JMIR Publications


Electronic Proceedings for leading conferences


Journal Description

iproc (iproceedings) is a peer-review and publishing platform for conference papers. JMIR Publications partners with leading conferences such as Medicine 2.0 or the Connected Health Symposium to provide peer-review and editing services. If you run a leading medical or technology conference, and wish to outsource the peer-reviewing process, please contact us.



2016 Call for Abstracts/Papers – Poster Session at Connected Health Symposium, Boston

Full call for abstracts/papers

The Connected Health Symposium is a change-agent conference that promotes innovative thinking and the application of personal consumer health technologies to support new models of care delivery. This year's theme, “The Internet of Healthy Things: Integrating Connected Health into Real World Care Delivery,"  focuses on trends at the intersection of technology and new models of health care delivery. The Symposium, presented by Partners HealthCare, convenes thought leaders in an effort to grow the rapidly-expanding connected health marketplace. The audience is a high-profile gathering of innovators, researchers, industry representatives, and policymakers who gather for knowledge-sharing across the connected health landscape. Over 100 speakers and more than 1,000 attendees come together to define the future of care delivery and impact the day-to-day lives of patients.

As in the last year, there are no submission/publication fees (unless presenters want to turn their submissions into full papers published in a JMIR journal) and poster presenters will enjoy free registration (no registration fees) at the symposium. And if that's not enough, presenters get 20% discount on APFs if they publish their full work in JMIR.

What is different in 2016 from previous years is that we no longer require an expanded abstract (5 pages) - a 500 word abstract is enough!


Recent Articles:

  • Poster presented at Connected Health Symposium.

    Wearables, Gamified Group Challenges and Behavioral Incentives: A Preliminary Study of an Engagement Program to Increase Physical Activity


    Background: Healthcare literature supports the development of accessible interventions that integrate behavioral economics, wearable devices, principles of evidence-based behavior change, and community support. However, there are limited real-world examples of large-scale, population-based, member-driven reward platforms. Subsequently, a paucity of outcome data exists and health economic effects remain largely theoretical. To complicate matters, an emerging area of research is defining the role of Superusers, the small percentage of unusually engaged digital health participants who may influence other members. Objective: The objective of this preliminary study is to analyze descriptive data from GOODcoins, a self-guided, free-to-consumer engagement and rewards platform incentivizing walking, running and cycling. Registered members accessed the GOODcoins platform through PCs, tablets or mobile devices, and had the opportunity to sync wearables to track activity. Following registration, members were encouraged to join gamified group challenges and compare their progress with that of others. As members met challenge targets, they were rewarded with GOODcoins, which could be redeemed for planet- or people-friendly products. Methods: Outcome data was obtained from the GOODcoins custom SQL database. The reporting period was December 1, 2014 to May 1, 2015. Descriptive self-report data was analyzed using MySQL and MS Excel. Results: The study period includes data from 1298 users who were connected to an exercise tracking device. 52.6% (n=683) were female. 33.7% (n=438) were between the ages of 20-29, and 24.8% (n=322) were between the ages of 30-39. 77.5% (n=1006) of connected and active members met daily-recommended physical activity guidelines of 30 minutes, with a total daily average activity of 107 minutes (95% CI 90, 124). 96.1% (n=1248) of connected and active users engaged in walking as their primary activity. Of members who exchanged GOODcoins, the mean balance was 4,000 (95% CI 3850, 4150) at time of redemption. 50.4% (n=61) were exchanged for fitness or outdoor products, while 4.1% (n=5) were for food-related items. Participants were most likely to complete challenges when rewards were between 201-300 GOODcoins. Conclusions: This analysis is observational, and its purpose is to form a baseline for future research. Results indicate that challenges and incentives may be effective for connected and active members, and may play a role in achieving daily-recommended activity guidelines. Registrants were typically younger, walking was the primary activity, and rewards were mainly exchanged for fitness or outdoor products. Remaining to be determined is whether members were already physically active at time of registration and are representative of healthy adherers, or were previously inactive and were incentivized to change their behavior. As challenges are gamified, there is an opportunity to investigate the role of Superusers and their impact on behavioral norms. Study limitations and future research agendas are discussed.

  • Philips Lifeline AutoAlert pendant (Copyright is with Philips Lifeline).

