Article

Evaluation of Smartphone Menstrual Cycle Tracking Applications Using an Adapted APPLICATIONS Scoring System

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Abstract

Objective: To identify smartphone menstrual cycle tracking applications (apps) and evaluate their accuracy, features, and functionality. Methods: In this systematic evaluation, we searched the Apple iTunes store for free menstrual cycle tracking apps for patient use. We considered an application accurate if menstrual cycle predictions were based on average cycle lengths of at least three previous cycles, ovulation (when included) was predicted at 13-15 days before the start of the next cycle, and the application contained no misinformation. We modified the APPLICATIONS Scoring System to evaluate the features and functionality of accurate apps. Results: Our search criteria yielded 1,116 apps; 108 remained after excluding duplicate, non-English, nonmenstrual cycle tracking, and priced apps. We further eliminated 88 that did not meet inclusion or accuracy criteria. Of the 20 accurate, free apps, 80% contained information for conception and 50% for contraception. Common features and functionality included password protection (55%); no requirement for Internet connectivity (80%); no advertisements (65%); in-application technical support (70%); medical disclaimers (65%); health education (55%); tracking of menstrual flow (70%), symptoms (70%), and intercourse (75%); alerts for next menses (65%) and fertility (55%); and cycle length information (75%). Forty percent were available for Android. Usefulness for fertility medications (15%), professional involvement (5%), and cited literature (5%) were rare. Conclusion: Most free smartphone menstrual cycle tracking apps for patient use are inaccurate. Few cite medical literature or health professional involvement. We list accurate apps to aid health care providers in understanding the key components they can use to evaluate and recommend apps for patients.

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... To fill this knowledge gap, we used a systematic approach to identify existing apps containing prenatal genetic testing information and summarize their characteristics. We then adapted existing app evaluation tools [16][17][18] to evaluate the quality of these apps. We believe our findings will have the potential to help obstetricians become familiar with prenatal genetic testing apps and make recommendations to their patients. ...
... To evaluate the quality of the selected apps, we developed the App Quality Assessment Scoring System (AQASS) by adapting two common app evaluation tools-MARS [18] and the "APPLICATIONS" evaluation criteria [16,17]. The AQASS was used to assess 16 items in each app, including the number of prenatal genetic tests mentioned, comprehensiveness, information quality, quality of information sources, evidence base, readability, visual prenatal genetic testing information, customization, interactivity, text search field, ease of navigation, app layout, visual appeal, interdevice compatibility, connectivity, and price. ...
... Beyond reporting the characteristics of the identified apps, we developed the AQASS to capture a detailed overview of the quality of the apps we reviewed, as most apps were not created with the primary purpose of conveying prenatal genetic testing to pregnant women. Our AQASS was based on commonly used and validated app scoring systems (ie, MARS and APPLICATIONS) [16][17][18]. We adopted both these systems because several items of MARS (eg, "Quality of information: Is app content correct, well written, and relevant to the goal/topic of the app?") and APPLICATIONS (eg, "advertisements" and "subjective presentation") were not applicable to the evaluation of the apps that provide prenatal genetic testing information in our study. ...
Article
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Background: Prenatal genetic testing is an essential part of routine prenatal care. Yet, obstetricians often lack the time to provide comprehensive prenatal genetic testing education to their patients. Pregnant women lack prenatal genetic testing knowledge, which may hinder informed decision-making during their pregnancies. Due to the rapid growth of technology, mobile apps are a potentially valuable educational tool through which pregnant women can learn about prenatal genetic testing and improve the quality of their communication with obstetricians. The characteristics, quality, and number of available apps containing prenatal genetic testing information are, however, unknown. Objective: This study aims to conduct a firstreview to identify, evaluate, and summarize currently available mobile apps that contain prenatal genetic testing information using a systematic approach. Methods: We searched both the Apple App Store and Google Play for mobile apps containing prenatal genetic testing information. The quality of apps was assessed based on the criteria adopted from two commonly used and validated mobile app scoring systems, including the Mobile Application Rating Scale (MARS) and the APPLICATIONS evaluation criteria. Results: A total of 64 mobile apps were identified. Of these, only 2 apps were developed for a specific prenatal genetic test. All others were either pregnancy-related (61/64, 95%) or genetics-related (1/64, 2%) apps that provided prenatal genetic testing information. The majority of the apps (49/64, 77%) were developed by commercial companies. The mean quality assessment score of the included apps was 13.5 (SD 2.9), which was equal to the average of possible theoretical score. Overall, the main weaknesses of mobile apps in this review included the limited number of prenatal genetic tests mentioned; incomprehensiveness of testing information; unreliable and missing information sources; absence of developmental testing with users (not evidence based); high level of readability; and the lack of visual information, customization, and a text search field. Conclusions: Our findings suggest that the quality of mobile apps with prenatal genetic testing information must be improved and that pregnant women should be cautious when using these apps for prenatal genetic testing information. Obstetricians should carefully examine mobile apps before referring any of them to their patients for use as an educational tool. Both improving the quality of existing mobile apps, and developing new, evidence-based, high-quality mobile apps targeting all prenatal genetic tests should be the focus of mobile app developers going forward.
... Notably, for some studies reporting on a single app (rather than an evaluation of a suite of apps), the function was multipurpose and enabled the user to indicate their reproductive goals to receive either pregnancy prevention, contraception or cycle tracking information Li et al., 2016;Setton et al., 2016). This flexibility in functionality is evident in an app evaluation study by Moglia et al. (2016) which excluded 'fertility tracking' apps in their review of apps for menstrual cycle tracking. Nevertheless, their search returned apps containing fertility information, illustrating the level of interconnectedness within women's reproductive health information. ...
... Other types of fertility information identified by this scoping review relate to contraceptive advice (Mangone et al., 2016;Mesheriakova & Tebb, 2017;Sridhar et al., 2015), quantifying the quality of fertility information in apps (Johnson et al., 2018;Kalke et al., 2018;Mangone et al., 2016;Moglia et al., 2016), and descriptions of the types of content without depth of examination or reporting Hamper, 2020;Lee & Kim, 2019;Shopov et al., 2019;Staric et al., 2019;Vanya et al., 2017). Fertility information for contraceptive advice apps, while limited in scope to the short-term consequences of long acting, reversible contraceptives (LARCs) on fertility (Mesheriakova & Tebb, 2017;Sridhar et al., 2015), was accurate and instructive. ...
... In an evaluation of apps for preventing pregnancy (Mangone et al., 2016) fertility tracking apps were among the category which had the least representations of best practices for pregnancy prevention. Another evaluation study of women's reproductive health apps focussed only on menstrual cycle tracking apps identified as accurate (determined by their ability to accurately predict a 23-day cycle after at least 3 prior cycles input) (Moglia et al., 2016). This limitation to a 23 day-cycle for verifying accuracy makes an inference that an app able to predict a 'short' cycle is reliable, potentially overlooking those with longer or variable cycles. ...
Article
The growth of smartphone application use across areas of female reproductive health has led to increased interest into their functions and benefits. This scoping review aims to determine the nature and extent of the peer-reviewed literature presented on fertility-based apps, to identify the reliability of the information within the apps, and to determine the ability of this information to educate users. A systematic search of six databases was conducted in April 2020, returning a total of 21,158 records. After duplicate removal, title and abstract screening exclusionary steps, 27 records were reviewed and charted. Records covered a variety of reproductive health themes including contraception, sexual health, and family planning, and used a range of methodologies. The accuracy of fertility information within the apps reported in these studies was variable, but overall there was a lack of depth in the coverage of content in apps. It was common for studies in this review to base fertile window algorithms on stringent cycle length and variability requirements, limiting the applicability of information delivered to users. Furthermore, studies from app affiliates often lacked collaborations with researchers, minimising the potential for fertility knowledge improvements integrated across the suite of female reproductive health apps.
... 15 Menstrual trackers are becoming mainstream commodities with high engagement, 16 and the research community has started assessing their design, intended use, and potential unintended consequences. [17][18][19][20][21] Menstrual tracking apps are a key area of personal informatics, with the potential to empower users and challenge oppressive social structures while enabling individual-level and population-level insights. ...
... Search strategy and screening To curate a corpus encompassing the broadest representation of menstrual tracking apps available and that potential users are most likely to encounter, we undertook a multipronged search strategy across both the Google and Apple app stores. First, we screened apps included in prior menstrual tracking app reviews, 18,19,[40][41][42][43][44] then we added apps from the top 50 results across 6 distinct searches (menstrual OR period AND tracker OR calendar OR diary) on both app stores, ignoring duplicates. The first author (AP) completed the searches and data extraction in June 2020. ...
... Existing menstrual trackers are designed with narrow goals-managing menstrual bleeding and conceptionwhereas the scoping review identified broader needs of menstruators across ensuring health and wellness, overcoming shame and stigma, and ensuring equity. Others have also found that the needs of menstruators are not met with existing designs of menstrual trackers, 18,19,117 and the Human-Computer Interactions community has recently highlighted these topics. 118 Our findings and implications contribute toward the common goal of designing more inclusive FemTech that meets the multifaceted needs of menstruators. ...
