Digital Food Records in Community-Based Interventions: Mixed-Methods Pilot Study

BackgroundThe terms health app and medical app are often used interchangeably but do not necessarily mean the same thing. To better understand these terms and better regulate such technologies, we need distinct definitions of health and medical apps.ObjectiveThis study aimed to provide an overview of the definitions of health and medical apps from an interdisciplinary perspective. We summarized the core elements of the identified definitions for their holistic understanding in the context of digital public health.MethodsThe legal frameworks for medical device regulation in the United States, the European Union, and Germany formed the basis of this study. We then searched 6 databases for articles defining health or medical apps from an interdisciplinary perspective. The narrative literature review was supported by a forward and backward snowball search for more original definitions of health and medical apps. A qualitative analysis was conducted on the identified relevant aspects and core elements of each definition. On the basis of these findings, we developed a holistic definition of health and medical apps and created a decision flowchart to highlight the differences between the 2 types.ResultsThe legal framework showed that medical apps could be regulated as mobile medical devices, whereas there is no legal term for health apps. Our narrative literature review identified 204 peer-reviewed publications that offered a definition of health and medical apps. After screening for original definitions and applying the snowball method, 11.8% (24/204) of the publications were included in the qualitative analysis. Of these 24 publications, 22 (88%) provided an original definition of health apps and 11 (44%) described medical apps. The literature suggests that medical apps are a part of health apps. To describe health or medical apps, most definitions used the user group, a description of health, the device, the legal regulation, collected data, or technological functions. However, the regulation should not be a distinction criterion as it requires legal knowledge, which is neither suitable nor practical. An app’s intended medical or health use enables a clear differentiation between health and medical apps. Ultimately, the health aim of an app and its main target group are the only distinction criteria.ConclusionsHealth apps are software programs on mobile devices that process health-related data on or for their users. They can be used by every health-conscious person to maintain, improve, or manage the health of an individual or the community. As an umbrella term, health apps include medical apps. Medical apps share the same technological functions and devices. Health professionals, patients, and family caregivers are the main user groups. Medical apps are intended for clinical and medical purposes and can be legally regulated as mobile medical devices.

The number of older adults using mobile devices has doubled over recent years; however, many need assistance in learning how to use their device. To address this gap, we developed patient education materials teaching older Veterans how to download apps and the basics of mobile device and app use. For example, we developed step-by-step guides for three Veteran Affairs mobile apps that target mental health symptoms. Material development involved feedback from providers and older Veterans using a multi-step mixed methods evaluation process. Local technology and geriatric content experts provided initial feedback; all experts agreed the materials would be helpful to teach Veterans about mental health apps. We subsequently interviewed older Veterans (M = 78.5 years) who evaluated the materials. Over 50% of Veterans found the guides clear, articulate, and useful; 83.3% noted they would recommend to others. Lastly, providers who see older Veterans regularly rated the materials; 79% of providers rated the materials as helpful, with an average rating of 4.3 (1 = Strongly Disagree to 5 = Strongly Agree). Providers viewed the materials and apps as useful supplements to psychotherapy and especially useful for individuals who are unable to return to clinic. Overall, both providers and Veterans found the materials easy to understand and valuable for those new using mobile apps or devices. Findings from the evaluation process suggest the design of the materials may be vital to increasing the use of mental health mobile apps among older Veterans.

