JMIR mHealth and uHealth

A Deep Neural Network for Interpreting Wearable Electrocardiogram Data in Atrial Fibrillation: Prospective Observational Diagnostic Accuracy Study

2026-04-23T12:45:14-04:00

Background: Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias associated with the risk of ischemic stroke, which can be reduced with anticoagulation therapy. Thus, early diagnosis of AF and AFL is essential. However, diagnosis may be challenging due to the paroxysmal and asymptomatic nature of these arrhythmias. Objective: Current diagnostic workflows involve time-consuming and resource-intensive manual review of noisy signals and prolonged recordings. We evaluated a mobile system that combines a wireless wearable single-lead chest strap electrocardiogram (ECG) and a novel deep neural network (DNN)–based artificial intelligence (AI) method for detecting AF/AFL episodes, AF/AFL burden, and rhythm change and estimated the delay in the detection of rhythm change from AF/AFL to sinus rhythm. We also assessed the rhythm classification performance. Methods: A total of 116 patients with recent-onset AF or AFL undergoing cardioversion were monitored using a mobile single-lead chest strap ECG system. Simultaneously, a 3-lead Holter ECG served as the reference. The DNN-based AI analyzed the single-lead chest strap ECG data to detect AF/AFL, non-AF/AFLrhythm, and noninterpretable segments, as well as to estimate AF/AFL burden and detect rhythm change. Performance metrics included sensitivity, specificity, positive predictive value, negative predictive value, and intraclass correlation coefficient for AF and AFL burden estimation. Results: The sensitivity and specificity for detecting AF/AFL were 91.9% (204.9/223.0 h) and 99.6% (242.4/243.5 h), respectively. The sensitivity for detecting AF was 96.2% (191.5/199.0 h), whereas it was 55.8% (13.4/24.0 h) for detecting AFL. The positive predictive value and negative predictive value for AF/AFL detection were 99.5% (204.9/206.0 h) and 93.1% (242.4/260.5 h), respectively. The intraclass correlation coefficient between the AF/AFL burden estimated by the DNN-based AI method and that derived from the physician-interpreted reference ECG was 0.96 (95% CI: 0.94‐0.97; <.001). Rhythm change detection occurred within 1 minute in most cases. Conclusions: The mobile single-lead chest strap ECG system powered by a DNN-based AI algorithm demonstrated strong performance in detecting AF, estimating AF burden, and recognizing rhythm change to sinus rhythm. This AI-driven approach enables automated and accurate rhythm analysis, supporting clinical decision-making. Further validation in real-world ambulatory settings is warranted.

Effectiveness of Mobile Health Interventions in Pediatric Cancer: Systematic Review and Meta-Analysis of Randomized Controlled Trials

2026-04-22T16:15:12-04:00

Background: Cancer poses a significant threat to children’s health, and mobile health (mHealth) is emerging as a key tool for remote disease management, health education, and follow-up. However, evidence of its effectiveness remains limited. Objective: This study aimed to summarize the effects of mHealth interventions for pediatric cancer compared with usual care, providing evidence-based support for optimizing intervention models and improving patient outcomes. Methods: A systematic search of 14 databases identified randomized controlled trials (RCTs) on mHealth apps for pediatric patients with cancer from inception to August 1, 2025. Two reviewers independently screened studies, extracted data, assessed bias risk, and graded evidence quality. The meta-analysis was conducted using RevMan 5.4 and Stata 15. Results: A total of 24 RCTs involving 2645 patients were included. This review found that mHealth interventions significantly reduced infection rates (odds ratio [OR] 0.25, 95% CI 0.10-0.60; =.002) and the overall incidence of peripherally inserted central catheter (PICC) complications (OR 0.16, 95% CI 0.10-0.24; <.001), while improving quality of life (standardized mean difference [SMD] 1.34, 95% CI 0.13-2.55; =.03), self-management ability (SMD 6.39, 95% CI 1.26-11.53; =.01), and treatment adherence (OR 2.83, 95% CI 1.41-5.66; =.003). However, mHealth interventions had no significant effect on PICC catheter displacement (OR 0.44, 95% CI 0.15-1.29; =.13) or health knowledge (SMD 4.44, 95% CI −2.40 to 11.29; =.20). Further high-quality studies are needed to verify their impact in these areas. The intervention components covered 9 behavior change techniques: goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution, reward and threat, comparison of outcomes, natural consequences, and regulation. Conclusions: This systematic review and meta-analysis synthesized evidence from RCTs. The findings support the use of mHealth to reduce infections and PICC-related complications among pediatric patients with cancer while improving quality of life, self-management capabilities, and treatment adherence. These results underscore the importance of incorporating mHealth strategies into pediatric cancer care and guide the development and enhancement of future mHealth interventions. Trial Registration: PROSPERO CRD420251108938; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251108938

