Introduktion: Långvarig smärta kostar samhället mycket pengar varje år. Under 2020 och 2021 utvecklades applikationen Vitala som stöd för patienter med behov av fysisk aktivitet i sin rehabilitering av sjukdomar. I applikationen ingår en del som syftar till rehabilitering för personer med muskuloskeletala besvär i nacke, axlar, rygg och höft. Den här studien är den första av sitt slag som utvärderar rehabiliteringsdelen i Vitala. Syftet med denna studie var att undersöka användbarhet, deltagarnas förståelse för applikationens frågor och instruktioner, samt relevansen av Vitalas val av övningar för deras smärtmekanismer. Metod: Tio studiedeltagare med besvär i nacke-/skuldra och ländrygg-/höft sedan ≥4 veckor rekryterades genom en privat fysioterapi- och naprapatklinik i Stockholm. Deltagarna observerades när de använde applikationen för att diagnostisera sina besvär och deras förståelse för appens frågor och tester bedömdes. Efter användning skattades användbarhet genom frågeformulär (Health-ITUES och System Usability Scale). Validitet undersöktes genom att jämföra funktionsdiagnos och övningar som förskrevs av Vitala med en erfaren fysioterapeuts bedömning av funktionsdiagnos och rekommenderade övningar. Resultat: Användbarheten i rehabiliteringsdelen skattades mellan mycket bra och bästa tänkbara. Studiedeltagarna förstod frågor och instruktioner i 88% av fallen. Applikationens funktionsdiagnoser var i linje med fysioterapeutens i 9 av 10 fall. Överensstämmelsen av övningarna var fullständiga för fem av deltagarna, fyra saknade något element och endast en bedömdes bristfällig. Konklusion: Studiedeltagarna visade en god förståelse för Vitalas frågor och instruktioner, vilket var i linje med deras egna skattningar där appen bedömdes vara lätt att använda. En viss svårighet med att förstå vad som menades med begreppen smärta och besvär uppstod hos en del. Vitala hade en god överensstämmelse gällande övningar och funktionsdiagnos, med undantag för deltagare med patoanatomiska förändringar eller nociplastiska smärttillstånd.

Background: Shared decision-making (SDM) counseling for lung cancer screening is recommended by multiple professional societies and mandated by the Center for Medicare and Medicaid Services since lung cancer screening has both benefits and risks. However, uptake of SDM counseling as well as lung cancer screening itself remain low. We sought to develop educational text messages about lung cancer screening as an innovative implementation intervention tool to promote patient-provider discussion about lung cancer screening. Methods: After the study team drafted educational text messages about lung cancer screening, informed by existing decision aids, participants who had had lung cancer screening were recruited and asked to review and edit text messages. After that, participants eligible for lung cancer screening without the previous screening experience were recruited and were asked to select the messages to be included in this text message intervention. The final set of 14 text messages were delivered to the participants both with and without the previous lung cancer screening over a period of 14 days. Participants completed a telephone survey assessing their reactions to the messages after receiving the last message. Results: We successfully involved twelve participants with lung cancer screening experience and eleven lung cancer screening eligible participants without previous screening experience in the development of educational text messages about lung cancer screening. After one participant withdrew, 22 participants received text messages and completed the survey regarding the messages. Most participants (18 of 22) reported reading all 14 text messages, however most recommended sending fewer messages (median recommended number of messages = 10). Participants found the educational text messages informative. Only four participants reported the text messages triggered anxiety and two reported text messages disrupted their daily activities. Participants perceived the text messages would empower patients to discuss lung cancer screening with their providers. Conclusion: Participants generally supported the use of educational text messages about lung cancer screening to increase patients’ awareness and promote patient-provider discussion. Engaging patients in the development and evaluation of text messages elicited helpful feedback that will inform the content of the messages to be delivered via this lung cancer screening text messages intervention.