BackgroundRheumatoid arthritis flares have a profound effect on patients, causing pain and disability. However, flares often occur between regularly scheduled health care provider visits and are, therefore, difficult to monitor and manage. We sought to develop a mobile phone app combined with a population management system to help track RA flares between visits.ObjectiveThe objective of this study is to implement the mobile app plus the population management system to monitor rheumatoid arthritis disease activity between scheduled health care provider visits over a period of 6 months.MethodsThis is a randomized controlled trial that lasts for 6 months for each participant. We aim to recruit 190 patients, randomized 50:50 to the intervention group versus the control group. The intervention group will be assigned the mobile app and be prompted to answer daily questionnaires sent to their mobile devices. Both groups will be assigned a population manager, who will communicate with the participants via telephone at 6 weeks and 18 weeks. The population manager will also communicate with the participants in the intervention group if their responses indicate a sustained increase in rheumatoid arthritis disease activity. To assess patient satisfaction, the primary outcomes will be scores on the Treatment Satisfaction Questionnaire for Medication as well as the Perceived Efficacy in Patient-Physician Interactions questionnaire at 6 months. To determine the effect of the mobile app on rheumatoid arthritis disease activity, the primary outcome will be the Clinical Disease Activity Index at 6 months.ResultsThe trial started in November 2016, and an estimated 2.5 years will be necessary to complete the study. Study results are expected to be published by the end of 2019.ConclusionsThe completion of this study will provide important data regarding the following: (1) the assessment of validated outcome measures to assess rheumatoid arthritis disease activity with a mobile app between routinely scheduled health care provider visits, (2) patient engagement in monitoring their condition, and (3) communication between patients and health care providers through the population management system.Trial RegistrationClinicalTrials.gov NCT02822521, http://clinicaltrials.gov/ct2/show/NCT02822521 (Archived by WebCite at http://www.webcitation.org/6xed3kGPd)

The purpose of this study was to conduct a systematic evaluation of community-based participatory research (CBPR) interventions on diabetes outcomes. Understanding of effective CBPR interventions on diabetes outcomes is limited, and findings remain unclear. A reproducible search strategy was used to identify studies testing CBPR interventions to improve diabetes outcomes, including A1C, fasting glucose, blood pressure, lipids, and quality of life. Pubmed, PsychInfo, and CINAHL were searched for articles published between 2010 and 2020. Using a CBPR continuum framework, studies were classified based on outreach, consulting, involving, collaborating, and shared leadership. A total of 172 were screened, and a title search was conducted to determine eligibility. A total of 16 articles were included for synthesis. Twelve out of the 16 studies using CBPR approaches for diabetes interventions demonstrated statistically significant differences in 1 or more diabetes outcomes measured at a postintervention time point. Studies across the spectrum of CBPR demonstrated statistically significant improvements in diabetes outcomes. Of the 16 studies included for synthesis, 14 demonstrated statistically significant changes in A1C, fasting glucose, blood pressure, lipids, and quality of life. The majority of studies used community health workers (CHWs) to deliver interventions across group and individual settings and demonstrated significant reductions in diabetes outcomes. The evidence summarized in this review shows the pivotal role that CHWs and diabetes care and education specialists play in not only intervention delivery but also in the development of outward-facing diabetes care approaches that are person- and community-centered.

“Essential Security Practices for Fortifying Mobile Apps” is a definitive guide designed to empower developers, security professionals, and organizations with the knowledge and tools needed to secure mobile applications in an increasingly complex digital landscape. This comprehensive book covers every aspect of mobile app security, providing actionable insights and practical strategies to protect apps from the ever-evolving threat landscape. The book begins with an Introduction to Mobile App Security (Chapter 1), where readers are introduced to the critical importance of securing mobile apps. It discusses common security threats, the principles of security by design, and the unique challenges faced in mobile app development. The chapter also includes case studies of major security breaches, offering real-world context to the concepts discussed. In Secure Development Lifecycle (Chapter 2), the book emphasizes the importance of integrating security into the Software Development Lifecycle (SDLC). Topics such as threat modeling, secure coding practices, and penetration testing are explored in depth. This chapter also covers the role of continuous integration in maintaining security and the necessity of incident response planning and security training. Authentication and Authorization (Chapter 3) dives into the mechanisms that ensure only authorized users have access to mobile apps. It covers secure authentication methods, including multi-factor authentication and token-based authentication, as well as best practices for session management and password storage. The chapter provides guidelines to avoid common authentication flaws that could compromise app security. Data Protection and Privacy (Chapter 4) addresses the crucial aspects of encrypting data both at rest and in transit. It discusses secure data storage, privacy by design principles, and the handling of personally identifiable information (PII). Readers will learn about secure data deletion and compliance with data protection regulations, as well as the use of secure cryptographic libraries. Network Security (Chapter 5) explores the protocols and techniques needed to secure communication between mobile apps and their backend systems. The chapter covers the correct use of TLS/SSL, protecting against man-in-the-middle attacks, and securing backend APIs. It also discusses the importance of monitoring and logging network activity to detect and respond to potential threats. The book then moves on to Secure Coding Practices (Chapter 6), providing guidance on avoiding common coding vulnerabilities through input validation, error handling, and defensive programming techniques. It also covers secure code reviews and the best practices for using mobile platform APIs securely. Mobile Device Security (Chapter 7) shifts focus to the security of the devices on which mobile apps run. The chapter discusses mobile device threats, secure device configuration, and the use of mobile device management (MDM) solutions. It also addresses the security features of mobile devices, such as secure boot and remote wiping, which are essential for protecting against device theft or loss. In Secure Deployment and Distribution (Chapter 8), readers will learn about secure strategies for deploying and distributing mobile apps. Topics include code signing, protecting against repackaging and tampering, and securely distributing sensitive data. The chapter also covers handling updates and patches, ensuring that apps remain secure after deployment. Security Testing and Validation (Chapter 9) provides an in-depth look at the various types of security testing, including automated and manual testing techniques. It discusses penetration testing best practices, vulnerability assessment, and the integration of security testing into CI/CD pipelines. Regular security audits and addressing found vulnerabilities are also emphasized. Incident Response and Management (Chapter 10) guides readers in building an effective incident response team and creating a robust incident response plan. The chapter covers the steps for detecting, analyzing, containing, eradicating, and recovering from security incidents. Post-incident analysis and communication with stakeholders are also discussed, alongside legal and regulatory considerations. Finally, Future Trends in Mobile App Security (Chapter 11) explores the emerging threats and advancements in mobile security technologies. The chapter discusses the role of artificial intelligence in security, the integration of IoT with mobile devices, and the potential of blockchain in enhancing mobile security. It also highlights the importance of user education and awareness in safeguarding mobile applications in the future. “Essential Security Practices for Fortifying Mobile Apps” is an invaluable resource for anyone involved in the development, deployment, and management of mobile applications, offering a thorough understanding of the security challenges and the strategies needed to overcome them.

