Tag: mobile apps

Literacy and e-Health

By Rachel Kurtzman

Your phone buzzes and you look down- it’s a text that your prescription is ready for pickup, a medication reminder, or a communication from your doctor. For most of us reading health messages like this isn’t an issue, but it is for millions of adults in the U.S. who have low literacy skills. Nearly 14% of U.S. adults have below basic literacy skills and 29% have basic literacy skills- about 92 million people.1 Low literacy is linked to many adverse health outcomes, including increased mortality and poor control of chronic health problems.2

Many mobile health applications rely on individuals being able to read and interpret health messages, and fail to consider those who cannot. Studies have found that most apps available through the app store rely on high literacy and numeracy skills.3 There are very few guidelines on how to develop apps that are more accessible for this population, but some recommendations include using larger font, more images, larger graphics, lowering the reading level, and having the option of text to voice responses.3

Our health care system is evolving and e-health has the potential to help more people engage with the tools necessary to manage their health, but not creating products that are accessible for individuals with a broad range of literacy levels risks widen disparities and leaving behind a vulnerable segment of our population.


  1. Eichner J, Dullabh P. Accessible Health Information Technology (Health IT) for Populations With Limited Literacy: A Guide for Developers and Purchasers of Health IT. (Prepared by the National Opinion Research Center for the National Resource Center for Health IT). AHRQ Publication No. 08-0010-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2007.
  2. Pignone, M.P., DeWalt, D.A. Literacy and Health Outcomes: Is Adherance the Missing Link? J Gen Intern Med. 2006 Aug; 21(8): 896-7.
  3. Chaudry, B.M., Connelly, K.H., Siek, K.A., Welch, J.L. Mobile interface design for low-literacy populations. IHI’12. January 28-30th, 2012. Miami Florida, USA. DOI: 1145/2110363.2110377


Stethoscopes and Smartphones? How Doctors are Using mHealth Apps for Patient Care

By Elizabeth Adams, MA

There was a time when doctors circulated the hallways of hospitals with nothing but a beeper pinned to the waistline of their scrubs.

But today, you might notice your doctor enter the exam room clutching a more advanced communication device – a Smartphone or tablet. A 2014 survey reported that 85% of medical faculty, 90% of medical residents, and 85% of medical students used a Smartphone in a clinical setting1. Modern doctors are increasingly replacing laptops or desktops with Smartphones and tablets2.

Doctors are constantly on their feet, moving throughout hospitals, emergency rooms, or clinics.  They use these devices for variety of job-related tasks, including remote patient monitoring, electronic health record access, e-prescribing, drug reference calculations, reading medical news, and decision-making support3. Now there is a marketplace for health professionals to locate apps designed specifically for clinical practice. In 2011, the iPhone App Store introduced the “Apps for Health Care Professionals” section, which has expanded to include more than 80 app options4.

Here are a few ways doctors are using apps to improve patient care:

 Retrieving Information. Doctors increasingly rely on mhealth to inform complex clinical assessments and decisions. One survey indicated that two-thirds of doctors use medication-interaction assistance apps to aid in the prescription decision-making process5. In addition, medical residents rely on mobile phones in clinical consultation to look up drug information, perform clinical calculations, take notes, or look up clinical guidelines4. Instantaneous access to information can help doctors and trainees make more accurate decisions regarding treatment.

 Communicating with Patients. Electronic health record software, such as Epic (link to: https://www.inova.org/for-physicians/epiccare-apps) – the program used by UNC HealthCare – incorporate apps Haiku and Canto, which facilitate direct correspondence between patients and health care teams. Other third-party apps, such as OhMD (link to: https://www.ohmd.com), TigerText (link to: https://www.tigertext.com/), and Hale (link to: http://hale.co/), are compatible with electronic health record programs and connect patients to doctors through text messaging platforms.

