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BMC Medical Informatics and Decision Making

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Open Access 01-12-2018 | Research article

Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review

Authors: Jung-Ah Lee, Mona Choi, Sang A Lee, Natalie Jiang

Published in: BMC Medical Informatics and Decision Making | Issue 1/2018

Abstract

Background

Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management.

Methods

Relevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion.

Results

Of the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system.

Conclusions

Findings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes.

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World Health Organization. Noncommunicable diseases country profiles 2014. 2014. http://apps.who.int/iris/bitstream/10665/128038/1/9789241507509_eng.pdf. Accessed 22 Dec 2017.

Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:E62. https://doi.org/10.5888/pcd11.130389.PubMedPubMedCentral

US Centers for Disease Control and Prevention. Death and Mortality: NCHS FastStats Web Site. 2013. https://www.cdc.gov/nchs/fastats/deaths.htm. Accessed 22 Dec 2017.

US Agency for Healthcare Research and Quality. Multiple Chronic Conditions Chartbook: 2010 Medical expenditure panel survey data. AHRQ Publication No Q14–0038. 2014. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf. Accessed 22 Dec 2017.

Nolte E, Knai C, McKee M. Managing chronic conditions: experience in eight countries. 2008. http://www.euro.who.int/__data/assets/pdf_file/0008/98414/E92058.pdf?ua=1. Accessed 22 Dec 2017.

Sharma J. Chronic disease managment in the South-East Asia Region: a need to do more. WHO South East Asia J Public Health. 2013;2(2):79–82. https://doi.org/10.4103/2224-3151.122935.CrossRefPubMed

Healthcare Information and Management Systems Society. Definitions of mHealth. 2012. http://www.himss.org/definitions-mhealth. Accessed 22 Dec 2017.

Bitsaki M, Koutras G, Heep H, Koutras C. Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up. Healthc Inform Res. 2017;23(1):67–73. https://doi.org/10.4258/hir.2017.23.1.67.CrossRefPubMedPubMedCentral

Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015;17(2):e52. https://doi.org/10.2196/jmir.3951.CrossRefPubMedPubMedCentral

10.

Park YT. Emerging New Era of Mobile Health Technologies. Healthc Inform Res. 2016;22(4):253–4. https://doi.org/10.4258/hir.2016.22.4.253.CrossRefPubMedPubMedCentral

11.

Free C, Phillips G, Felix L, Galli L, Patel V, Edwards P. The effectiveness of M-health technologies for improving health and health services: a systematic review protocol. BMC Res Notes. 2010;3:250. https://doi.org/10.1186/1756-0500-3-250.CrossRefPubMedPubMedCentral

12.

Fiordelli M, Diviani N, Schulz PJ. Mapping mHealth research: a decade of evolution. J Med Internet Res. 2013;15(5):e95. https://doi.org/10.2196/jmir.2430.CrossRefPubMedPubMedCentral

13.

Widmer RJ, Collins NM, Collins CS, West CP, Lerman LO, Lerman A. Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis. Mayo Clin Proc. 2015;90(4):469–80. https://doi.org/10.1016/j.mayocp.2014.12.026.CrossRefPubMedPubMedCentral

14.

de Ridder M, Kim J, Jing Y, Khadra M, Nanan R. A systematic review on incentive-driven mobile health technology: as used in diabetes management. J Telemed Telecare. 2017;23(1):26–35. https://doi.org/10.1177/1357633X15625539.CrossRefPubMed

15.

Cui M, Wu X, Mao J, Wang X, Nie M. T2DM self-management via smartphone applications: a systematic review and meta-analysis. PLoS One. 2016;11(11):e0166718. https://doi.org/10.1371/journal.pone.0166718.CrossRefPubMedPubMedCentral

16.

Sieverdes JC, Treiber F, Jenkins C. Improving diabetes management with mobile health technology. Am J Med Sci. 2013;345(4):289–95. https://doi.org/10.1097/MAJ.0b013e3182896cee.CrossRefPubMed

17.

Whitehead L, Seaton P. The effectiveness of self-management mobile phone and tablet apps in long-term condition management: a systematic review. J Med Internet Res. 2016;18(5):e97. https://doi.org/10.2196/jmir.4883.CrossRefPubMedPubMedCentral

18.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100.CrossRefPubMedPubMedCentral

19.

Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. 2011. http://handbook-5-1.cochrane.org/chapter_8/8_assessing_risk_of_bias_in_included_studies.htm. Accessed 22 Dec 2017.

20.

Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452–7. https://doi.org/10.1016/j.amepre.2009.02.002.CrossRefPubMedPubMedCentral

21.

Hebert M. Telehealth success: evaluation framework development. Stud Health Technol Inform. 2001;84(Pt 2):1145–9.PubMed

22.

Kristjansdottir OB, Fors EA, Eide E, Finset A, Stensrud TL, van Dulmen S, et al. A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: randomized controlled trial. J Med Internet Res. 2013;15(1):e5. https://doi.org/10.2196/jmir.2249.CrossRefPubMedPubMedCentral

23.

Kristjansdottir OB, Fors EA, Eide E, Finset A, Stensrud TL, van Dulmen S, et al. A smartphone-based intervention with diaries and therapist feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain. part 2: 11-month follow-up results of a randomized trial. J Med Internet Res. 2013;15(3):e72. https://doi.org/10.2196/jmir.2442.CrossRefPubMedPubMedCentral

24.