Mobile apps are software programmes that run on smartphones and other mobile devices. Mobile health apps can help people manage their own health and wellness, promote healthy living and gain access to useful information when and where they need it. The Brush DJ oral health app was developed to use the opportunity mobile apps offer to motivate an evidence-based oral hygiene routine. A literature review has found no research investigating the use of a mobile app to motivate evidence-based oral hygiene behaviour. The objective of this preliminary investigation was to assess user perception of an oral health app to give a basis for future research and development of app technology in relation to oral health. A cross-sectional qualitative user perception questionnaire.RESULTS :One hundred and eighty-nine people responded to the questionnaire. Seventy percent (n = 113) of respondents reported that their teeth felt cleaner since using the app. Eighty-eight percent (n = 133) reported the app motivated them to brush their teeth for longer and 92.3% (n = 144) would recommend the app to their friends and family. Four broad themes relating to how the app helped toothbrushing were reported. These themes were motivation, education, compliance and perceived benefits. A mobile app is a promising tool to motivate an evidence-based oral hygiene routine.

Smartphones and mobile applications (apps) in clinical nursing education: A student perspective

Mobilizing Partnerships for Social Change Sarena D. Seifer (bio) and Annika Sgambelluri (bio) How do we combine the knowledge and wisdom in communities and in academic institutions to solve the major health, social and economic challenges facing our society? How do we ensure that community-driven social change is central to service-learning and community-based participatory research (CBPR)? Answering these critical questions was the central purpose of the Community-Campus Partnerships for Health (CCPH) 10th anniversary conference and the special section of conference papers appearing in this issue. The conference, “Mobilizing Partnerships for Social Change,” sought to nurture a growing network of community-campus partnerships that are striving to achieve the systems and policy changes needed to address the root causes of health, social and economic inequalities. The conference convened a diverse group of over 650 CCPH members from 40 states and the District of Columbia in the United States, 10 provinces in Canada, the Central African Republic, Germany, Ghana, Kenya, Nepal, Nigeria, Norway, South Africa, Sudan, Uganda and the United Kingdom for four days of skill-building, networking, and agenda-setting. Generous scholarship support from conference cosponsors contributed to an equitable mix of participants from community and institutional settings, with an especially strong contingent from Aboriginal and Indigenous communities. As CCPH’s first conference in Canada, participants were able to learn from Canadian experiences with community-campus partnerships and the social determinants of health, and to explore synergies across North America and beyond. Further, holding the conference in one of the most diverse cities in the world enabled participants to explore critical issues of race, ethnicity, socioeconomic status, wealth and culture. Through plenary presentations, interactive workshops, story-telling sessions, posters, exhibits and community site visits, the conference sought to build knowledge, skills and actions for achieving healthy and just societies. The papers appearing in the CCPH theme section tackle critical issues of significance to community-academic partnerships and CBPR that are of broad interest to readers of the journal. Davis and her colleagues voice what many of us feel: “When working on social justice issues, it is easy to become overwhelmed by the problems faced.”1 These papers provide creative, practical and replicable strategies for solving the major health, social and economic challenges facing our society. Two papers make a compelling case for communities as the center of learning, discovery and engagement. In their paper, May and Law demonstrate how building the capacity of community-based organizations to conduct CBPR can yield research findings that galvanize communities to take action.2 Similarly, Davis et. al. show how engaging community members in documenting their experiences with homelessness through numbers, stories and photos can raise awareness and action on a social justice issue that is often overlooked or ignored.1 In theory, CBPR involves community participation in every phase of the research process, but in practice this rarely happens. Three papers explore the practicalities, challenges and rewards of community participation in research. Jackson describes in depth the participatory group process she used to analyze qualitative