Introduction: Mobile health applications (mHealth apps) may support people’s chronic obstructive pulmonary disease (COPD) self-management. Current research has demonstrated the promising effects of mHealth apps for people with COPD but there is still limited information on these apps’ characteristics and qualities, especially those in the public domain. Therefore, there is the need to use a standardized evaluation framework to: 1) describe characteristics and qualities of COPD apps from past studies; 2) characterize the features and qualities of public COPD apps; and 3) determine the appropriateness of public COPD apps from the perspective of clinicians and patients living with COPD. Methods: The mHealth Index and Navigation Database (MIND) framework, an objective evaluation tool was applied across studies. Project 1: A systematic review was conducted, including randomized controlled trials investigating interactive mHealth apps for people living with chronic lung diseases (CLD). Project 2: An evaluation study of the public marketplace (Android and Apple app stores) was conducted. Free mHealth apps created specifically for COPD self-management were included. Project 3: Reviewed COPD apps were presented to stakeholders in an infographic format. A RAND/UCLA Appropriateness Method (RAM) was used to collect feedback from stakeholders on the state of public COPD apps. Results: Many of the COPD apps trialed in past studies have inconsistent reports of their features and qualities, with many publicly unavailable. Most public COPD apps lacked clinical evidence to support their use and have questionable qualities. Stakeholders agreed that public COPD apps were mostly inappropriate but did not dismiss the need to discuss their potential in COPD care plans. Significance: This thesis project advocates for the partnership with multiple heath disciplines and patient-participants for app evaluations to gain stronger understanding of their potential. Future opportunities may include exploring other apps for lung diseases to promote stakeholder engagement throughout the process. / Thesis / Candidate in Philosophy

Submitted by Vanessa Christiane (referencia@ufersa.edu.br) on 2018-06-15T00:08:00Z No. of bitstreams: 1 IngridyMPB_DISSERT.pdf: 7607381 bytes, checksum: c08a68ab4cbff8326651716b5e44e1d8 (MD5) / Approved for entry into archive by Vanessa Christiane (referencia@ufersa.edu.br) on 2018-06-18T16:55:37Z (GMT) No. of bitstreams: 1 IngridyMPB_DISSERT.pdf: 7607381 bytes, checksum: c08a68ab4cbff8326651716b5e44e1d8 (MD5) / Approved for entry into archive by Vanessa Christiane (referencia@ufersa.edu.br) on 2018-06-18T16:56:28Z (GMT) No. of bitstreams: 1 IngridyMPB_DISSERT.pdf: 7607381 bytes, checksum: c08a68ab4cbff8326651716b5e44e1d8 (MD5) / Made available in DSpace on 2018-06-18T16:56:45Z (GMT). No. of bitstreams: 1 IngridyMPB_DISSERT.pdf: 7607381 bytes, checksum: c08a68ab4cbff8326651716b5e44e1d8 (MD5) Previous issue date: 2018-02-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The use of mobile devices for the continuous monitoring of patients with a particular pathology may benefit in their prevention, diagnosis and treatment. The objective of this work is the construction of a Medical Assistance Equipment (EMA) for the monitoring of patients with pathology related to di culty in the food intake process and/or Oropharyngeal Dysphagia. The EMA works by capturing the movements and sound signals generated during the chewing and swallowing process and, from this, identifies the physical type of the food, classifying it as: i) liquid; ii) pasty; iii) solid. It is important to emphasize the requirements for a construction of EMA were taken from the context of Dysphagia. After a classification, the information is stored generating a food history, with detailed information about the meals performed and the distribution of Dysphagia that the patient is. To this end, a domain ontology was implemented with logical axioms capable of classifying the type of physical material of the swallowed food based on the analysis of the data captured during the swallowing process. In order to analyze the results generated by the EMA, experiments were carried out in a real environment with 10 participants, authorized by the ethics committee under the following opinion number: 2.332.026. Each participant was invited to swallow liquid, pasty and solid foods. The data generated by the participants were analyzed and classified by the developed ontology. At the end, the results presented 100% of correct answers in relation to experiments with solid foods, 80% of correct answers in experiments with liquid foods and 75% of correct answers in relation to experiments with pasty foods. A general analysis of the EMA presented the safety