GPS mHealth Intervention among People Experiencing Homelessness: A Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Leticia R. Moczygemba ◽  
Whitney Thurman ◽  
Kyler Tormey ◽  
Anthony Hudzik ◽  
Lauren Welton-Arndt ◽  
...  
Keyword(s):  
Community Health ◽  
Mobile Health ◽  
Care Coordination ◽  
Information Exchange ◽  
Social Needs ◽  
Local Health ◽  
Hospital Visit ◽  
Mhealth Intervention ◽  
Significant Difference ◽  
E Mail

BACKGROUND People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased utilization, poor health outcomes, and high health care costs. The majority of homeless individuals have a cell phone of some type, which makes mobile health interventions a feasible way to connect a person experiencing homelessness with providers. OBJECTIVE To investigate the accuracy, acceptability, and preliminary outcomes of a global positioning system-enabled mobile health (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness were in the ED or hospital. METHODS This was a pre-post design with baseline and 4-month post-enrollment assessments. A person experiencing homelessness taking at least two medications for chronic conditions who scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9) and had at least two ED or hospital visits in the prior 6 months was eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily e-mail to assess medication adherence. GPS alerts were compared to ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t-tests compared scores on the PHQ-9, Medical Outcomes Study Social Support Survey, and ASK-12 adherence survey at baseline and exit. Semi-structured exit interviews examined perceptions and benefits of the intervention. RESULTS Thirty participants enrolled; the mean age was 44.1 years (SD 9.7). Most were male (67%; n = 20), White (57%; n = 17), and not working (63%; n = 19). The GPS app showed limited accuracy in ED or hospital visit alerts. Only 18.8% of the alerts aligned with HIE data (3/16), mainly due to patients not having the phone with them during the visit, phone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (M=16.9, SD=5.8) and exit (M=12.7, SD=8.2); t(19)=2.9, p=.009 and a significant difference in adherence barriers between baseline (M=2.4, SD=1.4) and exit (M=1.5, SD =1.5); t(17)=2.47, p = .025). Participants agreed that the app was easy to use (M=4.4/5 with 5 = strongly agree (SA)) and indicated the e-mail helped them remember to take their medications (M=4.6/5). Qualitative data indicated that unlimited phone access allowed participants to meet social needs and maintain reliable contact with case managers, healthcare providers, family, and friends. CONCLUSIONS mHealth interventions are feasible for and acceptable to people experiencing homelessness. Objective data from the HIE provided more accurate ED and hospital visit information, but unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. CLINICALTRIAL Not applicable

scholarly journals A Critical Realist Evaluation of an Integrated Care Project for Vulnerable Families in Sydney, Australia

2020 ◽  
Author(s):  
Elaine Tennant ◽  
Erin Miller ◽  
Kathryn Costantino ◽  
Denise De Souza ◽  
Heidi Coupland ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Coordination ◽  
Social Needs ◽  
Local Health ◽  
Programme Theory ◽  
Critical Realist ◽  
Vulnerable Families ◽  
Integration Of Services

Abstract Background Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was established to improve the care of families with complex health and social needs who reside in Sydney Local Health District. HHAN seeks to provide long-term multi-disciplinary care coordination as well as enhance capacity building and promotion of integrated care. We describe the qualitative component of a critical realist pilot case study aimed at exploring, explaining and refining emerging HHAN programme theories in relation to care coordination. Methods Semi-structured qualitative interviews with HHAN clients (n=12), HHAN staff and other stakeholders (n=21). Emerging themes informed the development of Context-Mechanism-Outcome configurations aimed at evaluating HHAN’s effectiveness and refining the programme theory. Results HHAN’s effectiveness was based on two process mechanisms: Engagement of vulnerable clients and integration of services. The relational mechanisms underpinning effective engagement of clients by care coordinators included: building trust, leveraging other family, social and organisational relationships, meeting clients on their own terms, demonstrating staff effectiveness as quickly as possible, and client empowerment. Operational mechanisms for enhancing care integration included knowledge transfer activities and shared learning among collaborators, structural and cultural changes, enhancing mutual respect, co-location of multidisciplinary and/or interagency staff and cultivating faith in positive change among staff. Conclusions Use of a critical realism case study approach served to elucidate the varied influences of contexts and mechanisms on programme outcomes, to highlight what works for whom and in what context. Findings supported the initial programme theory that engagement and trust building with clients, alongside enhanced collaboration and integration of services, improved outcomes for vulnerable families with complex needs. Further research is needed to explore the cost-effectiveness of integrated care initiatives, in view of the long term nature of service provision and the risk of staff burnout.