data.3 Fernández-Peña and his colleagues present community-developed guidelines to support researchers in disseminating findings in ways that reach community constituencies.4 Plumb and her colleagues report on an evaluation of seven grantees that sought to determine whether the collaborative process contributed to their projects’ outcomes.5 Although the findings are inconclusive, they point to an essential area of further inquiry as CBPR skeptics continue to question the “added value” of CBPR over traditional approaches to research. [End Page 81] Finally, two papers address perceived gaps in the field. Responding to the predominance of lecture- and textbook-based approaches to teaching the social determinants of health, Rossiter and Reeve offer an experiential tool.6 Taking the idea of “walking in someone else’s shoes” to a participatory level, “The Last Straw” helps people gain a new appreciation of what advantage and disadvantage means in our society. Responding to debates about what constitutes “evidence” and “quality” in community-based prevention, Wright and his colleagues are testing a rigorous participatory peer review process that aims to develop valid and widely accepted indicators by synthesizing diverse perspectives.7 Taken together, these papers offer inspirational...

Nurses Need Training and Policies to Address Barriers to Use of Mobile Devices and Apps for Direct Patient Care in Hospital Settings

Socioeconomic and racial disparities in the outcomes of medical management remain common across pulmonary diseases in the United States and worldwide. Acknowledging this, the American Thoracic Society recently put forth recommendations to advance respiratory health equity. Through engagement of vulnerable communities in search of collaborative solutions to improve health disparities, community-based participatory research embodies concepts essential to the American Thoracic Society mission for respiratory health equity. The purpose of this commentary is to provide an overview of the principles of community-based participatory research and the application of this approach to addressing inequity in the outcomes of treatment for lung disease. Community-based participatory research aims to decrease health disparities by recognizing the social and ecological paradigms of health care and by partnering community members with academic researchers in all aspects of the research process. Community partners are uniquely poised to offer insight into local culture, circumstances that guide health behaviors, and other challenges to improve their own community's health. Sustainable interventions, either through strengthening existing community assets or through community empowerment and local capacity building throughout the research process, are essential to the success of community-based participatory research. The National Institutes of Health and other funding agencies offer funding opportunities to support specific interventions aimed at engaging community members in the research process. In pulmonary medicine, community-based initiatives have focused primarily on improving pediatric asthma outcomes. Using a community-based approach in adult asthma and other pulmonary diseases could be an ideal manner in which to decrease pulmonary health disparities.

BackgroundCanada is one of the world’s most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents’ SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada.ObjectiveThe purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents.MethodsWe will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app.ResultsRecruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024.ConclusionsOur study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale.International Registered Report Identifier (IRRID)PRR1-10.2196/45389

Research continues to be a dirty word for many Indigenous people. Community-based participatory research (CBPR) is a means to disrupt power dynamics by engaging community members within the research process. However, the majority of relationships between researcher and participants within CBPR are structured within Western research paradigms and they often reproduce imbalances of power. The purpose of this article is to reflect on the process of CBPR within a research project focused on Indigenous men's masculinity and mental health. In doing so, we aim to contribute to reflexive practice in CBPR and flatten research hierarchies to facilitate more equitable knowledge sharing. Our reflections highlight the importance of prioritizing healing, centering cultural protocols, negotiating language, and creating space for Indigenous research partners to lead. These critical lessons challenge Western researchers to ground their practices in Indigenous culture while they "sit outside the circle" to facilitate more equitable and engaged partnerships.

