Consumer health information technology in an adult public health primary care clinic: A heart health education feasibility study

ObjectiveTo explore the feasibility and short term outcomes of using an interactive kiosk integrated into office flow to deliver health information in a primary care clinic.MethodsFifty-one adults with BMI ≥25 were randomly assigned to use a kiosk with attached devices to receive a six-week healthy eating/weight monitoring (intervention) or general health/BP monitoring (attention-control) program. Outcomes were measured at baseline, 8 weeks (post) and three month follow-up.ResultsParticipants completed an average of 2.73 weekly sessions, with transportation and time given as limiting factors. They found the kiosk easy to use (97%), liked the touchscreen (94%), and would use the kiosk again (81%). Although there were no differences between groups, the 27 completing all assessments showed reduced weight (p = .02), and decreased systolic (p = .01) and diastolic BP (p < .001) at follow-up. Although healthy eating behaviors increased, the change was not statistically significant.ConclusionUsing a kiosk within a clinic setting is a feasible method of providing health information and self-monitoring. Multi-session educational content can provide beneficial short-term outcomes in overweight adults.Practice implicationsA kiosk with attached peripherals in a clinic setting is a viable adjunct to provider education, particularly in medically underserved areas.     

Tailored DVDs: A novel strategy for educating racially and ethnically diverse older adults about their medicines

IntroductionThe availability of comprehensive and accurate medication history information in electronic medical records and through electronic prescribing provides the opportunity to create tailored interventions based on individuals’ particular medication information needs. To meet the challenges of providing medication information to low-literate English and Spanish speaking older adults, we sought to create individualized, culturally and linguistically inclusive medication education materials for older adults from diverse backgrounds.MethodsWe used a mixed-method design including a systematic review, analysis of existing data, a telephone survey (n = 326), and exploratory focus groups stratified by race/ethnicity and language spoken (11 focus groups; n = 106) to identify what information about medications older adults need, want to learn, and in what format. We evaluated reactions to three DVDs at low-income senior community centers (2 focus groups; n = 16).ResultsExploratory focus groups provided insights on areas for improvement in patient–provider communication, and suggested use of vignettes and testimonials. Upon viewing, participants could relate to the testimonials in which actors portrayed people who have problems with their medications and were interested in the medication advice presented, especially when it was presented by a healthcare professional.DiscussionTailored medication education materials in English and Spanish DVD and print material format are suitable for low-literate audiences, acceptable to older adults, and feasible to implement using health IT. Virtually all households in the United States have a television, with most having a DVD player. DVD segments can be used in Internet links, physician office-based television, and consumer health IT applications.     

Has the prevalence of health care services use increased over the last decade (2001–2009) in elderly people? A Spanish population-based survey

Objectives(1) To describe the prevalence of general practitioner visits and hospitalization according to sex and age groups; (2) to identify which factors are independently associated with a higher use of health care services among elderly Spanish; and (3) to study the time trends in the prevalence of use of health care services 2001–2009.Study DesignObservational study. We analyzed data from the Spanish National Health Surveys conducted in 2001 (n = 21,058), 2003 (n = 21,650), 2006 (n = 29,478) and 2009 (n = 22,188). We included responses from adults aged 65 years and older.Outcome measuresThe main variables were the number of general practitioner visits in the last 4 weeks and hospitalization in the past year. We stratified the adjusted models by the main variables. We analyzed socio-demographic characteristics, health related variables, using multivariate logistic regression models.ResultsThe total number of subjects was 24,349 (15,041 woman, 9309 men). Women were significantly older than men (P < 0.001). Women had higher prevalence of general practitioner visits than men in all surveys. Men had significantly higher prevalence of hospitalizations than women in the years 2001, 2006 and 2009. When we adjusted the hospitalization by possible confounders using logistic regressions, men had a higher probability of being hospitalized than women (OR 1.53, 1.39–1.69). The variables that were significantly associated with a higher use of health care services were lower educational level, worse self-rated health, chronic conditions, polypharmacy, and the level of disability. The number of general practitioner visits among women and men significantly increased from 2001 to 2009 (women: OR 1.43, 1.27–1.61; men: OR 1.71, 1.49–1.97).ConclusionsThe current study revealed an increase in health care services utilization from 2001 to 2009 in the older Spanish population.     

Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight

ObjectiveTo examine the association of women’s body weight with provider communication during prenatal care.MethodsWe coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication.ResultsCompared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44–0.99, p = 0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32–0.82, p = 0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51–0.91, p = 0.01) and concern statements (IRR 0.68, 95% CI 0.53–0.86, p = 0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19–0.84 p = 0.02).ConclusionLess lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care.Practice implicationsInterventions to increase use of patient-centered communication – especially for women with overweight and obesity – may improve prenatal care quality.     

Complementary health approaches for health and wellness in midlife and older US adults

ObjectivesTo characterize the use of complementary health approaches (CHA) and examine the perceived benefits of using CHA by reason for use among midlife and older adults.Study designAnalysis of 2012 National Health Interview Survey data, a nationally representative US sample using cross-tabulations with design-based F-tests and multiple logistic regression. The analytic sample included adults aged over 50 years (N = 14,849).Main outcome measuresThe proposed benefits of using CHA included: (1) better control over health, (2) reduced stress/relaxation, (3) better sleep, (4) feeling better emotionally, (5) coping with health problems, (6) improved health/feeling better, and (7) improved relationships.ResultsOverall, 31% of this sample of midlife and older US adults had used CHA in the past year. Among users, 15% had used CHA for treatment only, 40% for wellness only, and 45% for combined wellness and treatment. Herbs (60%), chiropractic (28%), massage (22%), and yoga (19%) were the most common CHA. Wellness-only and combined users had significantly higher odds of reporting that CHA conferred benefit compared with treatment-only users.ConclusionsCHA are used by nearly a third of midlife and older adults and are perceived to provide substantial benefit. Integrating CHA as part of a healthy lifestyle has the potential to contribute to healthy aging among midlife and older adults.     

Examining the context and helpfulness of family companion contributions to older adults’ primary care visits

ObjectiveOlder adults commonly involve family (broadly defined) in their care. We examined communication behaviors of family companions during older adults’ primary care visits, including whether these behaviors vary with respect to how older adults manage their health, preferences for involving family in medical decision-making, and ratings of companion helpfulness.MethodsAnalysis of audio-taped primary care visits of older patients who were accompanied by a family companion (n = 30 dyads) and linked patient surveys.ResultsFamily companions predominantly facilitated doctor and patient information exchange. More than half of companion communication behaviors were directed at improving doctor understanding of the patient. Companions were more verbally active during visits of patients who delegated the management of their health to others than visits of patients who co-managed or self-managed their health. Companions were rated as more helpful by patients who preferred active involvement of family in medical decision-making.ConclusionFamily companion participation and helpfulness in primary care communication varies by patients’ preferences for involving family in medical decision-making and approach to manage their health.Practice implicationsResearch to examine the effects of clarifying patient and family companion expectations for primary care visits could inform strategies to improve the patient-centeredness of medical communication.     

Sociotechnical analysis of nurses’ use of personal mobile phones at work

BackgroundNurses’ use of personal mobiles phones at work is a growing trend in healthcare organizations. Although recent studies have explored the positive and negative implications of nurses using personal mobile phones at work, none has yet analyzed the interactions of sociotechnical components (users, technology and policy) on nurses’ use of personal mobile phones at work.ObjectivesIdentify sociotechnical interactions by analyzing each sociotechnical component (users, technology and policy) that affects nurses’ use of personal mobile phones at work.MethodsIn-depth interviews were conducted with 30 nurses employed in 13 hospitals in the Philippines. The respondents include staff nurses (n = 23), charge nurses (n = 4), and nurse managers (n = 3). Staff nurses were asked on their use of personal mobile phones at work, while charge and nurse managers were asked on their observations regarding staff nurses’ use of personal mobile phones at work. Responses were analyzed qualitatively using sociotechnical analysis.ResultsSociotechnical analysis indicated that staff nurses used their personal mobile phones at work in various ways because its use helped in their nursing work, but inevitably altered a few of their routines. Although most hospitals had policies that prohibit the use of mobile phones, staff nurses justified their use of personal mobile phones by using it for work purposes and for the benefit of their patients. Staff nurses highlighted the absence of hospital-provided mobile phones as a key reason for using personal mobile phones at work. Charge nurses and nurse managers also influenced staff nurses’ use of personal mobile phones at work.ConclusionsNurses could use their personal mobile phones at work for work purposes to enhance their clinical performance and improve patient care. Hospital administrators can leverage on nurses’ use of personal mobile phones at work by formulating policies that consider both the benefits and potential drawbacks of mobile phone usage. Recommendations are made for the formulation of hospital policies to optimize the use of personal mobile phones of nurses at work.     

