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During the COVID-19 pandemic era that began in 2020, there has been a growing trend in the literature to tackle the problem of health stress (HS) for promoting a sense of public health. In turn, this developing area of research has a high level of relevancy linked to business and economic recovery (Čvirik, 2020). Since HS has increased sharply during the COVID-19 pandemic era, there has been a need to further investigate the balance between coping with HS and the positive continuous intention to use mobile health applications (mHealth apps) among the public. This is the first study that takes the Asia-Pacific region as its case study and empirically investigates the validity of extensions based on the theories of expectation confirmation theory (ECT) (Bhattacherjee, 2001) on user continuous behavior relating to mHealth apps during the COVID-19 pandemic. Results reveal that HS as an emotion can positively affect perceived usefulness and satisfaction in relation to the continuous intention to use mHealth apps. The differences between new and frequent users are confirmed. Discussion and implications for practices are provided in the end.

IntroductionMobile health (mHealth) apps are a promising adjunct to traditional mental health services, especially in underserviced areas. Developed to foster resilience in youth, the JoyPop™ app has a growing evidence base showing improvement in emotion regulation and mental health symptoms among youth. However, whether this novel technology will be accepted among those using or providing mental health services remains unknown. This study aimed to evaluate the JoyPop™ app's acceptance among (a) a clinical sample of youth and (b) mental health service providers.MethodA qualitative descriptive approach involving one-on-one semi-structured interviews was conducted. Interviews were guided by the Technology Acceptance Model and were analyzed using a deductive-inductive content analysis approach.ResultsAll youth ( n  = 6 females; M age = 14.60, range 12–17) found the app easy to learn and use and expressed positive feelings towards using the app. Youth found the app useful because it facilitated accessibility to helpful coping skills (e.g., journaling to express their emotions; breathing exercises to increase calmness) and positive mental health outcomes (e.g., increased relaxation and reduced stress). All service providers ( n  = 7 females; M age = 43.75, range 32–60) perceived the app to be useful and easy to use by youth within their services and expressed positive feelings about integrating the app into usual care. Service providers also highlighted various organizational factors affecting the app's acceptance. Youth and service providers raised some concerns about apps in general and provided recommendations to improve the JoyPop™ app.DiscussionResults support youth and service providers' acceptance of the JoyPop™ app and lend support for it as an adjunctive resource to traditional mental health services for youth with emotion regulation difficulties.

Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians' ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics' time, encourage broader screening practices, and increase early detection of cognitive decline. The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants' rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants' abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia.

Background: Sedentary behavior is associated with various adverse health outcomes. Medical students often experience high academic demands, leading to increased sedentary time. This study aimed to evaluate the effectiveness of a mobile app providing real-time feedback in reducing total sedentary time and prolonged sedentary bouts and in promoting physical activity among medical students. Methods: Seventy-seven medical students from Jazan University (mean age: 21.4 years; range: 20–25 years) participated in this study. Participants were assigned to either the control group (n = 40) or the intervention group (n = 37). The intervention group received real-time vibration feedback via a mobile app, prompting movement every 30 min of sedentary time, while the control group received no intervention. Sedentary behavior and physical activity levels were assessed using the Activities Completed Over Time in 24 h. Paired t-tests were conducted to examine within-group changes, and a two-way ANOVA was used to assess the interaction effect of time and group on sedentary time and physical activity. Results: After six weeks, the intervention group showed significant within-group reductions in their total sedentary time of 1.82 h (p = 0.01) and prolonged sedentary bouts of 1.91 h (p = 0.001), while the control group had no significant changes. Physical activity levels did not significantly change within either group. The two-way ANOVA revealed that there was no significant change over time between the two groups in their total sedentary time F (1, 75) = 1.590, p = 0.21, prolonged sedentary bouts F (1, 75) = 3.499, p = 0.06, or physical activity F (1, 75) = 0.565, p = 0.45. Conclusions: Real-time feedback from mobile apps resulted in significant within-group reductions in total and prolonged sedentary time among medical students in the intervention group. Low-cost mobile apps providing real-time feedback may be an effective intervention for reducing sedentary behavior among medical students, potentially improving their health and well-being.

