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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (14 January 2022) | Viewed by 42061

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Special Issue Editors

Prof. Dr. Enrique J. Gómez Aguilera

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Guest Editor

Department of PT and Bioengineering, Faculty of Telecommunication Engineering, Universidad Politécnica de Madrid, 28040 Madrid, Spain
Interests: mHealth; digital health; chronic care; neurorehabilitation engineering; brain health

Dr. Jennifer Whetham

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Assistant Guest Editor

HIV/GUM Research Department, Brighton and Sussex University Hospitals NHS Trust (BSUH), The Elton John Centre, Sussex House, 1 Abbey Road, BRIGHTON BN2 1ES, UK
Interests: mHealth; digital health; co-design; HIV; Sexual Health

Special Issue Information

Dear Colleagues,

The use of mobile and wireless technologies is changing the way in which health services are delivered around the world. With more than 2.5 billion people worldwide owning a mobile phone, the opportunities for the use of digital health solutions to improve public health are unprecedented. The number and type of mHealth services are continuously evolving: facilitating access to specialist clinical diagnostics and treatment advice and other areas, such as emergencies and disaster management, health promotion, treatment compliance, mobile patient records, information access and health surveys.

mHealth is integrating many new technologies for intelligent patient monitoring, data collection, and artificial intelligence decision support systems. These services and technologies are applied in many clinical areas, such as chronic care, palliative care, brain health, maternal and childcare, neurorehabilitation, emergency, health behaviour change programmes and patient education. The acceptance of new clinical pathways by clinicians, patients, administrators and policymakers is increasing trends which have been accelerated by the COVID-19 pandemic.

Despite advances, mHealth still faces challenges related to delivering more person-centred health care, ensuring citizens’ secure access to their health data, effective citizen empowerment, early diagnosis and illness prevention. mHealth has become an essential part of public health programme, aiming to empower patients, improve patient–clinician communication, decrease inequality, support vulnerable groups and achieve better health outcomes in a cost-effective manner.

Papers addressing these topics are invited for this Special Issue, especially those combining a high academic and scientific quality coupled with a practical focus on providing emerging mHealth solutions.

Prof. Dr. Enrique J. Gómez Aguilera
Dr. Jennifer Whetham
Guest Editors

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Keywords

mHealth
digital health
chronic care
palliative care
deprived communities
health behaviour change programmes
patient education
patient empowerment

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Published Papers (9 papers)

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Research

24 pages, 1298 KiB

Open AccessArticle

Mobile Health (m-Health) in Retrospect: The Known Unknowns

by Robert S. H. Istepanian

Int. J. Environ. Res. Public Health 2022, 19(7), 3747; https://doi.org/10.3390/ijerph19073747 - 22 Mar 2022

Cited by 75 | Viewed by 10868

Abstract

For nearly two decades, mobile health or (m-Health) was hailed as the most innovative and enabling area for the digital transformation of healthcare globally. However, this profound vision became a fleeting view since the inception and domination of smart phones, and the reorientation of the concept towards the exclusivity of global smart phone application markets and services. The global consumerization of m-Health in numerous disciplines of healthcare, fitness and wellness areas is unprecedented. However, this divergence between ‘mobile health capitalism’ and the ‘science of mobile health’ led to the creation of the ‘m-Health schism’. This schism was sustained by the continued domination of the former on the expense of the latter. This also led to increased global m-Health inequality and divide between the much-perceived health and patient benefits and the markets of m-Health. This divergence was more evident in low and middle income (LMIC) countries compared to the developed world. This powerful yet misguided evolution of the m-Health was driven essentially by complex factors. These are presented in this paper as the ‘known unknowns’ or ‘the obvious but sanctioned facts’ of m-Health. These issues had surreptitiously contributed to this reorientation and the widening schism of m-Health. The collateral damage of this process was the increased shift towards understanding ‘digital health’ as a conjecture term associated with mobile health. However, to date, no clear or scientific views are discussed or analyzed on the actual differences and correlation aspects between digital and mobile health. This particular ‘known unknown’ is presented in detail in order to provide a rapprochement framework of this correlation and valid presentations between the two areas. The framework correlates digital health with the other standard ICT for the healthcare domains of telemedicine, telehealth and e-health. These are also increasingly used in conjunction with digital health, without clear distinctions between these terms and digital health. These critical issues have become timelier and more important to discuss and present, particularly after the world has been caught off guard by the COVID-19 pandemic. The much hyped and the profiteering digital health solutions developed in response of this pandemic provided a modest impact, and the benefits were mostly inadequate in mitigating the massive health, human, and economic impact of this pandemic. This largely commercial reorientation of mobile health was unable not only to predict the severity of the pandemic, but also unable to provide adequate digital tools or effective pre-emptive digital epidemiological shielding and guarding mechanisms against this devastating pandemic. There are many lessons to be learnt from the COVID-19 pandemic from the mobile and digital health perspectives, and lessons must be learnt from the past and to address the critical aspects discussed in this paper for better understanding of mobile health and effective tackling of future global healthcare challenges. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

