Background Mobile health (mHealth) interventions show promise for supporting diabetic foot self-care; however, sustained engagement remains a challenge, particularly in low- and middle-income countries. While educational strategies are commonly used to address diabetic foot ulcers, they often fail to translate knowledge into long-term self-care. Understanding behavioral mechanisms underlying mHealth use, including the role of caregivers, is critical for improving implementation and effectiveness. Objective This study explored how behavioral interactions between people with diabetes and caregivers shape the use of an mHealth app for diabetic foot self-care. Methods This qualitative explanatory study was embedded within a parent study of an mHealth app for diabetic foot care that was conducted in primary care settings in Peru. It used the COM-B (capability, opportunity, motivation–behavior) model and the Theoretical Domains Framework (TDF) to identify mechanisms relevant for intervention design and scale-up. Semistructured interviews were conducted with people with diabetes and caregivers about their experiences related to accessing the app. Data were analyzed using deductive and inductive thematic analysis informed by the COM-B and TDF. Results In total, 14 people with diabetes (median age 54 y, 8 women and 6 men) and 10 caregivers (median age 28.5 y, all women) were interviewed. The app use depended on varying interactions between COM-B domains, while other behavioral determinants aligned with a single domain. Across domains, interactions between people with diabetes and caregivers also affected the app use. For example, caregivers often compensated for physical capability limitations through foot positioning or environmental adjustments. Environmental context and resources, including internet access, lighting, and device compatibility, affected the app use for all participants. Motivation for all participants was largely driven by beliefs about the app’s preventive value, although reassurance from health professionals and altruism also emerged. Conclusions The app use often depended on collaboration between people with diabetes and caregivers as a dyad, rather than on independent users. This highlights the need to design digital interventions around caregiver demographics, competing responsibilities, and the additional responsibilities an app may introduce. Participants’ preference for individual follow-up suggests that nonphysician health personnel and other human support may help maintain continuity and reassurance alongside digital monitoring. Although the app was an early prototype intended for algorithmic training, participant experiences provided insight into real-world usability and contextual barriers for future app development.
Background Chronic heart failure (CHF) imposes a dual and dynamically interrelated burden on patients and family caregivers, whose health and illness management behaviors are interdependent. Exercise interventions that actively engage the patient-caregiver dyad as the unit of rehabilitation in the home setting remain underdeveloped. Objective This study aimed to develop a home-based, digitally assisted, dyadic tai chi (HDTC) intervention and evaluate its feasibility, acceptability, safety, and preliminary effects among dyads of patients with CHF and their caregivers. Methods This sequential, multiphase study comprised intervention development followed by a single-center, assessor-blinded, parallel-group pilot randomized controlled trial. Phase 1 integrated literature review, theoretical frameworks, and stakeholder focus group interviews to develop and refine the HDTC intervention. In phase 2, eligible adults with CHF (aged 18-75 years; New York Heart Association class I-III) and their primary caregivers were recruited from a tertiary medical center in Qingdao, China, from October 14 to November 12, 2024, and followed for 12 weeks. Forty dyads were allocated 1:1 to the 12-week HDTC intervention plus usual care or usual care alone (n=20 per group). Outcome assessors and the data analyst were blinded to group allocation. Feasibility, acceptability, and safety were the primary focus of the pilot trial. Patient, caregiver, and dyadic health outcomes were preliminarily explored at baseline and 4 and 12 