Web-based oral health promotion program for older adults: Development and preliminary evaluation

ObjectiveThis study reports on the impact evaluation of a Web-based oral health promotion programme aimed at improving the oral health knowledge, attitudes, practices and self-efficacy of independent-living older adults from Melbourne, Australia.MethodsWith ethics approval from the University of Melbourne, a convenience sample of volunteers 55 years or older was invited to participate in a study to test a web-based oral health promotion program. Consenting volunteers were asked to undergo a structured interview as part of the pre-intervention data collection. The intervention was based on the ORHIS (Oral Health Information Seminars/Sheets) Model and involved computer interaction with six oral health presentations, with no direct oral health professional input. A one group pre-test–post-test quasi-experimental design was chosen to evaluate the intervention. A series of paired t-tests were used to compare pre-test with post-test results.ResultsForty-seven active, independent-living older adults participated in this evaluation. After the intervention participants responded with higher levels of achievement than before participating in this Web-based oral health program. Participants showed significant improvements in oral health attitudes (4.10 vs. 4.94; p < 0.01), knowledge (18.37 vs. 23.83; p < 0.0001), and self-efficacy (84.37 vs.89.23; p < 0.01), as well as, self-reported oral hygiene practices (i.e., frequency of use of dental floss) (p < 0.05).ConclusionThe e-ORHIS approach was successful in improving oral health knowledge, attitudes and self-efficacy. As such, it represents a helpful approach for the design of (oral) health interventions in older adults. Further evaluation with a larger sample is required to test the long-term impact including the economic evaluation of the e-ORHIS approach.     

Patient–provider communication and reproductive health among HIV-positive women in Rio de Janeiro,Brazil

ObjectiveTo qualitatively assess the influence of patient–provider communication on contraceptive choice among HIV-positive women in the context of universal antiretroviral therapy (ART) access.MethodsFocus group discussions (FGD; n = 3), in-depth (IDI; n = 15) and freelist interviews (FLI; n = 36) were conducted with HIV-positive women aged 18–40 years recruited from public health units in Rio de Janeiro/Brazil.ResultsOf 70 participants, 49 used ART and the median time since HIV diagnosis was 6 years (range: 1–18). The majority of participants (71.4%) reported some degree of dissatisfaction with their health providers (usually lack of open dialogue) and a few reported experiences of stigma/prejudice during appointments. Intra, interpersonal and social factors modulated behaviors and reproductive health decisions, and those issues were rarely addressed by providers during HIV clinical care.ConclusionDespite dramatic increases in survival and life quality after universal ART implementation in Brazil, reproductive health issues are neglected by multiple cadres of HIV health providers. Communication on reproductive health issues remains fragmented and potentially contradictory, compromising care in these settings.Practice implicationsAdequate provider training to address reproductive health-related issues in a comprehensive, culturally sensitive manner and improved integration of HIV and reproductive health care are urgently needed in this setting.     

Using mobile health technology to deliver decision support for self-monitoring after lung transplantation