Article
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Objective: The aim of this study was to examine trends in the intended users and functionalities advertised by menstrual tracking apps to identify gaps in personas and intended needs fulfilled by these technologies. Materials and methods: Two types of materials were collected: a corpus of scientific articles related to the identities and needs of menstruators and a corpus of images and descriptions of menstrual tracking apps collected from the Google and Apple app stores. We conducted a scoping review of the literature to develop themes and then applied these as a framework to analyze the app corpus, looking for alignments and misalignments between the 2 corpora. Results: A review of the literature showed a wide range of disciplines publishing work relevant to menstruators. We identified 2 broad themes: "who are menstruators?" and "what are the needs of menstruators?" Descriptions of menstrual trackers exhibited misalignments with these themes, with narrow characterizations of menstruators and design for limited needs. Discussion: We synthesize gaps in the design of menstrual tracking apps and discuss implications for designing around: (1) an irregular menstrual cycle as the norm; (2) the embodied, leaky experience of menstruation; and (3) the varied biologies, identities, and goals of menstruators. An overarching gap suggests a need for a human-centered artificial intelligence approach for model and data provenance, transparency and explanations of uncertainties, and the prioritization of privacy in menstrual trackers. Conclusion: Comparing and contrasting literature about menstruators and descriptions of menstrual tracking apps provide a valuable guide to assess menstrual technology and their responsiveness to users and their needs.
... They are a popular and ever-developing field, with more than 200 million downloads. 1 The apps that allow the monitoring of menstrual cycles, commonly known as period tracker apps, are the fourth most popular health app among adults. 2 Since the release of the first-ever period tracker, Glow, in 2013, the industry has continuously expanded, with the FemTech market estimated to be worth $50 billion by 2025. 3 Fertility-based FemTech apps are marketed towards women wanting to know when they should or should not be having sexual intercourse to achieve or avoid pregnancy. 4 They are able to do this through user input of biological markers, described as fertility awareness-based methods (FABM), which predict ovulation. ...
... 1,5 Today, the choice of period tracker apps is vast, with 7% of the 90,088 health apps in the Apple store focussed on women's health and pregnancy. 2 However, it is important that the app a woman chooses to download provides accurate information, is effective in predicting her period and is beneficial to her lifestyle. Period tracker apps have a responsibility to users as incorrect information about the menstrual cycle could cause stress when periods are earlier or later than expected, and giving incorrect information about ovulation could lead to pregnancy or infertility. ...
Article
Introduction: Using an online survey, the aim of this study was to ask women about their real-life experiences of using period tracker apps, their attitudes towards using their app, the information the app provided regarding ovulation and how the accuracy of the app in predicting period start dates affects their feelings and behaviours if their period comes earlier or later than predicted. Methods: This mixed-methods observational study was conducted by an online survey of 50 multiple-choice and open-ended questions. The survey was generated with Qualtrics XM® and promoted via social media. It was open to any person who had used a period tracker. Results: From 375 total responses, 330 complete responses were obtained, giving a completion rate of 88.0%. Respondents were aged between 14 and 54, with a mean age of 26.0 (±7.81). When asked what was the best thing about using the app, 29.7% (98/330) of respondents selected 'To know when I'm ovulating'. Respondents were asked if their period ever started earlier than the app predicted; 54.9% (189/330) said it had and 72.1% (238/330) said it had started later than predicted. When asked how they felt if their period arrived earlier or later than expected, thematic analysis of periods starting earlier revealed four themes: feeling unaffected, being frustrated/unprepared, feeling anxious/stressed and feeling confused/intrigued. Thematic analysis when their period arrived later revealed six themes: anxious/concerned about pregnancy, disappointed about pregnancy, seeking advice/informing healthcare professionals, thoughts about menopause, feeling unaffected and being better prepared. Conclusion: Period trackers need to be clearer on their intended use and reliability, especially for period due date and ovulation. Qualitative analysis shows the impact of inaccurate predictions on aspects of the users' health. This study calls for period tracker app companies to update their apps to provide transparency to their users about their intended use and capabilities.
... The app can be considered as accurate if: -The projections of future menstrual cycles take into account the mean length of at least three previous menstrual cycles, -Ovulation is accurately predicted i.e. around 14 days before the beginning of the next period, -The app includes information about both conception and contraception, and -If it is comprehensible and easy to use and does not provide any false information (4). A technically versatile app should be protected with password, not need Internet connection, have no commercials or endorsements, provide medical and technical support within the app and include scientific literature (4). ...
... The app can be considered as accurate if: -The projections of future menstrual cycles take into account the mean length of at least three previous menstrual cycles, -Ovulation is accurately predicted i.e. around 14 days before the beginning of the next period, -The app includes information about both conception and contraception, and -If it is comprehensible and easy to use and does not provide any false information (4). A technically versatile app should be protected with password, not need Internet connection, have no commercials or endorsements, provide medical and technical support within the app and include scientific literature (4). From the results obtained by Gazibara et al, it is noticed that in Serbia, although the vast majority of adolescent girls use smartphones, only 29.7% of female high school students use apps to track menstrual cycle (1,5). ...
... Within a fast-growing 'Fem Tech' industry, fertility awareness smartphone apps are among the most popular health-tracking technologies in high-income countries and are gaining popularity around the world (Haile et al., 2018, Lupton, 2015b, Moglia et al., 2016. Such apps help identify the 'fertile window' within the menstrual cycle when conception is most likely, based on a wide range of personal information, such as users' mood, sexual and physical activity, bodily signs, symptoms and dimensions. ...
... In public health and popular discourse, it is often argued that such technologies afford greater bodily autonomy (Moglia et al., 2016) and indeed 'revolutionise birth control' (Savage, 2017). Yet social scientists argue that they also place responsibility on women to be good, 'digitised reproductive citizens' who 'master' their fertility and maximise their (and their prospective child's) health through self-tracking (Lupton, 2015a). ...
Article
Full-text available
Fertility awareness apps, which help to identify the 'fertile window' when conception is most likely, have been hailed as 'revolutionising' women's reproductive health. Despite rapidly growing popularity, little research has explored how people use these apps when trying to conceive and what these apps mean to them. We draw on in-depth, qualitative interviews, adopting a critical digital health studies lens (a sub-field of science and technology studies), to explore the experiences of cisgender women and partners with one such app, Natural Cycles, in the context of their daily lives. We found that many women valued the technology as a 'natural', inobtrusive alternative to biomedical intervention, and a means of controlling and knowing their bodies, amid a dearth of fertility-related education and care. Yet this technology also intervened materially and affectively into the spaces of their lives and relationships and privileged disembodied metrics (temperature) over embodied knowledge. Meanwhile, app language, advertising and cost have contributed to characterising 'typical' users as white, heterosexual, affluent, cisgender women without disabilities. In the context of neoliberal shifts towards bodily self-tracking, technologies appealing as novel, liberating and 'natural' to individuals who can access them may nevertheless reproduce highly gendered reproductive responsibilities, anxieties and broader health and social inequalities.
... Studies analyzing fertility apps have primarily focused on evaluating the accuracy of predictions, finding that most apps do not explain how data are calculated, do not cite scientific literature, and have varying accuracy. [32][33][34][35] Recent studies have also evaluated how apps may impact people's lives by scoring the quality of apps [36][37][38] and examining apps' approaches to privacy and menstrual literacy. 29,39 Studies have additionally discussed how fertility apps can stereotype the gender of the user 8,17,40 and examined the difficulty of communicating uncertainty in fertility predictions. ...
... For the feature analysis, two researchers downloaded and analyzed each app by entering four months of fertility data to observe apps' visualizations and other feedback, a time frame used in previous fertility studies. 32,38 All available health indicators were entered, including common variations (eg, regular and irregular cycle length) to understand app output. The researchers an- Based on this initial analysis, a codebook was created to analyze user reviews to focus on goals, app interaction, and fertility experiences described in prior work 6,8,16,23,25,39,47 and the positive and negative perspectives in each review (eg, reviews describing how users liked the app vs reviews describing challenges). ...
Article
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Objective Fertility is becoming increasingly supported by consumer health technologies, especially mobile apps that support self-tracking activities. However, it is not clear whether the apps support the variety of goals and life events of those who menstruate, especially during transitions between them. Methods Thirty-one of the most popular fertility apps were evaluated, analyzing data from three sources: the content of app store pages, app features, and user reviews. Findings Results suggest that fertility apps are designed to support specific life goals of people who menstruate, offering several data collection features and limited feedback options. However, users often desire holistic tracking that encompasses a variety of goals, life events, and the transitions among them. Discussion These findings suggest fertility patients can benefit more from holistic self-tracking and provide insights for future design of consumer health technologies that better support holistic fertility tracking. Conclusion Fertility apps have the potential to support varied experiences of people who menstruate. But to achieve that, apps need to expand their support by offering ways for more users to perform holistic, personalized, and personally meaningful tracking, so they can derive long-term benefit from the data they collect.
... Among mHealth applications, those which offer a calendar for menstruation tracking (Fertility Tracking Application, FTA) are considered extremely popular. They are the 4 th most popular applications among adults and the 2 nd most popular among adolescents [22]. Sexually active women use these applications as a tool to identify their fertile window and enhance their fecundability (34% of users). ...
... Only a few of these apps are free to use with the rest being either available for a fee or free with limited functionality. Most importantly, the quality of their content is not always validated, since they are not designed by professionals and only a small portion of them are based on scientific literature or experts' opinions [22]. A reliable, patient-centred application, validated by a professional body, can have a significant impact on a woman's everyday life and promote positive cognitive and behavioural changes [34]. ...