    Predictive Modeling of Emergency Hospital Transport Using Medical Alert Pattern Data: Retrospective Cohort Study


    Background: In the transition from a fee-for-service to a fee-for-value system, health care organizations (HCOs) are under pressure to keep patients healthy through preventive services and population health management. Predictive analytics based on the past health behavior of the patient population can be used to predict future risk of decline. Objective: The objective of this study was to develop robust predictive models of impending emergency transports to the hospital based on enrollment and medical alert pattern data from subscribers of a Personal Emergency Response System (PERS) service. This enables targeting of clinical programs to members that need it the most. Methods: De-identified medical alert pattern data of 551,127 subscribers to a PERS service were used. Multivariate logistic regression was performed on subscriber demographics, self-reported medical conditions, variables related to the care giver network and variables derived from up to one year of retrospective medical alert data. A 10-fold cross-validation scheme was used to predict transport to the hospital by emergency medical services in the next 30 days. Furthermore, the model performance was evaluated after retraining using up to 90 days of medical alert data, and using enrollment data only. Results: Emergency hospital transport in the 30-day window was experienced by 2.4% of all subscribers. The area under the receiver operator characteristic curve (auROC) was 0.75 ± 0.01 in the validation cohorts. The model using up to 90 days of data resulted in auROC = 0.71 ± 0.01 and the model using enrollment data only resulted in auROC = 0.62 ± 0.01. Conclusions: Our model for emergency hospital transport in subscribers of a medical alert service showed good discriminatory accuracy on retrospective validation data. While the model yields good discriminatory accuracy with up to 90 days of data, best performance is achieved using up to one year of medical alert data. The model using enrollment data only, without medical alert pattern data, does not perform as well. We are planning a prospective validation of the algorithm to determine the value of the predictive model in assisting HCOs with planning early interventions to avoid emergency department visits and hospitalizations.

  • Group Teletherapy at SCALE with SLP.

    Chronic Aphasia Treatment Outcomes after Teletherapy & Online Exercises - A Comprehensive A-FROM Analysis


    Background: Following a stroke or traumatic brain injury, many acquire a communication disorder called aphasia. For some, aphasia is acute and resolves after therapy, for others it’s a chronic condition. Research has shown that adults with chronic aphasia can get better with on-going treatment and practice. Armed with this knowledge, Lingraphica partnered with the Snyder Center for Aphasia Life Enhancement (SCALE) at The League in Baltimore, Md. to conduct a 12-week Framework for Outcome Measurements in Aphasia (A-FROM) study with nine chronic aphasic SCALE members. These members received teletherapy services that combined group therapy with one-on-one therapy sessions; and worked at home using online language exercises when they wished. Objective: The four areas requiring attention to improve life for persons with aphasia (PWA) include the following categories: -Language and related impairments -Communication and language environment -Personal identity, attitudes, and feelings -Participating in life situations Methods: To diminish impairment: Participants were setup and encouraged to use online TalkPath Therapy exercises to reduce speaking, listening, reading, and writing impairments. To modify communication environments: Participants used remote communication technologies to communicate with others at a geographic distance. To widen opportunities for participation: Participants used the remote communication technology to receive individual therapy session at home. To enhance attitudes and feelings: Participants received individualized training, and support in uses of advanced therapeutic and communication technologies. Results: Language and related impairments were assessed using the Western Aphasia Battery - Aphasia Quotient (AQ), the metric of overall severity, improved in the mean for the participants by 3.5†, with a trend toward statistical significance (†P=.057). Additionally, the National Outcomes Measurement System (NOMS), diminished by modest, though statistically significant amounts in the four rated items, e.g., mean improvement in Speaking= +0.6* (*P=.006). Participation in life situations were assessed using the Communicative Effectiveness Index overall mean (CETI Overall). The CETI showed a robust improvement of +17.8* (*P=.011). Personal identity, attitudes, feelings were tested using the Communication Confidence Rating Scale for Aphasia (CCRSA-RIC). It showed an improvement of +10.1* (*P=.0004). Additionally, the users’ satisfaction levels were high at the end of the study. On a Likert Scale of 1 (least satisfied) to 5 (most satisfied), by far most items received scores in the 4-5 range. Participation in life situations also showed improvement. Spouses reported their loved ones were more engaged, and reports from the online exercises show that independent work increased. Conclusions: The findings represent a proof of concept for teletherapy services that combine: remote one-on-one sessions; remote group therapy sessions; and online language exercise use, between remote therapy sessions. These findings document some of the important, widespread additional benefits the future can hold, and suggests some of the practical ways to deliver them to PWAs. Trial Registration: N/A

  • Feature Image.