weeks. All 40 randomized dyads were included in the intention-to-treat analyses. Results The HDTC intervention comprised an online educational seminar, nurse-led dyadic coaching, preliminary face-to-face tai chi training, and supervised HDTC practice. The recruitment rate was 83.3% (40/48), mean session attendance was 73.7% (SD 8.6%), and 70% (14/20) of participants achieved high adherence rate (≥75% attendance). All intervention dyads rated the intervention as acceptable. No intervention-related adverse events were identified. Exploratory generalized estimating equation analyses suggested greater improvements from baseline to 12 weeks in the intervention group than in the control group in functional capacity (β=38.858; P=.001), together with greater reductions in Minnesota Living With Heart Failure Questionnaire scores (β=−1.850; P=.002), sedentary time (β=−1.025; P=.01), and fear of activity (β=−6.550; P=.01). Caregiver burden also decreased (β=−4.350; P<.001), while mutuality improved more for both patients (β=10.508; P<.001) and caregivers (β=6.450; P<.001). Conclusions The HDTC intervention was feasible and acceptable, with preliminary improvements across patient, caregiver, and dyadic outcomes. By integrating shared patient-caregiver participation with digitally supported home-based tai chi, the HDTC intervention extends patient-centered rehabilitation toward a dyad-oriented model. If confirmed in a fully powered trial, this approach may offer a practical strategy for expanding home-based cardiac rehabilitation. Trial Registration ClinicalTrials.gov NCT06876441; https://clinicaltrials.gov/study/NCT06876441
Abstract Background Approximately 1 in 100 children worldwide are diagnosed with autism spectrum disorder (ASD), and 46% to 89% of those diagnosed experience significant feeding difficulties. Mobile health (mHealth) apps are a potential tool for scalable support. However, there is nascent literature on the quality and relevance of mHealth apps for managing ASD-related feeding challenges. Objective This study aimed at systematically identifying and reviewing the content, behavior change strategies, and quality of free English-language mHealth apps supporting the feeding of children with autism. Methods A systematic search was conducted on the Apple App Store and Google Play Store between September and October 2024 and updated between June and July 2026. Apps were included if they were free or freemium, in English, updated within the past year, and explicitly focused on the feeding of children with autism. Apps were excluded if they targeted clinicians rather than parents or children; could not be installed on the test devices; or primarily focused on learning or communication rather than feeding, despite descriptions suggesting relevance to feeding. We identified intervention strategies in the included apps using the behavior change wheel (BCW) framework and evaluated their quality using the Mobile App Rating Scale (MARS). Results The search returned 333 apps from both app stores. After removing duplicates and screening, only 2 iOS apps (EduKitchen-Toddlers Food Games and Autism Food Coach 2) met all inclusion criteria. 331 apps were excluded due to their focus on communication, early education, or other autism support that was not food related. EduKitchen-Toddlers Food Games provided child-centered interactive games and sensory-friendly visuals, while Autism Food Coach 2 provided structured caregiver tools, visual meal plans, and progress tracking. EduKitchen-Toddlers Food Games provided the BCW intervention functions of education, training, enablement, incentivization, and modeling, while Autism Food Coach 2 provided education, training, enablement, persuasion, incentivization, and environmental restructuring. The apps received MARS scores of 3.9 and 3.7, respectively, indicating acceptable quality. The apps’ shortcomings included limited customization for diverse user needs and the absence of documented clinical validation. Conclusions There is a critical shortage of mHealth apps for feeding difficulties in children with autism that are both evidence-based and of high quality. Future development must integrate robust clinical validation and comprehensive, caregiver-centered support features to address this significant gap.