area of 85%. Finally, the EMA provided relevant results regarding correct classification of data. Thus, a medical team can monitor, from a distance, the patient’s evolution onwards, the detailed information available, not EMA, facilitating the monitoring process and improving a quality of life of patients requiring remote monitoring / O uso de dispositivos móveis para o monitoramento contínuo de pacientes com uma determinada patologia pode beneficiar significativamente em sua prevenção, diagnóstico e tratamento. O objetivo deste trabalho é a construção de um Equipamento Médico Assistencial (EMA) para o monitoramento de pacientes com alguma patologia relacionada à dificuldade no processo de ingestão de alimentos e/ou Disfagia Orofaríngea. O EMA funciona através da captura dos movimentos e dos sinais sonoros gerados durante o processo de mastigação e deglutição, e, a partir disso, identifica o tipo físico do alimento, classificando-o em: i) líquido; ii) pastoso; iii) sólido. É importante ressaltar que os requisitos definidos para a construção do EMA foram retirados do contexto da Disfagia. Após a classificação, essas informações são armazenadas gerando um histórico alimentar com informações detalhadas sobre as refeições realizadas e o nível de Disfagia que o paciente se encontra. Para este fim, foi implementada uma ontologia de domínio com axiomas lógicos capazes de classificar o tipo físico do alimento deglutido tendo por base a análise dos dados capturados durante o processo de deglutição. Com o intuito de analisar os resultados gerados pelo EMA, foram realizados experimentos em ambiente real com 10 participantes, autorizado pelo comitê de ética sob o seguinte número de parecer: 2.332.026. Cada participante foi convidado a deglutir alimentos líquidos, pastosos e sólidos. Os dados gerados pelos participantes foram analisados e classificados pela ontologia desenvolvida. Ao final, os resultados apresentam 100% de acerto em relação aos experimentos realizados com alimentos sólidos, 80% de acerto em relação aos experimentos realizados com alimentos líquidos e 75% de acerto em relação aos experimento realizados com alimentos pastosos. A análise geral do EMA apresentou o nível de acurácia de 85%. Por fim, o EMA proporcionou resultados relevantes quanto à classificação correta de dados. Assim, a equipe médica pode acompanhar, a distância, a evolução do paciente diante das informações detalhadas disponíveis no EMA, facilitando o processo de monitoramento e melhorando a qualidade de vida dos pacientes que necessitam de acompanhamento a distância / 2018-06-14

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Information technology (IT) is empowering consumers, service providers, and inventor teams with superior services. Various IT innovations are enabling diverse groups of people to search, exchange, and learn from information. In healthcare services, the context of the three essays of this dissertation, information resources are often not equally accessible to consumers, not transparent between patients and physicians, and hard to locate across technological domains that may be relevant to the development of breakthrough innovations. Focusing on empowering roles of IT in healthcare services, I develop a three-essay dissertation to study how IT can enable information access to (i) address health inequalities in developing regions of the world, (ii) strengthen the physician-patient relationship where patient trust in the physician has atrophied, and (iii) energize inventor teams in the development of medical device innovations. Essay 1 examines consumers’ awareness and use of mobile health that can empower consumers to access health advice information. Essay 2 investigates how online health consultation communities can empower physicians to build trust with patients, and gain social and economic advantages in competitive healthcare services. Essay 3 studies the role of digital capabilities to empower inventor teams in medical device companies by converting expertise of inventor teams into broad and deep knowledge capital and expanding knowledge production regarding medical device innovations. I adopt a pluralistic approach to collect data (surveys administered in multiple languages for Essay 1, scraping web data from online communities for Essay 2, and constructing a multisource archival panel dataset for Essay 3) and analyze data (multivariate analysis for Essay 1, multilevel modeling and econometrics for Essay 2 and Essay 3). The essays contribute to our understanding about the acceptance of empowering IT innovations, the empowering role of user-generated content in online communities for providers of credence services, and the empowering role of IT for inventor teams of healthcare innovations.

