The Effectiveness of Dietary Approaches to Stop Hypertension (DASH) Mobile Applications in Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review (Preprint)

BACKGROUND Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approach to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile applications (apps) have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP OBJECTIVE This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and, consequently, reduce BP. A secondary aim was to assess user engagement, satisfaction and acceptance, and usability related to DASH mobile app use. METHODS EMBASE (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The included articles’ reference lists were also checked. RESULTS Five studies (three RCTs and two pre-post studies) including 334 participants altogether examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the three RCTs had a high risk of bias. One pre-post study had a high risk of bias, the other had a low risk. As a consequence, no firm conclusions can be drawn regarding DASH smartphone apps’ effectiveness in increasing DASH diet adherence and lowering blood pressure. All the apps appeared to be accepted and easy to use. CONCLUSIONS There is weak emerging evidence of a positive effect of using DASH smartphone apps supporting self-management to improve DASH diet adherence and, consequently, lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps. CLINICALTRIAL Review article

A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study

Background Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic. Objective This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app. Methods In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app. Results The results of the quantitative analysis did not support this study’s hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement. Conclusions Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary.

Citizen Participation via Mobile Applications

Participatory smartphone apps empower citizens to interact with the city's administration. The purpose of this case study is to investigate the current state of participatory apps in Germany. Within this study, we examined 248 applications aimed at strengthening citizen participation. These apps were found in Google Playstore and Apple Appstore using search terms extracted from the relevant literature. Many of the apps give users the opportunity to report problems within their cities, such as broken street lamps or potholes. The information created and disseminated by the citizens through the app mainly includes the topics “mobility” and “environment.” Information provided by the city itself is much more diverse. Topics such as “Points of Interest,” “News and Events,” “Government” or “City Services” can be identified here. In the southern part of Germany, there is a significantly larger number of municipalities which have a citizen participation app. None of the apps examined uses gamification, although the use of game elements is very promising to foster the engagement and motivation of citizens.

Development and Validation of a Smartphone-Based App for the Longitudinal Assessment of Anxiety in Daily Life

Current methods to assess human anxiety often ignore that anxiety is a dynamic process and have limitations such as high recall bias and low generalizability to real life. Smartphone apps using ecological momentary assessment (EMA) may overcome such limitations. We developed a smartphone app for the longitudinal evaluation of anxiety symptoms using EMA. We assessed the feasibility (retention and compliance) and psychometric properties (reliability and validity) of the app over 6 months in a sample of 99 participants with different levels of anxiety. The EMA-based smartphone app was highly feasible. It showed excellent within-person and between-person reliability, high convergent and moderate discriminant validity, and significant incremental validity. Assessing anxiety longitudinally using a smartphone and following EMA principles is feasible and can be reliable and valid. Studies combining EMA-based anxiety longitudinal assessments with other assessment methods deserve further research and may offer novel insights into human anxiety.

Improving well-being with mobile AI-powered Acceptance Commitment Therapy tool: Pragmatic Retrospective Study (Preprint)

BACKGROUND The research and dissemination of smartphones-based apps to deliver coaching and psychological driven intervention had seen a great surge in recent years. Notably, Acceptance Commitment Therapy (ACT) protocols were shown to be uniquely effective in treating symptoms for both depression and anxiety when delivered through smartphone apps. The aim if this study to expand on that work and test the suitability of AI driven intervention delivered directly through popular texting apps. OBJECTIVE This study evaluated our hypothesis that using Kai.ai will result in improved well-being. METHODS A pragmatic retrospective analysis of 2909 users who used Kai.ai on one of the top messaging apps (iMessage, WhatsApp, Discord, Telegram, etc.) Users’ well-being levels were tracked using the WHO-5 well-being questionnaire throughout the engagement with service. Paired sample t-test was used to assess well-being levels pre and post usage, and Hierarchical Linear Modeling was used to examine the change in symptoms over time. RESULTS The median well-being score at the last measurement was better (Mdn = 52) then at the start of the intervention (Mdn = 40), indicating a significant improvement (W=2682927, p<.001, one tailed test). Furthermore, HLM results showed that the improvement in well-being was linearly related to the number of daily messages a user sent (beta =.029, t(81.36)=4, p<.001), as well as the interaction between the number of messages and unique number of days (beta = -.0003, t(81.36)=-2.2, p<.028). CONCLUSIONS mobile based Acceptance Commitment Therapy (ACT) interventions are effective means to improve individuals’ well-being. findings reported in this paper further demonstrate Kai.ai’s great promise in helping individuals improve and maintain high levels of well-being, and thus improve their daily life.

