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.

Fetal exposure to an intrauterine environment affected by maternal obesity and excessive gestational weight gain (GWG) pose several adverse short- and long-term health risks to infants. Excessive GWG and maternal obesity are of high priority to public health across many nations. Improving maternal and child health can be achieved by encouraging women to meet Institute of Medicine (IOM) weight gain recommendations, sound clinical guidance, and other forms of support. Another means of helping women adhere to weight gain guidelines is by making use of the near ubiquitous nature of mobile technology and promoting healthy pregnancies through reliable mobile health (mHealth) applications (apps). The objective of the first study of this thesis was to examine the associations between psychosocial factors and achieving IOM-recommended weight gain during pregnancy. Cross-sectional data were collected from pregnant and postpartum women who responded to a validated questionnaire, the Electronic Maternal health survey. Multiple linear logistic regression analyses were used to determine correlates associated with meeting IOM guidelines. The objective of the second study was to conduct a preliminary exploration of women’s attitudes towards an evidence-based, mHealth app, SmartMoms Canada, as a valid source of pregnancy-related information and its ability to offer physical activity, nutrition, and lifestyle support. Focus groups were organized to assess women’s attitudes towards the app and inductive thematic content analysis was utilized to interpret focus group data. It was found that self-efficacy and perceived controllability of behaviours are important factors contributing to whether women meet IOM weight gain recommendations. Further, pregnant women are quite receptive to mHealth technology and positively viewed the future prospective of SmartMoms Canada as a means of promoting overall maternal health. Combined, these findings will contribute to our understanding of how to best improve maternal-fetal health outcomes in the near future.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In this paper, we proposed a wearable technology model to control and monitor hypertension during pregnancy. We enhanced prior models by adding a series of health parameters that could potentially prevent and correct hypertension disorders in pregnancy. Our proposed model also emphasizes the application of real-time data analysis for the healthcare organization. In this process, we also assessed the current technologies and systems applications offered in the market. The model consists of four phases: 1. The health parameters of the patient are collected through a wearable device; 2. The data is received by a mobile application; 3. The data is stored in a cloud database; 4. The data is analyzed on real-time using a data analytics application. The model was validated and piloted in a public hospital in Lima, Peru. The preliminary results showed an increased-on number of controlled patients by 11% and a reduction of maternal deaths by 7%, among other relevant health factors that allowed healthcare providers to take corrective and preventive actions. / Revisión por pares

Context. With the pervasive nature of mobile phones, many mobile health (mHealth) apps are released in market. It is of supreme importance to consolidate compliance right in the development of app. There are many policies and regulations formed in various countries that fundamentally protect patient information. Further, there are stringent actions taken for not complying with the regulations. This being the case, how do app developers from start-up to small scale companies find solutions to the problem? It is necessary to study the situation from developer’s perspective to create innovation and sustain. Objectives. In this study, we identify tools, techniques, methods or process used by developers to create a compliant app. This study also throws light on challenges being faced by the developers. Finally, a guideline is devised for the app developers to facilitate in development of a compliant app. Methods. A case study is performed with two data collection methods namely interviews and survey questionnaire to strengthen the findings. With not much of literature support, interview study helped in gaining perspective of developers instrumental in creation of survey instrument. Results. Different tools, techniques, methods, processes used by developers were identified. Alongside, challenges were also listed based on the importance level. Further, a guideline was drafted that serves as recommendation for the app developers in development of complaint mobile health app. The guideline devised is at a higher level that can help developers focus on key aspects with regards to development of a complaint mHealth app.   Conclusions. Author concludes that app developers mainly use project management tools available. There is a need for specific tools, techniques to be developed for the developers such that it becomes easy for app developers to develop compliant mHealth app. In fact, there must be effective guidelines drafted in the clearest possible way that can be used by developers without any ambiguity. This research acts as an exploratory study aimed at identifying the current practice of developers. More research is needed in this field to solve the developers’ problem.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In this article, we propose a wireless monitoring solution for gait parameters using low-cost sensors in the physical rehabilitation of patients with gait disorders. This solution consists of infrared speed sensors (IRSS), force-sensing Resistor (FSR) and microcontrollers placed in a walker. These sensors collect the pressure distribution on the walker's handle and the speed of the steps during therapy session. The proposal allows to improve the traditional physiotherapy session times through a mobile application to perform the monitoring controlled by a health specialist in real time. The proposed solution consists of 4 stages: 1. Obtaining gear parameters, 2. Data transmission, 3. Information Storage and 4. Data collection and processing. Solution was tested with 10 patients from a physical rehabilitation center in Lima, Peru. Preliminary results revealed a significant reduction in the rehabilitation session from 25 to 5.2 minutes. / Revisión por pares

