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      mHealth 2.0: Experiences, Possibilities, and Perspectives

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          Abstract

          With more than 1 billion users having access to mobile broadband Internet and a rapidly growing mobile app market, all stakeholders involved have high hopes that this technology may improve health care. Expectations range from overcoming structural barriers to access in low-income countries to more effective, interactive treatment of chronic conditions. Before medical health practice supported by mobile devices ("mHealth") can scale up, a number of challenges need to be adequately addressed. From a psychological perspective, high attrition rates, digital divide of society, and intellectual capabilities of the users are key issues when implementing such technologies. Furthermore, apps addressing behavior change often lack a comprehensive concept, which is essential for an ongoing impact. From a clinical point of view, there is insufficient evidence to allow scaling up of mHealth interventions. In addition, new concepts are required to assess the efficacy and efficiency of interventions. Regarding technology interoperability, open standards and low-energy wireless protocols appear to be vital for successful implementation. There is an ongoing discussion in how far health care-related apps require a conformity assessment and how to best communicate quality standards to consumers. "Apps Peer-Review" and standard reporting via an "App synopsis" appear to be promising approaches to increase transparency for end users. With respect to development, more emphasis must be placed on context analysis to identify what generic functions of mobile information technology best meet the needs of stakeholders involved. Hence, interdisciplinary alliances and collaborative strategies are vital to achieve sustainable growth for "mHealth 2.0," the next generation mobile technology to support patient care.

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          Most cited references57

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          Apps of steel: are exercise apps providing consumers with realistic expectations?: a content analysis of exercise apps for presence of behavior change theory.

          To quantify the presence of health behavior theory constructs in iPhone apps targeting physical activity. This study used a content analysis of 127 apps from Apple's (App Store) Health & Fitness category. Coders downloaded the apps and then used an established theory-based instrument to rate each app's inclusion of theoretical constructs from prominent behavior change theories. Five common items were used to measure 20 theoretical constructs, for a total of 100 items. A theory score was calculated for each app. Multiple regression analysis was used to identify factors associated with higher theory scores. Apps were generally observed to be lacking in theoretical content. Theory scores ranged from 1 to 28 on a 100-point scale. The health belief model was the most prevalent theory, accounting for 32% of all constructs. Regression analyses indicated that higher priced apps and apps that addressed a broader activity spectrum were associated with higher total theory scores. It is not unexpected that apps contained only minimal theoretical content, given that app developers come from a variety of backgrounds and many are not trained in the application of health behavior theory. The relationship between price and theory score corroborates research indicating that higher quality apps are more expensive. There is an opportunity for health and behavior change experts to partner with app developers to incorporate behavior change theories into the development of apps. These future collaborations between health behavior change experts and app developers could foster apps superior in both theory and programming possibly resulting in better health outcomes.
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            Diagnostic inaccuracy of smartphone applications for melanoma detection.

            To measure the performance of smartphone applications that evaluate photographs of skin lesions and provide the user with feedback about the likelihood of malignancy. Case-control diagnostic accuracy study. Academic dermatology department. PARTICIPANTS AND MATERIALS: Digital clinical images of pigmented cutaneous lesions (60 melanoma and 128 benign control lesions) with a histologic diagnosis rendered by a board-certified dermatopathologist, obtained before biopsy from patients undergoing lesion removal as a part of routine care. Sensitivity, specificity, and positive and negative predictive values of 4 smartphone applications designed to aid nonclinician users in determining whether their skin lesion is benign or malignant. Sensitivity of the 4 tested applications ranged from 6.8% to 98.1%; specificity, 30.4% to 93.7%; positive predictive value, 33.3% to 42.1%; and negative predictive value, 65.4% to 97.0%. The highest sensitivity for melanoma diagnosis was observed for an application that sends the image directly to a board-certified dermatologist for analysis; the lowest, for applications that use automated algorithms to analyze images. The performance of smartphone applications in assessing melanoma risk is highly variable, and 3 of 4 smartphone applications incorrectly classified 30% or more of melanomas as unconcerning. Reliance on these applications, which are not subject to regulatory oversight, in lieu of medical consultation can delay the diagnosis of melanoma and harm users.
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              Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes management.

              Cell phone text messaging, via the Short Messaging Service (SMS), offers the promise of a highly portable, well-accepted, and inexpensive modality for engaging youth and young adults in the management of their diabetes. This pilot and feasibility study compared two-way SMS cell phone messaging with e-mail reminders that were directed at encouraging blood glucose (BG) monitoring. Forty insulin-treated adolescents and young adults with diabetes were randomized to receive electronic reminders to check their BG levels via cell phone text messaging or e-mail reminders for a 3-month pilot study. Electronic messages were automatically generated, and participant replies with BG results were processed by the locally developed Computerized Automated Reminder Diabetes System (CARDS). Participants set their schedule for reminders on the secure CARDS website where they could also enter and review BG data. Of the 40 participants, 22 were randomized to receive cell phone text message reminders and 18 to receive e-mail reminders; 18 in the cell phone group and 11 in the e-mail group used the system. Compared to the e-mail group, users in the cell phone group received more reminders (180.4 vs. 106.6 per user) and responded with BG results significantly more often (30.0 vs. 6.9 per user, P = 0.04). During the first month cell phone users submitted twice as many BGs as e-mail users (27.2 vs. 13.8 per user); by month 3, usage waned. Cell phone text messaging to promote BG monitoring is a viable and acceptable option in adolescents and young adults with diabetes. However, maintaining interest levels for prolonged intervals remains a challenge.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications Inc. (Toronto, Canada )
                2291-5222
                Apr-Jun 2014
                16 May 2014
                : 2
                : 2
                : e24
                Affiliations
                [1] 1Institute for Drug Safety Department of Nephrology University Hospital Essen EssenGermany
                [2] 2Marketing Department Ono Academic College Kiryat OnoIsrael
                [3] 3Lifepatch GmbH KasselGermany
                [4] 4Black Tusk AG FilzmoosAustria
                [5] 5Division of Nephrology University of Maryland School of Medicine Baltimore, MDUnited States
                [6] 6PL Reichertz Institute for Medical Informatics Hannover Medical School HannoverGermany
                Author notes
                Corresponding Author: Urs-Vito Albrecht albrecht.urs-vito@ 123456mh-hannover.de
                Article
                v2i2e24
                10.2196/mhealth.3328
                4114478
                25099752
                4ac55e22-4d35-4473-ba59-a25f0e2ac92d
                ©Stefan Becker, Talya Miron-Shatz, Nikolaus Schumacher, Johann Krocza, Clarissa Diamantidis, Urs-Vito Albrecht. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 16.05.2014.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 17 February 2014
                : 10 March 2014
                : 03 April 2014
                : 02 May 2014
                Categories
                Viewpoint
                Viewpoint

                mhealth,mobile applications,text-messaging,stakeholders,consumer,mobile technology,technology interoperability,behavior change,regulation

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