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Medical-grade ultrasound devices are now pocket sized and can be easily transported to underserved parts of the world, allowing health care providers to have the tools to optimize diagnoses, inform management plans, and improve patient outcomes in remote locations. Other great advances in technology have recently occurred, such as artificial intelligence applied to mobile health devices and cloud computing, as augmented reality instructions make these devices more user friendly and readily applicable across health care encounters. However, broader awareness of the impact of these mobile health technologies is needed among health care providers, along with training on how to use them in valid and reproducible environments, for accurate diagnosis and treatment. This article provides a summary of a Mayo International Health Program journey to Bwindi, Uganda, with a portable mobile health unit. This article shows how point-of-care ultrasonography and other technologies can benefit remote clinical diagnosis and management in underserved areas around the world.

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.

Die hohe Müttersterblichkeit in Entwicklungsländern ist zum Teil auf indirekte Faktoren wie Analphabetismus und eingeschränkten Zugang zu Gesundheitsinformationen für Mütter zurückzuführen. Während gebildete Frauen auf Gesundheitsinformationen über Online-Plattformen und mHealth-Apps zugreifen können, müssen Analphabetinnen diese in Gesundheitseinrichtungen abrufen, was aufgrund der Transportkosten oft nicht möglich ist. Mobilfunktechnologie hat in der Gesundheitsversorgung Chancen für ressourcenarme Gemeinschaften eröffnet, die sonst nicht von den digitalen Technologien profitiert hätten. Obwohl Mobilfunktechnologie in der Müttergesundheit eingesetzt wird, können die meisten Maßnahmen nicht von Analphabeten genutzt werden, verwenden Sicherheitsmodelle die nicht auf den Kontext von Entwicklungsländern zugeschnitten sind, und wurden nicht auf ihre Auswirkungen auf die Müttergesundheit hin evaluiert. In dieser Arbeit wurden zwei (Web und Mobile) Apps entwickelt, die die Übermittlung von multimedialen Nachrichten zur Müttergesundheit, Terminerinnerungen und Anrufe/Chats erleichtern. Um die Anforderungen der Nutzer zu erfassen, wurde eine Feldstudie mit halbstrukturierten Interviews und Fokusgruppendiskussionen mit schwangeren Analphabetinnen, Gesundheitsexperten und Entwicklern durchgeführt. Es folgte die Entwicklung eines Sicherheitsmodells (T2RoL) zur Sicherung der Gesundheitsinformationen in den Apps, die dann nach einem nutzerzentrierten Designansatz entwickelt wurden. Eine zweite Feldstudie in Form von halbstrukturierten Interviews und Umfragen wurde durchgeführt, um die mobile App in einer randomisierten kontrollierten Studie mit 80 schwangeren Analphabetinnen über 9 Monate zu evaluieren. Die Auswertung zeigte, dass die App akzeptiert wurde sowie einfach zu erlernen und zu benutzen war. Das Wissen über Müttergesundheit in der Interventionsgruppe verbesserte sich, was sich positiv auf gesundheitsbezogene Entscheidungen und Gesundheitsmaßnahmen auswirkte. / Maternal mortality is high in developing countries partly due to indirect factors such as illiteracy and limited access to maternal health information. While literate women can access health information from online platforms, and mHealth apps, illiterate women must get it from health facilities which is often not possible due to lack of transport fees. Mobile technology has opened opportunities in maternal health care for low resource communities that would otherwise not have benefited from digital technologies. Although used in maternal health, most interventions are not usable by the illiterate, use security models that are not tailored to the developing countries’ context, and have not been evaluated to assess their impact on maternal health care. In this thesis, two (web and mobile) apps that facilitate delivery of multimedia-based maternal health messages, appointment reminders, and calls/ chats were developed. To gather user requirements, a field study in form of semi-structured interviews and focus group discussions was conducted with illiterate pregnant women, health practitioners and developers. Development of a security model (T2RoL) to secure the health information in the apps followed. The apps were then developed following a user-centered design approach. A second field study in form of semi-structured interviews and surveys was conducted to evaluate the mobile app through a randomized controlled trial with 80 illiterate pregnant women that were followed for 9 months. Overall, results show that the app was acceptable, easy to learn and use. There was improved maternal health knowledge among the intervention group which positively influenced health related decision making and health practices.