BACKGROUND: Polycystic Ovary Syndrome (PCOS) is an endocrine disrupting disorder affecting at least 10 percent of reproductive-aged women. In many cases, women develop comorbidities such as diabetes, cardiovascular disease, and other metabolic disorders. In North America and Europe, it takes several years and multiple doctors for women to receive a diagnosis of PCOS. This results in lost time for risk-reducing interventions. Menstrual tracking applications are one potential tool to alert women of their risk for PCOS and prompt them to seek further evaluation from a medical professional. OBJECTIVE: The objective was to develop the Irregular Cycles Feature (ICF) on the mobile phone application Clue®, which generates a probability of a user’s risk for PCOS. The secondary aim was to assess the accuracy of the tool by testing the feature on virtual test subjects. METHODS: A literature review was conducted to generate a list of signs and symptoms of PCOS. Probabilities were assigned to each variable and built into a Bayesian Network. The Irregular Cycles Feature, an adaptive questionnaire, was then developed in order to detect high-risk PCOS patients. The ICF detected at risk Clue® users through self-reported menstrual cycles and answers to medical history questions. Upon completion of the questionnaire, a Result Screen is displayed to the user. The Screen is a summary of the individual’s probability of having PCOS. For each eligible user, a Doctor’s Report is also generated. This is a screen containing information regarding menstrual irregularities and a brief medical history to be used by a medical professional in order to make a final diagnosis. Both the Result Screen and Doctor’s Report disclose information about PCOS and detailed explanations for consulting a medical provider. A brief statistical validation was then performed to compare the output of the network to predictions made by a physician-scientist using a correlation coefficient, a p-value, and a Pearson’s coefficient. RESULTS: The Irregular Cycles Feature successfully predicts probability of PCOS based on eight test cases. The correlation between the network’s calculation and the assessment made by a board-certified reproductive endocrinology/infertility physician-scientist was 0.82, with a p-value of less than 0.05. The Pearson’s coefficient was calculated to be 0.69. These values indicate that the ICF made statistically significant predictions when compared to the physician-scientist. CONCLUSIONS: The ICF provides consumer-friendly ways to improve interactions between medical providers and patients. The tool can be adapted to capture other causes of menstrual irregularities and can serve as an important mechanism for drawing attention to potentially hazardous health problems. Further validation studies will be conducted to confirm the utility of the ICF with Clue® users, particularly amongst those who receive an official diagnosis from a medical professional. / 2020-06-17T00:00:00Z

A Sindrome da Apneia Hipopneia obstrutiva do sono (SAHOS) é caracterizada por episódios repetidos de obstrução parcial (hipopneia) ou completa (apneia) das vias aéreas superiores durante o sono. Os efeitos clínicos da SAHOS estão relacionados aos efeitos cumulativos da exposição à asfixia periódica e à fragmentação do sono causada por apneias e hipopnéias, como o aumento do risco de hipertensão, disritmias noturnas, insuficiência ventricular, infarto do miocárdio e acidente vascular cerebral. O padrão ouro para o diagnóstico de SAHOS é a Polissonografia (PSG), na qual requer que o paciente permaneça durante a noite inteira no laboratorio de sono, conectado a diferentes sensores biológicos e sob a supervisão de um técnico. Além do desconforto causado pelos sensores invasivos, a necessidade de um ambiente clínico e infraestrutura altamente especializada resulta em uma longa lista de espera nos laboratórios do sono e altos custos, restringindo assim o acesso ao diagnóstico e tratamento. Para melhorar o monitoramento da evolução da OSA, o acesso ao diagnóstico e o acompanhamento do tratamento, propõe-se uma solução baseada em Mobile Health (mHealth) para utilizar os recursos do smartphone a fim de desenvolver uma estimativa não invasiva da gravidade da SAHOS. Utiliza-se o áudio gravado através de um smartphone para detectar automaticamente os eventos de ronco durante a noite e, através da análise desses eventos, estimar a necessidade do paciente para o tratamento de Pressão Positiva Contínua nas Vias Aéreas (CPAP). Para isso, dividimos nossa solução em duas fases: (i) uma solução completamente não supervisionada para detectar automaticamente os eventos de ronco em um ambiente não controlado e (ii) a análise das características acústicas dos eventos de ronco para estimativa de gravidade da SAHOS. Na primeira fase, podemos comprovar a viabilidade de gravar o áudio e detectar os eventos de ronco usando um smartphone em um ambiente suscetível a ruídos aleatórios. Na segunda fase, mostramos que um conjunto de características acústicas globais dos eventos de ronco pode prever a necessidade do paciente para o tratamento com CPAP. Nossa solução proposta foi avaliada em ambiente não controlado (domicílio do paciente) e controlado (laboratório do sono), atingindo resultados satisfatórios na detecção de eventos de ronco e classificação do paciente de acordo com a necessidade de tratamento com CPAP. / Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of partial (hypopnea) or complete (apnea) obstruction of the upper airway during sleep. The clinical effects of OSA are related to the cumulative effects of exposure