iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions

Abstract

BackgroundIndividuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population.ObjectiveThe project’s goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians.MethodsWe developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery.ResultsThere were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient’s self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients’ conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau.ConclusionsThe system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement ...

Feasibility of Using Mobile Health to Promote Self-Management in Spina Bifida

“…The current study uses the interactive Mobile Health and Rehabilitation (iMHere) system, 14 which was designed to support self-management of adults with disabilities ( Fig. 1).…”

Design of Customized Mobile Application for Patient Adherence to Oral Anticancer Medications Utilizing User-Centered Design

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Exploring mHealth Participation for Emergency Response Communities

“…It is recognized that social networking has the potential to change patterns of health inequalities and access to health care, alter the stability of health care provision and lead to a reformulation of the role of health professionals (Griffiths et al, 2012). The study of mobile telephony and social networking's impacts on health care delivery is widespread but has been limited to the behavioural effects of information sharing (Shrank, Choudhry, Swanton, & et al, 2011), patient monitoring (Weitzman, Kelemen, Quinn, Eggleston, & Mandl, 2013), intervention and behaviour modification (Gold et al, 2012), and peer influencing, with a more recent focus on the day-to-day management of chronic conditions (Parmanto et al, 2013).…”