    Design of A Smartphone Application for Automated Wound Measurements for Home Care


    Background: There are 8.5 million Americans who suffer from a chronic wound. Due to the lack of an objective system to measure and characterize wounds, the current standard of care relies highly on provider guesswork. This leads to misinformed care decisions, ultimately leading to prolonged healing times and high healthcare expenditures. Objective: This study describes the design and validation of a smartphone image-based system for accurately measuring and characterizing chronic wounds in an automated and objective fashion. Methods: Photos (n=81) were collected by the study team from patients (n=25) at the Johns Hopkins Bayview Wound Clinic in an IRB-approved study. Photos were taken using a variety of smartphones such that our training data set would include nuances of different smartphone cameras. We combined supervised image classification and computer vision to detect wound edges and segment the tissues within the wound. 15 individuals (“raters”) with various levels of training were then instructed to trace wound regions in a diverse subset of the wound images arbitrarily selected by the study team (n=10). The ensemble wound edge and tissue segmentation algorithms were compared against an 80% inter-rater gold standard. Results: The automated method resulted in a sensitivity = 98.31 ± 2.18 and specificity = 92.06 ± 7.86). In contrast, the ruler-based measurement resulted in sensitivity = 1 ± 0, Specificity = 0.57 ± 0.30. A normalized area measurement for the automated method resulted in a normalized area of 1.14 ± 0.17. In comparison, the standard of care method resulted in a normalized area of 1.86 ± 0.30 relative to gold standard. With respect to tissue segmentation, the overall average tissue classification accuracy on k-fold cross validation using the sparse neural network method is 93.6% ± 3.3%. Conclusions: The result illustrates the large overestimation of wound size that occurred when the wounds were measured using the ruler measurement. It also corroborates the literature-reported value of measurement inaccuracy by standard methods. Our study shows the feasibility of an easily deployed smartphone system to classify wounds in an automated manner with high accuracy. Such a system could be used to objectify measurements by nurses in the home care environment, thus improving the accuracy of wound care and, potentially, the outcomes of patients.

  • Poster presented at Connected Health Symposium.

    Clinical Managers - Ignored yet Critical to Innovation Success

    Authors List:


    Background: Innovating new models for healthcare differs dramatically from leading established operations or incremental quality improvement (QI). The project to re-create hospitals to deliver less expensive patient-centered care for increasing complex situations is an “adaptive challenge.” Any solution must be newly invented because the knowledge and engineering of the past are not sufficient. What got you here won't get you there. The situation is ambiguous, and the path uncharted. Few address how to lead healthcare innovation. The key leadership needs identified in the management literature (e.g., Hill Brandeau Truelove 2014) challenge traditional medical and nursing practice of experts acting autonomously. These capabilities don’t fit easily with clinical education’s norms. Leaders must inhibit leaping to solutions, truly collaborate across an increasing number of boundaries, value and integrate others’ ideas, and, crucially, be comfortable not knowing. The many current healthcare leadership courses, even those aiming for “transformational leaders,” fail to address these critical capabilities for successful innovation except marginally. For hospitals and care delivery to adopt connected health opportunities, they must work safely and seamlessly in patient care. The care providers must be willing and ready to use them. Yet they disrupt not only workflow but deeply felt professional beliefs and expectations. Objective: Neither the medical literature nor leadership practice identifies clearly the capacities needed for successful innovation. Moreover organizations have singularly focused attention and resources on “top” decision-makers. This overlooks middle managers: their innovation willingness and capacities to implement new processes and roles prove critical to success. This article identifies why and how managers’ vital contributions turn innovations into consistent practice that improve patient outcomes. Methods: This article reviews literature published about US hospitals and clinical care in US-based journals published since the year of Affordable Care Act passage, 2010. The search focused on Pubmed using the keywords that follow plus the author’s familiarity with the management literature on innovation and leadership in other sectors as well as healthcare. Results: Middle managers implement innovations that produce positive results. At the same time they must ensure on-going patient care remains safe and high quality. They perform multiple, varied roles simultaneously. Key innovation roles for middle and to a lesser extent frontline managers include: - Bridges. - Design reality-testers - Enablers. This includes the roles of Culture creator, motivator, and opportunity creator. - Improvement monitors. The literature on physician leadership, transformational leadership, and leading innovation in healthcare mentions some of these capacities for leaders, yet does so vaguely and inconsistently and with little rationale. Their lists narrow to the task of QI and change management: leading innovation is a riskier, more uncertain and more complex undertaking. Almost none identify middle managers and their capacities as key to the leadership or innovation success. Conclusions: The specific capabilities that link middle managers to innovation success deserves research attention. Critically healthcare executives must include their managers in their innovation thinking, planning and resource allocation.