Article
Objective: The objective of this research was to evaluate how menstrual tracking applications can promote gynaecological health. Materials and methods: We performed a systematic review in Medline and Scopus, for papers evaluating menstrual tracking mobile applications. We excluded review articles and those not written in English. Results: We identified 14 articles measuring the outcome resulting from the use of a single Fertility Tracking Application (FTA). Eight studies evaluated 2 different applications used as a contraception method. One study assessed a fecundity enhancing application. Five studies referred to applications, used to treat or monitor various gynaecologic issues. All studies reported efficacy for their intended use or a high satisfaction rate. Discussion: There is a plethora of FTAs, however a minority of them are appraised by medical experts. Several safety and privacy concerns have been expressed regarding their use and these issues should be addressed in the future. All studies identified in our search demonstrated that FTAs can facilitate users in terms of contraception, fertility, and menstrual awareness. Conclusion: Menstrual tracking applications can serve as a valuable health tool, nevertheless, their content should be more vigorously evaluated.
... A 2016 review of 108 free menstrual tracking apps found only 20 were accurate in predicting average cycle lengths, ovulation prediction, and contained no misinformation. 23 Also, an evaluation of popular menstrual tracking apps found that most did not support menstrual literacy well, assumed users wanted to track fertility, and were biased towards heteronormative and cisgender conceptualizations of menstruation. 24 Comparatively fewer informatics solutions have been developed within the space of gynecologic disease. ...
... Prior research on the needs, design, and use of menopause technologies has predominantly focused on self-tracking symptoms data via mobile applications or wearable devices with limited use of those tracked data for predictions or prevention of burdensome experiences (eg, [15][16][17]. This limited scope and use is also present in technologies for other gynecologic phenomena, including menstruation 23,24 and endometriosis, 29,30 that could be used to inform the development of menopause solutions. However, self-tracking technologies risk trivializing nonmedical experiences and emphasizing menopause as a negative health condition. ...
Article
Objective To elicit novel ideas for informatics solutions to support individuals through the menopausal transition. (Note: We use “individuals experiencing menopause” and “experiences” rather than “symptoms” when possible to counter typical framing of menopause as a cisgender women’s medical problem.) Methods A participatory design study was conducted 2015–2017 in the Western US. Two sessions were held with individuals experiencing menopause recruited from the general public; and 3 sessions with healthcare practitioners (HCPs) including nurses, physicians, and complementary and integrative health (CIH) practitioners were held. Participants designed technologies addressing informational needs and burdensome experiences. HCPs reflected on designs from participants experiencing menopause. Directed content analysis was used to analyze transcripts. Results Eight individuals experiencing menopause (n = 4 each session) and 18 HCPs (n = 10 CIH, n = 3 nurses, n = 5 physicians) participated. All participants provided ideas for solution purpose, hardware, software, features and functions, and data types. Individuals experiencing menopause designed technologies to help understand and prevent burdensome menopause experiences. HCPs designed technologies for tracking and facilitating communication. Compared to nurses and physicians, CIH practitioners suggested designs reframing menopause as a positive experience and accounted for the complex lives of individuals experiencing menopause, including stigma; these ideas corresponded to comments made by participants experiencing menopause. Participants from both populations were concerned about data confidentiality and technology accessibility. Conclusions Participant generated design ideas included novel ideas and incorporated existing technologies. This study can inform the development of new technologies or repurposing of existing technologies to support individuals through the menopausal transition.
... [6][7][8] However, although there is potential in using mHealth apps for monitoring the menstrual cycle, controversy regarding the credibility and benefits of these technologies remains. 7,9,10 Thus, it is likely that currently available apps are underserving many of the most individuals that menstruate. Therefore, significant interest remains in the development and evaluation of mHealth apps focused on tracking the menstrual cycle on the part of health experts, health researchers, and an adequately representative group of willing users. ...
Article
Aim: To perform a systematic review of available mHealth apps for menstrual cycle monitoring in Brazil. Methods: A search for menstrual cycle mHealth apps from the Google Play Store and AppStore in Brazil was performed by two independent reviewers on October 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Results: Our review identified 2400 potentially relevant mHealth apps, of which 56 were eligible for inclusion. The majority of the apps offered tools to track menstruation symptoms (63%) and educational content for users (32%). The mean (±SD) MARS app quality score for the 28 evaluated apps in Android was3.5 ± 0.6 on a 0–5 scale. For the 28 evaluated apps in iOS, the mean app quality score was 3.8 ± 0.4. Most of the included apps, for both systems, scored average for credibility, user interface, and engagement. Conclusion: The majority of available tools in Brazil are of moderate quality and limited functionality for menstrual cycle monitoring. This study highlights the top three mHealth apps available on each online store for individuals seeking menstrual cycle monitoring options.
... In addition, addressing the complexity of the menstrual cycle in research may no longer be as complicated as it has been suggested in the past, particularly when considering pairing hormonal testing with wearable technology (i.e., Oura Ring) (Maijala et al., 2019). and FDA-approved menstrual cycle tracking apps (i.e., Natural Cycles, Clue) (Berglund Scherwitzl, 2015; Moglia et al., 2016;Berglund Scherwitzl et al., 2017). that utilize temperature and menstrual period dates to track and predict menstrual cycle phases. ...
Article
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As the fields of kinesiology, exercise science, and human movement developed, the majority of the research focused on male physiology and extrapolated findings to females. In the medical sphere, basing practice on data developed in only males resulted in the removal of drugs from the market in the late 1990s due to severe side effects (some life-threatening) in females that were not observed in males. In response to substantial evidence demonstrating exercise-induced health benefits, exercise is often promoted as a key modality in disease prevention, management, and rehabilitation. However, much like the early days of drug development, a historical literature knowledge base of predominantly male studies may leave the exercise field vulnerable to overlooking potentially key biological differences in males and females that may be important to consider in prescribing exercise (e.g., how exercise responses may differ between sexes and whether there are optimal approaches to consider for females that differ from conventional approaches that are based on male physiology). Thus, this review will discuss anatomical, physiological, and skeletal muscle molecular differences that may contribute to sex differences in exercise responses, as well as clinical considerations based on this knowledge in athletic and general populations over the continuum of age. Finally, this review summarizes the current gaps in knowledge, highlights the areas ripe for future research, and considerations for sex-cognizant research in exercise fields.
... g, a birth control website recommended to me by a medical provider, and written by medical providers, the typical use of period tracking apps results in an effective rate as low as 77 percent (Bedsider Birth Control Support Network, n.d.). A research article tracking the effectiveness of free period tracking apps found that most were inaccurate (Moglia et al., 2016). Therefore, when I hear cisgender women discussing the novelty and efficacy of this hormone-free option for birth control through the use of their phones, my alarm bells go off. ...
Chapter
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Over the course of our lifespan, we have conversations with friends, family members, and intimate partners about sexual health that enlighten us about our personal choices, decisions, and preferences. They solidify the idiosyn- cratic ways we negotiate our bodies. This chapter draws on one such con- versation that began with two panelists at a national conference. We asked them to continue it via this chapter. In it, they offer a deeper dive into the importance of difference, conversations, and new perspectives that challenge how we navigate our bodies differently. The authors provide their responses to the questions they posed, and to each other, in this dialogic forum. Author names and discussions are presented alphabetically, both contributed equally to this chapter. For background, they begin by explaining their experiences with birth control that led them to their interest in the subject.
... Given that apps differ greatly in the number of symptoms they record and the specificity to which the symptoms are tracked, there is a need to achieve a tradeoff between the two metrics. Presenting a user with apps that record numerous symptoms with great granularity may lead to user fatigue and diminished data completeness, whereas using an app that records only a few symptoms with great granularity can lead to misinformed conclusions [15]. This is further complicated by the rates at which current apps are updated and new apps are introduced. ...
Article
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Purpose of review: The goal of this review was to evaluate whether the fields available in iOS mobile phone apps for recording menstrual cycle symptoms are able to be harmonized across platforms for potential use in research, such as aggregated data analysis. Recent findings: Symptom tracking capabilities are a common feature among menstrual health apps but have been the subject of limited investigations. Apps differ with respect to which symptoms are included and the rationale for these differences is unclear. Epidemiologic studies are poised to incorporate these data; however, a thorough exploration of symptom tracking functionality across apps is required. Summary: Our review finds that the language used to describe symptoms and the specificity with which symptoms are collected varies greatly across the most used iOS tracking apps. Although some apps allow numerical and qualitative description of symptoms, such as sleep and mood, most simply record the presence or absence of a symptom. Collaborative efforts between clinicians and researchers to guide what and how data is collected may allow tracking apps to realize their potential diagnostic applicability. Regardless, with the increasing use of menstrual health tracking apps, it is imperative that data retrieved from such apps can realize its potential in the research and clinical ecosystems.
... Knowing one's body, and caring for one's health, are increasingly mediated through technological devices predicated on "data" (Ruckenstein & Schüll 2017), furthering the ongoing biomedicalization of health and medicine (Clarke et al 2003) and the long arc of bureaucratized scientific knowledge that heralds Artificial Intelligence as the final elimination of subjectivity (Davis 2019). An estimated 165,000 apps focused on health were already available in September 2015 (Riaz 2015), and among those, period tracking apps were reportedly the fourth most popular among adults and second most popular among adolescent women (Moglia et al. 2016). They are part of the "femtech" wave that is projected to have a market potential of $50 billion by 2025 (Frost & Sullivan 2018). ...
