Usability of a smartphone food picture app for assisting 24-hour dietary recall: a pilot study

BACKGROUND/OBJECTIVES

The Recaller app was developed to help individuals record their food intakes. This pilot study evaluated the usability of this new food picture application (app), which operates on a smartphone with an embedded camera and Internet capability.

SUBJECTS/METHODS

Adults aged 19 to 28 years (23 males and 22 females) were assigned to use the Recaller app on six designated, nonconsecutive days in order to capture an image of each meal and snack before and after eating. The images were automatically time-stamped and uploaded by the app to the Recaller website. A trained nutritionist administered a 24-hour dietary recall interview 1 day after food images were taken. Participants'' opinions of the Recaller app and its usability were determined by a follow-up survey. As an evaluation indicator of usability, the number of images taken was analyzed and multivariate Poisson regression used to model the factors determining the number of images sent.

RESULTS

A total of 3,315 food images were uploaded throughout the study period. The median number of images taken per day was nine for males and 13 for females. The survey showed that the Recaller app was easy to use, and 50% of the participants would consider using the app daily. Predictors of a higher number of images were as follows: greater interval (hours) between the first and last food images sent, weekend, and female.

CONCLUSIONS

The results of this pilot study provide valuable information for understanding the usability of the Recaller smartphone food picture app as well as other similarly designed apps. This study provides a model for assisting nutrition educators in their collection of food intake information by using tools available on smartphones. This innovative approach has the potential to improve recall of foods eaten and monitoring of dietary intake in nutritional studies.     

Is a Self-Monitoring App for Depression a Good Place for Additional Mental Health Information? Ecological Momentary Assessment of Mental Help Information Seeking among Smartphone Users

ABSTRACT

Mobile devices and apps offer promising opportunities for both patients and healthcare professionals, for example, to monitor and assess health status, and also to provide relevant health information. However, health information seeking within a mood-tracking app has not yet been addressed by research. To bridge this gap, the depression-related health information seeking of 6,675 users of a mood-tracking smartphone app was unobtrusively monitored. The study shows that self-monitored depressive symptoms are associated with higher depression-related information seeking within the app. Health information seeking was low in general, with differences across 12 depression-related topics (e.g., depressive thoughts, a depression diagnosis, or depression facts), but the findings are also promising as the smartphone app was shown to be a place where users can inform themselves about health topics related to the main purpose of the app. Smartphone apps would therefore seem to be a vehicle through which to provide additional health information about, for example, comorbidities, or pre- or post-interventions, even going beyond the original purposes of such mobile health (mHealth) monitoring apps.     

Dietary Self-Monitoring,But Not Dietary Quality,Improves With Use of Smartphone App Technology in an 8-Week Weight Loss Trial

ObjectiveDietary self-monitoring is linked to improved weight loss success. Mobile technologies, such as smartphone applications (apps), might allow for improved dietary tracking adherence. The authors assessed the use of a popular smartphone app for dietary self-monitoring and weight loss by comparing it with traditional diet counseling and entry methods.MethodsDiet tracking and weight loss were compared across participants during an 8-week weight loss trial. Participants tracked intake using 1 of 3 methods: the mobile app “Lose It!”, the memo feature on a smartphone, or a traditional paper-and-pencil method.ResultsApp users (n = 19) recorded dietary data more consistently compared with the paper-and-pencil group (n = 15; P = .042) but not the memo group (n = 13). All groups lost weight over the course of the study (P = .001), and no difference in weight loss was noted between groups.Conclusions and ImplicationsSmartphone apps could represent a novel and feasible dietary self-monitoring method for individuals.     

Nutritional monitoring of patients post‐bariatric surgery: implications for smartphone applications

Background

Optimal results from bariatric surgery are contingent on patient commitment to dietary and lifestyle changes and follow‐up care. The present study aimed to investigate the attitudes and use of mobile health (mHealth) smartphone applications (apps) as a potential tool for maintaining connectivity between dietitians and patients post‐bariatric surgery.

Methods

A cross‐sectional online survey was developed and distributed to a purposeful sample of bariatric dietitians and bariatric patients in Australia. The survey questions explored technology penetration (smartphone and app use), communication preferences, nutrition monitoring methods, professional relationship expectations and reasons for loss to follow‐up.