Background: Early warning systems (EWS) have the potentialto reduce heat-related health risks, yet feware designed specifically for vulnerable populations. Pregnant women and infants, often cared for by postpartum women, are particularly susceptible to heat-related illnesses. The MotherHeat Alert mobile app is a heat EWS specifically developed for pregnant and postpartum women. Objective: This study aimed to assess the usability and effectiveness of the MotherHeat Alert in the Tshwane District, South Africa. Methods: This prospective observational evaluation study included a cohort of 201 participants (100 pregnant and 101 postpartum) who were followed over a 6-month period. In addition, a questionnaire was administered at 3 time points (baseline, midpoint, and end point) to collect self-reported information on health, living situation, and heat exposure, among other parameters. Usability was evaluated in the end point questionnaire through a validated Post-Study System Usability Questionnaire (PSSUQ), using descriptive statistics. Effectiveness was assessed through changes in self-reported heat-protective behaviors between baseline, midpoint, and end point, as well as through end point assessments of heat-health knowledge increase and self-reported behavior change attributableto the intervention. Generalized estimating equations were used to analyze repeated measures of heat-protective behaviors, while descriptive statistics were used to summarize end point-reported knowledge gains and behavior change. Results: Usability scores indicated high overall usability, with mean PSSUQ scoresof 1.76 (SD 0.60) among pregnantwomen and 1.37 (SD 0.45) among postpartum women. Similar patterns were observed across most PSSUQ subscales, including system usefulness, interface quality, and information quality. Most self-reported behavior change due to alerts received through the app was rated as large to very large by the pregnant women (47/70, 67%) and postpartum women (68/82, 83%). Nevertheless, comparing behavior change at baseline and end point mainly highlighted a decrease in protective behavior in both pregnant and postpartum cohorts. Self-reported knowledge increase among pregnant and postpartum women was reported as large to very large following the use of the EWS (55/70, 79% and 72/82, 88%, respectively). Importantly, however, attrition was substantial, particularly among pregnant participants, reaching 30% (30/100) in the pregnant cohort and 19% (19/101) in the postpartum cohort by end point. Conclusions: The MotherHeat Alert app demonstrated positive outcomes in usability. Effectiveness showed conflicting results, with positive self-reports on behavior change and knowledge increase, yet a decrease in protective heat behaviors when comparing baseline and midpoint with end point results, likely due to seasonality effects. Nevertheless, these findings highlight the potential of tailored EWS to support heat adaptation among pregnant and postpartum populations. Successful implementation and scalability require careful consideration of contextual factors, further assessment of long-term usability and integration into existing health infrastructure.
Background: Relaxation-based mobile health (mHealth) interventions hold strong potential to address perioperative anxiety and pain management in a scalable manner. However, there is limited research on how surgical patients engage with these interventions and what aspects may be most helpful. Objective: This study had 3 goals: (1) explore how users interact with a relaxation-based mHealth intervention during the perioperative period; (2) understand how user performance and perceptions relate to perceived benefits; and (3) identify design considerations to enhance user engagement and behavior change outcomes in mHealth interventions. Methods: We conducted a prospective longitudinal cohort, mixed methods study to evaluate user engagement with MiCarePath, a relaxation-based mHealth intervention. A total of 19 perioperative patients (mean age 41.3 years; 14/19, 74%, female) undergoing elective surgery and reporting sometimes-to-always anxiety were enrolled using 3 recruitment methods. Participants used the app from 10 days before surgery to 4 weeks after surgery. We collected quantitative data on video engagement metrics (eg, duration of watching, response rate to videoprompts) and ecological momentary assessments of anxiety and pain. Concurrently, we conducted semistructured, data-prompted interviews at 3 time points to assess user perceptions. These data were integrated using descriptive statistics, repeated-measures ANOVA, and qualitative thematic analysis to examine the relationship between user performance and perceived benefits. Results: Eleven participants reported developing or improving relaxation-based self-management strategies (high benefit), whereas 8 reported little benefit from the intervention. The high-benefit group showed significantly greater total watching time (difference 223.8 minutes, 95% CI 95.54-366.46 minutes, P<.001), higher adherence to video prompts (73.45% vs 34.60%, P<.001), and greater perceived helpfulness of the content (79.80% vs 25.50%, P<.001) compared with the low-benefit group. A significant group-by-time interaction effect was observed for engagement (F1,17=17.02, P<.001). No difference was observed in delay in response to video prompts. However, within each group, participant perceptions were not fully reflected in performance. Some participants in the high-benefit group showed decreased video watching after surgery but still reported feeling engaged with the intervention. Interview data revealed that "intentional use" behavior-where users actively seek content to manage symptoms independent of prompts-distinguished these participants. Those who developed intentional use were able to practice relaxation techniques without the app and resume app engagement following contextual disruptions. Conclusions: This study explored user engagementwith arelaxation-based mHealthintervention for perioperative care, advancing the literature by integrating user perceptions and performance for digital anxiety and pain management. Results indicate that perceived benefit may not always be reflected in user performance. Intentional use emerges as a promising indicator of effective mHealth engagement in perioperative care. Future designs should aim to foster intentional use through features such as reflection prompts and adaptive notifications. Future work should also develop computational models to detect intentional use and evaluate adaptive interventions in larger cohorts.