The Move to Smart Mobile and its Implications for Antitrust Analysis of Online Markets

Severe weather events, exacerbated by climate change, can lead to hardships such as displacement, resource scarcity, and social network disruptions. Such disasters impact mental health, triggering conditions such as anxiety, depression, and posttraumatic stress disorder. For communities in the Gulf South, the increasing frequency of disasters often further exacerbates already disastrous levels of inequality. In this context, there is an urgent need for evidence-based, multilevel, community-based interventions to support individual and community mental health and resilience. This protocol describes the design of a community-based participatory research (CBPR) study to improve individual and community mental health in Gulf South communities by examining the implementation and effects of the multilevel, community-based intervention, Communities Organizing for Power through Empathy (COPE). Specifically, this study aims to (1) examine factors affecting the implementation, effectiveness, and adoption of the COPE intervention and (2) test its effects on mental health and community resilience. We hypothesize that participants in the COPE intervention will experience greater reductions in psychological distress (eg, perceived stress, anxiety, and depression); improvements in protective factors (eg, social support and coping self-efficacy); and community participation as compared with an attention control group. The Consolidated Framework for Implementation Research guides our analysis of data collected from surveys, fidelity and field notes, interviews, and focus groups to examine aim 1. We examine aim 2 primarily via a 2-arm pragmatic stepped-wedge cluster randomized trial (SW-CRT) with individuals (approximately n=300) in clusters (faith-based and secular community-based organizations; approximately n=15) in a disaster-prone community in the US Gulf Coast. The cluster-based design implemented in steps supports the community-based nature of the study where timelines differ by organization. A total of 5 self-assessments will be conducted both in person and via email at later time points. We will integrate mixed methods in our analyses for aim 1 by combining themes from interviews and focus groups with implementation measures, and for aim 2 by constructing a data matrix to combine findings from the SW-CRT with thematic analyses of field notes and interviews. The SW-CRT is being conducted from June 2022 to June 2025. Recruitment began in April 2023, to conclude in spring 2025, to assess mental health, social support, and community resilience at 5 time points. Data analysis and dissemination of results are expected by spring of 2026. This protocol is among the first to use a CBPR approach to examine the implementation and effectiveness of a multilevel intervention on psychological distress and resilience. This study provides new insights into how CBPR can enhance intervention implementation research and expand the evidence on community-based mental health interventions during disasters. Policy makers should consider integrating CBPR approaches into disaster response frameworks to ensure culturally relevant and sustainable outcomes. ClinicalTrials.gov NCT06093737; https://clinicaltrials.gov/study/NCT06093737. DERR1-10.2196/63723.

Abstract. Georeferenced field data collection has become a popular practice allowing everyone to contribute to mapping objects or reporting events. The spread of mobile devices - capable of recording and sharing location coordinates, media and features while on the go - is primarily accountable for such diffusion. Accordingly, a number of mobile apps and software frameworks have been developed and released to perform field data collection. These frameworks allow to customize and dispatch collection forms as well as to manage contributors and records through web interfaces or database management systems. From the contributors’ perspective, specific mobile client apps need to be installed to access selectively the collection forms and contribute to the data collection on the field using their mobile devices. This operation might inhibit the sporadic contribution of occasional users who may not be willing to install additional software. To overcome this limitation, this work presents the Geo Collector Bot, an alternative software toolkit to empower field data collection projects avoiding the development and/or the installation of a specific mobile app on contributors’ devices. The Geo Collector Bot is a configurable Telegram-based chatbot enabling to dispatch of data collection forms that can be activated and filled in through Telegram chats. The ultimate goal of the presented work is to provide an alternative free and open-source software framework suitable for general-purpose field data collection applications. Development patterns and system architecture are described in detail alongside future improvements and outlooks for the Geo Collector Bot project.