Continuing Education. Mobile continuing education curricula promises to supply doctors and trainees with current medical information and impart recent standards of practice without the time-consuming requirement of sitting at a desktop or in a classroom. In addition, top-tier medical journals, including the New England Journal of Medicine’s This Week app (link to: http://www.nejm.org/doi/full/10.1056/NEJMe1201837) and the American Medical Association’s CPT QuickRef app (link to: https://www.ama-assn.org/practice-management/applying-cpt-codes), deliver scientific articles and guidelines.

 More research is necessary to understand the relationship between mhealth app adoption and improved clinical care outcomes. Smartphones could be considered impediments to patient care, so they must be used with some discretion. But next time your doctor walks in with a tablet or glances at a Smartphone, remember that he or she might be using an app to make better decisions for your health.


  1. Ventola, C. Lee. “Mobile Devices and Apps for Health Care Professionals: Uses and Benefits.” Pharmacy and Therapeutics5 (2014): 356–364.
  2. Murfin, M. Know your apps: an evidence-based approach to evaluation of mobile clinical applications. Journal of Physician Assist Education. 2013; 24(3):38-40.
  3. Kaufman, Michele B,PharmD., R.Ph. “Mobile Health Increases as Physicians Seek New Ways to Manage Patients.”Formulary, vol. 47, no. 4, 2012, pp. 161-162, ProQuest, http://libproxy.lib.unc.edu/login?url=https://search-proquest-com.libproxy.lib.unc.edu/docview/1145903653?accountid=14244.
  4. Dolan, B. Apple’s Top 80 Apps for Doctors, Nurses, and Patients. [Online] November 27, 2012. http://www.mobihealthnews.com/19206/apples-top-80-apps-for-doctors-nurses-patients/
  5. Boruff, J. T. M., & Storie, D. M. M. A. Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information. Journal of the Medical Library Association, (2014): 102(1), 22-30.

HIV Medication Adherence Apps: Challenges Faced

By Chunyan Li

The success of HIV medications has changed HIV from a fatal disease to a chronic illness. However, like other chronic diseases that require lifetime medication (at least for now), maintaining good adherence to antiretroviral therapy is not easy for HIV-positive people for reasons such as the complex drug regimens, strict requirements on the time of daily medication, and sometimes intolerable side effects. Having a mobile phone-based application to remind patients of daily medication is a good way out, but the effectiveness of such medication adherence apps remains less studied.

One significant challenge that such apps often face is a lack of behavioral science in design. Some experts described the development of many healthcare apps as a “black box”[1], blaming that app developers often focus too much on technology while neglecting behavior change theories or research evidence. One 2016 research study [2] reviewed all health apps on Google Play, Apple App Store and Windows Phone Store, and found that the reviewed 28 eligible health apps only used 5.6 out of the total 37 behavioral change principles on average. Among the four categories of behavior change principles proposed by the researchers (task support, dialogue support, system credibility and social support), the most used principles were about “system credibility” and “task support”, including features like surface credibility, expertise, authority, and providing general information and function of self-monitoring.  The two categories “dialogue support” and “social support”, which require higher user-provider interactivity and more constructive design based on behavioral science, are somehow neglected.

In another systematic review [3] that reviewed all eHealth-based HIV intervention studies (including smartphone-, Web- and general Internet-based interventions), 10 out of the 14 studies that had a component of adherence improvement were smartphone-based. As HIV patients are usually required to take medicines on quite a strict daily schedule, and sometimes even to be in private if HIV/AIDS is heavily stigmatized, smartphone-based apps are better for portability and privacy protection. However, it could also be challenged when people feel unsafe to disclose HIV status or worry about leaving digital footprints on such apps. In lower-income settings where cell phones are shared with family members, using apps to keep track of medication adherence might not be an ideal option for HIV-positive people.