BackgroundLung transplant recipients (LTR) experience problems recognizing and reporting critical condition changes during their daily health self-monitoring. Pocket PATH^®, a mobile health application, was designed to provide automatic feedback messages to LTR to guide decisions for detecting and reporting critical values of health indicators.ObjectivesTo examine the degree to which LTR followed decision support messages to report recorded critical values, and to explore predictors of appropriately following technology decision support by reporting critical values during the first year after transplantation.MethodsA cross-sectional correlational study was conducted to analyze existing data from 96 LTR who used the Pocket PATH for daily health self-monitoring. When a critical value is entered, the device automatically generated a feedback message to guide LTR about when and what to report to their transplant coordinators. Their socio-demographics and clinical characteristics were obtained before discharge. Their use of Pocket PATH for health self-monitoring during 12 months was categorized as low (≤25% of days), moderate (>25% to ≤75% of days), and high (>75% of days) use. Following technology decision support was defined by the total number of critical feedback messages appropriately handled divided by the total number of critical feedback messages generated. This variable was dichotomized by whether or not all (100%) feedback messages were appropriately followed. Binary logistic regression was used to explore predictors of appropriately following decision support.ResultsOf the 96 participants, 53 had at least 1 critical feedback message generated during 12 months. Of these 53 participants, the average message response rate was 90% and 33 (62%) followed 100% decision support. LTR who moderately used Pocket PATH (n = 23) were less likely to follow technology decision support than the high (odds ratio [OR] = 0.11, p = 0.02) and low (OR = 0.04, p = 0.02) use groups. The odds of following decision support were reduced in LTR whose income met basic needs (OR = 0.01, p = 0.01) or who had longer hospital stays (OR = 0.94, p = 0.004). A significant interaction was found between gender and past technology experience (OR = 0.21, p = 0.03), suggesting that with increased past technology experience, the odds of following decision support to report all critical values decreased in men but increased in women.ConclusionsThe majority of LTR responded appropriately to mobile technology-based decision support for reporting recorded critical values. Appropriately following technology decision support was associated with gender, income, experience with technology, length of hospital stay, and frequency of use of technology for self-monitoring. Clinicians should monitor LTR, who are at risk for poor reporting of recorded critical values, more vigilantly even when LTR are provided with mobile technology decision support.     

Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers

ObjectiveRates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics. This study compared smoking outcomes for pregnant women (n = 105) who were randomized to receive either usual care (standard cessation advice from the health care provider) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor.MethodsSubjects were 105 low income, predominantly Hispanic, pregnant patients in an urban prenatal clinic. Smoking outcomes were assessed at end of pregnancy and 6 months post-partum.ResultsAt follow-up, 28.3% and 9.4% of participants in the experimental intervention and 9.6% and 3.8% of patients in usual care were abstinent at end of pregnancy (p = .015) and 6 months post-partum, respectively (p = .251). Cost of the intervention was $56 per patient and cost to produce a non-smoker at end of pregnancy was $299.ConclusionsThis model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy.Practical implicationsIf these findings are replicated, prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session.     

Existing instruments for assessing physician communication skills: Are they valid in a computerized setting?

ObjectivesThis study aims to highlight the differences in physicians’ scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it.MethodsWe use the Wilcoxon Signed Ranks Test to compare physicians’ scores on each of the tools during 16 simulated medical encounters that were rated by two different raters.ResultsResults show a significant difference between physicians’ scores on each tool (z = −3.519, p < 0.05 for the first rater, and z = −3.521, p < 0.05 for the second rater), while scores on the EMR-specific communication skills checklist were significantly and consistently lower.ConclusionThese results imply that current communication assessment tools that do not incorporate items that are relevant for communication tasks during EMR use may produce inaccurate results.Practice implicationsWe therefore suggest that a new instrument, possibly an extension of existing ones, should be developed and empirically validated.     

Airmen and health-care providers’ attitudes toward the use of genomic sequencing in the US Air Force: findings from the MilSeq Project

PurposeThe use of genomic sequencing (GS) in military settings poses unique considerations, including the potential for GS to impact service members’ careers. The MilSeq Project investigated the use of GS in clinical care of active duty Airmen in the United States Air Force (USAF).MethodsWe assessed perceived risks, benefits, and attitudes toward use of GS in the USAF among patient participants (n = 93) and health-care provider participants (HCPs) (n = 12) prior to receiving or disclosing GS results.ResultsParticipants agreed that there are health benefits associated with GS (90% patients, 75% HCPs), though more HCPs (75%) than patients (40%) agreed that there are risks (p = 0.048). The majority of both groups (67% HCPs, 77% patients) agreed that they trust the USAF with genetic information, but far fewer agreed that genetic information should be used to make decisions about deployment (5% patients, 17% HCPs) or duty assignments (3% patients, 17% HCPs). Despite their hesitancy, patients were supportive of the USAF testing for nondisease traits that could impact their duty performance. Eighty-seven percent of patients did not think their GS results would influence their career.ConclusionResults suggest favorable attitudes toward the use of GS in the USAF when not used for deployment or assignment decisions.     

