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Purpose: This study identified facilitators and barriers pertaining to the use of multiple mobile health (mHealth) devices (Fitbit Alta® fitness tracker, iHealth® glucometer, BodyTrace® scale) that support self-management behaviors in individuals with type 2 diabetes mellitus (T2DM)., Design: This qualitative descriptive study presents study participants' perceptions of using multiple mobile devices to support T2DM self-management. Additionally, this study assessed whether participants found visualizations, generated from each participant's health data as obtained from the three separate devices, useful and easy to interpret., Methods: Semistructured interviews were completed with a convenience sample of participants (n = 20) from a larger randomized control trial on T2DM self-management. Interview questions focused on participants' use of three devices to support T2DM self-management. A study team member created data visualizations of each interview participant's health data using RStudio., Results: We identified two themes from descriptions of study participants: feasibility and usability. We identified one theme about visualizations created from data obtained from the mobile devices. Despite some challenges, individuals with T2DM found it feasible to use multiple mobile devices to facilitate engagement in T2DM self-management behaviors., Discussion: As mHealth devices become increasingly popular for diabetes self-management and are integrated into care delivery, we must address issues associated with the use of multiple mHealth devices and the use of aggregate data to support T2DM self-management., Clinical Relevance: Real-time patient-generated health data that are easily accessible and readily available can assist T2DM self-management and catalyze conversations, leading to better self-management. Our findings lay an important groundwork for understanding how individuals with T2DM can use multiple mHealth devices simultaneously to support self-management., (© 2021 Sigma Theta Tau International.)

Objective: This study examined the perspectives on the use of data visualizations and identified key features seriously ill children, their parents, and clinicians prefer to see when visualizing symptom data obtained from mobile health technologies (an Apple Watch and smartphone symptom app)., Materials and Methods: Children with serious illness and their parents were enrolled into a symptom monitoring study then a subset was interviewed for this study. A study team member created symptom data visualizations using the pediatric participant's mobile technology data. Semi-structured interviews were conducted with a convenience sample of participants (n = 14 children; n = 14 parents). In addition, a convenience sample of clinicians (n = 30) completed surveys. Pediatric and parent participants shared their preferences and perspectives on the symptom visualizations., Results: We identified 3 themes from the pediatric and parent participant interviews: increased symptom awareness, communication, and interpretability of the symptom visualizations. Clinicians preferred pie charts and simple bar charts for their ease of interpretation and ability to be used as communication tools. Most clinicians would prefer to see symptom visualizations in the electronic health record., Discussion: Mobile health tools offer a unique opportunity to obtain patient-generated health data. Effective, concise symptom visualizations can be used to synthesize key clinical information to inform clinical decisions and promote patient-clinician communication to enhance symptom management., Conclusions: Effectively visualizing complex mobile health data can enhance understanding of symptom dynamics and promote patient-clinician communication, leading to tailored personalized symptom management strategies., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Children with life-threatening illness (C-LTI) experience considerable symptom distress. Mobile technology may offer opportunities to better obtain symptom data that will lead to better symptom management. A mixed-methods study was conducted to explore the feasibility of monitoring and visualizing symptoms using 2 mobile health devices in C-LTI. Participants engaged with the Apple Watch 56% and recorded in the study app 63% of their study days. Our findings showed feasibility of using mobile technology for monitoring symptoms and further explored opportunities to visualize these data showing symptom occurrences, patterns, and trajectories in C-LTI., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives: The high level of acceptance and consistent use of smartphones by children and adolescents present new opportunities to monitor and collect health data. For acutely ill children and adolescents, collecting symptom data via smartphone applications (apps) provides patient-reported data that can be collected daily and offers the potential to provide a more comprehensive picture of the symptom experience. The purpose of this study was to employ user-centered design principles and medical professional input in order to obtain feedback and insight into redesigning our Technology Recordings for better Understanding Blood and Marrow Transplant (TRU-PBMT) app. This redesigned app will be used for children and adolescents with cancer or undergoing blood and marrow transplantation. Method: We interviewed six pediatric blood and marrow transplant patients (ages 10-17 years) who had pilot tested the app, and we surveyed 30 pediatric oncology clinicians. Results: Interview feedback from previous app users and survey feedback from clinicians guided the app redesign. We incorporated suggestions to make the app more engaging, meaningful, personal, and motivating in order to increase symptom reporting. We added emojis to the symptom tracker, a mood scale, and personalized symptom graphs. Conclusion: Leveraging mobile health technologies may be a useful and acceptable approach to obtain symptom data; however, design and software development needs to be evidenced-based and informed by user needs. Our approach using patient and clinician feedback was valuable in the redesign of the TRU-PBMT app and will contribute to symptom research for acutely ill children and adolescents.