In a qualitative research study about the HIV treatment continuum that I’m recently working on, a frequently-mentioned desired feature of app-based interventions by HIV-positive people is having communication with human counselors. Many adherence apps may have functions of knowledge education, tracking medications and pushing reminders, but lack an emotional support. Living with HIV is a chronic and multidimensional (physical, psychological and cultural) stress, and a successful coping with such a stress requires consistent support from families, friends and health professionals. Though the advantages of health apps include its mass-reach to users and increasing access to care in limited-resource settings, we should never ignore the needs for human caring and support. How to incorporate human support into HIV medication adherence apps could be one of the future research directions.


[1] Tomlinson, M., Rotheram-Borus, M. J., Swartz, L., & Tsai, A. C. (2013). Scaling Up mHealth: Where Is the Evidence? PLoS Medicine, 10(2). https://doi.org/10.1371/journal.pmed.1001382

[2] Geuens, J., Swinnen, T. W., Westhovens, R., de Vlam, K., Geurts, L., & Vanden Abeele, V. (2016). A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement. JMIR mHealth and uHealth, 4(4), e118. https://doi.org/10.2196/mhealth.6286

[3] Muessig, K. E., Nekkanti, M., Bauermeister, J., Bull, S., & Hightow-Weidman, L. B. (2015). A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care. Current HIV/AIDS Reports. https://doi.org/10.1007/s11904-014-0239-3


Should There Be an App for That? Regulating the App Store

By Nikhil Sanon

There is mixed evidence that mHealth smartphone applications, commonly referred to as “apps,” are effective in achieving their intended outcome. Furthermore, a quarter of all app downloads are used only once, and consumers fail to return to apps that they do not find engaging. While some postulate that employing a User-Centered Design approach in the development of mHealth apps is necessary to stimulate engagement with mHealth apps, I believe that a more fundamental problem needs to be addressed: Any developer can publish a mHealth app to the Apple App Store or Google Play Store with no vetting for empirical evidence in support of the app’s effectiveness.

Both the Apple App Store and the Google Play Store have published guidelines for app developers that describe criteria that will result in an app failing to be uploaded to their respective stores. However, most of the criteria focus on the appropriateness of the content on the app, not the validity of the app itself. This is particularly problematic when considering that mHealth apps are uniquely positioned to provide healthcare services to their users. The guidelines for the Apple App Store state that medical apps “must clearly disclose data and methodology to support accuracy claims relating to health measurements.” However, no additional disclosures need to be made for medical apps with a scope beyond collecting or providing health measurements.

Stricter regulation of mHealth apps uploaded to the Apple App Store and the Google Play Store is necessary, such that apps with empirical support for their effectiveness are clearly labeled and marketed as such. This will not inherently solve the issue of poor consumer engagement with mHealth apps, but it will ensure that the mHealth apps available to consumers are safe to use.



[1] Tara McCurdie, Svetlena Taneva, Mark Casselman, Melanie Yeung, Cassie McDaniel, Wayne Ho, and Joseph Cafazzo (2012mHealth Consumer Apps: The Case for User-Centered Design. Biomedical Instrumentation & Technology: Mobile Health, Vol. 46, No. s2, pp. 49-56. https://doi.org/10.2345/0899-8205-46.s2.49

[2] App Review. https://developer.apple.com/app-store/review/. Accessed 01/25/2018

[3] Developer Policy Center https://play.google.com/about/developer-content-policy/#!?modal_active=none. Accessed 01/25/2018

Image: Betta, Christiano. “App Store.” 26 Sept 2008. Online image licensed under a Creative Commons Attribution 2.0 Generic (CC-BY2.0). Accessed 26 Jan 2018. https://www.flickr.com/photos/cristiano_betta/2909483129

Apps, Websites, mHealth, Oh My!

Mobile health applications have taken off as opportunities for public health intervention coinciding with the increasing usage of mobile phones and mobile phone applications in everyday life. A search for “mobile app” in the Journal of Medical Internet Research returns over 1,000 results.

While some of these applications are certainly changing the way we approach our health and lifestyles, some of them can also do more harm than good. As a result, the FDA has developed guidance for the development of these applications to ensure their safety.