Migraine is ranked as the third most widespread disease in the world by Global burden of Disease and study 2010. To reduce pressure on health care and also help patientsunderstand their condition, mobile health applications have become increasingly popularand accessible. These applications help by providing disease information, to documentsymptoms and analyze attack patterns. However, there is both a lack of patient centeredperspective and scientific based knowledge behind the design of these applications. Therefore, the aim of this study is to explore what might affect the patients’ motivationto use a mobile application to explore their condition. This by looking into how these applications can be designed so that patients’ find them helpful and easy to use. This wasdone by doing a qualitative interview study with ten patients with severe migraine andanalyzing the transcribed data through a reflexive thematic analysis. The thematic analysis resulted in three overarching themes personal motivations of exploring migraine, healthcare related motivations of exploring migraine, and technical support for motivation of exploringmigraine. Each overarching theme contained themes and sub-themes that are backed up byquotes in the data from the interviews. Also a proposal on how to visualize the threeoverarching themes in relation to each other is presented.In conclusion, designing applications that help with acceptance of condition, adaptivecontent and functionality, and deciding on a specific target patient group, are central findings of this study. Directives from health care was found to be the largest motivationaldrive in this study and could further be explored to work better with migraine applications.

No description available.

To date, there are no existing models for evaluating foreign markets, adapted to mobile health (mHealth) consumer medical device (CMD) start-ups seeking to launch their products or services in new countries. This calls for the development of a suitable international market selection (IMS) model that captures the complexity of and opportunities for mHealth. mHealth is a sub-segment of electronic health (eHealth), which furthermore is part of the wider phenomenon of digital health. mHealth covers medical and public health practice supported by mobile devices. This paper proposes a multidimensional IMS model comprising both macro and micro level factors. Our specialized approach integrates tools and theories by a number of researchers and is showcased in the assessment of the European Union (EU) for the mHealth CMD company AdhereBox. AdhereBox is a Swedish start-up that has developed a CMD consisting of a “smart” pillbox and a complementary mobile software application. We propose a number of dimensions that should be evaluated when assessing the potential  of the different EU health care markets in regards to mHealth CMD start-ups. Our suggested approach includes factors which are categorized into two groups of parameters: (i) stakeholders (which comprises consumers, providers, payers, distributors and collaborators) and (ii) barriers & enablers (consisting of incentives, reimbursement models, technological infrastructure, regulations and existing solutions). In summary, our study identifies critical factors that mHealth CMD start-ups should consider when evaluating foreign markets in an IMS. By applying our IMS model on AdhereBox, we illustrate how our model can be used, its parameters assessed and the interdependencies between these analyzed in order to arrive at a set of recommendations for further market analysis and conclusions on country attractiveness. As such, we believe that our research could provide valuable insights and guidelines for firms within mHealth seeking to expand their business within the EU, as well as for governmental organizations that want to better leverage and stimulate the potentials of a flourishing domestic mHealth ecosystem.

Many Syrian refugees residing in Germany have been exposed to traumatizing events, while treatment options are scarce. Therefore, the self-help app “Sanadak” was developed to target post-traumatic stress in Syrian refugees. We aimed to inspect the recruitment and baseline characteristics of the participants in the trial, which is conducted to evaluate the app. Analyses were based on the recruitment sample (n = 170) and the trial sample (n = 133). Data were collected during structured face-to-face interviews in the Arabic language. Targeted outcomes included post-traumatic stress (primary; Post-traumatic Diagnostic Scale for DSM-5/PDS-5) and depressive symptoms, anxiety, resilience, among others (secondary). Recruited individuals were M = 32.8 (SD = 11.2, range = 18–65) years old; 38.8% were women. The average PDS-5 score was 23.6 (SD = 13.2) regarding trauma exposure, which was most frequently related to experiencing military- or combat-related events (32.9%). Moreover, 46.5% had major depression and 51.8% showed low resilience. Anxiety was present in 40.6% of the trial participants. Psychological distress was high in Syrian refugees residing in Germany, enrolled in a trial targeting post-traumatic stress. This underlines the need for intervention. Our results provide important figures on the mental health of a not well-studied population group in Germany.