Results

Survey completion rate was 85% (n = 50/59) for dietitians and 80% (n = 39/49) for patients. Smartphone ownership was 98% and 95% for dietitians and patients, respectively. Common reasons given for losing patients to follow‐up suggest that a traditional in‐clinic practice setting could be a barrier for some. Most dietitians (n = 48; 91%) prefer to see patients face‐to‐face in their clinic, whereas patient preferences extended to e‐mail and mobile messaging. Sixty‐eight percent of bariatric patients were receptive to two‐way communication with dietitians via an app between clinic visits. Both cohorts recognised the potential for emerging technologies to be used in practice, although there was no single routinely recommended mHealth app.

Conclusions

The present study provides the first insight into the use of mobile devices and apps by post‐bariatric patients and the dietitians who support them. A mixture of traditional methods and smartphone technology is desirable to both dietitians and patients. The utility and effectiveness of such technologies should be confirmed in future intervention studies.     

Migrant's access to immunization in Mediterranean Countries

Countries bordering the Mediterranean are part of a major migration system. The aim of this study is to assess the main access barriers to immunization of mobile populations in the region and propose an action based framework to decrease health access inequalities. A survey on formal and informal barriers to immunization among mobile communities was conducted among public health officials formally appointed as focal points of the EpiSouth Network by 26 Mediterranean countries. Twenty-two completed the questionnaire. Thirteen countries reported at least one vaccine preventable disease (VPD) outbreak occurring among mobile populations since 2006 even though their legal entitlement to immunization is mostly equivalent to the general population's. Informal barriers, particularly lack of information and lack of trust in authorities, and disaggregation of data collection are the major issues still to be addressed. Mediterranean countries need to fill the gap in immunization coverage among pockets of susceptible individuals in order to prevent VPD outbreaks. Having for the most part ensured free entitlement, introducing more migrant friendly approaches, increasing information availability among mobile communities, building trust in public health services and disaggregating data collection to monitor and evaluate service performance among mobile groups are key aspects to address in the region.     

There’s an App for That: A Guide for Healthcare Practitioners and Researchers on Smartphone Technology

Smartphone technology is nascent compared to other technologies; however, it has shown an unprecedented uptake amongst lay consumers and professionals. This article presents the history, components, and key features of smartphones, as well as their related concepts and how they work, and it also delineates the process of smartphone applications (apps) development and publishing in the app stores. It also describes and discusses smartphone technology utilisation for health consumers, healthcare professionals, and health researchers, as well as the regulations of health-related apps.     

Medical students’ attitudes and wishes towards extending an educational general practice app to be suitable for practice: A cross-sectional survey from Leipzig,Germany

Background: In medical education and practice, smartphone apps are increasingly becoming popular. In general practice, apps could play an important future role in supporting medical education and practice.

Objectives: To explore medical students’ perceptions regarding the potential of a general practice app for training and subsequent work as a physician.

Methods: Cross-sectional survey among Leipzig fourth-year medical students who were provided with an app prototype for a mandatory general practice course.

Results: Response rate was 99.3% (n?=?305/307); 59.0% were female and mean age was 24.5 years. Students certified that the app had a higher potential than textbooks in both education (57.4% vs. 18.0%) and practice (47.1% vs. 22.8%). Students’ most desired possible app extensions when anticipating its use for subsequent work as a physician were looking up information for diagnostics, therapy and prediction (85.1%), access to electronic patient files (48.1%), communication and networking (44.3%), organization of medical training (42.9%) and online monitoring of patients (38.1%). Students experienced with medical smartphone apps were more interested in app extensions. Consideration to use the app to support the opening of their own practice was significantly associated with higher interest in accessing electronic patient files, networking with colleagues and telemedicine.

Conclusion: Fourth year medical students from Leipzig see a high potential in smartphone apps for education and practice and are interested in further using the technology after undergraduate education.     