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16 pages, 2741 KiB

Open AccessArticle

Motivating Physical Activity for Individuals with Intellectual Disability through Indoor Bike Cycling and Exergaming

by Antonio Martinez-Millana, Henriette Michalsen, Valter Berg, Audny Anke, Santiago Gil Martinez, Miroslav Muzny, Juan Carlos Torrado Vidal, Javier Gomez, Vicente Traver, Letizia Jaccheri and Gunnar Hartvigsen

Int. J. Environ. Res. Public Health 2022, 19(5), 2914; https://doi.org/10.3390/ijerph19052914 - 2 Mar 2022

Cited by 9 | Viewed by 4095

Abstract

People with intellectual disabilities have more sedentary lifestyles than the general population. Regular physical activity is of both medical and social importance, reducing the risk of cardiovascular disease and promoting functioning in everyday life. Exergames have been envisioned for promoting physical activity; however, most of them are not user-friendly for individuals with intellectual disabilities. In this paper, we report the design, development, and user acceptance of a mobile health solution connected to sensors to motivate physical activity. The system is mounted on an indoor stationary bicycle and an ergometer bike tailored for people with intellectual disabilities. The development process involved the application of user-centered design principles to customize the system for this group. The system was pilot-tested in an institutional house involving six end-users (intervention group) and demonstrated/self-tested to relatives of persons with ID and staff (supervision group). A System Usability Scale and open-ended interview in the supervision group were used to assess the user acceptance and perceived usefulness. Results indicate that the users with an intellectual disability enjoyed using the system, and that respondents believed it was a useful tool to promote physical activity for the users at the institution. The results of this study provide valuable information on beneficial technological interventions to promote regular physical activity for individuals with intellectual disabilities. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

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14 pages, 3255 KiB

Open AccessArticle

Development and On-Field Deployment of a Mobile-Based Application ‘MoSQuIT’ for Malaria Surveillance in International Border Districts of Northeast India—Challenges and Opportunities

by Saurav Jyoti Patgiri, Gunenja Gobinda Gohain, Santanu Kumar Goswami, Dibya Ranjan Bhattacharyya, Sudhanshu Hari Das Debnath, Lakshmi Panat, Ganesh Karajkhede, Pradyumna K. Mohapatra, Devojit Kumar Sarma, Ipsita Pal Bhowmick, Kongkona Gogoi, Sujit Biswas, Jayanta Debnath, Sukanta Acharjee, Susmita Senapati, Rahul Neog, Prabal Nath, Keisham Meitei, Subrata Baidya, Dinesh Debbarma, Ajit Sarma, Rahim A. Ahmed, Hemkanta Boro, Rubal Chandra Das, Jagadish Mahanta, Satya Ranjan Debbarma and Harpreet Kaur Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(5), 2561; https://doi.org/10.3390/ijerph19052561 - 23 Feb 2022

Cited by 2 | Viewed by 2995

Abstract

The conventional paper-based system for malaria surveillance is time-consuming, difficult to track and resource-intensive. Few digital platforms are in use but wide-scale deployment and acceptability remain to be seen. To address this issue, we created a malaria surveillance mobile app that offers real-time data to stakeholders and establishes a centralised data repository. The MoSQuIT app was designed to collect data from the field and was integrated with a web-based platform for data integration and analysis. The MoSQuIT app was deployed on mobile phones of accredited social health activists (ASHA) working in international border villages in the northeast (NE) Indian states of Assam, Tripura and Arunachal Pradesh for 20 months in a phased manner. This paper shares the challenges and opportunities associated with the use of MoSQuIT for malaria surveillance. MoSQuIT employs the same data entry formats as the NVBDCP’s malaria surveillance programme. Using this app, a total of 8221 fever cases were recorded, which included 1192 (14.5%) cases of P. falciparum malaria, 280 (3.4%) cases of P. vivax malaria and 52 (0.6%) mixed infection cases. Depending on network availability, GPS coordinates of the fever cases were acquired by the app. The present study demonstrated that mobile-phone-based malaria surveillance facilitates the quick transmission of data from the field to decision makers. Geospatial tagging of cases helped with easy visualisation of the case distribution for the identification of malaria-prone areas and potential outbreaks, especially in hilly and remote regions of Northeast India. However, to achieve the full operational potential of the system, operational challenges have to be overcome. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