Contexte: Malgré l’avancement des recherches sur les applications de santé mobile servant à la télésurveillance, on n’en sait très peu sur l’expérience des patients qui en utilisent. Objectifs: La présente recherche vise à évaluer l’expérience des patients des effets positifs de la télésurveillance sur la prise en charge de l’insuffisance cardiaque à domicile, des difficultés éprouvées et des facteurs favorisant ou limitant l’utilisation de l’application mobile TakeCareMC. Méthodologie: Des entrevues semi-dirigées ont été menées auprès de 12 patients suivis dans la clinique d’insuffisance cardiaque d’un centre hospitalo-universitaire et ayant utilisé l’application de surveillance à domicile pour téléphone intelligent pendant au moins trois mois d’une intervention pilote. L’application mobile demande au patient de prendre quotidiennement ses signes vitaux et de répondre à des questions sur les symptômes. Un infirmier clinicien s’occupe de surveiller les données à distance (5 jours sur 7) et de joindre le patient par téléphone en cas d’alerte. Le plan de traitement est ensuite modifié si nécessaire, soumis de nouveau au comité de surveillance et envoyé au clinicien. Les entrevues ont été enregistrées, transcrites et analysées de manière manuelle. Résultats: Tous les participants ont convenu des avantages et de la facilité d’emploi de l’application. Les avantages étaient notamment le fait que l’application favorisait la surveillance de la maladie, autant par les cliniciens que par les participants eux-mêmes, et les effets positifs perçus sur leur état de santé, l’amélioration d’un lien avec le personnel clinique et d’un accès aux soins. Les patients ont insisté sur la nécessité de personnaliser la rétroaction et les fonctions de communication interactive de l’application. L’adoption d’une telle nouvelle technologie par les patients aînés pourrait être influencée par le soutien social (des professionnels cliniques), technique et financier. Conclusion: L’application TakeCareMC a été bien reçue par les patients atteints d’insuffisance cardiaque. L’expérience et la participation des patients sont cruciales dans la mise à jour de l’application. / Background: Despite the advancement in the development of mobile health applications, little is known about the patients’ experience of using these applications for telemonitoring at home. Objective: This research aims to assess the experience of patients with heart failure on the impact, difficulties and facilitating or limiting factors of use of the TakeCareMC mobile application in the telemonitoring at home. Methods: Semi-structured interviews were conducted with 12 patients who are followed by a heart failure clinic of a university hospital center, and who used a smartphone application at home after 3 months of pilot intervention. The mobile app asks patients to measure physiological signs daily and answer daily symptoms questions. A clinical nurse took care of remote monitoring (5 days a week) and contacted the patient by telephone when there was an alert. The treatment plan was then adjusted, resubmitted to the monitoring committee and sent to the clinician. Interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: All participants expressed benefits and ease of use of the TakeCareMC application. Benefits included the fact that the app facilitated disease monitoring, both by clinicians and participants themselves, and the perceived positive effects on their health status, improved connection with staff clinic and access to care. Patients emphasized the need for personalization of feedback information and interactive communication app functions. The adoption of such a new technology with elderly patients could be influenced by social (from clinical professionals), technical and financial support. Conclusions: TakeCareMC was well accepted by heart failure patients. The experience and participation of patients are strongly recommended in the design and updating of applications.