scholarly journals Socio-cultural contextual factors that contribute to the uptake of a mobile health intervention to enhance maternal health care in rural Senegal

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Margaret E. MacDonald ◽  
Gorgui Sene Diallo
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Community Health ◽  
Health Care Providers ◽  
Mobile Health ◽  
Maternal Health Care ◽  
Care Group ◽  
Care Providers ◽  
Mhealth Intervention

Abstract Background Although considerable progress has been made in reducing maternal mortality over the past 25 years in Senegal, the national maternal mortality ratio (MMR), at 315 deaths per 100,000 live births, is still unacceptably high. In recent years a mobile health (mHealth) intervention to enhance maternal health care has been introduced in rural and remote areas of the country. CommCare is an application that runs on cell phones distributed to community health workers known as matrones who enroll and track women throughout pregnancy, birth and the post-partum, offering health information, moral support, appointment reminders, and referrals to formal health care providers. Methods An ethnographic study of the CommCare intervention and the larger maternal health program into which it fits was conducted in order to identify key social and cultural contextual factors that contribute to the uptake and functioning of this mHealth intervention in Senegal. Ethnographic methods and semi-structured interviews were used with participants drawn from four categories: NGO field staff (n = 16), trained health care providers (including physicians, nurses, and midwives) (n = 19), community level health care providers (n = 13); and women belonging to a community intervention known as the Care Group (n = 14). Data were analyzed using interpretive analysis informed by critical medical anthropology theory. Results The study identified five socio-cultural factors that work in concert to encourage the uptake and use of CommCare: convening women in the community Care Group; a cultural mechanism for enabling pregnancy disclosure; constituting authoritative knowledge amongst women; harnessing the roles of older women; and adding value to community health worker roles. We argue that, while CommCare is a powerful tool of information, clinical support, surveillance, and data collection, it is also a social technology that connects and motivates people, transforming relationships in ways that can optimize its potential to improve maternal health care. Conclusions In Senegal, mHealth has the potential not only to bridge the gaps of distance and expertise, but to engage local people productively in the goal of enhancing maternal health care. Successful mHealth interventions do not work as ‘magic bullets’ but are part of ‘assemblages’ – people and things that are brought together to accomplish particular goals. Attention to the social and cultural elements of the global health assemblage within which CommCare functions is critically important to understand and develop this mHealth technology to its full potential.

Infrastructure Development of mHealth Systems in Developing Countries (Case Study: Implementation NusaHealth Apps in Yogyakarta Indonesia) (Preprint)

2020 ◽  
Author(s):  
Surahyo Sumarsono ◽  
Peter M.A. van Ooijen ◽  
Widyawan Widyawan
Keyword(s):  
Developing Countries ◽  
Health System ◽  
Community Health ◽  
Data Storage ◽  
Mobile Health ◽  
Rural Areas ◽  
Pilot Project ◽  
Management Program ◽  
Local Health ◽  
Infrastructure Development