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18 pages, 4449 KiB

Open AccessArticle

A Sensor-Based mHealth Platform for Remote Monitoring and Intervention of Frailty Patients at Home

by Jorge Calvillo-Arbizu, David Naranjo-Hernández, Gerardo Barbarov-Rostán, Alejandro Talaminos-Barroso, Laura M. Roa-Romero and Javier Reina-Tosina

Int. J. Environ. Res. Public Health 2021, 18(21), 11730; https://doi.org/10.3390/ijerph182111730 - 8 Nov 2021

Cited by 13 | Viewed by 3591

Abstract

Frailty syndrome is an independent risk factor for serious health episodes, disability, hospitalization, falls, loss of mobility, and cardiovascular disease. Its high reversibility demands personalized interventions among which exercise programs are highly efficient to contribute to its delay. Information technology-based solutions to support frailty have been recently approached, but most of them are focused on assessment and not on intervention. This paper describes a sensor-based mHealth platform integrated in a service-based architecture inside the FRAIL project towards the remote monitoring and intervention of pre-frail and frail patients at home. The aim of this platform is constituting an efficient and scalable system for reducing both the impact of aging and the advance of frailty syndrome. Among the results of this work are: (1) the development of elderly-focused sensors and platform; (2) a technical validation process of the sensor devices and the mHealth platform with young adults; and (3) an assessment of usability and acceptability of the devices with a set of pre-frail and frail patients. After the promising results obtained, future steps of this work involve performing a clinical validation in order to quantify the impact of the platform on health outcomes of frail patients. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

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13 pages, 498 KiB

Open AccessArticle

Tele-Yoga in Long Term Illness–Protocol for a Randomised Controlled Trial Including a Process Evaluation and Results from a Pilot Study

by Anna Strömberg, Ingela Thylén, Lotti Orwelius, Leonie Klompstra and Tiny Jaarsma

Int. J. Environ. Res. Public Health 2021, 18(21), 11343; https://doi.org/10.3390/ijerph182111343 - 28 Oct 2021

Cited by 9 | Viewed by 3367

Abstract

Background: For people with long-term illness, debilitated by severe symptoms, it can be difficult to attend regular yoga classes. We have therefore developed a tele-health format of yoga that can be delivered in the home. The tele-yoga was co-designed with members of a patient-organisation, yoga-instructor, and IT-technician. It includes live-streamed group-yoga sessions twice a week and an app with instructions on how to self-perform yoga. Aim: To describe a study protocol for a randomised controlled trial (RCT) including a process evaluation and report on a pilot study evaluating method- and intervention-related components including feasibility, safety, and efficacy. Methods: Ten participants with heart failure aged between 41–76 years were randomised to tele-yoga (n = 5) or to the control group (n = 5). In the pilot study recruitment, enrolment, randomisation, and data collection of all outcomes including primary, secondary and process evaluation measures were tested according to the study protocol. Fidelity, adherence and acceptability to the tele-yoga group training and app use was determined. Safety was assessed by adverse events. Results: The pilot revealed that the methodological aspect of the protocol worked sufficiently in all aspects except for missing data in the physical test of two participants and one participant in the control-group that dropped out of the study at three months follow-up. The tele-yoga training did not lead to any adverse events or injuries, adherence of tele-yoga was sufficient according to preset limits. The tele-yoga intervention also showed some favourable trends of improvements in the composite-end point compared to the active control group. However, since data only was presented descriptively due to the small sample size, the impact of these trends should be interpreted carefully. Conclusion: Our pilot study showed promising results in feasibility, safety, and acceptability of the tele-yoga intervention. Some changes in the protocol have been made to decrease the risk of missing data in the measures of physical function and in the full-scale RCT now ongoing the results of the sample size calculation for 300 participants have included the estimated level of drop outs and missing data. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

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12 pages, 353 KiB

Open AccessArticle

Feasibility of Utilizing Social Media to Promote HPV Self-Collected Sampling among Medically Underserved Women in a Rural Southern City in the United States (U.S.)