Spanish Version of the mHealth App Usability Questionnaire (S-MAUQ): Translation, Adaptation, and Validation Study

2026-04-20T15:15:10-04:00

Background: In the current digital landscape, ensuring optimal usability is one of the most crucial factors determining the success of any mobile app. Questionnaire-based usability evaluations represent a highly prevalent methodology for this purpose. To date, questionnaires have been developed to assess the general system usability; however, there are hardly any questionnaires specifically designed to assess the usability of mobile health (mHealth) apps. The most widespread, the mHealth App Usability Questionnaire (MAUQ), has been developed in 4 versions according to the type of app (interactive or standalone) and the target user (patient or provider). Objective: The objective of this study was to translate and validate the English version of the MAUQ (standalone, for patients) into a Spanish version (S-MAUQ). Methods: The methodology used here follows that proposed by Sousa and Rojjanasrirat, which comprises 4 stages. The initial stage of the process entails a translation, harmonization, and adaptation procedure. The second and third entailed content validation (by 10 experts) and face validation (by 12 target users), respectively, which were conducted to evaluate the relevance and clarity of the questionnaire items. The item-level content validity index, scale content validity index (S-CVI), item-level face validity index, and scale face validity index (S-FVI), as well as the modified kappa statistic (κ) were used to evaluate interrater agreement among the raters, considering the probability of agreement by chance (Pc). The fourth and final stage of the process involved the assessment of the questionnaire’s reliability. A sample of 61 young adult participants installed an mHealth app (the Yazio app), used it, and responded to the S-MAUQ. The Cronbach α value for the entire questionnaire and its subscales were then calculated. Results: For the second stage, the S-CVI was initially 0.778. We removed items #14 and #15 from the Spanish version as they were unclear and not relevant. The S-CVI changed to 0.881. The third stage had an S-FVI of 0.927, indicating that the items are clear and straightforward for the nonexpert target user to understand. Furthermore, with each κ value >0.74, the validity of the instrument is supported. The fourth stage demonstrated the reliability of the S-MAUQ with a Cronbach α value of 0.87. Conclusions: The final version of the S-MAUQ met the validation criteria, demonstrating reliability and validity that are comparable with those of the original version. Consequently, the S-MAUQ is suitable for evaluating the usability of mHealth apps for young Spanish adults. Further research involving larger and more diverse samples is recommended.

Effect of a Comprehensive Mobile-Based Respiratory Training Program on Respiratory Function in Survivors of Acute Stroke: Randomized Controlled Trial

