In the past decade, mobile communication services such as cell phones and other types of hand-held devices have become relatively cheap, affordable and accessible, especially in developing countries, including Peru. The applications of mobile devices in health, or mHealth, are surfacing and have the potential to improve the delivery and quality of health by eliminating the distance barriers; permitting the availability and retrieval of data in a timely manner; educating the public on prevention; supporting the management of diseases, and promoting patient empowerment to the population, including those that are socially stigmatized. Equally important, in conjunction with technology, training is another important factor to build a critical mass of professionals to develop and evaluate mHealth strategies. In order to take advantage of the technology at hand, health professionals must be able to know how to use these tools that are available to them. The purpose of the study is to explore the research and training, and mHealth strategies being developed in Peru. The study has the following aims: • To examine the process, progress and lessons learned of a) the mobile health initiatives of Peru through the lens of the Cell-POS project, and b) the training initiatives on mHealth in Peru through the lens of the QUIPU project; • To discover how people with HIV can achieve patient empowerment and involvement in managing their own health through the use of cell phones. For the mobile health project (Cell-POS) both quantitative and qualitative data collection was gathered, which resulted in an in-depth research analysis evaluating the efforts and initiatives of mHealth solutions in Peru, with a focus on how the use of mobile technology can help people with HIV feel empowered. In addition, it was explored how mobile health is being positioned in the area of training through the lens of the QUIPU project. A two-day expert meeting which took place on March 26 and March 27, 2010 in Lima, Peru resulted in insightful discussions of the problems and necessities regarding training in Biomedical and Health Informatics; specific issues about the curricula and the level of multidisciplinary were also discussed. Through the QUIPU project it was found that the challenges and needs are very similar across Latin America; however, through collaboration and partnerships, global health initiatives are on a rise. The Cell-POS project examined the feasibility, acceptability, perceived ease of use, and usefulness towards mHealth in relation with patient empowerment. The primary finding was that participants were satisfied and accepted the Cell-POS platform quickly and without difficulty. After six months of use, the results demonstrated that the participants perceived that the messages were clear, effective, and understandable and it was easy to incorporate the Cell-POS system to their daily activities. Most participants perceived that Cell-POS enhanced their knowledge related to HIV treatment and improved their ability to take their medications correctly and on time. Through proper planning, research initiatives and collaborative work, a successful project can be achieved. Peru has great potential, which is already starting to show through the research and work that is currently taken place. This study examines selected mHealth initiatives in the context of research and training of mHealth in Peru. / Graduate

Master of Public Health / Kinesiology / Brandon Irwin / Background: Emerging technologies (i.e. smartphones, Internet) may be effective tools for promoting physical activity (PA); however few studies have provided effective means of using them to enhance social support. Face-to-face programs that use group dynamics-based (GDB) principles of behavior change have been shown to be highly effective in promoting group cohesion and PA however few studies have examined their effects in web-based programs. The present study examines the effect of a GDB application on group cohesion and PA. We expected partner’s level of presence to moderate this effect. Methods: Subjects (n=135) were randomized into same-sex dyads and randomized to an experimental condition: low cohesion/low presence (LC-LP), high cohesion/low presence (HC-LP), high cohesion/high presence (HC-HP), or individual. Participants performed two blocks of planking exercises (pre-post). Between blocks, participants in partnered conditions were met their partner using either a standard social support application (LC-LP) or a GDB social support application (HC-LP and HC-HP), where they participated in a series of team-building exercises. Individual subjects were given a rest period. Participants in the HC-HP saw a live video stream of their partner exercising during Block 2. Perception of cohesion was measured using a modified Physical Activity Group Environment-Questionnaire (PAGE-Q). PA was calculated as performance during Block 2 controlled for by performance during Block 1. Results: Findings show that perception of cohesion was higher for the HC-LP condition compared to the LC-LP conditions in three of the four cohesion dimensions: ATG-S(p=0.002), GI-T(p=0.002), GI-S(p=0.022), but not ATG-T(p=0.170). Cohesion means did not differ between HC-LP and HC-HP conditions. Only the HC-HP condition produced significant gains in PA compared to other conditions (HC-LP: p=0.044; LC-LP: p=0.018; Individual: p=0.001). Conclusions: Findings suggest that a GDB application may be an effective method of improving group cohesion, however it may be insufficient on its own to improve PA. Increasing presence may be an effective method of improving performance during a single session of PA, however further research is needed to determine its effect on long term behavior change.