Article
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Period tracking is an increasingly widespread practice, and its emphasis is changing from monitoring fertility to encompassing a more broad-based picture of users' health. Delving into the data of one's menstrual cycle, and the hormones that are presumed to be intimately linked with it, is a practice that is reshaping ideas about health and wellness, while also shaping subjects and subjectivities that succeed under conditions of surveillance capitalism. Through close examination of six extended interviews, this article elaborates a version of period tracking that sidesteps fertility and, in doing so, participates in the "queering" of menstrual technologies. Apps can facilitate the integration of institutional medical expertise and quotidian embodied experience within a broader approach to the self as a management project. We introduce the concept of "hormonal health" to describe a way of caring for, and knowing about, bodies, one that weaves together mental and physical health, correlates subjective and objective information, and calls into question the boundary between illness and wellness. For those we spoke with, menstrual cycles are understood to affect selfhood across any simplistic body-mind division or reproductive imperative, engendering complex techniques of self-management, including monitoring, hypothesizing, intervening in medical appointments, adjusting schedules, and interpreting social interactions. Such techniques empower their proponents, but not within conditions of their choosing. In addition to problems with data privacy and profit, these techniques perpetuate individualized solutions and the internalization of pressures in a gender-stratified, neoliberal context, facilitating success within flawed structures.
... 1 Furthermore, the use of mobile applications (hereafter referred to as "app" or "apps") to track menstrual cycles is the fourth most popular health monitoring app among adults, and the second most popular among adolescents who menstruate. 2 The inherent inter-and intra-individual variabilities of the menstrual cycle provide an opportunity for mobile apps to support an individualized approach to menstrual health awareness, management, and care. In 2018, Starling, et al., surveyed 1,000 self-identified women through online channels and reported that 23.1% had or currently used an app to track their menstrual cycle, while 76.9% reported their intention to use a menstrual tracking app in the future. ...
Article
Mobile technologies provide a unique opportunity to improve menstrual health awareness, management, and care. Nurses should consider incorporating a mobile tracking component into patient-care settings to promote menstrual health awareness and advocacy and to help create individualized healthcare plans.
... This not only gives recommendations based on mood and current state of mind, but also provides various short-term and long-term solutions such as in-app stress buster games, easy navigation to the nearby available professional help etc. Topping these, my app also has a period tracking [6][7] and prediction model built natively with in the app. Also, suggests nearby dieticians using google map location [8]. ...
Article
Polycystic ovarian syndrome(PCOS) is one of the predominant hormonal imbalances present in women of reproductive age. It needs to be diagnosed and treated at an earlier stage as it's inter-related to diabetes, high cholesterol levels, and obesity. This paper presents an application specially designed for women to help them keep track of their Body Mass Index, Blood Sugar, and Blood Pressure based on their age. The people diagnosed with PCOS(an endocrine disorder) can use this application to make their life easy since it helps follow certain exercises, diets, and timely reminders for water and medicines. It has features like the period tracker to track the user’s menstrual cycle, find dieticians nearby, links to various PCOS supplements, users can track their moods during different menstrual phases and control their mood swings. Finally, the application has games to add that interactive touch.
... Although FTAs are meant to help women understand fertility, many are inaccurate. Evaluation of 108 FTAs found only 20 provided accurate information about conception and contraceptives [12]. Another study found that less than 10% of FTAs could accurately predict a woman's ovulation [13]. ...
Article
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Background: Women use fertility tracking apps (FTAs) for conception purposes, but user perspectives on FTA use for conception are largely unknown. In collaboration with SPD Clearblue, this study explored: how women trying to conceive use FTAs; women's knowledge of their conception chances; and women's feelings towards a potential natural conception prediction app (NCPA). Methods: A mixed methods design was used (online survey and phone interviews). Participants were women 18-40 years old actively trying to conceive. Results: The survey received 154 responses and 24 interviews were conducted. Thematic analysis of interviews found that women consider several factors before trying to conceive (ex. age, financial and job security, stability of relationship, etc.) and may adopt lifestyle and behaviour changes when trying (ex. increasing exercise, smoking cessation, diet changes, etc.). Survey results indicated that nearly all respondents were aware of FTAs (n = 146, 94.8%), however, several other fertility and conception information sources were also used (ex. health care providers, online sources, family and friends, etc.). Nearly all respondents reported they would use an NCPA (n = 153, 99.4%). During interviews women had positive feelings towards such an app due to it offering new and individualised information, but worried the app could provide upsetting information. Conclusion: This research elaborates on women's uses of and interest in FTAs. Stakeholders should use this research to reflect on current conception experiences and possibilities for improvement through development of an NCPA. Future research should seek opinions from a more diverse sample of women to inform the development of an inclusive NCPA.
... Quando procuramos por palavras-chave como "menstruação", "ciclo menstrual" e "calendário menstrual" na cadernos pagu (59), 2020:e205908 Gabriela Cabral Paletta Marina Fisher Nucci Daniela Tonelli Manica 11 App Store da Apple e na Google Play Store aparecem mais de mil resultados de aplicativos relacionados, pagos e gratuitos (Moglia et al, 2016). Entre os aplicativos gratuitos mais instalados estão dois menstruapps que serão alvo de nossa análise: o "Calendário Menstrual" da empresa chinesa Simple Design Ltd., lançado em março de 2012; e o "Clue Calendário do ciclo menstrual e ovulação" desenvolvido pela alemã BioWink GmbH, lançado em outubro de 2014, com mais de 50 milhões e 10 milhões de downloads respectivamente. ...
Article
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Resumo Neste artigo discutimos as relações entre corpo, saúde, tecnologias e gênero, a partir da análise de aplicativos de monitoramento de ciclos menstruais e da gravidez. Nosso interesse central é analisar, da perspectiva de gênero, que corpos se constituem a partir das interfaces dos aplicativos, e que tipos de dados são produzidos nesses ambientes. Articuladas aos ativismos feministas ligados à tecnologia, propomos uma análise desses aplicativos que tratam da saúde reprodutiva feminina, procurando situá-los no contexto da ampliação das tecnologias da informação ligadas à saúde e ao monitoramento dos corpos (Lupton, 2014).
... With low additional costs, researchers can approximate position within an individual's menstrual cycle by using two dates: (1) the start date of the preceding cycle, and (2) the start date of the following cycle. With the widespread use of smartphone menstrual cycle tracking applications (Moglia et al., 2016), most individuals can easily access their exact start date. If a participant does not know the date, researchers can use the next menses start date to facilitate the preferred backward-count method. ...
Article
Despite decades of research on the physiological and psychological effects of the menstrual cycle, studies have not sufficiently adopted consistent methods for operationalizing the menstrual cycle. This has resulted in substantial confusion in the literature and limited possibilities to conduct systematic reviews and meta-analyses. In order to facilitate more rapid accumulation of knowledge on cycle effects, the present paper offers a set of integrative guidelines and standardized tools for studying the menstrual cycle as an independent variable. We begin with (1) an overview of the menstrual cycle and (2) premenstrual disorders, followed by (3) recommendations and tools regarding data collection in cycle studies. These recommendations address selecting the appropriate study design and sampling strategy, managing demand characteristics, identifying a sample of naturally-cycling individuals, and measuring menstrual bleeding dates, ovarian hormones, and ovulation. We proceed with suggestions for (4) data preparation and coding of cycle day and phases, as well as (5) data visualization, statistical modeling, and interpretation of menstrual cycle associations. We also provide (6) recommendations for using menses start day and ovulation testing to schedule visits in laboratory studies and end with a (7) comprehensive summary and conclusion. Regardless of whether the influence of the menstrual cycle is of central interest in a study or should be controlled to accurately assess the effects of another variable, the use of these recommendations and tools will help make study results more meaningful and replicable.
... Where research was been undertaken specifically around menstruapps, the focus has not been privacy. For example, research published in an obstetrics and gynaecology journal evaluated the features offered by the most popular apps and whether the information they were providing was accurate [39]. Otherwise, within the Human-Computer Interaction community, the focus has been about understating why people track and whether the design of apps aided them or not [18], and designing alternative modes of tracking [20]. ...
Article
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Menstruapps are mobile applications that can track a user’s reproductive cycle, sex life and health in order to provide them with algorithmically derived insights into their body. These apps are now hugely popular, with the most favoured boasting over 100 million downloads. In this study, we investigate the privacy practices of a set of 30 Android menstruapps, a set which accounts for nearly 200 million downloads.We measured how the apps present information and behave on a number of privacy related topics, such as the complexity of the language used, the information collected by them, the involvement of third parties and how they describe user rights. Our results show that while common pieces of personal data such as name, email, etc. are treated appropriately by most applications, reproductive-related data is not covered by the privacy policies and in most cases, completely disregarded, even when it is required for the apps to work. We have informed app developers of our findings and have tried to engage them in dialogue around improving their privacy practices.
... pen and paper, technology, etc.), and despite this, they report issues with predicting their cycle month-to-month. Previous research has analyzed the efficacy and accuracy of different methods of cycle tracking, ranging from using technology to memory [70,[72][73][74]. Future interventions should provide sophisticated menstrual tracking resources to adolescent girls to understand their implications for educational outcomes, taking into account equity concerns about smartphone health applications [75]. ...