2026-04-14T15:00:18-04:00

Background: Respiratory dysfunction frequently occurs during the acute phase of stroke and is associated with reduced ventilatory capacity, respiratory muscle weakness, and increased pulmonary complications. However, delivering standardized respiratory training during hospitalization is often constrained by staffing and service continuity. Objective: This study aimed to evaluate the efficacy, safety, and feasibility of a hospital-based comprehensive mobile-based respiratory training program (CMRTP) added to conventional rehabilitation in people with acute stroke who are inpatients. Methods: This single-center, assessor-blinded randomized controlled trial enrolled 40 patients within 2 weeks after stroke onset with respiratory dysfunction (forced vital capacity <80% predicted). Participants were randomized (1:1) to CMRTP plus conventional rehabilitation or conventional rehabilitation alone. The CMRTP was delivered via the WeChat-based AIRHUB platform and performed 20 minutes twice daily, 5 days per week for 2 weeks, either independently or with caregiver assistance as needed. The primary outcome was change in forced vital capacity from baseline to week 2. Secondary outcomes included forced expiratory volume in 1 second (FEV₁), peak expiratory flow, maximal inspiratory pressure, maximal expiratory pressure, and modified Barthel index. All outcomes were assessed face-to-face by a blinded senior physician, and all analyses followed an intention-to-treat principle. Results: Of 56 screened patients, 40 were randomized, and 39 completed the study. Adherence to the CMRTP reached 96%, and no serious adverse events occurred; mild, transient events (fatigue, dizziness, and hyperventilation) were recorded. Compared with the control group, the CMRTP group demonstrated greater improvement in forced vital capacity at week 2 (mean difference 0.77 L; 95% CI 0.39‐1.16; <.001; η²=0.32), with additional between-group differences in maximal inspiratory pressure (=.001; η²=.25), maximal expiratory pressure (<.001; η²=.08), and modified Barthel index (=.001; η²=.26). No significant group differences were found for forced expiratory volume in 1 second or peak expiratory flow. Conclusions: A 2-week hospital-based mobile respiratory training program is feasible and safe in people with acute stroke who are inpatients and yields clinically meaningful improvements in respiratory function and daily functional performance when added to conventional rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400088647; https://www.chictr.org.cn/showprojEN.html?proj=211239

Effectiveness of mHealth-Based Nutritional Interventions on Iron Status of Pregnant Women: Systematic Review of Randomized Controlled Trials

2026-04-09T16:00:19-04:00

Background: Anemia is a global health concern. It is disproportionately prevalent among pregnant women in low-resource regions, where iron deficiency is the leading cause. Given the multifactorial nature of anemia, a range of nutritional interventions is recommended. However, effective implementation is often hindered by limited health care access, poor adherence to supplementation, and gaps in nutrition knowledge and counseling. To address these challenges and optimize hemoglobin (Hb) levels among pregnant women, mobile health (mHealth)−based nutritional interventions offer a promising alternative. Objective: The aim of the study is to review available evidence on the effectiveness of mHealth-based nutritional interventions on iron status (Hb and/or serum ferritin concentration) among pregnant women. Methods: Searches were conducted in Embase, CINAHL, Cochrane Library, PubMed, Web of Science, and Scopus, and supplemented by snowballing to identify additional relevant studies from citation lists. The key search strings comprised 4 concepts: “mobile health,” “nutritional intervention,” “Hb, anemia or iron deficiency anemia,” and “pregnant women.” Predefined inclusion and exclusion criteria were applied during screening. The methodological quality of included studies was assessed using the Risk of Bias 2 tool. The primary end point was the change in mean Hb concentration or serum ferritin level. Effect sizes (ESs) were calculated as standardized mean differences, including Cohen and Hedges . Results: Of the 14,284 studies identified, only 11 randomized controlled trials were included. These studies used various modes of delivery, including mobile phone calls (n=1), SMS text messaging (n=3), and mobile apps (n=4), with some using more than 2 modes (n=3). The effect of mHealth-based nutritional interventions on iron status varied significantly. In total, 4 studies demonstrated a large ES (>0.8), with 3 relying on WhatsApp Messenger as an mHealth delivery mode. Approximately 82% (9/11) of the included studies reported a positive effect ( values ranging from <.001 to .047) of the intervention on Hb level, whereas 2 studies reported no statistically significant association (=.33 and =.35, respectively). Notably, interventions with the largest ES achieved clinically significant improvements in Hb concentration, with within- and between-group differences exceeding 1 g/dL. However, including behavioral change theories and nutrition-sensitive components was not consistently associated with larger ESs. Due to high heterogeneity (>95%), attributed to variations in mHealth delivery modes, functions, and interactive features across the included studies, meta-analysis could not be performed. Conclusions: This review demonstrates that mHealth-supported nutritional interventions effectively optimize Hb concentration in pregnant women. While SMS text messaging was less effective in improving Hb concentration, combining it with another mHealth delivery mode, such as phone calls, improved intervention effectiveness. However, the variability in mHealth delivery modes, functions, and interactive features underscores the need for tailored strategies that account for context-specific challenges, digital literacy, and access to technology to enhance effectiveness. Trial Registration: PROSPERO CRD42025627769; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025627769