  • Searching Social Media, (C) Robin Hooijer.

    Patient Rating Sites for Daily Supervision by Healthcare Inspectorates: Implementation into Practice


    Background: Social media and especially patient rating sites (PRS’s) have shown to be an interesting new source of information about quality of care from the patient’s perspective. Several studies indicate a relationship between information on social media and quality of health care including patients’ experiences, mortality ratio’s, readmission rates and infection rates. Therefore, information on PRS’s could have added value in supervision the quality for care by official supervising bodies such as a healthcare inspectorate. Objective: To implement a system in which relevant information about the quality of care is efficiently identified and extracted from PRS’s and presented to inspectors by adding it to the risk judgment system for day-to-day supervision. Methods: The study consisted of three parts: (1) Exploration based on expert opinion by supervision experts of the Dutch Healthcare Inspectorate (DHI) of the added value for individual reviews with a poor rating (< 7 on a scale from 1-10) by making use of pre-developed scales. (2) Investigation of the opportunities for preselecting information by DHI researchers by scoring reviews in duos in order to test interrater agreement. (3) Designing a process description with all relevant stakeholders to create a realistic implementation path. Results: For 72 of 116 cases in supervision of long-term elderly care on four major risk themes (medication safety, hygiene, expertise and restriction of freedom) information was considered to be relevant. Preselecting information from PRS’s showed acceptable agreement for four out of five researchers. Based on these results we designed a process description of adopting PRS data into the risk database of the DHI for long-term elderly care by using a File Transfer Protocol, extracting data from the PRS. Starting from June 1st 2015 the DHI inspectors will receive information about long-term elderly care organisations of the major Dutch PRS, next to other quality and safety indicators. Conclusions: The results show that PRS’s could be used to include the patient’s perspective in day-to-day supervision. Important conditions are sufficient number of reviews and enthusiastic inspectors. These findings indicate that PRS’s may enable supervisory bodies to include the patients’ perspective in an efficient way. Future research should explore the opportunities of other healthcare sectors and other social media such as Twitter en Facebook.

  • DRESS system architecture hardware and infrastructure.

    Assistive Dressing System: A Capabilities Study for Personalized Support of Dressing Activities for People Living with Dementia


    People living with advanced stages of dementia (PWD) or other cognitive disorders do not have the luxury of remembering how to perform basic day-to-day activities, making them increasingly dependent on the assistance of caregivers. Dressing is one of the most common activities provided by caregivers. It is also one of the most stressful for both parties due to its complexity and privacy challenges posed during the process. In this paper, we present the first of its kind system (DRESS) that aims to provide much needed independence and privacy to individuals with PWDs, and afford additional freedom to their caregivers. The DRESS system is designed to deliver continuous, automated, personally tailored feedback to support PWD’s during the process of dressing. The core of DRESS consists of a computer vision based detection system that continuously monitors the dressing state of the user, identifies and prompts correct and incorrect dressing states, and provides corresponding cues to help complete the dressing process adequately with minimal, or ideally no, caregiver intervention. The DRESS system detects clothing location and orientation and status with respect to the dressing process by identifying and tracking fiducial markers (visual icons) attached to clothes. In preparation for in-home trials with PWDs, we evaluated the system’s ability to detect dressing events by asking 11 healthy participants to simulate common correct and incorrect dressing scenarios, such as donning shirt and pants inside out, back in front, and partial dressing, in a laboratory setting. We found that although the fiducial tracking system missed a few expected detections, it was generally capable of detecting dressing phases for both pants and shirt. Our study suggests that the use of a fiducial tracking system in the context of detecting dressing processes has the potential to automatically recognize, and generate prompts and feedback to assist PWDs or related cognitive disorders to correctly dress themselves with little or, ideally no assistance from their caregivers.