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>

Το mHealth, η χρήση δηλαδή φορητών τεχνολογιών για την βελτίωση των παρεχόμενων υπηρεσιών υγείας, είναι σήμερα ένα από τα πιο ταχέως αναπτυσσόμενα πεδία της ηλεκτρονικής υγείας (eHealth). Ο αριθμός των επαγγελματιών υγείας που υιοθετούν έξυπνα κινητά τηλέφωνα (smartphones) για την εκτέλεση πληθώρας λειτουργιών αυξάνεται συνεχώς, εξαιτίας των δυνατοτήτων και της φορητότητας που αυτά παρέχουν. Ταυτόχρονα, τα σφάλματα στη φαρμακευτική αγωγή είναι από τα πιο συνηθισμένα ιατρικά λάθη με επιπτώσεις τόσο στην υγεία του ασθενούς όσο και στις δαπάνες στην υγεία. Η χορήγηση φαρμάκων είναι μια πολύπλοκη διαδικασία, καθώς απαιτεί από τον ειδικό της υγείας την ανάλυση πληθώρας παραγόντων και την ανάκτηση, επεξεργασία και διαχείριση μεγάλου όγκου πληροφορίας. Σύμφωνα με τη βιβλιογραφία, η χρήση τεχνολογιών πληροφορικής για την υποβοήθηση των επαγγελματιών υγείας στη λήψη αποφάσεων κατά τη συνταγογράφηση, μπορεί να συμβάλει σημαντικά στη μείωση των σφαλμάτων φαρμακευτικής αγωγής. Στο πλαίσιο της παρούσας διπλωματικής εργασίας, προχωρήσαμε στη διερεύνηση και αξιολόγηση των σημαντικότερων εφαρμογών έξυπνων κινητών συσκευών για το φάρμακο, με στόχο την εξαγωγή χρήσιμων συμπερασμάτων για τα χαρακτηριστικά και τις λειτουργίες που ενσωματώνουν. Ένα από τα βασικά συμπεράσματα της έρευνας ήταν η απουσία αντίστοιχης εφαρμογής για τα φάρμακα που είναι εγκεκριμένα από τον Εθνικό Οργανισμό Φαρμάκων (ΕΟΦ). Ως εκ τούτου, προχωρήσαμε στο σχεδιασμό και την ανάπτυξη εφαρμογής για τον έλεγχο ασυμβασιών μεταξύ φαρμάκων, η οποία παρέχει επιπλέον τη δυνατότητα προβολής πληροφοριών συνταγολογίου για τα φάρμακα του ΕΟΦ. Ο σχεδιασμός της εφαρμογής έγινε λαμβάνοντας υπόψη τις ανάγκες και τις απαιτήσεις μελλοντικών χρηστών, όπως οι επαγγελματίες υγείας και οι ασθενείς, προκειμένου να διασφαλιστεί η λειτουργικότητα και η ευχρηστία της. Η εν λόγω εφαρμογή προορίζεται για έξυπνες κινητές συσκευές που διαθέτουν λειτουργικό σύστημα Android, ενώ η πληροφορία που ενσωματώνει βασίζεται αποκλειστικά στο εθνικό συνταγολόγιο του ΕΟΦ. / Mobile Health or mHealth, namely the use of mobile and wireless technologies in order to improve health services and achieve health goals, is today one of the most rapidly expanding fields of electronic health (eHealth). The number of health professionals that adopt smartphones to perform multiple tasks, during their everyday medical practice, is increasing constantly. This is due to the fact that smartphones provide advanced computing capabilities and high portability. Simultaneously, medication errors are among the most common medical errors which have negative impact both for the health of the patient and the expenditure on health sector. Drug prescribing is quite a complex procedure, considering the fact that requires the health expert to analyze multiple factors and retrieve, process, manage and digest large volume of information. According to the literature, the use of information technologies to assist health professionals in decision-making when prescribing drugs, can contribute significantly to the reduction of medication errors. In the context of our work, we explored and evaluated the major smartphone applications for drugs, aiming to the extraction of useful conclusions about the features and functions that they incorporate. One of the research key findings was the absence of a corresponding application for the drugs that are approved by the National Drug Organization of Greece. Therefore, we design and develop an application for checking drug-drug interactions which additionally provides the ability to view national formulary information about drugs. The analysis and design of the application was implemented in collaboration with future users, such as health professionals and patients, in order to ensure that will meet their needs and requirements and at the same time will remain user friendly. This application is intended for Android smart mobile devices (e.g. smartphones, tablet PCs) and the information that integrates is solely based on the national formulary of the National Drug Organization of Greece.