Article
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Menstrual hygiene management is an important determinant for girls’ educational outcomes. We develop a method of cross-sectional analysis that quantifies the relative importance of four distinct mechanisms: material, biological, social and informational constraints and consider four main schooling outcomes: absenteeism, early departure, concentration and participation. We use survey data from 524 female students enrolled in four co-educational secondary schools in Northern Tanzania. Average age at first period is 14.2 years (standard deviation = 1.1, range 9-19). Information is the least binding constraint: 90-95% of girls report they received information about menstruation and how to manage it. In contrast, biological constraints are hindering: (i) the distribution of menstrual cramps and pain is bifurcated: most girls report very light or very strong pain (rather than moderate) with considerable educational impacts for girls in the latter group, (ii) irregular cycles (62%) and difficulty predicting the cycle (60%) lead to stress and uncertainty. Socio-cultural constraints are binding as 84% would feel shame if male peers knew their menstrual status, and 58% fear being teased over periods. Material constraints include prohibitive costs: girls spending between 12-70% of the daily national poverty line (6,247 TSH per day) on pads during their period. However, we discern no statistically significant relationship between access to pads and absenteeism. In contrast, biological and socio-cultural constraints as well as lack of sanitary infrastructure have significant effects on absenteeism. The results have several implications. First, sanitary pad interventions should consider participation and concentration as main outcomes, in addition to absenteeism. Second, biological (menstrual cramps and pain) and socio-cultural (fear, stigma) constraints are drivers of menstruation-related absenteeism and participation in the classroom and need to be evaluated in trials. We suggest exploring analgesic use, alternative pain-management techniques, menstrual cycle tracking technologies, and social programming in future trials.
... More women are interested in using nonhormonal methods to manage their fertility as evidenced by numbers of fertility/menstrual cycle charting applications that are being developed, marketed, and used (Moglia et al. 2016(Moglia et al. , 1156Starling et al. 2018, 4). This increased interest is most likely due to the side effects of synthetic steroids used in hormonal contraception. ...
Article
Women of reproductive age need reliable and effective family planning methods to manage their fertility. Natural family planning (NFP) methods or fertility awareness-based methods (FABMs) have been increasingly used by women due to their health benefits. Nevertheless, effectiveness of these natural methods remains inconsistent, and these methods are difficult for healthcare providers to implement in their clinical practice. The purpose of this study is to evaluate the effectiveness of the Marquette Model NFP system to avoid pregnancy for women at multiple teaching sites using twelve months of retrospectively collected teaching data. Survival analysis (Kaplan–Meier) was used to determine typical unintended pregnancy rates for a total of 1,221 women. There were forty-two unintended pregnancies which provided a typical use unintended pregnancy rate of 6.7 per 100 women over twelve months of use. Eleven of the forty-two unintended pregnancies were associated with correct use of the method. The total unintended pregnancy rate over twelve months of use was 2.8 per 100 for women with regular cycles, 8.0 per 100 women for the postpartum and breastfeeding women, and 4.3 per 100 for women with irregular menstrual cycles. The Marquette Model system of NFP was effective when provided by health professionals who completed the Marquette Model NFP teacher training program. Summary This study involved determining whether healthcare professionals at ten sites across the United States and Canada trained to provide the Marquette Method NFP services can replicate the effectiveness demonstrated in previous studies of the method. We found a high level of effectiveness (i.e., very low pregnancy rates) in using the Marquette Method among women from various regions across North America with diverse reproductive backgrounds and in particular when using hormonal fertility marker. Healthcare providers who have been trained to teach NFP can successfully incorporate NFP services in their practice and assist their clients in choosing appropriate family planning methods.
... Then, we obtain the ovulation window and the next period date. [15][16][17] Contraceptive methods are based primarily on the use of pills, intrauterine device, and the contraceptive patch. Indeed, the pill is the most used method that replaces the natural sexual cycle of women by an artificial cycle making the ovaries unable to release eggs. ...
Article
Background: Sometimes, women find it difficult to conceive a baby and others use contraceptives that often have side effects. Researchers have already established the importance of measuring basal body temperature (BBT) and the potential of hydrogen (pH). Method: We have designed and realized a device that allows the simultaneous measurement of the BBT and the pH. We used an Arduino Uno board, a pH sensor, and a temperature sensor. The device communicates with a smartphone, can be integrated into all e-health platforms, and can be used at home. We validated our ovulation detector by a measurement campaign on a group of twenty women. If the pH is >7 and at the same time, the BBT is minimum and <36.5°C, the women is in ovulation phase. If the pH is ≤7 and in the same time, the BBT is between 36.5°C and 37°C, the women are in preovulation or follicular phase. If the pH is ≤7 and in the same time, the BBT is >36.5°C, the women are in postovulation or luteal phase. Results: We tested the contraceptive aspect of our ovulometer on a set of seven women. We also tested the help of conceiving babies by having intercourse during the ovulation period fixed by our ovulation detector. The results are satisfactory. Conclusions: In the final version of our device, we displayed just in "fertility period" if the pH is ≥7 and the BBT is <36.5°C else we displayed in "nonfertility period."
Article
Objectives This study aimed to evaluate frequency and experience in the use of menstrual cycle monitoring applications (apps) by Brazilian women. Methods A cross-sectional study was performed through an online survey, announced in social media women’s groups, among menstruating Brazilian women aged ≥18 years. The instrument collected sociodemographic, sexual, menstrual and technology usage data of all the women who agreed to participate. Results Of the 1160 participants, 71.2% used a menstrual cycle monitoring app. The principal motivation for using menstrual cycle apps was to track the menstrual cycle (94.3%), followed by pregnancy avoidance (49.5%). Users rated the apps with a mean 4.4 (standard deviation 0.65) stars out of five. There was a greater likelihood of using an app among women who used behavioural contraceptive methods (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.2, 2.7; p = 0.01), barrier methods (OR 1.6; 95% CI 1.1, 2.5; p = 0.02) and copper- or silver/copper-bearing intrauterine devices (IUDs) (OR 1.9; 95% CI 1.1, 3.5; p = 0.04) and a lower likelihood among women who used hormonal contraception (OR 0.5; 95% CI 0.3, 0.8; p = 0.00) and permanent contraception (OR 0.1; 95% CI 0.0, 0.4; p = 0.00). Conclusion The use of menstrual cycle monitoring apps was quite widespread in the studied group. Satisfaction with app use was considered adequate. The use of menstrual cycle apps was associated with the use of behavioural contraceptive and barrier methods as well as IUDs.
Article
Purpose of review: We reviewed published studies on menstrual cycle tracking applications (MCTAs) in order to describe the potential of MCTAs for epidemiologic research. Recent findings: A search of PubMed, Web of Science, and Scopus for MCTA literature yielded 150 articles. After exclusions, there were 49 articles that addressed the primary interest areas: 1) characteristics of MCTA users in research, 2) reasons women use or continue using MCTAs, 3) accuracy of identifying ovulation and utility at promoting and preventing pregnancy, and 4) quality assessments of MCTAs across several domains. Summary: MCTAs are an important tool for the advancement of epidemiologic research on menstruation. MCTA studies should describe the characteristics of their user-base and missing data patterns. Describing the motivation for using MCTAs throughout a user's life and validating the data collected should be prioritized in future research.
Thesis
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Menstruation is periodic and cyclic discharge has always been associated as one of the complex and difficult matters for Muslim women as far as ibadat is concerned. This matter does not only include ruling of worship ('ibadat), but it is related to health. Currently, artificial intelligence (AI), learning machine and big data technology have impacted every one in the world; male and female. One example is the menstrual tracking mobile application. This application offers Muslim women the abilities and advantages of menstrual tracking in calculating and tracking menstrual cycle while monitoring and maintaining their reproductive health. This usage of menstrual tracking mobile applications will have an effect on juristic ruling. This study aims to understand the issue of the menstruation (haid and istihadah) and ovulation from both Islamic Jurisprudence (fiqh) and clinical views and their relationship with the use of artificial intelligence in tracking menstruation cycle from the Islamic perspective and understand it roles to facillate women. This study adopted the qualitative method by content analysis and interviewing medical expert from Obstetric and Gynecology department and technology and information expert from Center for Artificial Intelligence and Technology (CAIT) to understand the usage of menstrual tracking mobile applications in medical field it’s relation and effects to Islamic Jurisprudence (fiqh). The result of this study revealed that these menstrual tracking mobile applications are based on the concept Personal Informatic Management (PIM) tools in medical technology which help women to achieve self-knowledge through their menstruation and higher degree of spiritual obligation especially when women face menstruation disorder (mutahayyirah fil haydh) and uncertainity. Despite the weaknesses and challenges in the usage of menstrual tracking mobile applications, it has ability to help women manage their personal health and worship
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Research question To characterize mobile fertility tracking applications (apps) to determine the use of such apps for women trying to conceive by identifying the fertile window. Design An exploratory cross-sectional audit study was conducted of fertility tracking applications. Ninety out of a possible total 200 apps were included for full review. The main outcome measures were the underlying app method for predicting ovulation, the fertile window, or both, price to download and use the app, disclaimers and cautions, information and features provided and tracked, and app marketing strategies. Results All the apps except one monitored the women’s menstrual cycle dates. Most apps only tracked menstrual cycle dates (n = 49 [54.4%]). The remainder tracked at least one fertility-based awareness method (basal body temperature, cervical mucus, LH) (n = 41 [45.6%]). Twenty-five apps measured dates, basal body temperature, LH and cervical mucus (27.8%). Seventy-six per cent of apps were free to download with free apps having more desirable features, tracking more measures and having more and better quality educational insights than paid apps. Seventy per cent of apps were classified as feminine apps, 41% of which were pink in colour. Conclusions Mobile fertility tracking apps are heterogenous in their underlying methods of predicting fertile days, the price to obtain full app functionality, and in content and design. Unreliable calendar apps remain the most commonly available fertility apps on the market. The unregulated nature of fertility apps is a concern that could be addressed by app regulating bodies. The possible benefit of using fertility apps to reduce time to pregnancy needs to be evaluated.