Background: Sustained self-monitoring and self-management behaviors are crucial to maintain optimal health for individuals with type 2 diabetes mellitus (T2DM). As smartphones and mobile health (mHealth) devices become widely available, self-monitoring using mHealth devices is an appealing strategy in support of successful self-management of T2DM. However, research indicates that engagement with mHealth devices decreases over time. Thus, it is important to understand engagement trajectories to provide varying levels of support that can improve self-monitoring and self-management behaviors., Objective: The aims of this study were to develop (1) digital phenotypes of the self-monitoring behaviors of patients with T2DM based on their engagement trajectory of using multiple mHealth devices, and (2) assess the association of individual digital phenotypes of self-monitoring behaviors with baseline demographic and clinical characteristics., Methods: This longitudinal observational feasibility study included 60 participants with T2DM who were instructed to monitor their weight, blood glucose, and physical activity using a wireless weight scale, phone-tethered glucometer, and accelerometer, respectively, over 6 months. We used latent class growth analysis (LCGA) with multitrajectory modeling to associate the digital phenotypes of participants' self-monitoring behaviors based on their engagement trajectories with multiple mHealth devices. Associations between individual characteristics and digital phenotypes on participants' self-monitoring behavior were assessed by analysis of variance or the Chi square test., Results: The engagement with accelerometers to monitor daily physical activities was consistently high for all participants over time. Three distinct digital phenotypes were identified based on participants' engagement with the wireless weight scale and glucometer: (1) low and waning engagement group (24/60, 40%), (2) medium engagement group (20/60, 33%), and (3) consistently high engagement group (16/60, 27%). Participants that were younger, female, nonwhite, had a low income, and with a higher baseline hemoglobin A 1c level were more likely to be in the low and waning engagement group., Conclusions: We demonstrated how to digitally phenotype individuals' self-monitoring behavior based on their engagement trajectory with multiple mHealth devices. Distinct self-monitoring behavior groups were identified. Individual demographic and clinical characteristics were associated with different self-monitoring behavior groups. Future research should identify methods to provide tailored support for people with T2DM to help them better monitor and manage their condition., International Registered Report Identifier (irrid): RR2-10.2196/13517., (©Qing Yang, Daniel Hatch, Matthew J Crowley, Allison A Lewinski, Jacqueline Vaughn, Dori Steinberg, Allison Vorderstrasse, Meilin Jiang, Ryan J Shaw. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 11.06.2020.)

Background: Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress. Mobile health (mHealth) technologies can be leveraged to improve understanding of the patient's symptom experience by providing continuous, real-time, in situ, patient-generated symptom data. This rich data stream can subsequently enhance symptom management strategies. However, limited research has been conducted in this area., Objectives: This pilot study seeks to (a) explore the feasibility of integrating mHealth technologies to monitor symptom data for PBMT patients and (b) evaluate the study design, measures, and procedures., Methods: An exploratory longitudinal design was employed to assess the feasibility of monitoring 10 PBMT patients' symptoms using data from two mHealth technologies: (a) a smartphone mHealth application (app) to collect symptom data and (b) a wearable tracking device (Apple watch) to collect physiological data. Feasibility was measured as usability and acceptability. Monthly patient interviews and an end-of-study feasibility survey were employed and analyzed to further understand reasons for sustained interest in and attrition from the study., Results: Overall usability of the wearable was 51%, and app was 56%. Children reported devices were easy to use and acceptable. The study demonstrated acceptability with an enrollment rate of 83% and an attrition rate of 30%, with 70% of the children remaining in the study for at least 40 days., Discussion: This pilot study is among the first to explore the feasibility of using mobile technologies to longitudinally obtain patient-generated symptom data to enhance understanding of the PBMT symptom experience. In addition, it will improve our understanding of how these data present, interact, and cluster together throughout the posttransplant period.