Trust and Use of Recommendations for Health Apps Among European Residents: Cross-Sectional Survey

2026-04-09T14:45:10-04:00

Background: There is growing recognition of the role of health apps in addressing health care system challenges, yet app quality and evidence vary widely, and consumers have little decision support at the point of download. Objective: This study aimed to explore which sources of recommendations European residents use and trust when choosing health apps and whether residents support government review and rating of health apps. Methods: We conducted a cross-sectional online survey (December 7, 2022, to February 16, 2023) in 26 languages targeting residents of the European Economic Area, the United Kingdom, and Ukraine. The survey contained 11 questions covering demographics, types of apps used, sources of advice used and trusted, and views on government review and rating. We included only fully completed responses (N=1228). Descriptive statistics are presented as counts and percentages. For subgroup analyses, we dichotomized trust responses (“I trust” vs other responses) and tested associations with gender (Fisher exact test), age group, and education level (chi-square test); an adjusted significance threshold was applied (<.004) to account for multiple testing. We followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines for reporting online surveys and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations for observational studies. Results: A total of 1228 respondents from 33 countries completed the survey; 1110 (90.4%) reported using one or more health apps. COVID-19 apps (763/1228, 62.1%) and activity apps (737/1228, 60.0%) were the most frequently used, whereas disease management (86/1228, 7.0%), diagnostic (77/1228, 6.3%), and treatment apps (70/1228, 5.7%) were the least used. Sources used to choose apps included family and friends (434/1228, 35.3%), health professionals (412/1228, 33.6%), and government or health authorities (358/1228, 29.2%). The most trusted sources were health professionals (987/1228, 80.4%), pharmacists (750/1228, 61.1%), and government or health authorities (736/1228, 59.9%). No statistically significant differences in trust by gender were observed (all >.0038). Some differences by age and education were observed for select sources (eg, government or health authorities: =8.546; =.003; family and friends: =19.133; <.001). Overall, 1060 (86.3%) of 1228 respondents supported government review and rating of health apps (either directly or by commissioning another organization). Conclusions: In this large multilingual European survey, most respondents reported experience with health apps and placed greatest trust in health professionals, pharmacists, and government or health authorities, yet professional recommendations were used less often than informal sources. There is clear public support for government-led review and rating schemes to guide consumer choice. Efforts to make trustworthy, easy-to-find information available at the point of download and to support health care professionals in recommending high-quality apps could help bridge the gap between trusted and used sources.

Promoting Self-Regulated Social Media Use on Smartphones With a Mobile Intervention App (Wellspent): Randomized Controlled Trial

2026-04-08T16:30:11-04:00

Background: Problematic social media use has been linked to reduced well-being and impulse control difficulties. While digital self-control apps show potential for reducing general app usage, they often lack customization, leading to limited effectiveness and increased user resistance. Their impact on problematic social media use remains uncertain. Objective: This study evaluates the effectiveness of the Wellspent app, a customizable mobile intervention app designed to promote self-regulated social media use by targeting user-defined problematic app use and offering tailored behavioral nudges. Methods: In a 3-week randomized controlled trial, 70 iPhone users (mean age 26.2, SD 5.6 years; 47/70, 67% female), regularly using at least 1 social media app, were randomly assigned to an intervention (n=35) or control group (n=35). The intervention group received personalized full-screen reminders with the option to quit or continue social media app use whenever an app session exceeded a self-defined time limit. Participants completed weekly online surveys measuring problematic social media use, problematic smartphone use, self-efficacy, and daily screen time on their most problematic app. Linear mixed models tested intervention effects. Results: While no significant reduction in problematic social media use or increase in self-efficacy was observed, the intervention group showed a significant reduction in daily screen time on their most problematic app by approximately 29 minutes (estimate=−29.35, SE 6.84, 95% CI −42.79 to –15.99; <.001), and a significant decrease in perceived problematic smartphone use (estimate=−0.46, SE 0.18, 95% CI −0.80 to –0.11; =.01). Conclusions: The Wellspent app demonstrated short-term efficacy in reducing problematic smartphone use. By allowing users to tailor interventions to their personal goals, the app shows promise as a self-directed tool to support healthier digital habits. Further research should explore long-term effects and feature-specific impacts. Trial Registration: German Clinical Trials Register DRKS00031767; https://drks.de/search/en/trial/DRKS00031767/details

