an interpretivist paradigm, a case study research design provided the basis to collect data from 20 diabetes patients in Mitchells Plain and Strandfontein. The theoretical model that was used as a lens for investigation comprised a juxtaposition of Hofstede’s cultural dimensions and Unified- Theory of Acceptance and Use of Technology 2 (UTAUT2). The analysis of the qualitative data was undertaken with Atlas Ti, using a thematic content analysis process. Results: Eight themes emerged from the data and key results of the study indicate that opinions towards medical practitioners, which reflects power distance has a positive impact on users and non-users. Diabetic patients comply with the opinions of their doctors as they fear disagreeing with them. As such, this may result in having a positive influence on a participant’s ability to adopt and use mobile applications. Caregiver influence, which reflects femininity, has a negative influence on users as a result of diabetic patients being responsible for taking care of their family and others are both home carers and providers for their families. This indicates that patients are more concerned with the quality of their life and family than with the adoption mobile applications. Future work: It is recommended that research should be conducted in other areas in the Western Cape, specifically in the Cape flats to see whether the same sorts of results will be achieved in different communities. This could help policymakers and application developers tailor mobile applications for this target population.

Mobile Health (mHealth) in evidence-based patient care is a fast-growing technology that is yet to be adapted in the healthcare setting for managing asthma. This research thesis aims to understand the determinant factors that can be recognized as drivers and barriers for mHealth implementation for asthma.  The literature review chapter outlined the aspects of wicked problems in implementing innovation, and the study of implementation science explained in relevant to the implementation of mHealth in the healthcare system. The selected framework is based on the implementation outcome and addressed all four categories of human organizational levels. A qualitative case study was carried out in metropolitan cities of India, and a purposive sampling method is applied to choose the engaged pulmonologist &amp; healthcare providers.  The empirical findings are categorized into themes using thematic analysis and identified the barriers and drivers under five themes, such as Technology, Human Factor, System, Literacy and Process.  The aspects under the theme technology include integrating IoT systems and data platforms, pre-testing, and adaptability. In contrast, the human factor’s theme revolves around the patient behaviour and attitude, emotions and beliefs on the technology. The aspects under the system and literacy theme mainly suggest that health literacy and language play a significant role. The results of these empirical studies have not previously been explored in the literature. And finally, the process theme indicates that the doctors play an essential role as an opinion leader and implementation leader in driving the implementation efforts. The analysis concludes that the determinant factors acting as barrier and driver are more under the human factors, technology and system aspects. These factors need to be considered when implementing the mHealth intervention for asthma management, and the role of healthcare practitioners engaging in the implementation process is foreseen as a potential driving factor for the successful outcome and technology acceptance by the patients.

Type 2 diabetes is a life-threatening condition, and it is rapidly growing in the world. If patients receive adequate education and support, they can manage their diabetes-related tasks effectively and reduce the severe complications of this disease. However, traditional self-management education and practices were not very effective in stimulating behaviour change and addressing patients’ diversified needs and expectations. Mobile text messaging is a promising method for type 2 diabetes self-management as it can provide continuous and customized support to these patients. However, there is a lack of knowledge about the optimal approach to designing and delivering mobile text messages. Hence, this dissertation aimed to define effective message strategies for mobile text messaging interventions targeting type 2 diabetes self-management. This manuscript-based dissertation consists of three complementary studies. The first manuscript includes a systematic review and a meta-analysis of tailored mobile text messaging interventions on type 2 diabetes self-management. It examines the tailoring strategies, message content, and structure and identifies the moderators of effectiveness in these interventions. The second manuscript includes a systematic review and a meta-synthesis of qualitative evidence on patients’ experiences and perspectives of mobile text messaging studies. The third manuscript consists of a prospective qualitative study to explore the text messaging design and delivery preferences of patients. In the first and second studies, the comprehensive search strategy included major electronic databases, key journal searches, and hand searches of the reference lists of related systematic reviews and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Collaboration's guidelines and recommended tools were used for data extraction, risk of bias and critical appraisal assessments, data analysis and reporting. Within a social marketing framework, the third study included semi-structured interviews and a thematic analysis of the main findings. In the first manuscript, 13 eligible trials were included for the systematic review and 11 eligible trials were further analyzed in the meta-analysis. This study concluded that tailored mobile text messaging interventions could improve glycemic control in patients with type 2 diabetes. The subgroup analyses revealed the importance of some moderators such as message delivery, message direction, message frequency, and using multi-modalities. In the second manuscript, the systematic review included 14 eligible studies, and the thematic synthesis included 13 eligible studies. Patients emphasized the importance of tailored text message design and delivery. They felt “supported” by using text messaging and improved their communication with family/friends and care providers. Mobile text messaging increased patients’ self-awareness, knowledge and control of diabetes. The third study explored that mobile text messages could be more effective if they are gain-framed and written in a standard format. Patients favoured the text messages that included simple and direct tone and provided statistical evidence. The findings demonstrated patients’ needs and expectations for advanced tailoring strategies in both message content and delivery. Together, the manuscripts fill a significant gap and inform research and practice for the development of more effective message strategies that could lead to reducing the spread of type 2 diabetes worldwide. / Graduate / 2022-05-12

