Accessibility needs and challenges of a mHealth system for patients with dexterity impairments.

Purpose State: An innovative mobile health system called iMHere (interactive Mobile Health and Rehabilitation) has been developed at the University of Pittsburgh to support self-care and adherence to self-care regimens for patients with chronic conditions. The goal of this study is to explore and to identify the accessibility needs and preferences of individuals with dexterity impairments when they use the iMHere system. METHOD: Participants were asked to perform tasks after a one-week field trial. The time for a participant to complete each task, the number of possible errors a participant made and the number of errors a participant was able to self-correct were recorded and analyzed. The Telehealth Usability Questionnaire was collected to rate participants' experiences. RESULTS: Nine participants with various levels of dexterity abilities were included in the study. A statistically significant negative correlation was identified between participants' dexterity levels and their error ratios by using a Pearson product-moment correlation (r = -0.434, n = 36, p = 0.004). Approximately 51% of errors detected was self-corrected without any help, but other errors called for resolution from a researcher. CONCLUSIONS: Due to the diversity of participants' dexterity impairments, their needs and preferences differ one from another. Personalized design may be the key to approaching these challenges in improving accessibility. Implications for Rehabilitation An innovative mobile health system called iMHere has been developed to support self-care and adherence to self-care regimens as part of rehabilitation for patients with chronic conditions. Before populations with these limitations can harness the potential of mHealth, accessibility of mHealth has to be addressed to ensure its quality and value. Dexterity limitations are commonly associated with chronic disease, accidents or aging. The study presented here identified the potential issues and barriers to accessibility related to user interface components for persons with dexterity impairments. The findings should be of interest for those working with mobile health, accessibility, smartphone apps, wellness and self-care.

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

OBJECTIVE: To determine feasibility of using the interactive Mobile Health and Rehabilitation (iMHere) system in spina bifida and its effects on psychosocial and medical outcomes. DESIGN: In a randomized controlled trial, 13 intervention participants using the iMHere system and receiving usual care and 10 control participants receiving usual care were followed for 1 year. RESULTS: Feasibility of use of the system was demonstrated by participants using a customized smartphone system for reminders to conduct various self-care tasks, upload photos of wounds, manage medications, complete mood surveys, and for secure messaging. High usage of the system was associated with positive changes in the subscales of the Adolescent Self-Management and Independence Scale II. CONCLUSION: Use of the iMHere system in spina bifida is feasible and was associated with short-term self-reported improvements in self-management skill. This system holds promise for use in many diverse chronic care models to support and increase self-management skills.

Development of mHealth system for supporting self-management and remote consultation of skincare.

BACKGROUND: Individuals with spina bifida (SB) are vulnerable to chronic skin complications such as wounds on the buttocks and lower extremities. Most of these complications can be prevented with adherence to self-care routines. We have developed a mobile health (mHealth) system for supporting self-care and management of skin problems called SkinCare as part of an mHealth suite called iMHere (interactive Mobile Health and Rehabilitation). The objective of this research is to develop an innovative mHealth system to support self-skincare tasks, skin condition monitoring, adherence to self-care regimens, skincare consultation, and secure two-way communications between patients and clinicians. METHODS: In order to support self-skincare tasks, the SkinCare app requires three main functions: (1) self-care task schedule and reminders, (2) skin condition monitoring and communications that include imaging, information about the skin problem, and consultation with clinician, and (3) secure two-way messaging between the patient and clinician (wellness coordinator). The SkinCare system we have developed consists of the SkinCare app, a clinician portal, and a two-way communication protocol connecting the two. The SkinCare system is one component of a more comprehensive system to support a wellness program for individuals with SB. RESULTS: The SkinCare app has several features that include reminders to perform daily skin checks as well as the ability to report skin breakdown and injury, which uses a combination of skin images and descriptions. The SkinCare app provides reminders to visually inspect one's skin as a preventative measure, often termed a "skin check." The data is sent to the portal where clinicians can monitor patients' conditions. Using the two-way communication, clinicians can receive pictures of the skin conditions, track progress in healing over time, and provide instructions for how to best care for the wound. CONCLUSIONS: The system was capable of supporting self-care and adherence to regimen, monitoring adherence, and supporting clinician engagement with patients, as well as testing its feasibility in a long-term implementation. The study shows the feasibility of a long-term implementation of skincare mHealth systems to support self-care and two-way interactions between patients and clinicians.

Accessibility of mHealth Self-Care Apps for Individuals with Spina Bifida.

As the smartphone becomes ubiquitous, mobile health is becoming a viable technology to empower individuals to engage in preventive self-care. An innovative mobile health system called iMHere (Internet Mobile Health and Rehabilitation) has been developed at the University of Pittsburgh to support self-care and adherence to self-care regimens for individuals with spina bifida and other complex conditions who are vulnerable to secondary complications. The goal of this study was to explore the accessibility of iMHere apps for individuals with spina bifida. Six participants were asked to perform tasks in a lab environment. Though all of the participants were satisfied with the iMHere apps and would use them again in the future, their needs and preferences to access and use iMHere apps differed. Personalization that provides the ability for a participant to modify the appearance of content, such as the size of the icons and the color of text, could be an ideal solution to address potential issues and barriers to accessibility. The importance of personalization--and potential strategies--for accessibility are discussed.

Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation.

Individuals with chronic conditions and disabilities who are vulnerable to secondary complications often require complex habilitative and rehabilitative services to prevent and treat these complications. This perspective article reviews the evolution of mHealth technologies and presents insights as to how this evolution informed our development of a novel mHealth system, iMHere (interactive mobile health and rehabilitation), and other technologies, including those used by the Veterans Administration. This article will explain the novel applications of mHealth for rehabilitation and specifically physical therapy. Perspectives on the roles of rehabilitation professionals in the delivery of health care using mHealth systems are included. Challenges to mHealth, including regulatory and funding issues, are discussed. This article also describes how mHealth can be used to improve patient satisfaction and delivery of care and to promote health and wellness.