abstract: Children are five times more likely to be overweight at the age of 12 years if they are overweight during the preschool period, and 60% of overweight preschoolers are overweight at the age of 12 years (Matusik & Malecka-Tendera, 2011). Primary care interventions are urgently needed to improve healthy lifestyle behaviors in families. Parental influence plays an important factor in the development of healthy behaviors in children. Cognitive behavioral interventions have demonstrated preliminary success in promoting healthy lifestyle behaviors in both adults and children. Mobile technology used to supplement interventions aimed at behavior change offers an outlet to bridge gaps in health disparities and generate innovative evidence. Therefore, the purpose of this research was to establish the feasibility, acceptability, and preliminary effects of a cognitive-behavioral intervention (TEXT2COPE) synergized with mobile technology on the healthy lifestyle behaviors of parents of overweight and obese preschoolers. Primary aims of the proposed pilot study were to (a) examine the feasibility and acceptability of the TEXT2COPE program among parents of overweight or obese preschoolers with mobile phones; (b) evaluate the preliminary effects of the TEXT2COPE program on healthy lifestyle behaviors in families with overweight or obese preschoolers; and (c) evaluate the relationship among the study variables (i.e., cognitive beliefs, perceived difficulty, and healthy lifestyle behaviors). Findings indicate that this program is feasible and acceptable in this population. The intervention improved healthy lifestyle beliefs and behaviors in parents. Further supported are the interconnected relationships between parental beliefs, thoughts, and behaviors. / Dissertation/Thesis / Ph.D. Nursing and Healthcare Innovation 2014

abstract: Mobile apps have improved human lifestyle in various aspects ranging from instant messaging to tele-health. In the current app development paradigm, apps are being developed individually and agnostic of each other. The goal of this thesis is to allow a new world where multiple apps communicate with each other to achieve synergistic benefits. To enable integration between apps, manual communication between developers is needed, which can be problematic on many levels. In order to promote app integration, a systematic approach towards data sharing between multiple apps is essential. However, current approaches to app integration require large code modifications to reap the benefits of shared data such as requiring developers to provide APIs or use large, invasive middlewares. In this thesis, a data sharing framework was developed providing a non-invasive interface between mobile apps for data sharing and integration. A separate app acts as a registry to allow apps to register database tables to be shared and query this information. Two health monitoring apps were developed to evaluate the sharing framework and different methods of data integration between apps to promote synergistic feedback. The health monitoring apps have shown non-invasive solutions can provide data sharing functionality without large code modifications and manual communication between developers. / Dissertation/Thesis / M.S. Computer Science 2014

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We have received a mission from a surgical ward at a hospital in northern Sweden; they want a solution that can be used on portable devices. On these devices the healthcare professionals should be able to document the measured vital signs and the results should automatically be documented in the patient record. In the context of a Participatory Design project we conducted design sessions which focused on the user interface of the solution but also deliberated possible functionalities that were not mentioned in the original mission description. The purpose of this study is to describe the situation surrounding the measurement of vital signs of patients. It is currently done manually on a paper form and then registered in the digital patient record. Our aim was to find a design and formulate the functional requirement of a tablet application together with the staff at a hospital in Sweden.

Many health care providers aim to become more patient-centered, and developing mobile health applications for patients might help achieve this. In the light of this, this thesis explores if the progressive web application (PWA) concept is suitable for mobile health applications. It is investigated by developing a PWA intended to be used to gather health care patients’ self assessments. The work follows the double diamond design process with: a discover phase containing a literature study, interviews with experts, and partaking in a workshop; a define phase where system requirements are specified; a develop phase with lo- and mid-fi prototypes as well as usability tests with six test users; and a deliver phase where the application is implemented using Polymer 2.0 and web components. To furthermore assess the patients satisfaction of a PWA, an evaluation phase is conducted where eleven test users tries it during five consecutive evenings and answers a survey at the end. The general opinions were that they thought it worked good and was easy to use, indicating that a PWA can be suitable for this purpose. Following this and discussions of findings, we suggest guidelines for how to design and implement a PWA for similar projects. However, the developed PWA was due to shortage of time not completely finished and the test users support for PWA features were rather limited, so future investigation is recommended to determine if PWAs are suitability in this context.

Bakgrund: Ungdomar i Sverige mår allt sämre psykiskt. Få söker hjälp hos vården när de mår dåligt. BUP har långa väntetider och därmed får få hjälp direkt när de behöver det. Ungdomar riskerar att försämras i sitt mående vid utebliven kontakt med vården. En app skulle kunna vara ett alternativ för dessa ungdomar innan de får möjlighet att komma till vården. Syfte: Studiens syfte är att belysa hur ungdomar som använder appen ”Här ligger jag…” uttrycker sitt mående. Metod: Studien har en kvalitativ ansats. Efter godkännande från användarna samlades data in från appen under en veckas tid, i mars 2020. Kvalitativ innehållsanalys användes för att analysera de 414 insamlade inläggen. Resultat: Resultatet består av fem kategorier av måenden. Det visade att ungdomarna har ett behov av att uttrycka sig kring ångest, depressiva symtom, ensamhet, hat och välbefinnande. Slutsats: Ungdomars behov att uttrycka sitt mående skulle kunna tillgodoses av en sjuksköterska med kunskap om ungdomar som ger vägledning till att hälsoappar finns att tillgå 24 timmar om dygnet. Ämnet psykisk ohälsa kan uppfattas som ett känsligt ämne att tala om och därför kan det vara lättare i ett forum där alla är anonyma. / Background: Mental health problems are increasing for adolescents in Sweden. Few of them seek help from health care when they are feeling unwell. Children and adolescents psychiatry in Sweden have excessive waiting lists for help seekers and therefore few who require help are getting it directly when needed. Adolescents are at risk of worsening their mental health status without available professional help. An mhealth app have the potential to be an alternative for adolescents with mental health problems before they have a chance to receive professional help. Objective: The aim of the study is to highlight how adolescents express their mood in the ”Här ligger jag…” app. Methods: This study has a qualitative approach to the field. The collection of data was carried out during one week in March of 2020 with consent from the users. A total of 414 posts was collected and analyzed using qualitative content analysis. Results: The result consist of five categories with expressions of feelings. It shows that adolescents have a need to express themselves about anxiety, depressive symptoms, loneliness, hatred and well-being. Conclusions: Nurses with knowledge about adolescents needs to express their mood could guide them to find mhealth apps which are available 24/7. Talking about mental health may be perceived as a difficult topic to discuss and therefore it may be easier in an anonymous forum.