BACKGROUND The size of the Indonesian population and the shifting pattern of illness from infectious to non-communicable diseases (NCDs), which leads to double disease burden, demand that Indonesia develop a variety of innovative efforts to control the numbers of NCDs. Moreover, NCDs are preventable and strongly influenced by lifestyle, therefore individual intervention to stimulate healthier lifestyle is important. One approach to support NCD programs is the use of mobile technology or mHealth. OBJECTIVE The purpose of this work is to show the process of designing and developing a mobile health system, NusaHealth, which will be implemented in rural areas of Yogyakarta province. The NusaHealth system will be our pilot project to get better understanding and knowledge how mobile health solution answers the health problems in rural areas in terms of promotion and prevention health services. METHODS Universitas Gadjah Mada (UGM) seeks to address the challenges of developing a technology-based health management program. The development of the NusaHealth system starts from looking at the potential of health data that can be processed and enriched to become health information. The NusaHealth project builds a digital healthcare infrastructure involving universities, healthcare providers (hospitals, community health centers, clinics, health offices and others) and communities (including health volunteers) in a mHealth approach that puts patient at the center of health care. RESULTS The NusaHealth system has been realized through the process of design and development which involved experts and partners. Technical descriptions including supported device specifications, operating systems requirements, feature needed, user interface, data storage, interoperability and security assessment produced in the paper. Moreover, the infrastructure to connect mobile devices network with the hospital information system has been developed, as well as supporting systems such as SMS gateway and servers. CONCLUSIONS This paper proves that the process of designing and developing a mobile health solution for rural areas in developing countries needs to be comprehensive and the process of field implementation should involve related partners. While the NusaHealth pilot project in rural areas of Yogyakarta province was successfully implemented, further activities need to be implemented to enhance community health through development of formal mobile health system supported by local health district offices’ policies and regulations. Wider geographical areas will be a challenging opportunity in measuring whether this system is suitable in the context of developing country. CLINICALTRIAL None

Benefits of mHealth for Symptom Management of Cancer Patients: A Meta-Analysis (Preprint)

2021 ◽  
Author(s):  
Jiarong Li ◽  
Mingxia Chen ◽  
Wang Su ◽  
Changying Liu ◽  
Linglong Liu
Keyword(s):  
Cancer Patients ◽  
Mobile Health ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Mhealth Intervention ◽  
Significant Difference ◽  
Registration Number ◽  
Mobile Health Applications

BACKGROUND At the present, cancer patients are experiencing symptoms that can seriously influence their quality of life. There are many mobile health applications in Internet medical services to manage those symptoms. However, further research is needed to see whether mobile health can provide benefits to cancer patients. OBJECTIVE The meta-analysis aimed to value the benefits of mHealth for depression, anxiety, pain, fatigue, and insomnia outcomes of cancer patients. METHODS We searched PubMed, CINHAL, Web of Science, Cochrane library Trials, EMBASE database to select random clinic trials that investigated the benefits of mHealth for cancer patients, from the date of inception to 17 April 2021. RESULTS Eight random clinic trials were eligible for this meta-analysis. Collectively, mHealth group has 1641 participants, the control group has 1463 participants. The meta-analysis revealed that the mHealth intervention improves significantly cancer patients’ fatigue(SMD −0.19, 95% CI −0.32 to −0.05），P= .007), insomnia(SMD −0.26, 95% CI −0.44 to −0.08, P= .005), depression(SMD −0.22, 95% CI −0.32 to −0.13，P<0.00001), and anxiety(SMD −0.27, 95% CI −0.47 to −0.07, P= .008), whereas no significant difference was found in pain score (SMD -0.27, 95%CI −0.68 to 0.13，P= .19). CONCLUSIONS mHealth intervention may significantly improve depression, anxiety, fatigue, and insomnia outcomes of cancer patients, but have no significant effort on pain. CLINICALTRIAL This meta-analysis was registered with The International Prospective Register of Systematic Reviews (PROSPERO) , registration number is: CRD42021272537.

Assessment of Electronic Procurement Practices on Project Delivery, Case Study of Selected Construction Companies in Oyo State

2018 ◽  
pp. 257-266
Keyword(s):  
Construction Industry ◽  
Information Exchange ◽  
Ease Of Use ◽  
Project Delivery ◽  
Development Programs ◽  
Construction Firms ◽  
Construction Companies ◽  
Electronic Procurement ◽  
Ict Infrastructure ◽  
E Mail