The fast rate of technological advances in the health care sector remain as a pressing need for effective solutions that address the unique health care needs of sexual and gender minorities. If these innovative solutions are considered, societal challenges such as stigma, discrimination, and a lack of tailored health care resources, as experienced by the lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more (LGBTQIA+) individuals could be addressed at lower cost. This study aimed to develop a mobile health (mHealth) app specifically designed to address the sexual and reproductive health (SRH) of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more (LGBTQIA+) individuals in Gauteng Province, South Africa. This study used a Design Science Research (DSR) framework and a mixed-method exploratory sequential approach. DSR was executed in three cycles: cycle one followed an ethnography approach; involved 33 health care providers (HCPs) and 22 LGBTQIA+ individuals, focusing on identifying specific SRH and the challenges encountered in accessing and providing these services. Participants shared their views on the potential role of mHealth apps in addressing these issues. Cycle two engaged 13 experts through Participatory Action Research (PAR) approach using the Nominal Group Technique (NGT) to collaboratively identify essential content for the app, fostering a co-creation process. Lastly, cycle three followed an interventional pre-experimental approach by involving software developers and principal investigator working together to develop a functional prototype of the mHealth app. This study revealed critical insights into the specific SRH of LGBTQIA+ individuals, alongside the barriers faced by health care providers in meeting these needs. The co-created app prototype named \"Queery wellness hub\" was developed and incorporated features tailored to enhance accessibility, confidentiality, and user engagement, addressing both user and provider perspectives. The findings underscore the potential of mHealth apps in transforming the delivery of SRH for LGBTQIA+ individuals in South Africa. Continued collaboration with stakeholders is essential for further refinement and successful implementation of the app, ultimately contributing to better health outcomes for sexual and gender minorities.

The Mobile Application Rating Scale (MARS) provides a reliable method to assess the quality of mobile health (mHealth) apps. However, training and expertise in mHealth and the relevant health field is required to administer it. This study describes the development and reliability testing of an end-user version of the MARS (uMARS). The MARS was simplified and piloted with 13 young people to create the uMARS. The internal consistency and test-retest reliability of the uMARS was then examined in a second sample of 164 young people participating in a randomized controlled trial of a mHealth app. App ratings were collected using the uMARS at 1-, 3,- and 6-month follow up. The uMARS had excellent internal consistency (alpha = .90), with high individual alphas for all subscales. The total score and subscales had good test-retest reliability over both 1-2 months and 3 months. The uMARS is a simple tool that can be reliably used by end-users to assess the quality of mHealth apps.

Background: The System Usability Scale (SUS) is a widely used scale that has been used to quantify the usability of many software and hardware products. However, the SUS was not specifically designed to evaluate mobile apps, or in particular digital health apps (DHAs). Objective: The aim of this study was to examine whether the widely used SUS distribution for benchmarking (mean 68, SD 12.5) can be used to reliably assess the usability of DHAs. Methods: A search of the literature was performed using the ACM Digital Library, IEEE Xplore, CORE, PubMed, and Google Scholar databases to identify SUS scores related to the usability of DHAs for meta-analysis. This study included papers that published the SUS scores of the evaluated DHAs from 2011 to 2021 to get a 10-year representation. In total, 117 SUS scores for 114 DHAs were identified. R Studio and the R programming language were used to model the DHA SUS distribution, with a 1-sample, 2-tailed t test used to compare this distribution with the standard SUS distribution. Results: The mean SUS score when all the collected apps were included was 76.64 (SD 15.12); however, this distribution exhibited asymmetrical skewness (–0.52) and was not normally distributed according to Shapiro-Wilk test (P=.002). The mean SUS score for “physical activity” apps was 83.28 (SD 12.39) and drove the skewness. Hence, the mean SUS score for all collected apps excluding “physical activity” apps was 68.05 (SD 14.05). A 1-sample, 2-tailed t test indicated that this health app SUS distribution was not statistically significantly different from the standard SUS distribution (P=.98). Conclusions: This study concludes that the SUS and the widely accepted benchmark of a mean SUS score of 68 (SD 12.5) are suitable for evaluating the usability of DHAs. We speculate as to why physical activity apps received higher SUS scores than expected. A template for reporting mean SUS scores to facilitate meta-analysis is proposed, together with future work that could be done to further examine the SUS benchmark scores for DHAs.