Health and information disparities among non-adopters of smartphones

ObjectivesMobile health technologies have gained increasing popularity in the healthcare industry, even though inequity in their adoptions has been documented. This study aimed to describe sociodemographic and clinical vulnerabilities among non-adopters of smartphones, identify their alternative ways of seeking health information, and explore potential outreach venues to these individuals.MethodsSmartphone users, basic cell phone users, and nonusers of mobile devices were identified from the 2019 Health Information National Trends Survey (HINTS). The three groups were compared on sociodemographic and clinical characteristics. Their health information seeking outcomes were compared in latent factor models, path models, and multinomial regression models.ResultsCompared to smartphone users, the nonusers were more likely to be older, less educated, have lower income, speak English less well, have a chronic condition, report poorer health, have lower self-care efficacy, and less likely to have family and friends to talk about their health. In the covariate adjusted models for health information seeking characteristics, compared to smartphone users, basic cell phone users and nonusers of mobile devices showed persistent disparities (less tendency) in search of health information with technology (p’s<.001) and access to online medical records (p’s <.01). Nonusers of smartphones were more likely to report no internet access and feeling uncomfortable with computers as the reasons not to access online medical records.ConclusionmHealth technologies may create additional barriers to health equity in the absence of equitable distributions of socioeconomic resources and access to mobile devices and the Internet. Education and training are warranted to make technology beneficial to the vulnerable population.     

A qualitative study of the attitudes of patients and staff to the use of mobile phone technology for recording and gathering asthma data

Linking mobile phone technology with electronic data collection may facilitate the research experience and improve compliance. We conducted a qualitative interview study using a purposeful sample of 10 patients with asthma and two research staff. Patient diary information was collected twice a day using an electronic peak flow meter linked to a mobile phone with an interactive screen to record current asthma symptoms transmitted to, and stored in, a server. An analysis of the interview data identified key technological adjustments and support factors which would improve the application of the technology in future clinical trials. Patients and staff believed that mobile phone technology would be useful in clinical practice as well as research. Its main uses were seen as identifying poor control more quickly and facilitating communication with healthcare professionals without the need for face-to-face consultation. There was a high degree of acceptability to both patients and staff.     

Building a Mobile HIV Prevention App for Men Who Have Sex With Men: An Iterative and Community-Driven Process

Background

Gay, bisexual, and other men who have sex with men (MSM) account for a disproportionate burden of new HIV infections in the United States. Mobile technology presents an opportunity for innovative interventions for HIV prevention. Some HIV prevention apps currently exist; however, it is challenging to encourage users to download these apps and use them regularly. An iterative research process that centers on the community’s needs and preferences may increase the uptake, adherence, and ultimate effectiveness of mobile apps for HIV prevention.

Objective

The aim of this paper is to provide a case study to illustrate how an iterative community approach to a mobile HIV prevention app can lead to changes in app content to appropriately address the needs and the desires of the target community.

Methods

In this three-phase study, we conducted focus group discussions (FGDs) with MSM and HIV testing counselors in Atlanta, Seattle, and US rural regions to learn preferences for building a mobile HIV prevention app. We used data from these groups to build a beta version of the app and theater tested it in additional FGDs. A thematic data analysis examined how this approach addressed preferences and concerns expressed by the participants.

Results

There was an increased willingness to use the app during theater testing than during the first phase of FGDs. Many concerns that were identified in phase one (eg, disagreements about reminders for HIV testing, concerns about app privacy) were considered in building the beta version. Participants perceived these features as strengths during theater testing. However, some disagreements were still present, especially regarding the tone and language of the app.

Conclusions

These findings highlight the benefits of using an interactive and community-driven process to collect data on app preferences when building a mobile HIV prevention app. Through this process, we learned how to be inclusive of the larger MSM population without marginalizing some app users. Though some issues in phase one were able to be addressed, disagreements still occurred in theater testing. If the app is going to address a large and diverse risk group, we cannot include niche functionality that may offend some of the target population.     

Médecins Sans Frontières' Clinical Guidance mobile application: analysis of a new electronic health tool

Many health care workers lack access to clinical support tools in rural and resource-limited settings. To address this gap, the Médecins Sans Frontières (MSF) Clinical Guidelines manual was converted into a static mobile health reference application (app) entitled MSF Guidance. The app''s utility and growth was examined, and within 6 months of its launch 150 countries had downloaded the app, with demonstrated retention among new and existing users. With over 3500 downloads and 36 000 sessions amounting to 250 000 screen views, MSF Guidance is a new mobile health platform with widely demonstrated utility, including potential use as an epidemiological tool, where clinical conditions investigated by app users were found to correlate with geographical outbreaks. These findings show that mobile apps can be used to disseminate health information effectively.     