For several decades, market fragmentation caused by different operating systems has been complicating and overpricing the process of creating new applications. Unified development for multiple platforms does not only save time and expenses, but also enables to reach a far wider audience. This work presents the topic of a cross-platform mobile development and analyzes the development of the market for currently the two most prevalent operating systems – Android and iOS. The results of the analysis are used to design and create a multiplatform tool intended to monitor immunopathologic reactions. The work also includes a marketing plan and expected economic valuation once the developed application is introduced to the market.

Problem Statement: Many developing countries are still grappling with poor health as a result of strained healthcare systems. Top among health inequalities is maternal care with maternal mortality rates being almost 19 times higher in developing countries than in their developed counterparts. mHealth presents the potential for developing countries to overcome some of the traditional healthcare challenges. However, despite the compelling evidence for the potential of maternal mHealth from the plethora of effectiveness studies, why when and how interventions work/do not work in different contexts are not fully understood. Socio-cultural factors are one of the most cited reasons for variance in uptake and utilisation of such technologies. To date, research explaining how socio-cultural factors shape mHealth utilisation is sparse. Purpose of the study: The main objective of the study was to explain how mHealth utilisation behaviour emerges within the healthcare-seeking socio-cultural context. To achieve the objective, the study identified the socio-cultural characteristics of the maternal healthcareseeking context and analysed the user-technology interaction within this context. Research methodology: Building on the foundation that human experiences are best understood in situ, the study adopted explanatory methods guided by an interpretivist paradigm. The study drew upon Activity Theory as a lens to understand the maternal mHealth utilisation phenomenon. Hence, we theorised healthcare-seeking as an activity whose cultural aspects were further understood using Hofstede typology of culture. The study used a Kenyan maternal mHealth intervention to elucidate the phenomenon. We employed semi-structured interviews, focus group discussions, observations, informal discussions, and document review to gather data. The sample was purposively selected and comprised various maternal health stakeholders: maternal health clients, their partners, project implementers and healthcare professionals. Key findings: The results of the study show that the healthcare-seeking socio-cultural context which is characterised by socio-cultural attributes such as high-power distance, high uncertainty avoidance, gendered relations, and collectivism shapes mHealth utilisation behaviour in a dialectical process. This process takes place as maternal health clients shape and are shaped by mHealth within their healthcare-seeking socio-cultural context through a process of internalisation and externalisation. From an internalisation perspective, uncertainties and risks in the maternal healthcare-seeking context resulted in hesitated adoption. Contextual perceptions of usefulness of the intervention resulted in the use of mHealth to substitute other healthcare structures while having different perceptions of the role of mHealth created dissonance among the maternal health clients. With regards to externalisation, maternal health clients adopted legitimisation strategies to reduce uncertainties and to develop trust required for initial and continued use of the intervention. They legitimised both the intervention artifact, and the information. Since the mHealth intervention presented appropriate social cues, being accompanied by the expected health provider's persona, maternal health clients readily humanised the intervention. The contextual social norms around pregnancy also presented a need for the maternal health clients to make their mHealth use an ‘appropriate behaviour' by negotiating use with relevant stakeholders in the context. Finally, in response to mHealth technology paradoxes that challenged the very motive of healthcare-seeking, maternal health clients coped by abandoning mHealth, or otherwise accommodating it. Originality/contribution: This study contributed to knowledge, theory, and practice. First, the study suggests theoretical propositions that explain how mHealth utilisation behaviour emerges. These findings may be useful to similar developing-country contexts. A further contribution to theory emerges from the use of Activity Theory to understand the phenomenon. The study helps to operationalise Activity Theory concepts in Information Systems research. Second, the study provides recommendations to practise with regard to the design and implementation of mHealth interventions. These insights may be useful to mHealth designers and implementers in designing mHealth solutions that are contextually relevant. Here, we propose the consideration of mHealth intervention characteristics that will aid utilisation, involving healthcare professionals and other community stakeholders in mHealth implementation and integrating mHealth into existing healthcare structures.