by Matthew Asare, Beth A. Lanning, Sher Isada, Tiffany Rose and Hadii M. Mamudu

Int. J. Environ. Res. Public Health 2021, 18(20), 10820; https://doi.org/10.3390/ijerph182010820 - 14 Oct 2021

Cited by 7 | Viewed by 2565

Abstract

Background: Social media (Facebook, WhatsApp, Instagram, Twitter) as communication channels have great potential to deliver Human papillomavirus self-test (HPVST) intervention to medically underserved women (MUW) such as women of low income. However, little is known about MUW’s willingness to participate in HPVST intervention delivered through social media. We evaluated factors that contribute to MUW’s intention to participate in the social media-related intervention for HPVST. Methods: A 21-item survey was administered among women receiving food from a local food pantry in a U.S. southern state. Independent variables were social media usage facilitators (including confidentiality, social support, cost, and convenience), and barriers (including misinformation, time-consuming, inefficient, and privacy concerns). Dependent variables included the likelihood of participating in social-driven intervention for HPVST. Both variables were measured on a 5-point scale. We used multinomial logistic regression to analyze the data. Results: A total of 254 women (mean age 48.9 ± 10.7 years) comprising Whites (40%), Hispanics (29%), Blacks (27%), and Other (4%) participated in the study. We found that over 44% of the women were overdue for their pap smears for the past three years, 12% had never had a pap smear, and 34% were not sure if they had had a pap smear. Over 82% reported frequent social media (e.g., Facebook) usage, and 52% reported willingness to participate in social media-driven intervention for HPVST. Women who reported that social media provide privacy (Adjusted Odds Ratio (AOR) = 6.23, 95% CI: 3.56, 10.92), provide social support (AOR = 7.18, 95% CI: 4.03, 12.80), are less costly (AOR = 6.71, 95% CI: 3.80, 11.85), and are convenient (AOR = 6.17, 95% CI: 3.49, 10.92) had significantly increased odds of participating in social media intervention for HPVST. Conclusions: The findings underscore that the majority of the MUW are overdue for cervical cancer screening, regularly use social media, and are willing to participate in social media-driven intervention. Social media could be used to promote HPV self-testing among MUW. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

19 pages, 2928 KiB

Open AccessArticle

Intelligent Coaching Assistant for the Promotion of Healthy Habits in a Multidomain mHealth-Based Intervention for Brain Health

by Diego Moreno-Blanco, Javier Solana-Sánchez, Patricia Sánchez-González, Manuel Jiménez-Hernando, Gabriele Cattaneo, Alba Roca, Joyce Gomes-Osman, Josep María Tormos-Muñoz, David Bartrés-Faz, Álvaro Pascual-Leone and Enrique J. Gómez

Int. J. Environ. Res. Public Health 2021, 18(20), 10774; https://doi.org/10.3390/ijerph182010774 - 14 Oct 2021

Cited by 2 | Viewed by 2705

Abstract

Brain Health is defined as the development and preservation of optimal brain integrity and neural network functioning for a given age. Recent studies have related healthy habits with better maintenance of brain health across the lifespan. As a part of the Barcelona Brain Health Initiative (BBHI), a mHealth platform has been developed with the purpose of helping people to improve and monitor their healthy habits, facilitating the delivery of health coaching strategies. A decision support system (DSS), named Intelligent Coaching Assistant (ICA), has been developed to ease the work of professional brain health coaches, helping them design and monitor adherence to multidomain interventions in a more efficient manner. Personalized recommendations are based on users’ current healthy habits, individual preferences, and motivational aspects. Taking these inputs, an initial user profile is defined, and the ICA applies an algorithm for determining the most suitable personalized intervention plan. An initial validation has been done focusing on assessing the feasibility and usability of the solution, involving 20 participants for three weeks. We conclude that this kind of technology-based intervention is feasible and implementable in real-world settings. Importantly, the personalized intervention proposal generated by the DSS is feasible and its acceptability and usability are high. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

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14 pages, 951 KiB

Open AccessArticle

Usability and Acceptability of a Mobile App for Behavior Change and to Improve Immunization Coverage among Children in Pakistan: A Mixed-Methods Study

by Abdul Momin Kazi, Nazia Ahsan, Waliyah Mughis, Saima Jamal, Raheel Allana, Mehreen Raza, Sahrish Muneer, Muhammad Ayub Khan Mughal, Hussain Kaleemuddin, Fareeha Sameen, Rao Moueed Ahmed, Munir Abbasi, Lampros K. Stergioulas and Saad Ahmed Qazi

