Despite legal and technological advances, women still face barriers to abortion care in legally restricted or low-resource settings. The advent of medication abortion using misoprostol with or without mifepristone, has enabled women to self-manage their abortions outside of the formal healthcare system. Self-managed abortions are often assisted by telemedicine services, which provide women with evidence-based guidance on managing the abortion process on their own. This thesis explores two separate abortion telemedicine services operating in legally restricted and/or low resource settings – a global online telemedicine service and an abortion support hotline in Venezuela – and evaluates the outcomes associated with each. By interviewing counsellors at a Venezuelan abortion support hotline and the women who used the service, we gained a stronger understanding of the hotline’s successes, barriers, and areas for improvement. We conclude that abortion telemedicine services provide effective and acceptable care, in general, and we recommend greater access to misoprostol in Venezuela.

Background: Tobacco use is one of the key problems that public health has to face. Tobacco smoking is among the main causes of morbidity and preventable mortality that can be effectively avoided. The eHealth approach uses information and communication technologies to improve the quality of health and healthcare. EHealth interventions delivered through technologies and the Internet are an effective therapeutic tool which contributes to behaviour change, including smoking cessation. This paper presents the results of continuous research on fully automated online eHealth intervention for smoking cessation. Aims: The main objective of this study was to identify the effect of the form of reminders (SMS vs. email) in eHealth smoking cessation intervention using the Endre eHealth program in the population of Czech tobacco smokers. Materials and methods: This research consists of two studies. First, a pilot study on user- acceptance of eHealth intervention was performed in a sample involving 30 respondents. This was followed by a randomized two-arm controlled study comparing the effect of a predictor in the form of eHealth intervention reminders for smoking cessation. Adult tobacco smokers were recruited based on advertising through a variety of online channels. 158 respondents were randomised for the...

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Malaria significantly contributes to morbidity and mortality rates in Zambia. The currently accepted malaria treatment is artemisinin-based combination therapy (ACT); it is more than 97% effective when the regimen is strictly adhered to. However, the mean ACT adherence rate in sub-Saharan Africa is only approximately 38-48%. Poor pharmacoadherence remains a significant barrier to malaria control and elimination. The purpose of this study was to determine if adherence rates to a six-dose ACT antimalarial treatment differ between patients in Zambia who received short message service (SMS) reminders and those who did not. An experimental, randomized, controlled trial was conducted to collect data from a sample of 96 adult patients with malaria who presented to Fisenge Clinic in the Copperbelt Province of Zambia. Participants were randomly assigned to a control or intervention group. The intervention group received SMS messages to remind them to take their medication according to the regimen. An electronic pillbox was used to measure pharmacoadherence for both groups, and patients were classified as probably adherent or probably non-adherent. Data were analyzed using Chi-square for association between the SMS intervention and pharmacoadherence, and logistic regression used for predictors of adherence. No significant association was found between SMS reminders and pharmacoadherence among malaria patients being treated with ACT when evaluated with respect to those who received the SMS reminders and those who did not (x2=0.19, df=1, p=0.67). Binary logistic regression indicated that there were no variables associated with adherence (p > 0.05). Findings from this study contribute to the research regarding the use of mobile phones to promote adherence. This is the first study of its kind using SMS directly to the patient for ACT adherence in sub-Saharan Africa known to the author. It is possible that the use of the electronic pillbox and/or the novelty of participating in a research study contributed to higher levels of adherence than previously found in this geographical area. While data suggested that there was no association between SMS and adherence, further research is needed to explore the value of this intervention.