En el Perú, según estudios realizados en el 2010, el 42% de los pacientes hipertensos son tratados, pero solo el 14% de los pacientes logran ser controlados. Esto se debe a que el proceso actual de control de la hipertensión no es completamente eficiente debido a que el paciente no se adhiere completamente al tratamiento y que los controles de la tensión arterial resultan ser muy puntuales tras periodos de tiempo largos de los cuales no se tiene información confiable relacionada con el progreso del paciente. Se plantea un sistema para el control y monitoreo de alteraciones hipertensivas en el embarazo con el uso de sensores biomédicos no invasivos. De esta manera aseguramos que la medición continua brinde la información precisa y confiable para que las mujeres gestantes puedan detectar a tiempo alguna alteración hipertensiva. Además, en segunda instancia, el sistema alerta a los familiares y al médico encargado sobre los niveles de presión arterial en caso de emergencia. El aporte del proyecto es reducir el aumento en la prevalencia de las enfermedades crónicas mediante la integración de los servicios de salud con la tecnología, y gestionar la información desde la colección de datos a través del wearable hasta la exposición. En base a las pruebas realizadas con pacientes gestantes, se obtiene que el 38.64% son controladas y monitoreadas el 75% del tiempo. Estos resultados indican que el uso de la tecnología puede influenciar positivamente en la reducción de la hipertensión en general o en enfermedades crónicas similares. / In Peru, according to studies conducted in 2010, 42% of hypertensive patients are treated, but only 14% of patients manage to be controlled. This is due to the fact that the current process of hypertension control is not completely efficient because the patient does not completely adhere to the treatment and that blood pressure controls turn out to be very punctual after long periods of time from which there is no reliable information related to the progress of the patient. A system is proposed for the control and monitoring of hypertensive disorders in pregnancy with the use of non-invasive biomedical sensors. In this way we ensure that continuous measurement provides accurate and reliable information so that pregnant women can detect any hypertensive disorder on time. In addition, the system alerts the family members and the doctor in charge about the blood pressure levels in case of emergency. The contribution of the project is to reduce the increase in the prevalence of chronic diseases by integrating health services with technology, and to manage information from data collection through wearable until data exposure. Based on the tests carried out with pregnant patients, 38.64% are controlled and monitored 75% of the time. These results indicate that the use of technology can positively influence the reduction of hypertension in general or in similar chronic diseases. / Tesis