With the rise of portable devices, the interest in health and medical applications(mhealth applications) has risen, and the importance of evaluating these applications is critical. The application stores on portable devices only require a good application quality and not the content. The content of the medical health applications could be harmful and need to be evaluated to decrease the potential health risks. In this report, a new mobile health application named POSITIVE gets evaluated with the help of interviewed questionnaires and user­personas. The POSITIVE application target is the older population with their aim to maintain and improve the intrinsic capacity involving primary care and caregivers. POSITIVE application content is monitored by customized exercise programs with medical tests with associated help devices.  The evaluation was done by creating user personas that give a user overview. User personas were designed with the help of data obtained through a interview protocol. The interview protocol was design for this specific evaluation with the help of research questionnaire tools. Questionnaire tools used for creating the interview protocol were the system usability scale(SUS), service user technology acceptability questionnaire(SUTAQ), patient activation measure(PAM), elderly information technology ability tool(EITAT), and mobile health app usability questionnaire(MAUQ) The results show that participants with a higher level of health problems had a lower exercise activity in the application. Participants with lower health problems have a higher exercise activity. Both participants’ groups liked the application’s design and felt it motivated them. Critiques towards the application were to have better customized exercises. / Med smarta mobila enheter växande tillgång har interesset för hälso och medicinska applikationer ökat där vikten att utvärdera dessa applikationer är mycket viktigt. Applikationsbutiker på mobila enheter har endast krav på bra kvalitet på funktioner men inte innehållet av applikationerna. Innehåll av medicinska eller hälsoapplikationer kan vara skadliga och behöver därför genomgå en utvärdering för att minska potentiella hälsorisker.  I denna rapport kommer en ny hälsoapplikation kallad POSITIVE att presenteras samt evalueras med hjälp av intervju protokoll och user personas. POSITIVEs målgrupp är den äldre populationen där deras mål är att förebygga skörhet bland äldre genom att involvera närstående, patienten samt primärvården. Applikationen innehåller ett anpassat och övervakat träningsprogram med medicinska tester som görs medtillhörande utrustning.  Evaluering utförs genom att skapa en ”user persona” som ger en överblick över användarna. User personan utformas med hjälp av data som erhålls genom intervju protokoll. Intervjuprotokollet är utformat med hjälp av forskade frågeformulärsverktyg. Frågeformulärsverktyg som använts till utformningen är system usability scale(SUS), service user technology acceptability questionnaire(SUTAQ), patient activation measure(PAM),eldery information technology ability tool(EITAT) och mobile health app usabilityquestionnaire(MAUQ). Resultatet visar att deltagare med fler hälsoproblem har mindre aktivitet i applikationen. Deltagare med mindre hälsoproblem har högre aktivitet i applikationen. Båda grupperna gillade designen på applikationen som ökade deras motivation. Kritik mot applikationen är att det borde funnits bättre anpassad träningsprogram.

South Africa has one of the highest HIV prevalence rates globally, with nearly 2.5 million people accessing antiretroviral treatment (ART) at the end of 2013. Retaining patients on ART has become a major problem in this country. When patients no longer show up for ART for unknown reasons, they are considered lost to follow-up (LTF). LTF is the highest contributor to ART attrition. This study, guided by the health belief model, evaluated the effectiveness of a technology-based, mobile health (mHealth) appointment reminder intervention on LTF among patients accessing ART services. The study ascertained differences in 6- and 12-month LTF rates between patients enrolled in the mHealth intervention (n = 832) and those in the standard of care comparison group (n = 918). A quantitative, retrospective cohort approach was used to answer the research questions using binary logistic regression analyses. The mHealth intervention was found to be significantly linked to lower likelihood of 6- and/or 12-month LTF among patients. There were 2 other key findings: a positive correlation between pregnancy and LTF, and a positive correlation between viral load increases and LTF. This study added evidence to the existing literature on the effectiveness of using mHealth-based interventions to improve HIV/AIDS care. Based on these findings, professionals should pay special attention to pregnant women and those clients with increasing viral loads to ensure they are not LTF. Positive social change that may result from this study is better health outcomes for patients on ART due to reduced risk of HIV related complications and other illnesses. This awareness would improve the lives of the patients, and positively impact their families, communities, and ultimately the global community, by reducing the overall impact of HIV disease.

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>