Bridging the Communication Gap: Successes and Challenges of Mobile Phone Technology in a Health and Demographic Surveillance System in Northern Nigeria

Maternal and child health indicators are generally poor in Nigeria with the northern part of the country having the worst indicators than the southern part. Efforts to address maternal and health challenges in Nigeria include, among others, improvement in health and management information systems. We report on the experience of mobile phone technology in supporting the activities of a health and demographic surveillance system in northern Nigeria. Our experience calls for the need for the Nigerian Government, the mobile network companies, and the international community at large to consolidate their efforts in addressing the mobile network coverage and power supply challenges in order to create an enabling environment for socio-economic development particularly in rural and disadvantaged areas. Unless power and mobile network challenges are addressed, health interventions that rely on mobile phone technology will not have a significant impact in improving maternal and child health.     

Use of workplace health promotion apps: Analysis of employee log data

ObjectiveStudies have shown that mobile applications (apps) can effectively support lifestyle-related health. Hence, apps are started to be used in workplaces with the expectation that they can promote the well-being of employees. However, no technological advance can make a difference if it is not utilised. This study investigated the usage of a health app in a workplace through analysing log data.MethodsThe average frequency of using the app by employees at a German IT company was assessed by analysing three months’ worth of log data together with 197 employees’ responses to a questionnaire. The app offered its users the results of an objective health screening, personalised information and assigned challenges. Correlations between the app usage frequency and various factors were established. The factors were gender, age, previous experience with apps, personal innovativeness towards new information technologies, health status and perceived app credibility.ResultsThe app usage frequency was relatively high due to the inclusion of the health screening results; however, it appeared to be impacted by only some of the considered factors.ConclusionDemographic and personal factors of the target group should be considered when developing health apps. The inclusion of appropriate functionalities and their personalisation can ensure a high uptake of health apps in workplaces.     

Experiences and implications of smartphone apps for depression and anxiety

Apps on smartphones are increasingly used for self-care for depression and anxiety, yet how and why they are accessed, and their social effects, remain under-investigated. Sociologists have begun to theorise how these technologies affect and relate; crucial questions for a contemporary sociology of health. This study seeks to contribute to our conceptualisation of how digital health technologies are implicated in health by investigating the motivations, experiences and relations of people using mobile apps for depression or anxiety. We interviewed 14 individuals living in England with a diagnosis of depression or an anxiety disorder, who used smartphone apps as part of self-care. Analysis followed a thematic approach. Three themes were identified. Apps exist within relational contexts – alongside smartphones, beliefs about mental health and other support – which shape app use and lead to an imprecise, casual approach. People engage with apps in a straightforward and uncomplicated manner, leading to immediate symptomatic alleviation, but to limited longer term benefit. The contradiction between the apps’ promise as tools of individual empowerment, with their ability to promote responsibilising frameworks that restrain users’ reflexivity, is central to their implications. Apps can thus contribute to isolation from interpersonal support and promote reductionist biomedical conceptualisations of mental ill health.     

Peer-to-Peer JXTA Architecture for Continuing Mobile Medical Education Incorporated in Rural Public Health Centers

ObjectivesMobile technology helps to improve continuing medical education; this includes all aspects of public health care as well as keeping one's knowledge up-to-date. The program of continuing medical and health education is intertwined with mobile health technology, which forms an imperative component of national strategies in health. Continuing mobile medical education (CMME) programs are designed to ensure that all medical and health-care professionals stay up-to-date with the knowledge required through mobile JXTA to appraise modernized strategies so as to achieve national goals of health-care information distribution.MethodsIn this study, a 20-item questionnaire was distributed to 280 health professionals practicing traditional training learning methodologies (180 nurses, 60 doctors, and 40 health inspectors) in 25 rural hospitals. Among the 83% respondents, 56% are eager to take new learning methodologies as part of their evaluation, which is considered for promotion to higher grades, increments, or as part of their work-related activities.ResultsThe proposed model was executed in five public health centers in which nurses and health inspectors registered in the JXTA network were referred to the record peer group by administrators. A mobile training program on immunization was conducted through the ADVT, with the lectures delivered on their mobiles. Credits are given after taking the course and completing an evaluation test. The system is faster compared with traditional learning.ConclusionMedical knowledge management and mobile-streaming application support the CMME system through JXTA. The mobile system includes online lectures and practice quizzes, as well as assignments and interactions with health professionals. Evaluation and assessments are done online and credits certificates are provided based on the score the student obtains. The acceptance of mobile JXTA peer-to-peer learning has created a drastic change in learning methods among rural health professionals. The professionals undergo training and should pass an exam in order to obtain the credits. The system is controlled and monitored by the administrator peer group, which makes it more flexible and structured. Compared with traditional learning system, enhanced study improves cloud-based mobile medical education technology.     

