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      Patients’ Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies

      review-article
      , MPH 1 , , MPH 2 , , MD, PhD 3 , 4 ,
      (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications
      mHealth, apps, mobile apps, qualitative studies, systematic review, mobile phone

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          Abstract

          Background

          Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded.

          Objective

          The aim of this paper is to reach a better understanding of people’s perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools.

          Methods

          A systematic review was carried out on qualitative studies published in English, on patients’ perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method.

          Results

          A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients’ point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools.

          Conclusions

          Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information.

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          Most cited references52

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          Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research.

          C Pope, N Mays (1995)
          Qualitative research methods have a long history in the social sciences and deserve to be an essential component in health and health services research. Qualitative and quantitative approaches to research tend to be portrayed as antithetical; the aim of this series of papers is to show the value of a range of qualitative techniques and how they can complement quantitative research.
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            mHealth 2.0: Experiences, Possibilities, and Perspectives

            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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              The use and value of digital media for information about pregnancy and early motherhood: a focus group study

              Background Many women in countries in the global North access digital media information sources during pregnancy and the early years of motherhood. These include websites, blogs, online discussion forums, apps and social media platforms. Little previous research has sought to investigate in detail how women use the diverse range of digital media now available to them and what types of information they value. A qualitative study using focus groups was conducted to address these issues. Methods Four focus groups were held in Sydney, Australia, including a total of 36 women who were either pregnant or had given birth in the previous three years. The participants were asked to talk about the types of digital media they used for pregnancy and parenting purposes, why they used them and in what ways they found them useful or helpful (or not). Group discussions were transcribed and thematically analysed, identifying the dominant information characteristics identified by women as valuable and useful. Results Nine characteristics emerged from the focus group discussions as most important to women: information that was: 1) immediate; 2) regular; 3) detailed; 4) entertaining; 5) customised; 6) practical; 7) professional; 8) reassuring; and 9) unbiased. These characteristics were valued for different purposes and needs. Digital media provided women with details when they most needed them or at times when they had opportunities to access them. The study showed that women value apps or digital platforms that are multi-functional. The findings revealed the importance of using digital information for establishing and maintaining social connections and intimate relationships with other mothers. However, participants also highly valued expert advice and expressed the desire for greater and more ready access to information and support offered by healthcare professionals. Conclusions Pregnant women and those with young children place a high value on the information and support they receive from and sharing using online sources and apps. They are accustomed to ready and immediate access to information using digital technologies and want better access to that offered by professionals. Recognising and finding ways to meet these needs should be included in planning healthcare provision and support for this group. Further research with women from socioeconomically disadvantaged backgrounds and non-urban locations is required to identify whether they have different information needs and values from the women who were included in the study reported here.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                July 2019
                10 July 2019
                : 7
                : 7
                : e13817
                Affiliations
                [1 ] Department of Epidemiology Columbia University New York, NY United States
                [2 ] Université Grenoble Alpes, Centre National de la Recherche Scientifique, Sciences Po Grenoble, Pacte Grenoble France
                [3 ] Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Développement Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale Marseille France
                [4 ] Institut Paoli-Calmettes CanBios UMR1252 Marseille France
                Author notes
                Corresponding Author: Aline Sarradon-Eck aline.sarradon@ 123456inserm.fr
                Author information
                http://orcid.org/0000-0001-9053-0715
                http://orcid.org/0000-0002-0190-5835
                http://orcid.org/0000-0002-6697-8058
                Article
                v7i7e13817
                10.2196/13817
                6652126
                31293246
                bcd86dd4-5678-46ca-a6b7-dfeaec15501b
                ©VanAnh Vo, Lola Auroy, Aline Sarradon-Eck. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 10.07.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), 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
                : 25 February 2019
                : 28 March 2019
                : 9 May 2019
                : 27 May 2019
                Categories
                Review
                Review

                mhealth,apps,mobile apps,qualitative studies,systematic review,mobile phone

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