Dicianno BE, Fairman AD, McCue M, Parmanto B, Yih E, McCoy A, et al. Feasibility of using mobile health to promote self-management in spina bifida. Am J Phys Med Rehabil. 2016;95(6):425–37. https://doi.org/10.1097/phm.0000000000000400.CrossRefPubMed

25.

Ginis P, Nieuwboer A, Dorfman M, Ferrari A, Gazit E, Canning CG, et al. Feasibility and effects of home-based smartphone-delivered automated feedback training for gait in people with Parkinson's disease: a pilot randomized controlled trial. Parkinsonism Relat Disord. 2016;22:28–34. https://doi.org/10.1016/j.parkreldis.2015.11.004.CrossRefPubMed

26.

Kearney N, McCann L, Norrie J, Taylor L, Gray P, McGee-Lennon M, et al. Evaluation of a mobile phone-based, advanced symptom management system (ASyMS) in the management of chemotherapy-related toxicity. Support Care Cancer. 2009;17(4):437–44. https://doi.org/10.1007/s00520-008-0515-0.CrossRefPubMed

27.

Garcia-Palacios A, Herrero R, Belmonte MA, Castilla D, Guixeres J, Molinari G, et al. Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study. Eur J Pain. 2014;18(6):862–72.CrossRefPubMed

28.

Cingi C, Yorgancioglu A, Cingi CC, Oguzulgen K, Muluk NB, Ulusoy S, et al. The "physician on call patient engagement trial" (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients. Int Forum Allergy Rhinol. 2015;5(6):487–97. https://doi.org/10.1002/alr.21468.CrossRefPubMed

29.

Hägglund E, Lynga P, Frie F, Ullman B, Persson H, Melin M, et al. Patient-centred home-based management of heart failure. Findings from a randomised clinical trial evaluating a tablet computer for self-care, quality of life and effects on knowledge. Scand Cardiovasc J. 2015;49(4):193–9. https://doi.org/10.3109/14017431.2015.1035319.CrossRefPubMed

30.

Martin SS, Feldman DI, Blumenthal RS, Jones SR, Post WS, McKibben RA, et al. mActive: a randomized clinical trial of an automated mHealth intervention for physical activity promotion. J Am Heart Assoc. 2015;4(11).

31.

Piette JD, Striplin D, Marinec N, Chen J, Trivedi RB, Aron DC, et al. A mobile health intervention supporting heart failure patients and their informal caregivers: a randomized comparative effectiveness trial. J Med Internet Res. 2015;17(6):e142. https://doi.org/10.2196/jmir.4550.CrossRefPubMedPubMedCentral

32.

DeVito Dabbs A, Song MK, Myers BA, Li R, Hawkins RP, Pilewski JM, et al. A randomized controlled trial of a mobile health intervention to promote self-management after lung transplantation. Am J Transplant. 2016;16(7):2172–80. https://doi.org/10.1111/ajt.13701.CrossRefPubMed

33.

Vuorinen AL, Leppanen J, Kaijanranta H, Kulju M, Helio T, van Gils M, et al. Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland: randomized controlled trial. J Med Internet Res. 2014;16(12):e282. https://doi.org/10.2196/jmir.3651.CrossRefPubMedPubMedCentral

34.

Cubo E, Mariscal N, Solano B, Becerra V, Armesto D, Calvo S, Arribas J, Seco J, Martinez A, Zorrilla L, et al. Prospective study on cost-effectiveness of home-based motor assessment in Parkinson's disease. J Telemed Telecare. 2016;23(2):328–38. https://doi.org/10.1177/1357633X16638971.CrossRefPubMed

35.

Lee JA, Evangelista LS, Moore AA, Juth V, Guo Y, Gago-Masague S, et al. Feasibility study of a mobile health intervention for older adults on oral anticoagulation therapy. Gerontol Geriatr Med 2016;2:2333721416672970. doi: https://doi.org/10.1177/2333721416672970.

36.

Mera TO, Heldman DA, Espay AJ, Payne M, Giuffrida JP. Feasibility of home-based automated Parkinson's disease motor assessment. J Neurosci Methods. 2012;203(1):152–6. https://doi.org/10.1016/j.jneumeth.2011.09.019.CrossRefPubMed

37.

Statista. Number of smartphone users in the United States from 2010 to 2022 (in millions). 2017. https://www.statista.com/statistics/201182/forecast-of-smartphone-users-in-the-us. Accessed 22 Dec 2017.

38.

Statista. Number of smartphone users worldwide from 2014 to 2020 (in billions). 2017. https://www.statista.com/statistics/330695/number-of-smartphone-users-worldwide. Accessed 22 Dec 2017.

39.

Pew Research Center. Record shares of Americans now own smartphones, have home broadband. 2017. http://www.pewresearch.org/fact-tank/2017/01/12/evolution-of-technology. Accessed 22 Dec 2017.

Title: Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review
Authors: Jung-Ah Lee
Mona Choi
Sang A Lee
Natalie Jiang
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Medical Informatics and Decision Making / Issue 1/2018
Electronic ISSN: 1472-6947
DOI: https://doi.org/10.1186/s12911-018-0591-0

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Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

Methods

Results

Conclusions

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