Int. J. Environ. Res. Public Health 2021, 18(18), 9527; https://doi.org/10.3390/ijerph18189527 - 9 Sep 2021

Cited by 14 | Viewed by 6000

Abstract

Background: Pakistan’s immunization uptake rates are still significantly lower than anticipated despite several initiatives. Lack of awareness, forgetting about vaccination schedule, and vaccine misconception/misinformation are a few of the major drivers that mitigate the rates of immunization. The current COVID-19 pandemic emphasizes the importance of immunization. The significant reductions in regular childhood vaccination during pandemic have increased the risk of outbreaks of vaccine-preventable diseases. Concerns among parents over possibly exposing their children to COVID-19 during child visits may have contributed to the reported declines. Innovative and cost-effective mHealth interventions must be implemented in order to address the problem of inadequate immunization rates. In addition, it is also critical to understand the end user needs in order to reflect on the highly relevant essence of the customized healthcare experience. Objective: The aim of this study was to learn about caregivers’ attitudes toward the usability and acceptability of behavior-change smartphone applications (mobile phones) for improving immunization coverage in Pakistan. Methods: A mixed-method design was employed for this study. The study was conducted at Aga Khan University, Hospital. Parents visiting the Community Health Center for 6-week vaccination of their children were recruited. The study was conducted in two stages. Stage 1 consisted of qualitative interviews that grasped the parent’s attitudes and challenges to immunization, as well as their acceptability and accessibility of the smartphone-based behavior-change application to increase vaccine uptake. Stage 1 was followed by stage 2, in which data were collected through a questionnaire designed by using data from qualitative interviews. Results: The majority of participants agreed that immunization serves an important role in protecting their child from illnesses that cause morbidity and mortality. Almost all of them emphasized the importance of using a pre-appointment method at vaccination center in order to reduce the waiting time. Furthermore, participants were also interested in AI-based behavior modification applications related to immunization. They also wanted to have applications in their native language for better understanding and communication of related information. In our study, approximately 95.2 percent of participants agreed to accept SMS immunization updates, which was also reasonably high. Lastly, the majority of them identified forgetfulness as a significant contributor to regular immunization. Conclusion: To enhance the uptake of childhood vaccines, overall vaccination rates, and overcome barriers related to vaccination coverage, cost-effective and user-friendly mHealth AI-based smart phone applications are required to raise awareness regarding the continuation of vaccination service and the importance of timely vaccination. Parents’ experiences and attitudes must be considered while designing and evaluating the efficacy of mHealth-based interventions. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

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15 pages, 4514 KiB

Open AccessArticle

EmERGE mHealth Platform: Implementation and Technical Evaluation of a Digital Supported Pathway of Care for Medically Stable HIV

by Francisco J. Gárate, Paloma Chausa, Jennifer Whetham, Christopher Iain Jones, Felipe García, César Cáceres, Patricia Sánchez-González, Edward Wallitt, Enrique J. Gómez and on behalf of the EmERGE Consortium

Int. J. Environ. Res. Public Health 2021, 18(6), 3156; https://doi.org/10.3390/ijerph18063156 - 18 Mar 2021

Cited by 13 | Viewed by 3796

Abstract

In this article, we described a new mobile-Health (mHealth) supported clinical pathway of care for people living with medically stable HIV in terms of platform acceptability, usability and technical feasibility. The EmERGE mHealth platform was codesigned with clinicians and the community, developed using Scrum agile methodology, integrated with hospital information systems and validated in a large prospective cohort study of 2251 participants. The evaluation of this new paradigm of care was conducted using a tailored Health Technology Assessment: the Model for Assessment of Telemedicine Applications. Usability and acceptability were assessed through the System Usability Score and a Patient Reported Experience Measure. The EmERGE platform was successfully deployed across diverse care settings in five European countries and used by 2251 patients and more than 20 clinicians for up to 30 months. Results from the formal evaluation demonstrated that the EmERGE platform is feasible and acceptable, with a high level of usability (median System Usability Score (SUS) 85.0%) and very positive patient-reported experiences (94.2% would recommend to a friend). The EmERGE platform is a secure and General Data Protection Regulation (GDPR)-compliant system with a complete set of functionalities that could be easily adapted to other clinical conditions, clinical sites and health systems thanks to its modular technical architecture. Full article

(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)

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