to periodic asphyxia and sleep fragmentation caused by apneas and hypopneas, such as an increased risk of hypertension, nocturnal dysrhythmias, ventricular failure, myocardial infarction, and stroke. The current gold standard for diagnosing OSA is the overnight Polysomnography (PSG), which requires a full-night sleep laboratory stay, attached to different biological sensors and under the supervision of a technician. Besides the discomfort caused by the invasive sensors, the necessity of a clinical setting and highly specialized infrastructure results in a long waiting list in sleep laboratories and high costs, thus restricting the access to diagnosis and treatment. To improve monitoring of OSA evolution, access to diagnosis and treatment follow up, we propose a Mobile Health (mHealth) solution to take advantage of the smartphone capabilities to deploy a non-invasive OSA severity estimation. We make use of the audio recorded through a smartphone to automatically detect snoring events throughout the night and through the analysis of such events estimate patient’s necessity for Continuous Positive Airway Pressure (CPAP) therapy. For that, we have divided our solution into two phases: (i) a completely unsupervised solution to automatically detect the snoring events in an uncontrolled environment and (ii) the analysis of acoustical features of the snoring events for OSA severity estimation. In the first phase, we can prove the viability of recording the audio and detect the snoring events using a smartphone under an environment susceptible to random noises. In the second phase, we show that a set of global acoustical features from the snoring events can predict the patient’s need for the CPAP therapy. Our proposed solution was evaluated in an uncontrolled (patient’s home) and controlled (sleep laboratory center) environment, reaching satisfactory results in snoring events detection and patient’s classification according to the need for CPAP therapy.

In this thesis, a novel graphene (GN) based electrocardiogram (ECG) sensor is designed, constructed and tested to validate the concept of coating GN, which is a highly electrically conductive material, on Ag substrates of conventional electrodes. The background theory, design, experiments and results for the proposed GN-based ECG sensor are also presented. Due to the attractive electrical and physical characteristics of graphene, a new ECG sensor was investigated by coating GN onto itself. The main focus of this project was to examine the effect of GN on ECG monitoring and to compare its performance with conventional methods. A thorough investigation into GN synthesis on Ag substrate was conducted, which was accompanied by extensive simulation and experimentation. A GN-enabled ECG electrode was characterised by Raman spectroscopy, scanning electron microscopy along with electrical resistivity and conductivity measurements. The results obtained from the GN characteristic experimentation on Raman spectroscopy, detected a 2D peak in the GN-coated electrode, which was not observed with the conventional Ag/AgCl electrode. SEM characterisation also revealed that a GN coating smooths the surface of the electrode and hence, improves the skin-to-electrode contact. Furthermore, a comparison regarding the electrical conductivity calculation was made between the proposed GN-coated electrodes and conventional Ag/AgCl ones. The resistance values obtained were 212.4 Ω and 28.3 Ω for bare and GN-coated electrodes, respectively. That indicates that the electrical conductivity of GN-based electrodes is superior and hence, it is concluded that skin-electrode contact impedance can be lowered by their usage. Additional COMSOL simulation was carried out to observe the effect of an electrical field and surface charge density using GN-coated and conventional Ag/AgCl electrodes on a simplified human skin model. The results demonstrated the effectiveness of the addition of electrical field and surface charge capabilities and hence, coating GN on Ag substrates was validated through this simulation. This novel ECG electrode was tested with various types of electrodes on ten different subjects in order to analyse the obtained ECG signals. The experimental results clearly showed that the proposed GN-based electrode exhibits the best performance in terms of ECG signal quality, detection of critical waves of ECG morphology (P-wave, QRS complex and T-wave), signal-to-noise ratio (SNR) with 27.0 dB and skin-electrode contact impedance (65.82 kΩ at 20 Hz) when compared to those obtained by conventional a Ag/AgCl electrode. Moreover, this proposed GN-based ECG sensor was integrated with core body temperature (CBT) sensor in an ear-based device, which was designed and printed using 3D technology. Subsequently, a finger clipped photoplethysmography (PPG) sensor was integrated with the two-sensors in an Arduino based data acquisition system, which was placed on the subject's arm to enable a wearable multiple physiological measurement system. The physiological information of ECG and CBT was obtained from the ear of the subject, whilst the PPG signal was acquired from the finger. Furthermore, this multiple physiological signal was wirelessly transmitted to the smartphone to achieve continuous and real-time monitoring of physiological signals (ECG, CBT and PPG) on a dedicated app developed using the Java programming language. The proposed system has plenty of room for performance improvement and future development will make it adaptabadaptable, hence being more convenient for the users to implement other applications than at present.