Article
The revelation that menstruation tracking apps share sensitive data with third parties, like Facebook, provoked a sense of violation among users. This case highlights the need to address ethics and governance of health data created outside of traditional healthcare contexts. Commodifying health data breaches trust and entails health and moral risks. Through the metaphor of The Wizard of Oz, we argue that these apps approximate healthcare without the professional competency, fiduciary duties, legal protections and liabilities such care requires and thus represent an innovation in the annals of snake-oil salesmanship and the systematic devaluing of women’s bodies, lives, and work.
Article
Resumen El sangrado menstrual abundante (SMA) se define como una pérdida excesiva de sangre menstrual que interfiere con la calidad de vida. Se trata de una alteración infradiagnosticada e infratratada debido a la escasa correlación entre la percepción de la paciente y la pérdida hemática menstrual objetiva, así como a la escasez de herramientas diagnósticas validadas. La anemia causada por el SMA es un problema frecuente, infravalorado en muchas ocasiones y con consecuencias que van más allá del ámbito de la ginecología. A pesar de su efecto negativo sobre la calidad de vida, la mayoría de las herramientas validadas para detectar el SMA no tienen en cuenta este concepto. El objetivo de este trabajo es revisar los principales instrumentos disponibles para detectar el SMA, sus ventajas e inconvenientes, su aplicabilidad en la práctica clínica habitual y recomendar aquellos que reúnen las mejores características.
Article
Introduction: Nowadays numerous mobile health applications (MHA) have been developed to assist and simplify the life of patients affected by erectile dysfunction (ED), however the scientific quality and the adherence to guidelines are not yet addressed and solved. Materials and methods: On 17 January 2022, we conducted a search in the Apple App Store and Google Play Store.We reviewed all mobile apps from iTunes App Store and Google Play Store for ED and evaluated different aspects as well as their usage in screening, prevention, management, and their adherence to EAU guidelines. Results: A total of 18 apps were reviewed. All apps are geared towards the patient and provide information about diagnoses and treatment of ED. Conclusions: MHA represent an integral part of patients' lives, and apps providing services for male sexual dysfunction are constantly increasing. Despite this the overall quality is still low. Although many of these devices are useful in ED, the problems of scientific validation, content, and quality are not yet solved. Further work is needed to improve the quality of apps and developing new accessible, user designed, and high-quality apps.
Thesis
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...The results have shown that needs and expectations change according to different trimesters and pregnant women types. Correspondingly, positive user experience dimensions with mobile pregnancy technologies and their conceptual relationships, as well as content, interaction, appearance, and function related characteristics and scopes of mobile pregnancy technologies have been revealed paying attention to wellness dimensions during pregnancy. Moreover, feeding from the results of the study and positive psychology literature, design descriptions have been delivered that would focus on the wellness and happiness of different pregnant women.
Article
Femtech technologies, such as period and fertility trackers, promise their users empowerment through reliable knowledge about and control over their bodies and ownership of their procreative health. However, the notion of empowerment through period and fertility apps deserves scrutiny. Based on a thematic analysis of a range of ‘female health’ app promotion materials, we explore the kind of empowerment promised by app providers and point towards significant contradictions and tensions in the discursive tales of empowerment. Building on digital sociology and intersectional feminist scholarship, we observe that the discourse promoting many of the health apps is grounded in exclusionary ontologies, normative femininity, epistemic injustice and heterosexist notions of female sexuality, which undermines the liberational rhetoric of these digital health technologies.
Chapter
The chapter uses the self-monitoring of menstrual cycles via an app as an example for an exploration of the ways in which people engage with data and its ambivalences in their daily lives. Period-tracking apps allow for the tracking and visualising of all kinds of personal data and offer a digitised, ‘smart’ version of the well-known menstruation calendar. In addition to insecurities emerging from ‘taming’ the uncertainties of (menstruating) bodies via quantification and algorithms, Sociology Compass , 8(12), 1344–1359 (2014)], the unanticipated collection of user data by private companies and the potential surveillance[Levy, Idaho Law Review , 51, 679–693 (2015)] raise issues of privacy and data security. This chapter will address these two forms of insecurity by drawing on material from an ongoing empirical study into the everyday use and discussion of period-tracking apps in Germany. For those interviewed, the negotiation of data insecurities can encompass an increased body competence, idiosyncratic interpretations of data or ignoring predictive deficiencies just as attempts of sidestepping dubious data collection or impositions of an algorithmic understanding of menstrual normalcy. Hence, the chapter gives insight into the multi-faceted ways people live with datafication and contributes to everyday perspectives in critical data studies.
Research
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This study, conducted in partnership with DAWN, seeks to undertake a feminist political economy exploration of data policies and practices through close analysis of the erosion of privacy and data autonomy in the menstrual apps market. It looks to examine how self data-tracking practices shape data subjectivity, as well as the policy aspects of data processing by platform companies (especially from the Global South), to examine whose data is collected by whom and for what, within the global circuits of surveillance capitalism.
Article
Infertility practitioners are increasingly turning to mobile applications (apps) to help improve patient care. Provider-facing apps range from reference to communication tools, to versions of the electronic health record. Some available evidence indicates that mobile apps facilitate patient care by increasing efficiency and accuracy in documentation, information retrieval, and coordination of care.1 The U.S. Food and Drug Administration (FDA) website currently lists dozens of cleared or approved applications for mobile ‘medical device’ apps, and reproductive healthcare has also certainly benefitted from this explosion in mobile technology. Reproductive and fertility-focussed apps now aim to treat and diagnose disease, aid clinical decision-making, and manage patient care. Infertility patients may use apps pretreatment to manage lifestyle factors, during treatment to manage medications and calendar appointments, and for message boards where they can share experiences, and seek or offer peer support. Here, the authors review the history of medical health and research apps, current reproduction-specific mobile applications, and discuss the implications of mobile technology for diagnostic point-of-care, clinical research, and patient health management.
Article
Objective: To analyze insulin delivery and glycemic metrics throughout the menstrual cycle for women with type 1 diabetes using closed-loop control (CLC) insulin delivery. Methods: Menstruating women using a CLC system in a clinical trial were invited to record their menstrual cycles through a cycle-tracking application. Sixteen participants provided data for this secondary analysis over three or more complete cycles. Insulin delivery and continuous glucose monitoring (CGM) data were analyzed in relation to reported cycle phases. Results: Insulin delivery and CGM metrics remained consistent during cycle phases. Intra-participant variability of CGM metrics and weight based insulin delivery did not change through cycle phases. Conclusions: For this sample of participants with type 1 diabetes using a CLC system, basal and bolus insulin delivery and glycemic metrics remained stable throughout menstrual cycle phases. Our novel data focusing on for menstruating women with type 1 diabetes highlights the need for further trials addressing this unmet need.
Article
Objectives: Most researchers who study the effects of hormonal contraception on menstrual bleeding rely on self-reported data via paper diaries, for which completeness and timeliness have been shown to be poor. The purpose of this exploratory study was to compare the completeness and timeliness of bleeding data collected via paper diaries, text messages or smartphone application (a.k.a "app"). Methods: This was a sub-study of a double-blinded, placebo-controlled randomized trial comparing the effects of a non-steroidal anti-inflammatory drug, naproxen, with placebo when using a copper IUD. Participants tracked bleeding and symptoms over 112 days. Participants tracked bleeding daily using a paper diary as well as with either text messages or a smartphone app. Participants who used paper and the app were also able to record non-bleeding symptoms. Results: Twenty-five participants submitted diaries. Of these participants, 10 completed both paper and app diaries, 7 completed both paper and text messages, 4 completed the paper diary only, 4 completed the app only. Text messages had the most complete data (108 days), followed by the app (96 days) and paper diaries (84 days). The lag time between a bleeding event and the date recording that event was 0.10 days for text, 1.0 days for app, and 4.73 days for paper diaries. Participants using the app reported a median of 33 other symptoms over the study period compared to 7 for the paper diaries. Discussion: Our findings suggest texts demonstrated more complete and timely bleeding data than either paper diaries, or the app. Compared to paper diaries, the app delivered more complete, timely data, and also collected a large set of symptoms.