  • Neuro-ICUs are data rich environments but the benefits of advanced informatics have been hindered by a lack of medical device connectivity.

    Review of Medical Device Connectivity in Neurocritical Care


    Background: Multimodal monitoring is the standard of care in neuroscience intensive care units (neuro-ICUs) and it has led to the creation of a data-rich environment. However, the data collected from each patient still varies from hospital to hospital and is rarely collected in a standardized format; a “plug-and-play” interoperable approach is not yet available for medical devices in neuro-ICUs and this has hindered the creation and adoption of valuable informatics tools such as clinical decision support. Objective: This paper presents a review of the characteristics of the device interfaces that have been examined by Moberg Research, Inc. for the development of their platform for neurocritical care data integration. Methods: Neurocritical care device interfaces were reviewed by answering a series of questions designed to describe the adherence to specifications, the acceptance of standards, the overall quality of the protocols and to uncover potential pitfalls. Results: A total of 26 devices interfaces were examined in this process; 2 were discarded because of their analog nature. Device manufacturers did not provide protocol specification documents for 2 of the 24 device interfaces. In the case of device interfaces for which protocol specifications were provided, an unexpected degree of deviation was encountered. 18% of the protocol implementations exhibited a behavior substantially different from what expected based on the specifications. A large number (32%) exhibited undocumented behaviors. Out of the 24 examined protocol implementations, 3 did not provide a protocol version field in the output and only one was based on an existing communication and nomenclature standard. No form of identification for the device source and/or data types was included in the protocol for 29% of the investigated devices. One device did not specify the units either in the protocol specification or in the transmitted data. While some device protocols provided checksums or at least parity bits, 54% of the devices did not provide either. Conclusions: The results of this review revealed a lack of adherence to published/provided specifications, creating significant barriers to the development of connected, interoperable systems. Almost no data standardization was implemented in the analyzed protocols, which imposes a high degree of technological overhead for those institutions that want to implement a connected neuro-ICU. Additionally, the lack of transmission error detection schemes or source identification could lead to data misinterpretation and, consequently, to delayed or incorrect treatment of patients. In order to reduce the currently identified barriers to connectivity, it is our recommendation that medical device manufacturers provide a well-designed and documented communication protocol for their devices. We also anticipate that our research will lead to the development of “best practices” that manufacturers could follow in the absence of widely adopted standards applicable to neurocritical care.

  • Example of a GHDonline PVC focused on quality and safety.

    Professional Virtual Communities for Health Care Implementers: Impact of Participation on Practice


    Background: Since 2008, has provided a platform of professional virtual communities (PVCs) for health care implementers around the world to connect and discuss delivery challenges. Initially focused on low-resource settings internationally, GHDonline received funding from the Agency for Healthcare Research and Quality (AHRQ) in 2013 to expand the platform and launch the US Communities Initiative (USCI), PVCs for US-based health care professionals working with underserved populations. Objective: Over the course of the three-year funding period, we established four PVCs focused on population health, quality and safety, costs of care, and delivery innovations. We aim to develop a greater understanding of the challenges facing US health care professionals while also facilitating the dissemination and translation of evidence-based resources and novel approaches to delivering care. We seek to understand the impact that participation in these PVCs has on the implementation and integration of best practices in care delivery around the country. Methods: Each PVC is supported by a team of expert moderators who guide and shape community goals, content, and programming. GHDonline works closely with these moderators to organize virtual Expert Panels (week-long, asynchronous online conferences), which facilitate the spread of evidence-based resources and, through dialogue with experts, educate members on strategies for adapting these tools for a range of delivery settings. Our impact evaluation includes three methods: analysis of site data, member surveys, and phone interviews. Site data shows the scope and engagement of readership in the PVCs. Surveys, fielded before and after each Expert Panel, assess members’ knowledge of and ability to implement relevant best practices. Individual interviews identify examples of PVC participation impacting practice, as well as opportunities to improve the PVCs themselves. Results: While evaluation efforts are ongoing, current survey data shows a majority of respondents, 91% (149/163), found information shared in Expert Panels relevant to the populations they serve. A strong majority, 73% (127/175), report an intention to make changes in their practice, and 47% (81/172) report implementing changes based on knowledge gained through PVC participation. We randomly selected 500 active members to participate in interviews and have completed 50 interviews to date. A significant majority of interviewees, 82% (41/50), recommended GHDonline to colleagues, and many, 60% (30/50), indicated they are making changes in their practice based on information gained through PVC participation. Conclusions: Recognizing the limitations of self-reported surveys and interview responses, and the preliminary nature of our current findings, we believe these results show strong potential for PVCs to facilitate dissemination and translation of evidence-based practices and improve care delivery in the US. Trial Registration: Not applicable.