O Sistema Nacional de Saúde (SNS) em Moçambique sofreu uma significativa degradação e fragilização, resultado em parte da guerra civil ocorrida por cerca de 20 anos, o país continua debatendo com problemas de fome, nudez e inúmeros outros socioeconômicos, que direta ou indiretamente afetam a saúde das populações, fato evidente nos dias de hoje, traduzido pelo difícil acesso a saúde das populações residentes em áreas rurais e urbanas. A cobertura no atendimento da saúde para as populações em cerca de 70%, residente na área rural, sob baixa renda, alto índice de analfabetismo, se caracteriza por deficiente no respeite a quantidade das unidades sanitárias disponíveis, e na falta de recursos humanos capazes de cobrir a demanda do País. A pesquisa que se propõe objetiva na busca de uma solução em curto prazo, tem por objeto levar a saúde às das comunidades rurais em áreas longínquas de difícil acesso ou com carência de unidades sanitárias, a partir de uma proposta Modelo de Unidade Sanitária Móvel, capaz de oferecer à população serviços de atendimentos básicos em cuidados primários e de prevenção. O modelo será definido com base nos resultados da análise feita ao SNS, tendo como pano de fundo: a população, doenças, indicadores social/saúde, recursos humanos, e impactos socioeconômicos. Que o resultado, além do proposto, seja aplicável no desenvolvimento do país, na melhoria e benefício das comunidades atendidas, e que partindo das diretrizes esboçadas, sirva de base para futuros projetos idêntica. O método de pesquisa que se pretende utilizar basear-se-á em levantamento bibliográfico e estudo caso a caso, com entrevistas a profissional e organizações que estejam atualmente envolvidas em ações idênticas, bem como a visita e eventual acompanhamento de expedições feitas pelas suas unidades. / The National Health Service (NHS) in Mozambique has suffered a significant degradation and weakening, in part as a result of the civil war tooked place for about 20 years, the country still struggling with problems of hunger, nakedness and numerous other socioeconomic factors, that directly or indirectly affect the health of populations, a fact evident today, translated by difficult access to the health of people living in rural and urban areas. The coverage in health care to populations, in about 70% residing in rural areas in low income, high illiteracy rate, is characterized by deficient in respecting the amount of available health facilities, and lack of human resources capable of cover the demand of the country. The research aims to propose a research of a short term solution, in order to bring health in rural communities in remote areas of difficult access or lack of health facilities, from a proposed Model of Mobile Health Unit capable of providing basic care services in primary care, and prevention to the population. The model will be defined on the results of analysis done on the NHS, having as backdrop: the population, disease, social indicators / health, human resources, and socio-economic impacts. As a result of the proposed addition, is applicable in the development of the country to improve and benefit the communities served, and using the guidelines outlined, serve for future similar projects. The research method intended to be used, will be based on a survey of publications and case studies, interviews with professionals and organizations currently involved in similar actions, as well as the visit and any follow-up mailings made by their units.

Technology plays an increasingly important role in modern health care. This thesis presents an approach to usability evaluation of mobile information and communications technologies designed for diabetes patients&rsquo / use in their daily lives. According to our study conducted on 60 diabetes patients, several important findings are obtained. Fifty nine (98.3%) diabetes patients were highly satisfied with the mobile health technology and expressed that they would use it, and found the measured values reliable. For 57 (95%) diabetes patients / measuring, checking and accessing the blood glucose level easily anytime and anywhere were very important. Fifty six (93.3%) said that they would wish to send their blood glucose levels to their physicians via e-mail. When participants were asked to provide a decision on future health care, predominate number of participants said they would change their lifestyle rather than visit a doctor regardless of their blood glucose level. In conclusion, little is known about such effects of mobile information and communications technologies in self-management care situations. It is clear that usability studies in the field are more difficult to conduct than laboratory evaluations. Further studies with larger sample sizes are needed to further evaluate these initial findings.