A Mobile App–Based Individualized Nonpharmacological Intervention for Behavioral and Psychological Symptoms in Dementia: Pilot Randomized Controlled Trial

2026-04-07T13:30:13-04:00

Background: Behavioral and psychological symptoms of dementia (BPSD) are common and negatively impact both individuals with dementia and their families. Although nonpharmacological interventions are recommended as the first-line treatments, their use in community settings is limited by access and caregiver resources. Existing approaches are often not individualized and rely on institutional or clinician-led delivery. Objective: We developed a caregiver-initiated and individualized multimodal mobile app. The app delivers tailored nonpharmacological interventions—such as music therapy, exercise, and reminiscence therapy—based on each user’s preferences and functional abilities. This study aimed to evaluate the effectiveness of this mobile app–based intervention in reducing BPSD in community-dwelling persons living with dementia. Methods: This study used a single-blinded randomized controlled trial design. Participants were recruited from an outpatient clinic of a tertiary hospital, a dementia care center, and 5 home care service centers. A total of 36 dyads participated, each comprising a community-dwelling person living with dementia aged 60 years or older and their primary family caregiver. The dyads were randomly allocated to either the intervention or control group. The intervention group received a caregiver-initiated, multimodal, mobile app–based individualized intervention for 4 weeks, whereas the control group continued with usual care. The primary outcomes were overall BPSD, agitated behavior, and depression. The secondary outcomes were nighttime sleep efficiency and caregiver competency in managing BPSD. Assessments were conducted at baseline, immediately after the intervention, and at a 2-week follow-up. Results: Of the 36 randomized dyads, 33 were included in the final analysis. Although the intervention group showed greater reductions in overall BPSD, agitated behavior, and depression after the intervention, no significant group-by-time interaction effects were observed in the total sample. In the subgroup analysis of participants with clinically significant baseline BPSD, a statistically significant improvement in overall BPSD was found in favor of the intervention group (=–12.885, 95% CI –24.530 to –1.240; =.03). No significant effects were observed for either nighttime sleep efficiency or competence in the management of BPSD. Conclusions: A mobile app–based individualized intervention may offer a flexible, caregiver-initiated approach to managing BPSD in home-care settings. While overall effects were limited, exploratory subgroup findings provided meaningful insights, indicating potential benefits for those with higher baseline symptom severity. The results highlight the need for further research on adaptive personalization and optimized intervention delivery to enhance the clinical effectiveness of digital dementia care. Trial Registration: Clinical Research Information Service KCT0008713; https://tinyurl.com/83xaa5ab

Effectiveness of a Telecare-Based Intervention Program in Supporting Informal Caregivers of Community-Dwelling Older Adults in Reducing Stress Levels: Randomized Controlled Trial