R-ALERGO. Rutas alergosaludables en Valencia

R-ALERGO is a project developed by researchers from the Universitat Politècnica de València and the Hospital Universitario La Fe (Valencia, Spain). The main objective of the project is to create a mobile application identifying, within the city of Valencia, the most favorable routes for allergic individuals. The application is developed using nine environmental variables with a potential effect on the development of clinical manifestations in allergic individuals. The application combines the use of spatial analysis based on network technology and implemented with a geographic information system software. The first 01 version is under evaluation for a Healthy app hallmark. The next step in this project is to design a clinical validation process to test its usefulness in allergic individuals.     

PeRsOnalised nutriTion for hEalthy livINg: The PROTEIN project

Personalised nutrition is a novel public health strategy aiming to promote positive diet and lifestyle changes. Tailored dietary and physical activity advice may be more appropriate than a generalised ‘one‐size‐fits‐all’ approach as it is more biologically relevant to the individual. Information and computing technology, smartphones and mobile applications have become an integral part of modern life and thereby present the opportunity for novel methods to encourage individuals to lead a healthier lifestyle. This article introduces the European Union‐funded PROTEIN project (PeRsOnalised nutriTion for hEalthy livINg) consortium and introduces the associated work packages. The primary objective of the PROTEIN project is to produce a novel adaptable mobile application suite based on sound nutrition and physical activity advice from experts in their field, accessible to all population groups, with differing health outcomes, whose behaviour can be tracked with a variety of sensors and health hazard perception. The mobile application ‘ecosystem’ that will be developed by the consortium includes a platform, mobile suite, cloud services, artificial intelligence advisor, game suite, modelling of expert’s knowledge, users’ behaviour data collection, data analysis and a dashboard for healthcare professionals. It is proposed that users will find the provision of personalised nutrition advice and real‐time data capture through a smartphone application useful, and importantly, will be encouraged by this to make positive health behaviour changes.     

“I Think the Temperature was 110 Degrees!”: Work Safety Discussions Among Hispanic Farmworkers

Heat-related illness (HRI) among migrant and seasonal farmworkers is an occupational risk addressed through varying mitigation strategies by individual workers and supervisors. The purpose of this pilot study was to describe farmworkers’ experience with HRI prevention strategies and assess HRI information seeking preferences, especially the feasibility of using mobile phone apps to access this information. Five focus groups were administered to Hispanic farmworkers in South Carolina. Questions included the following topics: health information seeking preferences; farmworkers’ perceptions of occupational risks; coping strategies; past experiences with HRIs; water, rest, and shade practices; access to health care; and any employer-provided training received. There was consensus across the groups that the workers at highest risk for HRIs were either inexperienced or new workers in the fields. Farmworkers ascribed responsibility for one’s well-being while working in the heat more as an individual factor than as an employer’s responsibility. Farmworkers received training on the OSHA Heat Safety Tool app and provided positive feedback about the educational content and temperature information warnings. These findings suggest the potential for supervisors to take a more active role in heat safety education using mobile technology.     

Rationalizing personal health management (PHM) policy: Identifying health IT use patterns via observations of daily living (ODLs) data

ObjectivesManaging personal health information is mainly dependent upon individual users’ adoption and use of new health technology. Despite the increasing popularity of mobile health apps, recent endeavors of self-health management have been somewhat limited to fitness management whose apps have selective features and capabilities. Under this context, it raises a question as to whether health consumers are capable of adopting and utilizing mobile health apps with varying features and capabilities in order to manage both medical and fitness health information.MethodsBorrowing from a theoretical lens of observations of daily living (ODLs), the authors posit that if individual health consumers can record their daily activities with both health and non-health related mobile IT, such self-tracking information can then serve as an evaluation tool for measuring their future capabilities of new health IT adoption. To explore the phenomenon, we administered an online survey to collect technology-related ODL data from 226 international health consumers with known ODL survey items.ResultsBy applying confirmatory factor analysis and K-means cluster analysis, we found health consumers’ use of social and finance-related technology are closely linked to the use of mobile health technology in their daily living. Moreover, health consumers who actively use all three technologies (i.e., social, financial and health technologies) tend to have affinitive perceptions toward health management outcomes.ConclusionThe findings of this study can inform health policymakers to vie for more effective mobile health technology in rationalizing personal health management (PHM) policy.