<p><strong>Background.</strong> People with psychotic disorders tend to die earlier than the general population, primarily due to preventable cardiovascular disease. Behavioral risk factors, such as poor diet, have been identified as major contributors. Given the importance of prevention, the early stages of psychosis have been described as a “critical” time to intervene on health behaviors. As such, a mobile-based intervention, Nutrition Enhancement in Early Psychosis (NEEP) was created to improve diet quality in persons with early psychosis. This study has three aims: (1) assess the feasibility of the intervention, (2) examine preliminary outcomes, and (3) investigate mechanisms associated with dietary change. </p> <p><br></p> <p><strong>Methods.</strong> NEEP incorporates a combination of nutrition education, goal setting, and mobile technology (i.e., a mobile application for dietary tracking, as well both automated and personalized text-messages). Given the pilot nature of the study, all participants <em>(N=15)</em> received the intervention. Feasibility was assessed through different metrics related to recruitment and adherence to the dietary tracking application, as well as self-report responses regarding acceptability. Preliminary outcomes (i.e., two measures of diet quality) and potential mechanisms of change (i.e., self-efficacy and motivation) were also evaluated using paired sample t-tests. Qualitative interviews were conducted following study participation. Given the emphasis on feasibility with a small sample, all significance tests were set at p <.10, and Hedges <em>g</em> was used to examine effects over time.</p> <p><br></p> <p><strong>Results.</strong> 15 participants were enrolled in the study and 12 participants completed follow-up assessments. Evaluative measures of feasibility suggest that the majority of those who were screened enrolled in this intervention and regularly engaged with the mobile tracking device to record their dietary consumption. In addition, participants enjoyed the intervention and found it to be useful in improving their diet. Preliminary evidence also suggests this intervention may improve diet quality. As such, one indicator of improvement in diet quality was considered significant (Rapid Eating Assessment for Participants- Shortened; p=.084), and both measures of diet quality suggested improvement in diet at the end of the 28-day intervention with small to medium effect sizes (REAP-S <em>g=</em>.44; Heathy Eating Index-2015 <em>g</em>=.69). Contrary to hypotheses, self-efficacy significantly decreased after the intervention (p=.028) and motivation remained relatively stable.</p> <p><br></p> <p><strong>Conclusion.</strong> Results suggest that NEEP is feasible as a low-cost, low-resource mobile intervention that is well-tolerated and may improve diet quality in people with early psychosis; however, mechanisms of change require further exploration. </p>

Half of American women do not sustain recommended levels of physical activity (PA). Wearable activity trackers (WATs) may increase both awareness of, and PA if worn daily. Thus, WATs should include features and designs that encourage daily use. This study aimed to determine WAT features and designs most appealing to women and the motivational effects of various WATs. For this mixed-method pilot study, 15 women each trialed three WATs; documented daily PA levels; and rated their satisfaction with each device's comfort, features, and motivational effect. Additionally, participants shared experiences and feedback in focus groups. Features that promote adoption of WATs among women are, 1) comfort 2) extended battery life, 3) durability, 4) immediate PA feedback, 5) intuitive PA sensing, and 6) programmability. WATs with these preferred qualities may effectively motivate women to increase PA, leading to improved overall health, and reduce healthcare costs.

Smartphone technology has transformed the process by which women understand themselves, manage their care decisions and access health information, while also creating a space for more integrated and individualized understandings of wellness. Using exploratory, semi-structured interviews (n = 27) and observation of phone use, this study examines how minority women in Boston engage with smartphones through health-related mobile applications and web searches. Drawing upon postphenomenology, I examine the way smartphones have become both a regulatory force and motivational tool in the formation of self. I argue that the integration of smartphones into user identity positions them as the primary entryway for health decision-making (Garro, 1986, 1998) and patient-clinician interactions.

AIM: To review and characterize dental mobile apps in the peer-reviewed literature and two popular mobile app stores, and assess their quality. METHODS: A scoping review methodology was used to identify different types of mobile dental apps in seven medical and technical databases. The data of the identified research studies on dental apps were extracted (coded) by two researchers in a systematic process and the results were analyzed. Dental apps’ characteristics, publication pattern, development methodology, efficacy, and usability were reported. Then, a systematic review was conducted in Google Play and iOS app stores to identify patient-facing dental apps. Popular keywords were identified from multiple sources such as using Google Trends. Two researchers extracted the information of the identified dental apps and descriptive, and correlation analyses were conducted. Apps were evaluated for the presence of behavior change techniques (BCTs), evidence-based guidelines, technological features, privacy and security, credibility and health literacy. Lastly, a quality assessment using MARS scale was conducted for a selected sample of dental patient-facing apps from the published literature and the popular app stores. RESULTS: The search resulted in 38 studies on dental apps. The identified dental apps (37) targeted multiple users and the common topic was oral pathology such as dental caries. The majority of dental apps was developed for diagnostics and screening purposes (40.5%). Apps included varied features and educational strategies. Only two papers used theories for developing dental apps, and five studies followed user-centered design principles. Fourteen papers only reported the use of clinical guidelines for developing dental apps (36.8%). Mobile app search resulted in 52 patient-facing dental apps (37 Android apps, and 15 iOS apps). The majority of apps focused on Oral Hygiene Behavior (31%). Apps targeted multiple users and contained varied features and BCTs including instructions (80.8%) and credible source (67.3%). Eleven apps were identified for the third project and the highest total MARS score was Philips Sonicare. The app contained the largest number of features compared to other apps (24). CONCLUSION: The dissertation will warrant the selection and prescription of high-quality dental apps, and will advance the research work in mobile apps in dentistry.