This study investigated the use of e-Procurement in selected construction firms in Oyo state, Nigeria. The data were derived using a well-structured questionnaire survey involving 104 respondents. Descriptive statistical and correlation analyses were used to analyze the data. Findings show that the use of electronic procurement in the selected construction firms for carrying out procurement function is high with majority of the professionals affirming the use of the system, the four categories of e-Procurement used were e-mail, static websites, web.2.0 technologies and portals that have capabilities of supporting the execution of functions limited to intra and inter firm communication and exchange of project information and data. Consequently, between 84 percent and 76 percent of the respondents used these e-Procurement technologies for communication of information, exchange of bill of quantities, project reports, CAD drawings and project specifications. Consequently, factors with the highest positive impacts on the use of these technologies in the firms were the speed of transactions, lower transaction cost and ease of use. The study implies that the selected construction firms in Oyo state Nigeria predominantly use e-mails and websites to support the execution of pre-award phase of construction procurement. Finding also shows that there is positive relationship between e-Procurement (e-Notifying, e-Exchange, and e-Submission of bid) and Project delivery. The study suggests that to accelerate the rate of uptake of e-Procurement and maximize its benefits in the Nigerian construction industry, there is a need to improve the quality and quantity of ICT infrastructure across the country; and to embark on aggressive enlightenment campaigns, training and skill development programs in the use of e-Procurement in the construction industry in this country.

scholarly journals The role of a clinician amid the rise of mobile health technology

2019 ◽  
Vol 26 (11) ◽  
pp. 1385-1388 ◽  
Author(s):  
William E Yang ◽  
Lochan M Shah ◽  
Erin M Spaulding ◽  
Jane Wang ◽  
Helen Xun ◽  
...  
Keyword(s):  
Mobile Health ◽  
Healthy Lifestyle ◽  
Clinical Care ◽  
Critical Role ◽  
Lifestyle Changes ◽  
Mhealth Intervention ◽  
Early Results ◽  
Modification Technique ◽  
Behavior Modification Technique

Abstract Mobile health (mHealth) interventions have demonstrated promise in improving outcomes by motivating patients to adopt and maintain healthy lifestyle changes as well as improve adherence to guideline-directed medical therapy. Early results combining behavioral economic strategies with mHealth delivery have demonstrated mixed results. In reviewing these studies, we propose that the success of a mHealth intervention links more strongly with how well it connects patients back to routine clinical care, rather than its behavior modification technique in isolation. This underscores the critical role of clinician-patient partnerships in the design and delivery of such interventions, while also raising important questions regarding long-term sustainability and scalability. Further exploration of our hypothesis may increase opportunities for multidisciplinary clinical teams to connect with and engage patients using mHealth technologies in unprecedented ways.

scholarly journals Incorporating Behavioral Trigger Messages Into a Mobile Health App for Chronic Disease Management: Randomized Clinical Feasibility Trial in Diabetes

10.2196/15927 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e15927
Author(s):  
Scott Sittig ◽  
Jing Wang ◽  
Sriram Iyengar ◽  
Sahiti Myneni ◽  
Amy Franklin
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Mobile Health ◽  
Self Efficacy ◽  
Chronic Disease Management ◽  
Text Messages ◽  
Feasibility Trial ◽  
Significant Difference ◽  
Within Subjects ◽  
The Impact