The importance that physical movement holds for people’s health is not up for debate. Staying active can alleviate a lot of symptoms, both physical and mental, that occur in both young and old, due to a sedentary lifestyle or to aging. Because of the way the society is developing, more and more people suffer from a sedentary lifestyle. Among all age groups, the older people have an especially high risk for negative side effects of too much sedentary time. The World Health Organization encourages countries to help combat the sedentary lifestyles and motivate people to exercise more. In their efforts to make sure people across countries have access to health information they also encourage the development of digital health tools and the use of eHealth, which falls under the umbrella term digital health. To create the lifestyle changes needed to become and stay more physically active there can be a need for motivational factors such as triggers, reminders and other motivators. Persuasive design in general and nudges in particular have the function where they will nudge people towards making a behavior change without removing the autonomy of the person. As the older people in Sweden are generally both digital and eHealth literate and are able to handle health related matters such as booking appointments and reading their health journal online, we see a possibility to examine the area of nudging the older towards a behavior change that leads to increased physical activity. Thus, in this study we examine to what extent digital nudges impact physical activities and related conditions, we chose a within subject design experiment which had two conditions – with and without a mobile application that offers digital nudges during two weeks of time period. In our study the test subjects are people above 65 years old as this group of people would greatly benefit from more physical activity and the study of how digital nudges would affect the older population in Sweden is an understudied area. The participants in one of the groups were nudged, using nudges such as the position effects, social norm and framing effects. A dependent t test was conducted and depending on the alpha level used, there was a statistical significance shown. Overall the amount of physical activity in older adults having a prototype with nudges was significantly higher. The results for this study are relevant to some degree since this is not something that has been studied before.

The healthcare and life sciences sectors are currently undergoing a transition towards becoming digitized. Mobile health (mHealth), a subset of digital health, offers many potential benefits to healthcare. Despite that, it has been reported that the majority of mHealth initiatives do not evolve beyond the pilot stage. A core reason seems to be the lack of user-centered value propositions in mHealth projects. Here, we evaluate if the use of the principles of design thinking (DT) can endorse the creation process of user-centered value propositions. For that, several scoping meetings with experts on topics of relevance were carried out, which helped define the scope, the methodology, and formulate the research question in the optimal direction. Interviews with the founders of four startups that operate in the mHealth industry constituted the basis of the findings, with the product or service development process as the central aspect. A framework for DT was employed to analyze the cases, which proposes five themes that should be considered throughout the process: User Focus, Problem Framing, Experimentation, Visualization and Diversity. Our research shows that the use of DT principles can help achieve more valuable outcomes (e.g. more user-centered value propositions), be more efficient and collaborate better. Nevertheless, more knowledge about DT is needed among entrepreneurs, as well as a more uniform consideration of the five themes of DT.