  • Time 2 Focus: A gamified mobile application developed with evidence-based behavioral approaches to help patients with type 2 diabetes build skills to manage their condition (Image taken by the authors who hold the copyright).

    Determining the Commercial Opportunity of a Skill-Based Mobile Application for Patients With Type 2 Diabetes:A Feasibility Test With Patients and Providers...


    Background: More than 29 million people in the U.S. live with diabetes. It is imperative to find solutions that empower and help patients build skills to better self-manage their disease independently in their daily lives. MicroMass Communications, Inc. will conduct a feasibility study to determine the acceptability and usability of Time 2 Focus, a type 2 diabetes mobile application (app). The app incorporates evidence-based behavioral techniques and leverages gamification principles to drive patients’ self-management behaviors. The experience guides patients through progressive skill-building activities related to real-world situations. Unlike current mobile apps for type 2 diabetes, Time 2 Focus goes beyond simple tracking and patient education. The app aims to improve patients’ confidence in their ability to carry out tasks, build problem-solving skills, and make better decisions—ultimately leading to better clinical outcomes. Objective: MicroMass has tested Time 2 Focus in a convenience sample of nine participants recruited from employer groups. To determine the acceptability and usability of the mobile app on a larger scale, MicroMass intends to conduct a feasibility study with FirstHealth of the Carolinas. FirstHealth serves a patient population that is disproportionately affected by type 2 diabetes. The study aims to determine if a type 2 diabetes mobile app to improve problem-solving skills is feasible and acceptable to patients/healthcare providers, and the optimal way to integrate the app into the process of care. Methods: FirstHealth will identify a representative sample (n=600) of patients with type 2 diabetes from their existing electronic health record (EHR) system. These patients will be mailed a survey about type 2 diabetes self-management and mobile app use. MicroMass will invite participants to take part in interviews. The MicroMass research staff will conduct interviews with 6 to 12 patients and interviews with 6 to 12 healthcare providers who work with patients with type 2 diabetes. Patients and healthcare providers will provide feedback on Time 2 Focus and how it could be implemented into the process of care. Results: Before the feasibility study, nine patients examined the usability of Time 2 Focus. From preliminary data, patients found Time 2 Focus to be helpful in managing their type 2 diabetes. Results from the feasibility study will direct next steps to help improve Time 2 Focus. Conclusions: Solutions that can easily be integrated into the existing process of care and meet the needs of patients with type 2 diabetes are needed. The intent in developing and testing the feasibility of Time 2 Focus is to make the app commercially available to health systems as a cost-effective, scalable, and wide-reaching solution to improve clinical outcomes.

  • Image of cell phone with tailored text message (image
created by authors, who hold the copyright).

    Using Theoretically Tailored Mobile Communications to Target Risky Drinking Among Employed Adults: Design of a Randomized Effectiveness Trial


    Background: A sizeable proportion of employed adults consume alcohol at non-dependent but risky levels, which is defined by the National Institutes of Health for men as drinking more than 14 drinks per week or more than 4 in a day and for women as drinking more than 7 drinks per week or more than 3 drinks in a day. Risky levels of drinking impact the health, well-being, and productivity of employees, while driving costs to employers in lost productivity, absenteeism, and health care costs. There is a lack of evidence-based behavior change programs targeting alcohol consumption for employer-sponsored wellness programs. Objective: The aim of this study is to evaluate the effectiveness of a stage-matched and individually tailored behavior change mHealth program based on the Transtheoretical Model of Behavior Change promoting responsible drinking to employed adults. Methods: A 2 arm randomized effectiveness trial is being conducted with 1,012 employed adults recruited by Survey Sampling, Inc. Participants randomized to the treatment group participate in the intervention across three timepoints and six months (0, 3, and 6 months), during which time the control group is asked to complete electronic assessments at two timepoints (0 and 6 months). Participants in both groups will be asked to complete electronic assessments at 12 and 18 months post baseline. Results: The effectiveness of the intervention will be assessed by comparing treatment and control participants on the following primary outcomes: a) proportion of participants who reach criteria (action or maintenance stages); b) quantity of alcohol use (number of drinks per week, number of drinks per drinking day); and c) frequency of alcohol use (days drinking above recommended limits during the past month, number of drinking days in the past month). Secondary outcomes include comparison on frequency of alcohol-related problems and well-being related to productivity. Conclusions: We hypothesize that the treatment group will demonstrate significant improvement on primary and secondary outcomes compared to control group participants. Using a mobile, responsive, and engaging platform, leveraging best practices of behavior change science including tailored communications, this program is well positioned to provide an efficacious, sustainable, and cost-effective means of reducing harmful drinking and the associated individual, employer, and societal impacts. Trial Registration: NCT02126163; (Archived by WebCite at http://www.webcitation/6cXwhAGqW)