Article
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The haematological module of the Athlete Biological Passport (ABP) monitors longitudinal haematological variations that could be indicative of blood manipulation. This study applied a multi-parametric model previously validated in elite cyclists to compare inferred and actual PV variations while the potential influence of the oral contraceptive pill (OCP) cycle on the ABP blood biomarkers and plasma volume (PV) in 14 physically active women taking OCPs was also investigated. Blood and serum samples were collected each week for 8 weeks, and the ABP haematological variables were determined according to the World Anti-Doping Agency guidelines. Transferrin (sTFN), ferritin (FERR), albumin (ALB), calcium (Ca), creatinine (CRE), total protein (TP), and low-density lipoprotein (LDL) were additionally computed as 'volume-sensitive' variables in a multivariate analysis to determine individual estimations of PV variations. Actual PV variations were indirectly measured using a validated carbon monoxide rebreathing method. We hypothesised ABP markers to be stable during a standard OCP cycle and estimated PV variations similar to measured PV variations. Measured PV variations were in good agreement with the predictions and allowed to explain an atypical passport finding (ATPF). The ABP biomarkers, Hbmass, and PV were stable over 8 weeks. Significant differences occurred only between week 7 and week 1, with lower levels of haemoglobin concentration ([Hb]), haematocrit (HCT), and red blood cell count (RBC)(-4.4%, p < 0.01; -5.1%, p < 0.01; -5.2%, p < 0.01) and higher levels of PV at week 7 (+9%, p = 0.05). We thus concluded that estimating PV variations may help interpret individual ABP haematological profiles in women.
Chapter
Promotion of family planning and prevention of unintended (mistimed or unintended) pregnancy through guaranteed access to preferred contraceptive methods for women and couples assures the well-being and autonomy of women in particular and of families, communities, and society in general.
Article
Background: Many pregnant women use the internet to obtain information about pregnancy and childbirth. Over 50% of pregnant women use pregnancy applications (apps) and must search through thousands of pregnancy or women's health-related apps available on app stores. COVID-19 is changing how women receive prenatal care. Mobile health apps may help maintain women's satisfaction with their prenatal care. Objective: Our objective is to identify pregnancy mobile apps and to evaluate the apps using a modified APPLICATIONS scoring system. Methods: A list of pregnancy apps was identified in the first 20 Google search results using the search term "pregnancy app." After excluding irrelevant, inaccurate, malfunctioning, or no longer available apps, all unique apps were downloaded and evaluated with the modified APPLICATION scoring system, which includes both objective and subjective criteria and evaluation of special features. Results: A total of 57 unique pregnancy apps were generated. After 28 apps were excluded, the remaining 29 apps were evaluated, with a mean score of 9.4 points out of a maximum of 16. The highest scoring app scored 15 points. Over 60% of apps were not comprehensive with information for every stage of pregnancy or did not contain all four desired components of pregnancy apps: health promotion/patient education, communication, health tracking, and notifications and reminders. Only 24% of apps included a text search field, and only 28% of apps cited literature. Conclusions: Our search yielded many high-scoring apps, but few contained all desired components and features. These identified and rated apps can lessen the burden on pregnant women and providers to find available apps on their own. While healthcare providers should continue to vet apps before recommending them to patients, these findings also highlight that a Google search is a successful way for patients and providers to find useful and comprehensive pregnancy applications. Clinicaltrial:
Article
Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with quality of life. It is an under-diagnosed and under-treated disorder due to the poor correlation between patient perception and objective menstrual blood loss, as well as the scarcity of validated diagnostic tools. Anaemia caused by HMB is a common problem, underestimated on many occasions and with consequences that go beyond the scope of gynaecology. Despite the condition’s negative effect on quality of life, most of the tools validated to detect HBM do not take this into account. The aim of this paper is to review the main instruments available to detect HMB, their advantages and disadvantages, their applicability in routine clinical practice, and to recommend those with the best characteristics.
Article
Digital apps for tracking menstruation are widely used. Taking a critical menstruation and critical digital health approach, this research asks how menstrual app users perceive their data. Interviews with 25 menstrual app users across Aotearoa New Zealand, were analysed using reflexive thematic analysis. Some participants only track their period, while others track additional symptoms. They appreciated having a choice of data to track, entering extensive amounts of data. Most participants had not given much thought to their data, viewing it as uninteresting and unproblematic. A small group were concerned by the data risks and managed this in several ways. Participants across both groups supported using data for menstrual health research. This research demonstrates a need for digital literacy and for limits on the use of menstruation information, where menstruators themselves are controlling and benefitting from their data.
Article
Introduction and hypothesisMobile applications (apps) are becoming an increasingly popular means of obtaining medical information. The aim of our study was to identify and evaluate patient-centered fecal incontinence (FI) mobile apps using a modified APPLICATIONS scoring system.Methods We conducted searches in the Apple App and Google Play stores to identify FI-related mobile apps using search terms reflecting both commonly accepted medical terms as well as colloquial terms used by our patients with FI. Apps that were in English, relevant to FI, patient-centered, and medically accurate were included. Each eligible app was then independently evaluated by the three authors using a modified 17-point APPLICATIONS scoring system.ResultsWe identified 2785 apps upon initial search using FI search terms. Fourteen apps met eligibility criteria for scoring. Most apps were bowel movement trackers (13/14, 93%), of which only three allowed for tracking of FI episodes. Only one (7%) app contained educational information specific to FI. Ten (71%) apps were fully functional at no cost. Thirteen (93%) apps cited literature. Median APPLICATIONS score was 10 (IQR 9–11). “BristolStoolChart,” “FreeToBe,” and “PoopLog” each received the highest total score of 13.Conclusions Patient-centered mobile apps that provide FI-specific educational information or allow for FI symptom tracking are scarce. While we did discover some accurate sources of information and means of tracking bowel habits, patients are likely to encounter inaccurate or irrelevant information even when searching for FI-related apps using appropriate terminology. Future app development should include FI-specific symptom tracking and educational information from reputable sources.
Preprint
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Background Nowadays the use of smartphones and the development of health-related mobile applications has increased worldwide. Menstrual cycle tracking applications (MCTAs) have become especially popular among women because of their practicality in recording menstrual cycles, characteristics of bleeding and prediction of cycle stages. There are various studies regarding the use of MCTAs for different aspects of womens health such as estimating a fertility window for both conception and contraception, help register last menstrual period for calculation of gestational age, record pre-menstrual symptoms, among others. However, effects of MCTAs have not been analyzed in a systematic review. Objective The aim of this study is to evaluate the effect of mobile applications for menstrual cycle or fertility trackers on womens health. Methods A systematic review will be conducted, starting with a search in PubMed, CENTRAL and Scopus using search terms related to mobile applications and menstrual or fertility tracking. Only randomized controlled trials will be screened with a sample of child-bearing aged women that use menstrual or fertility tracking mobile applications. Selected studies will be fully analyzed and the results will be recorded on a spread sheet. Study selection and data extraction will be conducted by two reviewers independently and the Cochrane Risk of Bias Tool for RCT will be used for assessment of risk of bias. Discrepancies will be reviewed with a third reviewer. Conclusion Currently, there is a lack of information on the effects of using MCTAs on womens health. This systematic review aims to provide an analysis on the outcomes of the usage of these applications and evaluate any potential effects. Keywords Menstrual cycle, mobile application, tracking, womens health Conflicts of interest All authors declare to have no conflicts of interest.
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Background The explosion of mobile phones with app capabilities coupled with increased expectations of the patient-consumers’ role in managing their care presents a unique opportunity to use mobile health (mHealth) apps. Objectives The aim of this paper is to identify the features and characteristics most-valued by patient-consumers (“users”) that contribute positively to the rating of an app. MethodsA collection of 234 apps associated with reputable health organizations found in the medical, health, and fitness categories of the Apple iTunes store and Google Play marketplace was assessed manually for the presence of 12 app features and characteristics. Regression analysis was used to determine which, if any, contributed positively to a user’s rating of the app. ResultsAnalysis of these 12 features explained 9.3% (R2=.093 n=234, P
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Digital health technologies are playing an increasingly important role in healthcare, health education and voluntary self-surveillance, self-quantification and self-care practices. This paper presents a critical analysis of one digital health device: computer apps used to self-track features of users' sexual and reproductive activities and functions. After a review of the content of such apps available in the Apple App Store and Google play™ store, some of their sociocultural, ethical and political implications are discussed. These include the role played by these apps in participatory surveillance, their configuration of sexuality and reproduction, the valorising of the quantification of the body in the context of neoliberalism and self-responsibility, and issues concerning privacy, data security and the use of the data collected by these apps. It is suggested that such apps represent sexuality and reproduction in certain defined and limited ways that work to perpetuate normative stereotypes and assumptions about women and men as sexual and reproductive subjects. Furthermore there are significant ethical and privacy implications emerging from the use of these apps and the data they produce. The paper ends with suggestions concerning the 'queering' of such technologies in response to these issues.
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This paper examines the state of the art in mobile clinical and health-related apps. A 2012 estimate puts the number of health-related apps at no fewer than 40,000, as healthcare professionals and consumers continue to express concerns about the quality of many apps, calling for some form of app regulatory control or certification to be put in place. We describe the range of apps on offer as of 2013, and then present a brief survey of evaluation studies of medical and health-related apps that have been conducted to date, covering a range of clinical disciplines and topics. Our survey includes studies that highlighted risks, negative issues and worrying deficiencies in existing apps. We discuss the concept of 'apps as a medical device' and the relevant regulatory controls that apply in USA and Europe, offering examples of apps that have been formally approved using these mechanisms. We describe the online Health Apps Library run by the National Health Service in England and the calls for a vetted medical and health app store. We discuss the ingredients for successful apps beyond the rather narrow definition of 'apps as a medical device'. These ingredients cover app content quality, usability, the need to match apps to consumers' general and health literacy levels, device connectivity standards (for apps that connect to glucometers, blood pressure monitors, etc.), as well as app security and user privacy. 'Happtique Health App Certification Program' (HACP), a voluntary app certification scheme, successfully captures most of these desiderata, but is solely focused on apps targeting the US market. HACP, while very welcome, is in ways reminiscent of the early days of the Web, when many "similar" quality benchmarking tools and codes of conduct for information publishers were proposed to appraise and rate online medical and health information. It is probably impossible to rate and police every app on offer today, much like in those early days of the Web, when people quickly realised the same regarding informational Web pages. The best first line of defence was, is, and will always be to educate consumers regarding the potentially harmful content of (some) apps.