The recent proliferation and adoption of smartphones has resulted in the widespread use of mobile applications. Mobile applications, or apps, are small programs that are designed to run on smartphones and mobile devices for providing information on a wide range of topics addressing the varied needs of an individual. Health apps are one of the more popular categories of apps that are used extensively among people who are interested in health and fitness. Apps in this category focus on topics such as diet, nutrition, fitness, and weight loss. This study examined popular, free weight loss health applications available in Apple iTunes (iOS) and Google Play (Android) to identify their characteristics and adherence to national health guidelines. A total of 89 weight loss apps across both platforms were selected for the content analysis. Each app was coded to examine the general characteristics and the presence of features such as interactivity, adherence to evidence-informed practices and health guidelines, user engagement, and credibility of health information. Descriptive statistics such as frequencies and percentages were calculated once the coding was done. Perhaps the most important finding of the study was that no single app completely adhered to all the health guidelines or evidence-informed practices outlined by national health agencies. However, there were some apps that showed high levels of adherence in certain categories. The study further indicated that weight loss apps are designed more for people interested in physical fitness and training and less for people who are trying diet and nutrition to lose weight. A majority of the apps analyzed did not adhere to evidence-informed practices, did not follow the clinical 10-step guidelines for treatment of weight loss recommended by national health agencies, and failed to meet HON (Health on the Net) standards for credibility. E-mail was the preferred form of communication present in all the apps, and interactive features were under utilized by app developers. This study found that mobile app developers make minimal use of theory-driven components in their app design. The provision to track user progress was the most employed user engagement (66%), followed by facilitating goal setting (53%), and self-monitoring (51%). Of all the 89 apps analyzed, the study found only one app with health professional input, seriously highlighting the need for involvement of health professionals in app design and development. Weight loss through mobile apps has a lot of potential for growth in terms of incorporating interactive features, theory-driven content, evidence-informed practices, and credibility of health information. While there is much emphasis on improving the functionality and features of apps, it is also important that health professionals with an understanding and knowledge of national health guidelines need to be actively involved in developing apps that are tailored, appropriate, and relevant for those interested in losing weight. There needs to be more initiatives where app developers, health professionals and agencies, avid app users, nongovernmental organizations, and policy makers come together and help address some of the issues highlighted in this study.

Social determinants of health (SDOH) affect quality-of-life outcomes and risks.  In underserved populations, health care access and quality are often poor.  Mainstream bioethics has highlighted the importance of equity in the delivery of healthcare with a focus on the community's health disparities and inadequate access to quality healthcare. Diabetes is one of the top ten causes of death according to the World Health Organization (WHO, 2020).  Many underserved populations in the U.S. including the city of Philadelphia have a high probability of developing diabetes due to their poor diets, obesity, and sedentary lifestyle. Often it is difficult to reach the underserved population that need education and healthcare screening. After a review of the history of the prevalence of diabetes in the U.S., I discuss and analyze the development and implementation of a mobile health vehicle (MHV) World Diabetes Day event in Philadelphia. / Urban Bioethics

The Canadian healthcare system, by design, has been historically oriented to delivering acute and symptom-driven care; however, the current cost of treating chronic disease has risen to an average of nearly 45% of direct costs of the national health budget. As a consequence more attention is being directed to the diagnosis and treatment of chronically ill patients who also may suffer from disabilities, illiteracy, impairment in judgment, depression, or multiple co-morbidities. This has also resulted in a new emphasis on health and disease self-management, to help patients to mitigate and manage the impacts of chronic diseases. This approach affects and involves the patient’s entire circle of care including the patient, healthcare providers, and the patient’s family and friends. This study discusses how support elements (i.e. decision support, education and training, family and community support) and sustainability elements (i.e. recreation and entertainment, rewards systems, online social networks) combined with online technological support can help to support and provide motivation for chronically ill patients to adopt self-management in a sustainable manner. The PLS (Partial Least Squares) statistical approach was used to validate a proposed SEM (Structural Equation Model) research model with data collected from 198 participants across North America without any prior exposure to our proposed system. The research model hypothesized that support and sustainability constructs have a strong positive influence on the willingness of users to adopt and use the proposed system. The model results in a very good fit for Behavioural Intention to Adopt for patients with no caregiver support (R2=0.71), and for patients with such support (R2=0.65). The results clearly validate our proposed model including a high predictive relevance for endogenous variables. This research provides useful theoretical and practical insights and understanding for design, development and promotion of chronic care self-management systems as well as the perceptions of users regarding the adoption and use of such systems. / Dissertation / Doctor of Philosophy (PhD)

No description available.

<p>The Community Intervention Trial for Smoking Cessation (COMMIT) was one of the largest health promotion interventions in North America. Using 11 pairs of matched intervention and control communities, the U.S. National Cancer Institute sought to establish the viability of a community-based approach to smoking cessation, with the expectation of significant impacts on cessation rates amongst heavy smokers during the four years of intervention.</p> <p>The evaluation components of the COMMIT trial relied primarily on the use of surveys to document quantitative changes in attitudes, beliefs and behaviours. A complementary ancillary qualitative evaluation was conducted by the author in the only Canadian intervention site in the trial in Brantford, Ontario. Depth interviews and focus groups were conducted with 45 members of a Smokers' Network established by COMMIT. Subsequently, 35 intervention staff, researchers and community influential were interviewed. Transcripts were coded and analyzed using qualitative analysis software.</p> <p>Several objectives guided the qualitative evaluation study in Brantford: 1) establish the degree to which the COMMIT met the needs of smokers for assistance in quitting; 2) identify the factors that inhibited or facilitated program success; and 3) consider the implications for community mobilization for smoking cessation. Findings in each of these areas are discussed.</p> <p>This work seeks to contribute to knowledge development in health promotion at the level of theory and method, as well as substantively in terms of the design and implementation of community health promotion interventions. A critical-interpretive methodology is advanced as being consistent with the 'new' health promotion, based on a review of the literature on social theory which also argues for an explicit critical and emancipatory orientation to theory and practice in health promotion. These approaches are applied to the examination of a community-level smoking cessation intervention. Chapter 9 contains a critical sociological examination of the nature of tobacco control, drawing upon the work of Goffman.</p> / Doctor of Philosophy (PhD)