2026-04-07T13:30:13-04:00

Background: Informal caregivers are essential in supporting community-dwelling older adults, especially as global populations age. However, caregiving responsibilities often result in high stress, depressive symptoms, and diminished quality of life. Traditional support services are fragmented, and many programs overlook caregivers’ emotional and informational needs. Telecare—the remote delivery of health and social care via digital technologies—offers a promising approach to provide accessible, personalized, and timely support. Objective: This study evaluated the effectiveness of a telecare-based intervention program, developed by a health-social partnership team, in improving psychological well-being and caregiving outcomes among informal caregivers of community-dwelling older adults. We hypothesized that caregivers in the intervention group would show greater improvements in stress, self-efficacy, depression, quality of life, and caregiving burden compared to those receiving usual care. Methods: A single-blind randomized controlled trial was conducted from January to December 2023, with 75 informal caregivers providing care to older adults (aged ≥60 y) for at least 4 hours per week. Participants were randomized to an intervention group (n=38, 51%) or a control group (n=37, 49%). The 3-month intervention included (1) biweekly online nurse case management supported by a multidisciplinary health-social team, (2) personalized WhatsApp videos on caregiving skills, and (3) a password-protected caregiver website offering resources and peer discussion. The control group attended 6 in-person educational sessions at a community center. Outcomes such as stress, self-efficacy, depression, quality of life, and caregiving burden were measured at baseline and postintervention. Results: Participants had a mean age of 65.5 (SD 9.617) years, and 81.3% (61/74) were female. Baseline characteristics were similar between groups. Compared to controls, the intervention group showed significantly higher self-efficacy (=1.98; =.04) and lower depression (=−2.24; =.03) at follow-up. Within-group improvements in the intervention group were also observed for stress, depression, self-efficacy, mental quality of life, and caregiving burden. No significant between-group differences were found for stress, quality of life, or caregiving burden. No significant within-group improvements were observed in the control group. Conclusions: This study provides novel evidence that a digitally delivered, nurse-led telecare program—integrating health and social services—can improve psychological outcomes among informal caregivers. These findings have practical implications for health systems seeking scalable, low-barrier solutions to support caregivers. Telecare models may be a valuable complement to traditional services, enhancing caregiver resilience and promoting aging in place while alleviating long-term strain on institutional care systems. Trial Registration: ClinicalTrials.gov NCT05636982; International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2023.1167479

Development and Launch of a Dutch Mobile App (MediMama) on Over-the-Counter Medication Safety During Pregnancy and Breastfeeding: Development and Usability Study

2026-04-02T16:00:17-04:00

Background: Over-the-counter (OTC) medicines are frequently used during pregnancy. As these medicines are often used without medical supervision, accessible and reliable safety information is essential. However, finding reliable and understandable information on the safety of these medicines during pregnancy is often experienced as difficult. Hence, there is a need for a new easily accessible electronic health (eHealth) tool that empowers women to actively seek information to support safer self-medication practices during pregnancy and breastfeeding. Objective: This study aimed to describe the development and dissemination process of a Dutch mobile app providing reliable safety information on OTC medicines during pregnancy and breastfeeding using a development and formative evaluation approach. Methods: The app was developed over a 2-year project comprising 5 phases, including preparation, development, preimplementation, implementation, and evaluation. Mixed-method strategies, including questionnaires, focus groups, and user feedback rounds, were applied to involve the target population in the development process. Medicine safety information in the app was based on the latest scientific evidence. First-year app-usage outcomes included app downloads, usage patterns, and information-seeking behavior. Results: Input from 253 potential users formed the foundation for the development of the MediMama app (Netherlands Pharmacovigilance Centre Lareb), with users expressing a need for clear, reliable, and easily accessible information on medication safety during pregnancy and breastfeeding. The app was launched on Mother’s Day 2024 and provides safety information on over 250 OTC medicines, including supplements and herbal remedies, across 27 medicine categories. Promotion occurred through multiple online and offline channels. During its first year, the MediMama app was downloaded 22,415 times, with an average of 370 unique daily users, indicating substantial user engagement. Information on paracetamol (acetaminophen) and nasal sprays was most frequently accessed, reflecting the need for information on commonly used OTC medicines among the target population. Conclusions: One year after its launch, the MediMama app is considered a promising tool in maternity care, meeting the target population’s need for accessible OTC medicine safety information. The app aims to support informed decision-making, contributing to safer medication use during pregnancy and breastfeeding. Further research is required to evaluate the effectiveness of the implementation strategy, as well as the app’s impact on maternal medication use behaviors and health outcomes.