OBJECTIVE: This study aimed to describe the usability and utility testing of a newly developed medication adherence app-Med Assist-among ambulatory care patients in Malaysia.
METHODS: The Med Assist app was developed based on the Theory of Planned Behavior and the Nielson usability model. Beta testing was conducted from March to May 2016 at a primary care clinic in Kuala Lumpur. Ambulatory care patients who scored ≥40% on the electronic health literacy scale, were aged ≥21 years, and were taking two or more long-term medications were recruited. Two rounds of in-depth interviews were conducted with each participant. The first interview, which was conducted upon participant recruitment, was to assess the usability of Med Assist. Participants were asked to download Med Assist on their phone and perform two tasks (register themselves on Med Assist and enter at least one medication). Participants were encouraged to "concurrently think aloud" when using Med Assist, while nonverbal cues were observed and recorded. The participants were then invited for a second interview (conducted ≥7 days after the first interview) to assess the utility of Med Assist after using the app for 1 week. This was done using "retrospective probing" based on a topic guide developed for utilities that could improve medication adherence.
RESULTS: Usability and utility testing was performed for the Med Assist app (version P4). A total of 13 participants were recruited (6 men, 7 women) for beta testing. Three themes emerged from the usability testing, while three themes emerged from the utility testing. From the usability testing, participants found Med Assist easy to use and user friendly, as they were able to complete the tasks given to them. However, the details required when adding a new medication were found to be confusing despite displaying information in a hierarchical order. Participants who were caregivers as well as patients found the multiple-user support and pill buddy utility useful. This suggests that Med Assist may improve the medication adherence of patients on multiple long-term medications.
CONCLUSIONS: The usability and utility testing of Med Assist with end users made the app more patient centered in ambulatory care. From the usability testing, the overall design and layout of Med Assist were simple and user friendly enough for participants to navigate through the app and add a new medication. From the participants' perspectives, Med Assist was a useful and reliable tool with the potential to improve medication adherence. In addition, utilities such as multiple user support and a medication refill reminder encouraged improved medication management.
OBJECTIVE: The objectives of this study are (1) to evaluate the feasibility of a brief mindfulness-based mobile app (BM-MA) for Indonesian senior high school teachers experiencing anxiety and stress and (2) to examine the effects of using the BM-MA on anxiety, stress, life satisfaction, self-efficacy, trait mindfulness, self-compassion, and physical and social dysfunction among the participants.
METHODS: We followed the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement for this feasibility randomized controlled trial (RCT) protocol. A total of 60 Indonesian senior high school teachers were recruited for this study and randomly assigned to either the intervention group (BM-MA) or a wait-list control group (CG) in a 1:1 ratio. The BM-MA group was required to engage in mindfulness practices using the app for 10-20 minutes per day for 3 weeks. All participants were assessed with a battery of self-report measures at baseline, postintervention, and at 1-month follow-up. Validated scales used to measure the outcome variables of interest included the Satisfaction With Life Scale (SLS), the Teachers' Sense of Efficacy Scale (TSES), the Self-Compassion Scale-Short Form (SCS-SF), Generalized Anxiety Disorder-7 (GAD-7), General Health Questionnaire-12 (GHQ-12), and the Five Facet Mindfulness Questionnaire (FFMQ). The practicality and acceptability of the app will be evaluated using the Client Satisfaction Questionnaire-8 (CSQ-8) and structured qualitative interviews. Data from the interviews will be analyzed with the deductive thematic analysis framework as a process of qualitative inquiry. Repeated measures ANOVA with groups (intervention vs control) as a between-subject factor and time as a within-subject factor (baseline, postintervention, and 1-month follow-up) will be used to examine the effects of the BM-MA on the outcome variables. The data will be analyzed using an intent-to-treat approach and published in accordance with CONSORT (Consolidated Standards of Reporting Trials) recommendations.
RESULTS: Participants were recruited in December 2023, and this pilot RCT was conducted from January through March 2024. Data analysis was conducted from March through May 2024. The results of this study are expected to be published in December 2024. The trial registration of this protocol was submitted to the Chinese Clinical Trial Registry.
CONCLUSIONS: This study aims to determine the feasibility and efficacy of the BM-MA, a digital mental health intervention developed using an existing mindfulness-based app, and assess its potential for widespread use.
TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300068085; https://tinyurl.com/2d2x4bxk.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56693.
METHODS: Using datasets collected from Asian regions of Bangladesh, China, Indonesia, Iran, Malaysia, Pakistan, Taiwan, Thailand, and Vietnam, data from 10,397 participants (mean age = 22.40 years; 44.8% men) were used for analyses. All participants completed the SABAS using an online survey or paper-and-pencil mode.
RESULTS: Findings from confirmatory factor analysis, Rasch analysis, and network analysis all indicate a one-factor structure for the SABAS. Moreover, the one-factor structure of the SABAS was measurement invariant across age (21 years or less vs. above 21 years) and gender (men vs. women) in metric, scalar, and strict invariance. The one-factor structure was invariant across regions in metric but not scalar or strict invariance.