However, mobile applications aren’t the only option for providing health information and interactive experiences to users on mobile devices, though they’ve become an incredibly popular option. Many mobile applications could likely be created as websites using responsive web design to make them easily viewable from computers, tablets, smartphones, and so on.

This is especially important when thinking about your target audience. While younger audiences might use their phones regularly, older individuals might be less inclined to use a mobile app, but they might visit a website from their computer or tablet.

A website with responsive web design will also work across platforms (so users can switch between their phone, tablet, computer, or other devices) and will likely take less time and money to develop. They’re also easier to update and maintain for longer periods of time.

Also, if any of your users are like me, they might hate downloading yet another app to take up space on their phone. Apps contribute to clutter on your mobile devices and take up storage space that could be used for pictures, music, emails, and other content.

In a rush to utilize new technologies and meet users where they are, some of these mobile health applications have come out poorly.

Turner-McGreivy, et al. (2016), available from PubMed Central, provide a great comparison of responsive-design websites versus mobile applications, including an easy-to-use table.

Health can’t be achieved overnight

Sleep is often overlooked when discussing health. We often focus on daytime activities like diet and exercise when trying to improve our health; however sleep has a major impact on our overall well being. Getting the recommended 7-9 hours can…

  • improve mood
  • improve concentration
  • improve reaction time
  • improve memory
  • improve immune system
  • reduce chances of accidents, particularly car accidents
  • reduce risk for obesity
  • reduce risk of diabetes
  • reduce risk for heart disease

If you aren’t getting enough sleep, what should you do? Track it!

There are many wearable fitness trackers and mobile apps that track sleep. Find one that is in your price range and start recording your data. Research has shown that simply tracking sleep levels can improve sleep habits. If you want to go a step further and self-monitor your progress, you can reap even more benefits. In addition, many sleep trackers and apps will provide feedback for enhancing sleep such as reducing caffeine intake or avoiding exercising right before going to bed. Incorporating these helpful tips can vastly improve your sleep over time.

The key to sleep tracking, or any health tracking for that matter, is to view the data over several days or weeks, try to find trends, and then make small adjustments to improve your numbers. Try to avoid seeing each night, or day, as a success or failure, but rather aim for gradual improvement. Essentially, achieving any health goal is a process, and can’t be achieved overnight (no pun intended).

Read more about which sleep trackers are best here.

Reference: mybasis.com

Image Source: wikipedia.org


Kate Muessig, PhD, Talks About Tech in Public Health

Kate Muessig, PhD, is an assistant professor in the Department of Health Behavior in the Gillings School of Global Public Health at UNC-Chapel Hill. Muessig has done a plethora of research, primarily focused on improving HIV/STI prevention and care in China among sex workers as well as in North Carolina among men who have sex with men. Much of her research focuses on developing eHealth and mHealth interventions for these populations.

Currently, Muessig is working with a research team developing a tablet-based virtual reality program for HIV-positive males that will help them develop effective communication and decision-making skills around disclosing their HIV status to others, particularly intimate partners. She is also working on creating an mHealth app for HIV-positive patients in China to assist in navigating the complex Chinese healthcare system for HIV, continuing regular care, adhering to prescribed treatments and medications, and providing an accurate resource for more information about the disease.

Muessig hopes that public health and technology can be more integrated in the future. In her experience, she describes one of the key challenges as developing common language and navigating different work styles and funding mechanisms in the collaborations between academia and technology development groups. Muessig stresses that technology has the potential to be an invaluable health tool, but researchers and health professions need to develop useful new health behavior theories that incorporate a technological component, establish best practices for eHealth and mHealth interventions, and learn how to create self-sustaining, desirable apps and websites all while making meaningful impacts on major health concerns.

Read more about Kate Muessig and her research.

How do you think technology is changing public health research and interventions? Is technology helping or hindering public health efforts? How can technology be used as an ‘invaluable health tool?’

Photo source: UNC