Suicide ranks as the second leading cause of death for youth aged 10-24. To address this public health problem, novel and effective risk mitigation interventions are needed. Evidence-based research has found that collaborative safety planning is a promising approach to reducing suicide risk. Traditionally, safety plans have been administered in a paper-based format. Emerging research has attempted to translate suicide prevention safety plans to mobile Health (mHealth) smart technologies (i.e., mobile apps); yet, this work is still in preliminary stages and lacks systematic assessment, especially mHealth apps for youth. Our research aims to highlight the needs of technological solution for suicide safety planning and call attention to the shortcomings of baseline safety planning apps so that mHealth researchers can build a better solution for youth to manage their mental health. To do this, we developed a mobile application for suicide safety planning called “SafeLINC.” We had young adult participants assess and compare this newly developed app with an open-source suicide safety planning app currently available for use (i.e., “Suicide Safety Plan") to identify whether either app would be useful for youth to manage their mental health through safety planning. SafeLINC is an Android and iOS app that incorporates the six dimensions of Stanley and Brown’s framework for suicide safety planning as well as sharing safety planning data with parents and clinicians, and visualizing safety planning data over time. We conducted a user study with ten college students (ages 18-21). We first aimed to understand how they currently managed their mental health and their perceptions. Then we asked them to complete a core set of tasks across both suicide safety planning applications to conduct a comparative analysis of the strengths and weaknesses of the two apps. We also asked participants to suggest new features to incorporate into the apps that would better support their mental health and coping strategies. We found that most participants use a variety of emotional outlets to cope with their mental health; sometimes using online tools to support these outlets. When using the apps, participants overall preferred SafeLINC to the baseline app because it allowed them to connect with their support network, provided better guidance in the creation of their safety plans, and enabled them to keep track of changes to their mental health. However, participants identified barriers that could inhibit their use of safety planning applications. For example, the downsides of including parents or guardians in the support network, unclear terminologies, and reminding negative feelings were prominent perceptions while using the SafeLINC app. Participants offered suggestions relating to the weaknesses they observed in both apps. Our study highlights how suicide safety planning apps may be beneficial to manage mental health, but contextual factors may still affect usage. We provide recommendations for overcoming these challenges based on the insights gained from our study.

Problem: A Major challenge for healthcare providers is the non-adherence of patients to prescrip- tions. One important area is hypertension treatment through medication. A treatment often starts with multiple adjustment cycles of medication type or dosage, which are based on regular at-home blood pressure measurements. Patients therefore need to adhere to regular medication intake and blood pressure measurements. Research Aim: The project first explored whether or not it is possible to develop a medication reminder system that checks patient adherence based on vital parameters. The project goal was adapted to the design and development of a reminder and data logging system for hypertension patients, based on the following research questions: 1) What are functional and non- functional requirements for the proposed artefact? 2) How can these requirements be implemented? Method: The project makes use of Design Science Research to create the system. The problem and requirement explication for the new artefact was achieved by working closely with a general prac- titioner who deals with hypertension patients. The artefact was evaluated by presenting it ex-post to a focus group of a hypertension patient, developers and founders in digital health. Results: The results of expert interviews concluded that the initial project aim is not feasible due to continuous vital monitoring being invasive and intrusive, lack of applicability for health conditions and medica- tions and other potential negative consequences. These insights led to the new research aim. The results address the question: ”What are functional and non-functional requirements for the proposed artefact?”. The envisioned product is a cross-platform application, illustrating the frequent medica- tion adjustments for hypertension patients. The treating doctor should configure all patient-specific parameters and the app should guide patients through daily tasks like measurements and medication intake. The patient should also be reminded of their tasks. The app should record, display, and export data for the doctor’s review, and ensure easy input of measurements. Future remote data exchange capabilities via servers were also considered. To address the research question ”How can these requirements be implemented?”, the researcher developed a cross-platform mobile application for iOS and Android with .NET Multi-Platform App UI (MAUI) that implements the desired features. A concept for remote data exchange and a system for scanning measured values of blood pressure devices were developed. The evaluation partially validated the problem area and discussed future implementations, such as remote data exchange, usage of patient data for research and adoption to other medication. The perceived high usability of the application was emphasized. Conclusions: The researcher concludes that the developed artefact addresses a relevant problem and extends existing solutions in the problem space. It is acknowledged that future research has to be conducted to prove the effectiveness of the tool as well as assess its usability and accuracy. Difficulties for accepting the artefact in real life settings are discussed.