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Mobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information. To describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision. The 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity. iTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features. The popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of 'shared maternity care' needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care.
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Background For the last decade, mHealth has constantly expanded as a part of eHealth. Mobile applications for health have the potential to target heterogeneous audiences and address specific needs in different situations, with diverse outcomes, and to complement highly developed health care technologies. The market is rapidly evolving, making countless new mobile technologies potentially available to the health care system; however, systematic research on the impact of these technologies on health outcomes remains scarce. Objective To provide a comprehensive view of the field of mHealth research to date and to understand whether and how the new generation of smartphones has triggered research, since their introduction 5 years ago. Specifically, we focused on studies aiming to evaluate the impact of mobile phones on health, and we sought to identify the main areas of health care delivery where mobile technologies can have an impact. MethodsA systematic literature review was conducted on the impact of mobile phones and smartphones in health care. Abstracts and articles were categorized using typologies that were partly adapted from existing literature and partly created inductively from publications included in the review. ResultsThe final sample consisted of 117 articles published between 2002 and 2012. The majority of them were published in the second half of our observation period, with a clear upsurge between 2007 and 2008, when the number of articles almost doubled. The articles were published in 77 different journals, mostly from the field of medicine or technology and medicine. Although the range of health conditions addressed was very wide, a clear focus on chronic conditions was noted. The research methodology of these studies was mostly clinical trials and pilot studies, but new designs were introduced in the second half of our observation period. The size of the samples drawn to test mobile health applications also increased over time. The majority of the studies tested basic mobile phone features (eg, text messaging), while only a few assessed the impact of smartphone apps. Regarding the investigated outcomes, we observed a shift from assessment of the technology itself to assessment of its impact. The outcome measures used in the studies were mostly clinical, including both self-reported and objective measures. Conclusions Research interest in mHealth is growing, together with an increasing complexity in research designs and aim specifications, as well as a diversification of the impact areas. However, new opportunities offered by new mobile technologies do not seem to have been explored thus far. Mapping the evolution of the field allows a better understanding of its strengths and weaknesses and can inform future developments.
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The introduction of Apple's iPhone provided a platform for developers to design third-party apps, which greatly expanded the functionality and utility of mobile devices for public health. This study provides an overview of the developers' written descriptions of health and fitness apps and appraises each app's potential for influencing behavior change. Data for this study came from a content analysis of health and fitness app descriptions available on iTunes during February 2011. The Health Education Curriculum Analysis Tool (HECAT) and the Precede-Proceed Model (PPM) were used as frameworks to guide the coding of 3336 paid apps. Compared to apps with a cost less than US $0.99, apps exceeding US $0.99 were more likely to be scored as intending to promote health or prevent disease (92.55%, 1925/3336 vs 83.59%, 1411/3336; P<.001), to be credible or trustworthy (91.11%, 1895/3336 vs 86.14%, 1454/3349; P<.001), and more likely to be used personally or recommended to a health care client (72.93%, 1517/2644 vs 66.77%, 1127/2644; P<.001). Apps related to healthy eating, physical activity, and personal health and wellness were more common than apps for substance abuse, mental and emotional health, violence prevention and safety, and sexual and reproductive health. Reinforcing apps were less common than predisposing and enabling apps. Only 1.86% (62/3336) of apps included all 3 factors (ie, predisposing, enabling, and reinforcing). Development efforts could target public health behaviors for which few apps currently exist. Furthermore, practitioners should be cautious when promoting the use of apps as it appears most provide health-related information (predisposing) or make attempts at enabling behavior, with almost none including all theoretical factors recommended for behavior change.
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Objective: Bleeding data in contraceptive trials areoftencollected using daily diaries, but data quality may vary due to compliance and recall bias. Text messaging is a widespread and promising modality for data collection. Study design: This trial randomized participants 1:1 to use text messages or paper diaries to report on bleeding experiencedduring the 90 days after intrauterine device insertion(IUD). Participants chose either the copper T380A or the 52mg levonorgestrel IUD.Our primary outcome was number of days of reported bleeding data. We hypothesized data gathered with daily text messages would have fewer missing values than paper diaries. Intention to treat analyses used the rank-sum test to compare medians. Results: Two hundred thirty women enrolled, and randomization yielded groups similar in baseline characteristics. Twenty percent of participants provided no bleeding data; of these, 77% were assigned to paper diaries. With 90 days of reporting, approximately twenty percent in each group provided complete bleeding data.The text groupreported amedian of 82 days (interquartile range [IQR] 40-89) and the paper group 36 (IQR 0-88) (p=<0.001).The number of responses received decreased gradually over the 90-day period, but was always higher in the text group. Women who had attained higher levels of education did well regardless of data collection modality, while text messages response rates were greater among those with a high school education or less (p < 0.01). Conclusions: Participants reporting bleeding via text messages provided more complete data than womenusingpaper diaries. Implications: Depending on resources and population of interest, text messages may be a useful modality to improve data collection for patient-reported outcomes.
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Mobile applications (apps) are becoming increasingly popular in medicine. However, there is no systematic way to rate apps that are useful to obstetrics and gynecology providers. This study aims to identify the top-rated pregnancy wheel apps using a newly developed APPLICATIONS scoring system. A list of pregnancy wheel apps was identified. Consumer-based and inaccurate apps were excluded. The APPLICATIONS scoring system was developed to rate the remaining apps. App comprehensiveness was evaluated. Objective rating components included price, paid subscription, literature used, in-app purchases, connectivity to Internet, advertisements, text search field, inter-device compatibility, and other components such as images or figures, videos, and special features. Subjective rating components were ease of navigation and subjective presentation. A complete list of 55 pregnancy wheel apps was created from three sources. Thirty-nine (71%) were consumer-based, inaccurate, or both, leaving 16 (29%) for analysis using the APPLICATIONS scoring system. More than two thirds of pregnancy wheel apps were excluded from our study secondary to being consumer-based, inaccurate, or both. This highlights the importance of identifying systematically, reviewing critically, and rating the thousands of available apps to health care providers to ensure accuracy and applicability. We propose that our APPLICATIONS scoring system be used to rate apps in all specialties with the goal of improving health care provider performance and thereby patient outcomes.
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Like many physicians, Suzanne Clough, MD, struggled to meet her patients’ needs regarding their type 2 diabetes in a few 12-minute visits each year. But too often, patients’ concerns about day-to-day condition management weren’t fully addressed. Many were frustrated, and some didn’t follow her guidance because they weren’t seeing results. The recommendations, she said, “didn’t have value [for them].” Clough wondered whether real-time, 24/7 diabetes management support would help. That question led her on a 10-year journey to develop the WellDoc BlueStar mobile app for patients with type 2 diabetes. It analyzes trends in patient-entered data on blood glucose level, carbohydrate consumption, medication use, and other information to provide real-time coaching for the patient. Patients can then securely share the data with their physician through a web portal.
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The Quantified Self Movement, which aims to improve various aspects of life and health through recording and reviewing daily activities and biometrics, is a new and upcoming practice of self monitoring that holds much promise. Now, the most underutilized resource in ambulatory health care, the patient, can participate like never before, and the patient's Quantified Self can be directly monitored and remotely accessed by health care professionals. © 2014 All rights reserved: reproduction in whole or part not permitted.
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mHealth apps are mobile device applications intended to improve health outcomes, deliver health care services, or enable health research.1 The number of apps has increased substantially, and more than 40 000 health, fitness, and medical apps currently are available on the market.2 Because apps can be used to inexpensively promote wellness and manage chronic diseases, their appeal has increased with health reform and the increasing focus on value. The bewildering diversity of apps available has made it difficult for clinicians and the public to discern which apps are the safest or most effective.
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There are thousands of medical applications for mobile devices targeting use by healthcare professionals. However, several factors related to the structure of the existing market for medical applications create significant barriers preventing practitioners from effectively identifying mobile medical applications for individual professional use. To define existing market factors relevant to selection of medical applications and describe a framework to empower clinicians to identify, assess and utilise mobile medical applications in their own practice. Resources available on the Internet regarding mobile medical applications, guidelines and published research on mobile medical applications. Mobile application stores (e.g. iTunes, Google Play) are not effective means of identifying mobile medical applications. Users of mobile devices that desire to implement mobile medical applications into practice need to carefully assess individual applications prior to utilisation. Searching and identifying mobile medical applications requires clinicians to utilise multiple references to determine what application is best for their individual practice methods. This can be done with a cursory exploration of mobile application stores and then moving onto other available resources published in the literature or through Internet resources (e.g. blogs, medical websites, social media). Clinicians must also take steps to ensure that an identified mobile application can be integrated into practice after carefully reviewing it themselves. Clinicians seeking to identify mobile medical application for use in their individual practice should use a combination of app stores, published literature, web-based resources, and personal review to ensure safe and appropriate use.
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