CONCLUSION: The present study findings showed that the SABAS possesses a one-factor structure across nine Asian regions; however, noninvariant findings in scalar and strict levels indicate that people in the nine Asian regions may interpret the importance of each SABAS item differently. Age group and gender group comparisons are comparable because of the invariance evidence for the SABAS found in the present study. However, cautions should be made when comparing SABAS scores across Asian regions.
DESIGN: Scoping review.
DATA SOURCE: PubMed, Embase, CINAHL, Cochrane Library, Google Scholar and Science Direct (January 2009-December 2020).
STUDY SELECTION: Studies that describe older adults' perspectives with regard to their willingness, barriers or motivators towards the use of mobile applications in monitoring and managing their health condition were included.
DATA EXTRACTION: Titles and abstracts were initially screened by two reviewers. Articles agreed by both reviewers were proceeded to full-text screening. One reviewer extracted the data, which were verified by a second reviewer. Findings were further classified according to the 14 TDF domains by two researchers.
RESULTS: Six studies were included in the final scoping review. Barriers to adopting mobile applications for health-related interventions among older adults were the most common topic identified in the included studies. Barriers included being unaware of the existence of mobile health applications, lack of technological skills, lack of perceived ability and time, absence of professional involvements, and violation of trust and privacy. With regard to willingness, older adults are willing to use mobile applications if the apps incorporated features from a trusted source and have valid credentials. Motivators included continuous improvements of mobile applications' design interface and personalised features tailored to older adults' needs.
CONCLUSIONS: With the constant research for more diversified technology, the development of mobile applications to help older adults to manage and monitor health is seen as feasible, but barriers have to be addressed. The most prominent barriers linked to TDF domains were: (1) technological skills, (2) belief about consequences, and (3) memory, attention and decision process. Future interventions should use behaviour change techniques that target these three TDF domains in order to improve the ability to engage older adults with mobile technology.
DESIGN: Prospective, single-blind, randomised controlled trial with an allocation ratio of 1:1 over a 12-week follow-up.
SETTING: Government Orthodontic Unit, Raub Dental Clinic, Raub, Pahang, Ministry of Health, Malaysia.
PARTICIPANTS: A total of 40 patients aged 13-25 years undergoing orthodontic treatment with fixed appliances.
METHODS: The 40 patients were recruited and randomly allocated to a control (n = 20) or trial group (n = 20). Participants in the trial group received weekly oral hygiene reminders via the WhatsApp application for 12 weeks, while the control group did not receive any reminders. The primary outcome was oral hygiene, which was measured by the single-blinded examiner using the Orthodontic Plaque Index (OPI) at three orthodontic check-ups: baseline (T0); 6-week follow-up (T1); and 12-week follow-up (T2).
RESULTS: The mean age of participants was 17 years, and 80% were female. At the end of the 12-week follow-up, improvements in OPI scores were observed, regardless of the intervention. At T2, the median OPI score for the trial group (n = 20) was 0 (interquartile range [IQR = 0) while that for the control group (n = 20) was 2 (IQR = 0). A Mann-Whitney U test revealed a statistically significant difference (P <0.05), with effect size r = 0.87 between the control and trial groups, whereby the latter witnessed marked improvement in OPI throughout the visits. No harms or adverse effects occurred in this trial.
CONCLUSION: The short-term findings demonstrated that participants receiving regular reminders of oral hygiene via WhatsApp messaging had a significant improvement in oral hygiene compared to the control group.
OBJECTIVE: The objective of this study was to comprehensively evaluate mobile apps used for medication compliance and nutrition tracking for possible use by CKD and ESRD patients.
METHODS: A systematic review framework was applied to the search, screening, and assessment of apps identified and downloaded from the iOS and Android app stores. We selected apps using 13 relevant search terms, narrowed down based on a set of inclusion and exclusion criteria, and then used the Mobile App Rating Scale (MARS), a widely adopted app evaluation tool to assess the effectiveness of apps. The internal consistency and interrater reliability were tested using Cronbach alpha and interclass correlation coefficients (ICCs), respectively.
RESULTS: The MARS total score had excellent internal consistency (Cronbach alpha=.90) and a moderate level of interrater reliability (2-way mixed ICC 0.65). Overall, 11 out of the 12 reviewed apps met the minimum acceptable score of 3.0 in MARS rating. The 3 apps with the highest combined scores were My Kidneys, My Health Handbook (MARS=4.68); My Food Coach (MARS=4.48); and National Kidney Foundation Malaysia (MARS=4.20). The study identified 2 general weaknesses in the existing apps: the apps fell short of accommodating advanced interactive features such as providing motivational feedback and promoting family member and caregiver participations in the app utilization.
CONCLUSIONS: The MARS rating system performed well in the app evaluation. The 3 highest ranked apps scored consistently high across the 5 dimensions specified in MARS. These apps were developed in collaboration with reputable organizations and field experts, demonstrating the importance of expert guidance in developing medical apps.