Digital transformation is evolving, and it is driving at the helm of the digital evolution. The amount of information accessible to us has revolutionized the way we gather information. Mobile technology and the immediate and ubiquitous access to information has changed how we engage with services including healthcare. Digital technology and digital transformation have afforded people the ability to self-manage in different ways than face-to-face and paper-based methods through different technologies. This study focuses on exploring the use of the most commonly used digital health technologies in the healthcare sector and how it affects physicians’ daily routine practice. The study presents findings from a qualitative methodology involving semi-structured, personal interviews with physicians from Sweden and a physician from Spain. The interviews capture what physicians feel towards digital transformation, digital health technologies and how it affects their work. In a field where a lack of information regarding how physicians work is affected by digital health technologies, this study reveals a general aspect of how reality looks for physicians. A new way of conducting medicine and the changed role of the physician is presented along with the societal implications for physicians and the healthcare sector. The findings demonstrate that physicians’ role, work and the digital transformation in healthcare on a societal level are important in shaping the future for the healthcare industry and the role of the physician in this future. / Den digitala transformationen växer och den drivs vid rodret för den digitala utvecklingen. Mängden information som är tillgänglig för oss har revolutionerat hur vi samlar in information. Mobila tekniker och den omedelbara och allmänt förekommande tillgången till information har förändrat hur vi tillhandahåller oss tjänster inklusive inom vården. Digital teknik och digital transformation har gett människor möjlighet att kontrollera sig själv och sin egen hälsa på olika sätt än ansikte mot ansikte och pappersbaserade metoder genom olika tekniker. Denna studie fokuserar på att utforska användningen av de vanligaste digitala hälsoteknologierna inom hälso- och sjukvårdssektorn och hur det påverkar läkarnas dagliga rutin. Studien presenterar resultat från en kvalitativ metod som involverar semistrukturerade, personliga intervjuer med läkare från Sverige och en läkare från Spanien. Intervjuerna fångar vad läkare tycker om digital transformation, digital hälsoteknik och hur det påverkar deras arbete. I ett fält där brist på information om hur läkare arbetar påverkas av digital hälsoteknik avslöjar denna studie en allmän aspekt av hur verkligheten ser ut för läkare. Ett nytt sätt att bedriva medicin och läkarens förändrade roll presenteras tillsammans med de samhälleliga konsekvenserna för läkare och vårdsektorn. Resultaten visar att läkarnas roll, arbete och den digitala transformationen inom hälso- och sjukvården på samhällsnivå är viktiga för att utforma framtiden för vårdindustrin och läkarens roll i framtiden.

Background: Regular physical activity (PA) is critical for children’s health and wellbeing. Despite the numerous health benefits, most Canadian children do not meet the Canadian PA guidelines. The emergence of the COVID-19 pandemic and social restrictions added new challenges to meeting the PA guidelines. Mobile health (mHealth) technology can be leveraged to promote PA among children. Combining gamification with mHealth interventions has the potential to further improve program effectiveness. Thus, “Draco” was developed as a virtual pet smartphone app to increase PA in children using self-determination theory as a framework to promote intrinsic motivation for PA. Objective: The primary objective is to evaluate the satisfaction and acceptability of the Draco app after four weeks. Secondary objectives include evaluating the preliminary effectiveness of the Draco app to improve average daily steps, average daily MVPA, perceived autonomy for PA, perceived competence for PA, and perceived relatedness to the app. Methods: 43 Canadian children, aged 8-14 years old, not meeting the Canadian PA guidelines of 60min of MVPA per day were randomly allocated to an intervention or control group. Participants in the control group used a step-tracking app for four weeks. Intervention participants were instructed to use the Draco app. Participants completed a baseline and follow-up questionnaire. PA outcomes were tracked using a Fitbit provided to each participant. Intrinsic PA motivation was assessed using an adapted version of the Intrinsic Motivation Inventory (IMI). Intrinsic motivation was assessed using the satisfaction subscale. Exit interviews were completed to determine app acceptability. Results: Participants demonstrated high levels of satisfaction and acceptability with the Draco app 2.83 (1.29). Intervention participants increased their average daily steps by 909 (1701). The control group increased their steps by 46 (1507). The Draco app had a small effect on promoting steps, MVPA, relatedness and small effects at increasing autonomy and competence. Conclusion: Participants demonstrated high levels of satisfaction and acceptability with the app. Participants in the intervention group showed greater increases in PA with small effect sizes. Preliminary evidence highlights the importance of tailoring game design to the users. Technical limitations impacted recruitment and user experiences. Additional development time should be taken to stabilize the app and add new game features for a definitive RCT. / Graduate