<p>Background: Obesity is the number one health risk facing Americans. The obesity epidemic in America is attributed to physical inactivity, unhealthy food choices, and excessive food intake. Structured weight loss programs have been successful in initiating behavior change and weight loss; however, weight is almost always regained over time. The rate of weight gain is highest immediately after cessation of a structured weight loss program. Thus, effective interventions are needed that can successfully be used following a structured weight loss program to sustain weight loss and prevent weight relapse. Due to low cost, ubiquity, and ease of use, healthcare communicated through mobile technology, or "mHealth", may be able to serve as an effective medium to reach a large number of people to facilitate weight loss behaviors. Short message service (SMS), also known as text messaging, is easy to use, ubiquitous, affordable, and can target people directly where they are regardless of geographic location, socioeconomic status, or demographic factors. A review of the literature demonstrated limited information regarding message content, timing and frequency of message delivery and only 3 of 14 SMS-related interventions reviewed demonstrated a statistically significant effect on weight loss, diet or exercise. Additionally, information on how to integrate and leverage SMS as a health promotion tool for weight loss was also limited in the literature.</p><p>The Behavior Change Process model was used as a guide to understand how to develop an intervention to help people sustain recent weight loss. Furthermore, research suggests interventions that target and frame messages about how people reach goals in their life through either a prevention or promotion focus may be beneficial at motivating people to self-regulate and sustain recent behavioral changes. The goal of this study was to design an intervention that would help people stay in the continued response phase of the Behavior Change Process and help prevent weight relapse. Using the Behavior Change Process and regulatory focus theory, an intervention was developed that leveraged short message service (SMS) to deliver messages to people who have recently lost weight in attempt to help them sustain weight loss and prevent relapse.</p><p>Methods: First, a pilot study was conducted to inform the development of a SMS software application, the development of message content and the frequency and timing of message delivery. Second, an exploratory 3-arm mixed methods randomized controlled trial was conducted to test the feasibility, acceptability, perception of the usefulness, and efficacy of a weight loss sustaining mHealth SMS intervention among people with obesity. Participants (N=120) were randomized to a promotion message group, a prevention message group, or an attention-control general health message group. Participants completed baseline assessments, and reported their weight at 1 and 3 months post-baseline to assess efficacy of the intervention on sustaining weight loss. In addition, participants partook in a phone interview follow completion of the intervention to assess acceptability and usefulness. </p><p>Results: Participants found the message content and intervention acceptable and a majority perceived value in receiving messages via SMS that promote weight loss sustaining behaviors. Interview data implied that the intervention served as a reminder and daily cue to action. Participants were favorable towards receiving a daily reminder, which they noted helped them to stay focused, and in some cases to keep them motivated to continue losing weight. And a majority, 42 (91%) who participated in a telephone interview said that they preferred to get messages on their cell phone due to accessibility and convenience. A minimum of one message per day delivered at approximately 8:00 A.M. was deemed the optimal delivery time and frequency. This was particularly true for weight loss, which many participants reported as a daily struggle that begins every morning. With regards to sustaining weight loss, there was a statistical trend in sustained weight loss at months 1 and 3 in the promotion and prevention framed message groups compared to the control group in both the intent-to-treat and evaluable case analyses. Clinically, there was a significant decrease in mean weight of approximately 5 pounds at month 3 in the promotion and prevention groups compared to the control. Additionally, effect sizes indicated a large effect of the intervention on sustaining weight loss in the promotion and prevention groups relative to the control group.</p><p>Conclusion: Overall results showed that at the continued response phase of the behavioral change process, it was feasible to design an application to deliver promotion and prevention framed weight loss sustaining messages. In particular, prevention framed messages may have been more useful in helping participants sustain weight loss. Though there was less than 80% power to detect a statistically significant difference, the observed effect sizes in this study were significant and demonstrated a large effect of the promotion and prevention interventions on sustaining weight loss relative to control. Furthermore, there was a clinically significant increase in mean weight loss and in the number of people who sustained weight loss in the promotion and prevention intervention groups compared to control.</p><p>These findings may serve as a reference for future interventions designed to help people thwart relapse and transition from a state of sustaining recent weight loss behaviors to a state of maintenance. Technological tools such as this SMS intervention that are constructed and guided by evidence-based content and theoretical constructs show promise in helping people sustain healthy behaviors that can lead to improved health outcomes.</p> / Dissertation