Background: Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress, and the use of mobile health (mHealth) technologies may enhance symptom management by providing patient-generated health data to foster personalized health strategies., Objectives: The aim of this study was to present a study protocol to explore feasibility, acceptability, and usability of integrating mHealth technologies to collect and monitor symptom data for PBMT patients., Methods: An exploratory mixed-methods design is employed for 20 PBMT patients to monitor symptoms using real-time data from two mHealth devices: (a) a self-developed mHealth application and (b) a wearable tracking device. Patient-Reported Outcomes Measurement Information System surveys for fatigue, pain, and sleep disturbance are obtained monthly. Interviews are conducted to obtain further feasibility and usability data., Results: The study began in October 2017; data collection should be completed in 2018. Feasibility and usability results to monitor and record symptom-related data daily via mobile devices will be reported. Patient-Reported Outcomes Measurement Information System surveys and interviews will further explore patients' symptoms and experiences with the mobile devices., Discussion: This study will be among the first to explore the feasibility, acceptability, and usability of integrating multiple mHealth technologies to obtain patient-generated symptom data for the PBMT population. Results will enhance our understanding of how these data present, interact, and cluster together throughout the posttransplant period for these children and lead to symptom management strategies. Results will focus on a high-risk population that potentially stands to benefit from the use of mobile technologies.

Purpose: Our investigative team is integrating mobile health technologies into pediatric blood and marrow transplant (PBMT) care. We aim to evaluate whether patient-generated health data can be used to monitor health status and enhance symptom management. While there are numerous health-related apps, none address the symptoms or care needs specific to PBMT patients. This article describes development of the Technology Recording to better Understand Pediatric Blood and Marrow Transplant (TRU-PBMT) mobile application., Design and Methods: A one-time survey was distributed to PBMT clinicians, caregivers, and outpatients to elicit feedback and suggestions for the app's design., Results: Feedback from clinicians (n = 23), caregivers (n = 5), and PBMT outpatients (n = 4) indicated the app would be acceptable and useable with this group of patients between eight and eighteen years of age. Suggestions from respondents included: making the app language and graphics more child-friendly; adding symptoms such as fatigue, mucositis, bleeding; and a visual stool chart., Conclusion: Patient, caregiver, and clinician feedback was valuable in creation of the TRU-PBMT app. We designed a pediatric friendly, PBMT-symptom-specific app, which we will test in future studies., Implications for Practice: This app facilitates patient-generated health data collection and informs health care plans., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Telehealth enhances communication across distances, facilitates teamwork, and increases access to care, particularly in rural areas. As the use of telehealth technology assimilates into clinical practice, its integration is also needed in clinical curricula. This project assessed the feasibility and acceptability to engage distance-based students in pediatric clinical simulations using a telepresence robot. Students participated in two pediatric scenarios in teams of three to four prelicensure nursing students, with one nurse practitioner student participating via a telepresence robot. Forty-eight prelicensure and 5 nurse practitioner students completed surveys following clinical simulations. It was feasible to use a telepresence robot as a tool in clinical simulation, and students reported high mean scores on the feasibility and acceptability of using the robot. Although there are challenges, incorporating telepresence technology into simulations opens up many opportunities for student engagement with patients and other clinicians, and affords students with an opportunity to actively participate in their distance-based education. [ABSTRACT FROM AUTHOR]