Improving well-being with mobile AI-powered Acceptance Commitment Therapy tool: Pragmatic Retrospective Study

Background The research and dissemination of smartphones-based apps to deliver coaching and psychological driven intervention had seen a great surge in recent years. Notably, Acceptance Commitment Therapy (ACT) protocols were shown to be uniquely effective in treating symptoms for both depression and anxiety when delivered through smartphone apps. The aim if this study to expand on that work and test the suitability of AI driven intervention delivered directly through popular texting apps.Objective This study evaluated our hypothesis that using Kai.ai will result in improved well-being.Methods A pragmatic retrospective analysis of 2909 users who used Kai.ai on one of the top messaging apps (iMessage, WhatsApp, Discord, Telegram, etc.) Users’ well-being levels were tracked using the WHO-5 well-being questionnaire throughout the engagement with service. Paired sample t-test was used to assess well-being levels pre and post usage, and Hierarchical Linear Modeling was used to examine the change in symptoms over time.Results The median well-being score at the last measurement was better (Mdn = 52) then at the start of the intervention (Mdn = 40), indicating a significant improvement (W=2682927, p&lt;0.001, one tailed test). Furthermore, HLM results showed that the improvement in well-being was linearly related to the number of daily messages a user sent (beta = 0.029, t(81.36)=4, p&lt;0.001), as well as the interaction between the number of messages and unique number of days (beta = -0.0003, t(81.36)=-2.2, p&lt;0.05).Conclusions mobile based Acceptance Commitment Therapy (ACT) interventions are effective means to improve individuals’ well-being. findings reported in this paper further demonstrate Kai.ai’s great promise in helping individuals improve and maintain high levels of well-being, and thus improve their daily life.

Towards Understanding the Usability Attributes of AI-Enabled eHealth Mobile Applications

Mobile application (app) use is increasingly becoming an essential part of our daily lives. Due to their significant usefulness, people rely on them to perform multiple tasks seamlessly in almost all aspects of everyday life. Similarly, there has been immense progress in artificial intelligence (AI) technology, especially deep learning, computer vision, natural language processing, and robotics. These technologies are now actively being implemented in smartphone apps and healthcare, providing multiple healthcare services. However, several factors affect the usefulness of mobile healthcare apps, and usability is an important one. There are various healthcare apps developed for each specific task, and the success of these apps depends on their performance. This study presents a systematic review of the existing apps and discusses their usability attributes. It highlights the usability models, outlines, and guidelines proposed in previous research for designing apps with improved usability characteristics. Thirty-nine research articles were reviewed and examined to identify the usability attributes, framework, and app design conducted. The results showed that satisfaction, efficiency, and learnability are the most important usability attributes to consider when designing eHealth mobile apps. Surprisingly, other significant attributes for healthcare apps, such as privacy and security, were not among the most indicated attributes in the studies.

Usage of Smartphone Apps in Self-care of Patients Undergoing Hemodialysis: A Scoping Review

Aim: Using smartphone apps can be a valuable tool for self-managing dialysis patients. This study aimed to review the usage of smartphone apps in the self-care of patients undergoing hemodialysis. Method: Resources were searched on three bibliographic databases, including PubMed, Scopus, and CINAHL, investigated from May 2005 through May 2021, using key terms, such as smartphone apps, mobile health, hemodialysis, chronic kidney disease, self-care, and self-management. Selecting articles were based on the PRISMA flow diagram. Results: The smartphone apps used for undergoing hemodialysis patients were categorized into five main categories. These categories included dietary monitoring, treatment adherence, lifestyle management, symptoms monitoring, and patient training. Conclusion: Smartphone apps must be developed by cooperation and supervision of healthcare agencies to improve patient adoption and ensure confidentiality. Further research efforts are needed to assess the impact of apps on quality of life outcomes through randomized controlled trials and cohort studies. In developing apps, the needs and preferences of patients must be considered.