Background Although there is a rise in the use of mobile health (mHealth) tools to support chronic disease management, evidence derived from theory-driven design is lacking. Objective The objective of this study was to determine the impact of an mHealth app that incorporated theory-driven trigger messages. These messages took different forms following the Fogg behavior model (FBM) and targeted self-efficacy, knowledge, and self-care. We assess the feasibility of our app in modifying these behaviors in a pilot study involving individuals with diabetes. Methods The pilot randomized unblinded study comprised two cohorts recruited as employees from within a health care system. In total, 20 patients with type 2 diabetes were recruited for the study and a within-subjects design was utilized. Each participant interacted with an app called capABILITY. capABILITY and its affiliated trigger (text) messages integrate components from social cognitive theory (SCT), FBM, and persuasive technology into the interactive health communications framework. In this within-subjects design, participants interacted with the capABILITY app and received (or did not receive) text messages in alternative blocks. The capABILITY app alone was the control condition along with trigger messages including spark and facilitator messages. A repeated-measures analysis of variance (ANOVA) was used to compare adherence with behavioral measures and engagement with the mobile app across conditions. A paired sample t test was utilized on each health outcome to determine changes related to capABILITY intervention, as well as participants’ classified usage of capABILITY. Results Pre- and postintervention results indicated statistical significance on 3 of the 7 health survey measures (general diet: P=.03; exercise: P=.005; and blood glucose: P=.02). When only analyzing the high and midusers (n=14) of capABILITY, we found a statistically significant difference in both self-efficacy (P=.008) and exercise (P=.01). Although the ANOVA did not reveal any statistically significant differences across groups, there is a trend among spark conditions to respond more quickly (ie, shorter log-in lag) following the receipt of the message. Conclusions Our theory-driven mHealth app appears to be a feasible means of improving self-efficacy and health-related behaviors. Although our sample size is too small to draw conclusions about the differential impact of specific forms of trigger messages, our findings suggest that spark triggers may have the ability to cue engagement in mobile tools. This was demonstrated with the increased use of capABILITY at the beginning and conclusion of the study depending on spark timing. Our results suggest that theory-driven personalization of mobile tools is a viable form of intervention. Trial Registration ClinicalTrials.gov NCT04132089; http://clinicaltrials.gov/ct2/show/NCT004122089

scholarly journals A Men Who Have Sex With Men–Friendly Doctor Finder Hackathon in Guangzhou, China: Development of a Mobile Health Intervention to Enhance Health Care Utilization (Preprint)

2019 ◽  
Author(s):  
Chunyan Li ◽  
Yuan Xiong ◽  
Hao Fong Sit ◽  
Weiming Tang ◽  
Brian J Hall ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Social Media ◽  
Social Networking ◽  
Computer Science ◽  
Mobile Health ◽  
Clinical Medicine ◽  
Web Based ◽  
Mhealth Intervention ◽  
Sex With Men

BACKGROUND Mobile health (mHeath)–based HIV and sexual health promotion among men who have sex with men (MSM) is feasible in low- and middle-income settings. However, many currently available mHealth tools on the market were developed by the private sector for profit and have limited input from MSM communities. OBJECTIVE A health hackathon is an intensive contest that brings together participants from multidisciplinary backgrounds to develop a proposed solution for a specific health issue within a short period. The purpose of this paper was to describe a hackathon event that aimed to develop an mHealth tool to enhance health care (specifically HIV prevention) utilization among Chinese MSM, summarize characteristics of the final prototypes, and discuss implications for future mHealth intervention development. METHODS The hackathon took place in Guangzhou, China. An open call for hackathon participants was advertised on 3 Chinese social media platforms, including Blued, a popular social networking app among MSM. All applicants completed a Web-based survey and were then scored. The top scoring applicants were grouped into teams based on their skills and content area expertise. Each team was allowed 1 month to prepare for the hackathon. The teams then came together in person with on-site expert mentorship for a 72-hour hackathon contest to develop and present mHealth prototype solutions. The judging panel included experts in psychology, public health, computer science, social media, clinical medicine, and MSM advocacy. The final prototypes were evaluated based on innovation, usability, and feasibility. RESULTS We received 92 applicants, and 38 of them were selected to attend the April 2019 hackathon. A total of 8 teams were formed, including expertise in computer science, user interface design, business or marketing, clinical medicine, and public health. Moreover, 24 participants self-identified as gay, and 3 participants self-identified as bisexual. All teams successfully developed a prototype tool. A total of 4 prototypes were designed as a mini program that could be embedded within a popular Chinese social networking app, and 3 prototypes were designed as stand-alone apps. Common prototype functions included Web-based physician searching based on one’s location (8 prototypes), health education (4 prototypes), Web-based health counseling with providers or lay health volunteers (6 prototypes), appointment scheduling (8 prototypes), and between-user communication (2 prototypes). All prototypes included strategies to ensure privacy protection for MSM users, and some prototypes offered strategies to ensure privacy of physicians. The selected prototypes are undergoing pilot testing. CONCLUSIONS This study demonstrated the feasibility and acceptability of using a hackathon to create mHealth intervention tools. This suggests a different pathway to developing mHealth interventions and could be relevant in other settings.

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