Digital health interventions, especially mobile apps, have become instrumental in helping women at risk of polycystic ovary syndrome (PCOS), increasing their understanding of the condition, improving self-care, and fostering empowerment. However, their rapid proliferation has brought about significant challenges regarding quality assessment and evidence-based determination. Therefore, establishing reliable quality assessment methods is essential to assist patients with PCOS in identifying effective and trustworthy mobile health tools. This study was designed to assess the content and quality of mobile apps developed for patients with PCOS using the Mobile App Rating Scale (MARS) to provide insights into their strengths, limitations, and areas needing improvement. In this descriptive-analytical study conducted in June 2024, a comprehensive search was performed to identify English and Persian mobile apps related to PCOS through the Café Bazaar and Google Play Store platforms, using both direct search methods and auxiliary tools such as AppAgg and AppBrain. Two trained reviewers (AR and NN) independently reviewed the apps using the MARS tool. The interrater reliability was measured using the intraclass correlation coefficient test. The quality of each app was scored across 4 dimensions: engagement, functionality, aesthetics, and information quality. Of the initial 199 apps identified, 15 met the inclusion criteria after screening and updates. The interrater agreement rate was 85%, which is considered acceptable. The apps' overall quality was sufficient, as assessed using the MARS, with a mean score of 3.6 (SD 0.52) of 5. Functionality and aesthetics emerged as the highest-scoring dimensions, highlighting user-friendliness and visual appeal (n=10). In contrast, engagement following information quality received the lowest average score, indicating limited interactivity and gaps in providing evidence-based information. The Ask PCOS app achieved the highest overall score, performing exceptionally well in subjective quality (4.75) and app-specific quality (4.33), reflecting its strong capacity to positively impact users' knowledge, attitudes, and behaviors related to PCOS. Uvi Health and Ask PCOS scored highest in engagement (4.2), while PCOS & PCOD Diet & Remedies led in functionality (5), and Uvi Health topped aesthetics (5). The findings revealed that even though many available PCOS-related apps demonstrate strengths in technical performance and design, critical limitations persist regarding user engagement and the credibility of the information provided. The predominance of commercially affiliated apps without academic or clinical oversight was identified as a key contributing factor to these shortcomings. These results underscore the need for future app development to incorporate more user-engaging features, reliable evidence-based content, and personalization strategies to enhance user engagement and support effective PCOS self-management. Addressing these limitations and leveraging the capabilities of existing mobile devices are essential steps toward improving the overall quality and impact of mobile health interventions for individuals with PCOS.

Telemedicine and mobile health (mHealth) apps have emerged as powerful tools in health care, offering convenient access to services and empowering participants in managing their health. Among populations with chronic and progressive disease such as multiple sclerosis (MS), mHealth apps hold promise for enhancing self-management and care. To be used in clinical practice, the validity and usability of mHealth tools should be tested. The most commonly used method for assessing the usability of electronic technologies are questionnaires. This study aimed to translate and validate the English version of the mHealth App Usability Questionnaire into Italian (ita-MAUQ) in a sample of people with MS. The 18-item mHealth App Usability Questionnaire was forward- and back-translated from English into Italian by an expert panel, following scientific guidelines for translation and cross-cultural adaptation. The ita-MAUQ (patient version for stand-alone apps) comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. After interacting with DIGICOG-MS (Digital Assessment of Cognitive Impairment in Multiple Sclerosis), a novel mHealth app for cognitive self-assessment in MS, people completed the ita-MAUQ and the System Usability Scale, included to test construct validity of the translated questionnaire. Confirmatory factor analysis, internal consistency, test-retest reliability, and construct validity were assessed. Known-groups validity was examined based on disability levels as indicated by the Expanded Disability Status Scale (EDSS) score and gender. In total, 116 people with MS (female n=74; mean age 47.2, SD 14 years; mean EDSS 3.32, SD 1.72) were enrolled. The ita-MAUQ demonstrated acceptable model fit, good internal consistency (Cronbach α=0.92), and moderate test-retest reliability (intraclass coefficient correlation 0.84). Spearman coefficients revealed significant correlations between the ita-MAUQ total score; the ease of use (5 items), interface and satisfaction (7 items), and usefulness subscales; and the System Usability Scale (all P values <.05). Known-group analysis found no difference between people with MS with mild and moderate EDSS (all P values >.05), suggesting that ambulation ability, mainly detected by the EDSS, did not affect the ita-MAUQ scores. Interestingly, a statistical difference between female and male participants concerning the ease of use ita-MAUQ subscale was found (P=.02). The ita-MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility, and acceptability of mHealth apps in people with MS.

Chatbots are an emerging technology that show potential for mental health care apps to enable effective and practical evidence-based therapies. As this technology is still relatively new, little is known about recently developed apps and their characteristics and effectiveness. In this study, we aimed to provide an overview of the commercially available popular mental health chatbots and how they are perceived by users. We conducted an exploratory observation of 10 apps that offer support and treatment for a variety of mental health concerns with a built-in chatbot feature and qualitatively analyzed 3621 consumer reviews from the Google Play Store and 2624 consumer reviews from the Apple App Store. We found that although chatbots' personalized, humanlike interactions were positively received by users, improper responses and assumptions about the personalities of users led to a loss of interest. As chatbots are always accessible and convenient, users can become overly attached to them and prefer them over interacting with friends and family. Furthermore, a chatbot may offer crisis care whenever the user needs it because of its 24/7 availability, but even recently developed chatbots lack the understanding of properly identifying a crisis. Chatbots considered in this study fostered a judgment-free environment and helped users feel more comfortable sharing sensitive information. Our findings suggest that chatbots have great potential to offer social and psychological support in situations where real-world human interaction, such as connecting to friends or family members or seeking professional support, is not preferred or possible to achieve. However, there are several restrictions and limitations that these chatbots must establish according to the level of service they offer. Too much reliance on technology can pose risks, such as isolation and insufficient assistance during times of crisis. Recommendations for customization and balanced persuasion to inform the design of effective chatbots for mental health support have been outlined based on the insights of our findings.