Electronic health record as a research tool: Frequency of exposure to targeted clinical problems and health care providers’ clinical proficiency

ObjectivesThe Electronic Health Record (EHR) could provide insight into possible decay in health care providers’ (HCP) clinical knowledge and cognitive performance. Analyses of the contributions of variables such as frequency of exposure to targeted clinical problems could inform the development and testing of appropriate individualized interventions to mitigate these threats to quality and safety of care.Materials/MethodsNine targeted clinical problems (TCP) were selected for further study, and de-identified, aggregated study data were obtained for one calendar year. Task analysis interviews of subspecialty physicians defined optimal management of each TCP and guided specification of quality of care metrics that could be extracted from the EHR. The Δ-t statistic, days since the provider’s prior encounter with a given TCP, quantified frequency of exposure.ResultsFrequency of patient encounters ranged from 1566 to 220,774 visits across conditions. Mean Δ-t ranged from 1.72 days to 30.79 days. Maximum Δ-t ranged from 285 to 497 days. The distribution of Δ-t for the TCPs generally fit a Gamma distribution (P < 0.001), indicating that Δ-t conforms to a Poisson process. A quality of care metric derived for each TCP declined progressively with increasing Δ-t for 8 of the 9 TCPs, affirming that knowledge decay was detectable from EHR data.Discussion/ConclusionsThis project demonstrates the utility of the EHR as a research tool in studies of health care delivery in association with frequency of exposure of HCPs to TCPs. Subsequent steps in our research include multivariate modeling of clinical knowledge decay and randomized trials of pertinent preventive interventions.     

The Ghana vasectomy initiative: Facilitating client–provider communication on no-scalpel vasectomy

ObjectiveIn 2003–2004 and 2007–2008, an initiative was implemented to improve client and provider knowledge and acceptance of no-scalpel vasectomy (NSV) in Ghana.MethodsAt eight facilities, physicians were trained in NSV and staff received training in the provision of “male-friendly” services. Health promotion activities provided NSV information to prospective clients. Client–provider communication was assessed via a mystery client study (n = 6). Knowledge and acceptance of NSV among potential clients were assessed with baseline and follow-up surveys (each n = 200) in 2003–2004 and three follow-up panel surveys in 2008 (each n = 240).ResultsTrained health staff exhibited improved attitudes and knowledge regarding NSV. Mystery clients reported receiving accurate, nonjudgmental NSV counseling. Awareness of NSV among panel respondents doubled from 31% to 59% in 2003–2004 and remained high (44%) in 2008. The proportion of men who would consider NSV increased from 10% to 19% in 2007–2008. NSV procedures increased three-fold from 2003 (n = 26) to 2004 (n = 83) and 2007 (n = 18) to 2008 (n = 53).ConclusionProvider training in client-centered services, coupled with targeted health promotion, improved client and provider knowledge and acceptance of NSV in an African context.Practice implicationsComplementary, sustained provider training and health promotion are needed to maintain NSV service quality and acceptance.     

Analyzing older users’ home telehealth services acceptance behavior—applying an Extended UTAUT model

BackgroundAlthough telehealth offers an improved approach to providing healthcare services, its adoption by end users remains slow. With an older population as the main target, these traditionally conservative users pose a big challenge to the successful implementation of innovative telehealth services.ObjectivesThe objective of this study was to develop and empirically test a model for predicting the factors affecting older users’ acceptance of Home Telehealth Services (HTS).MethodsA survey instrument was administered to 400 participants aged 50 years and above from both rural and urban environments in Slovenia. Structural equation modeling was applied to analyze the causal effect of seven hypothesized predicting factors. HTS were introduced as a bundle of functionalities, representing future services that currently do not exist. This enabled users’ perceptions to be measured on the conceptual level, rather than attitudes to a specific technical solution.ResultsSix relevant predictors were confirmed in older users’ HTS acceptance behavior, with Performance Expectancy (r = 0.30), Effort Expectancy (r = 0.49), Facilitating Conditions (r = 0.12), and Perceived Security (r = 0.16) having a direct impact on behavioral intention to use HTS. In addition, Computer Anxiety is positioned as an antecedent of Effort Expectancy with a strong negative influence (r = −0.61), and Doctor’s Opinion influence showed a strong impact on Performance Expectancy (r = 0.31). The results also indicate Social Influence as an irrelevant predictor of acceptance behavior. The model of six predictors yielded 77% of the total variance explained in the final measured Behavioral Intention to Use HTS by older adults.ConclusionThe level at which HTS are perceived as easy to use and manage is the leading acceptance predictor in older users’ HTS acceptance. Together with Perceived Usefulness and Perceived Security, these three factors represent the key influence on older people’s HTS acceptance behavior. When promoting HTS, interventions should focus to portray it as secure. Marketing interventions should focus also on promoting HTS among health professionals, using them as social agents to frame the services as useful and beneficial. The important role of computer anxiety may result in a need to use different equipment such as a tablet computer to access HTS. Finally, this paper introduces important methodological guidelines for measuring perceptions on a conceptual level of future services that currently do not exist.     

Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system

ObjectiveComputerized provider order entry systems commonly contain alerting mechanisms for patient allergies, incorrect doses, or drug–drug interactions when ordering medications. Providers have the option to override (bypass) these alerts and continue with the order unchanged. This study examines the effect of customizing medication alert override options on the appropriateness of override selection related to patient allergies, drug dosing, and drug–drug interactions when ordering medications in an electronic medical record.Materials and methodsIn this prospective, randomized crossover study, providers were randomized into cohorts that required a reason for overriding a medication alert from a customized or non-customized list of override reasons and/or by free-text entry. The primary outcome was to compare override responses that appropriately correlate with the alert type between the customized and non-customized configurations. The appropriateness of a subset of free-text responses that represented an affirmative and active acknowledgement of the alert without further explanation was classified as “indeterminate.” Results were analyzed in three different ways by classifying indeterminate answers as either appropriate, inappropriate, or excluded entirely. Secondary outcomes included the appropriateness of override reasons when comparing cohorts and individual providers, reason selection based on order within the override list, and the determination of the frequency of free-text use, nonsensical responses, and multiple selection responses.ResultsTwenty-two clinicians were randomized into 2 cohorts and a total of 1829 alerts with a required response were generated during the study period. The customized configuration had a higher rate of appropriateness when compared to the non-customized configuration regardless of how indeterminate responses were classified (p < 0.001). When comparing cohorts, appropriateness was significantly higher in the customized configuration regardless of the classification of indeterminate responses (p < 0.001) with one exception: when indeterminate responses were considered inappropriate for the cohort of providers that were first exposed to the non-customized list (p = 0.103). Free-text use was higher in the customized configuration overall (p < 0.001), and there was no difference in nonsensical response between configurations (p = 0.39).ConclusionThere is a benefit realized by using a customized list for medication override reasons. Poor application design or configuration can negatively affect provider behavior when responding to important medication alerts.     

Social networks for improving healthy weight loss behaviors for overweight and obese adults: A randomized clinical trial of the social pounds off digitally (Social POD) mobile app

ObjectiveTo test the efficacy of a weight loss mobile app based on recommender systems and developed by experts in health promotion and computer science to target social support and self-monitoring of diet, physical activity (PA), and weight (Social POD app), compared to a commercially available diet and PA tracking app (standard).Materials and methodsOverweight adults [N = 51] were recruited and randomly assigned to either the experimental group [n = 26; theory-based podcasts (TBP) + Social POD app] or the comparison group (n = 25; TBP + standard app). The Social POD app issued notifications to encourage users to self-monitor and send theory-based messages to support users who had not self-monitored in the previous 48 h. Independent samples t-test were used to examine group differences in kilograms lost and change in BMI. Analysis of covariance was used to analyze secondary outcomes while controlling for baseline values.ResultsParticipant attrition was 12% (n = 3 experimental and n = 3 comparison). Experimental group participants lost significantly more weight (−5.3 kg, CI: −7.5, −3.0) than comparison group (−2.23 kg, CI: −3.6, −1.0; d = 0.8, r = 0.4, p = 0.02) and had a greater reduction in BMI (p = 0.02). While there were significant differences in positive outcome expectations between groups (p = 0.04) other secondary outcomes (e.g., caloric intake and social support) were not significant.DiscussionUse of the Social POD app resulted in significantly greater weight loss than use of a commercially available tracking app. This mobile health intervention has the potential to be widely disseminated to reduce the risk of chronic disease associated with overweight and obesity.