  • Conceptual Model for M-Health Utilization: A Nigerian Adaptation


    Background: Compliance with Antenatal Care (ANC) and Postnatal Care (PNC) regimen is a known determinant of pregnancy outcomes. In most developing countries, access to Skilled Birth Delivery (SBD) and Childhood Immunization (CIm), socio-cultural beliefs, physical and financial barriers significantly influence perinatal health outcome. Mobile health (M-Health) is an emerging strategy for improving healthcare utilization and compliance but the extent to which it may influence uptake of available maternal and infant welfare services in Nigeria is not documented in literature. Nurses are the fulcrum for maternal healthcare but their knowledge and roles in the use of M-Health are not known in Nigeria. Objective: This study was designed to assess the effects of M-Health Nursing Intervention (MHNI) on uptake of maternal health services in Oyo South Senatorial District. Methods: This quasi-experimental study involved four out of nine local government areas randomly selected and allocated into Experimental (EG) and Control (CG) groups [a semi-urban and an urban each]. All the 12 Primary Health Care facilities which had nursing personnel were purposively selected. Forty-eight nurses (EG: 21 nurses; CG: 27 nurses) and 383 literate pregnant women (EG: 191 women; CG: 192 women) at gestational age of 4-6 months, registered at the PHC were recruited consecutively. Experimental group nurses were trained on M-Health and mobile telephones were given to nurses and registered pregnant women to facilitate communication. Over an 8-month period, pregnant women received free voice calls and health promotion text messages from nurses. At baseline, 3-month and 6-month, nurses’ knowledge about MHNI was assessed in EG and CG using a non-weighted 42-item pretested questionnaire. Outcome evaluation checklist was used to document utilization and completion of the following six indices among pregnant women: ANC, PNC attendance, SBD, Intermittent Preventive Treatments in pregnancy (IPTp), Tetanus Toxoid (TT), and CIm within 6 weeks of birth. Data were analyzed using descriptive statistics, Chi-square, repeated measures ANOVA and logistic regression at P=0.05. Results: In the EG, knowledge score significantly increased from 21.9±4.5 at baseline to 23.6±4.6 and 23.2±5.6 at three-month and six-month respectively while there was no significant difference in knowledge score among CG over the study period. Comparing EG with CG, significant differences were documented in ANC attendance (66.8% versus 53.1%; OR:1.7, CI: 1.2-2.7), uptake of IPTp (47.6% versus 18.4%; OR:1.7, CI: 1.2-2.7), CIm (62.6% versus 46.9%; OR:1.9, CI: 1.3-2.8) and TT (64.5% versus 54.1%; OR:1.02, CI: 0.5-1.9), SBD (69.8% versus 36.3%; OR:1.0, CI: 0.6-1.6), PNC (69.0% versus 51.0%; OR :2.1, CI: 1.4-3.2). Significantly more women in the EG who completed ANC had IPTp (OR: 14.9, CI: 6.3-35.7); TT (OR: 8.2, CI: 1.7-39.9) and SBD (OR: 2.3, CI: 1.2-4.5) than those who did not. Likewise in CG, more women who completed ANC had IPTp (OR: 21.9, CI: 5.1-94.1) and SBD (OR: 2.0, CI: 1.1-3.8). Conclusions: Mobile health nursing intervention improved uptake of maternal health services among pregnant women. Policy makers need to consider the adoption of mobile health to enhance uptake of maternal health services and improve pregnancy outcome.

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