Notes & Links: October 4, 2013

Assessing the Internal and External Validity of Mobile Health Physical Activity Promotion Interventions: A Systematic Literature Review Using the RE-AIM Framework

This is good less from the study and more from the fact the authors have demonstrated that we can review and critical appraise mobil apps. It’s hardly perfect but it is a step in the direction of helping patients and HCP know what works and what doesn’t. 

Blackman, Zoeliner, Berrey, et. al writing in JMIR have performed a Cochran Review on mobile apps. This is fascinating from the simple fact it begins to establish a methodology to review mobile apps for physical activity. 

Despite the popularity of commercially available health-related applications, there is little evidence that mobile phone-based interventions with demonstrated efficacy have been translated beyond the research setting and been broadly adopted [19]. Some potential reasons for the lack of translation of these interventions into more widespread use are that the scientific approach typically emphasizes high internal validity at the expense of external validity [20] and that the traditional research pace impedes the flow of disseminating relevant findings [21]. To date, reviews of mHealth interventions have evaluated the quality of studies through the lens of internal validity and emphasized improved reporting on potential confounding factors [22]. As a result, the conclusions are largely limited to factors related to intervention efficacy and the extent to which these mHealth interventions report on or achieve external validity to different settings and populations is unclear [1317,23]. 

This study used RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) to inform investigators who will do research on mHealth applications. This is the first I’ve seen on standardizing how we determine the value across a broad measure for mHealth applications. They also clearly show current limitations and where we as an industry need to improve. Mobile health applications are becoming the center piece to our healthcare in many regards. Also we know that they are bought, downloaded, and frequently forgotten about. Using RE-AIM along with other metrics can help determine the clinical value of apps and how to design better one not only from a shinny toy with bells and whistles perspective but from a patient outcome point of view. This sorely needed. 

The authors conclude

There is an emergent body of literature reporting on mHealth PA interventions. On average, the studies provide initial evidence that these interventions may have promise in helping participants initiate PA. However, few studies report on key internal (eg, delivery as intended) or external (eg, descriptions of participants, settings, and delivery staff) factors. As a result, the degree to which these findings are robust and generalizable cannot be determined. Improved reporting across RE-AIM dimensions and the use of intention-to-treat, tracking of costs, and mixed methods approaches are recommended to ensure mHealth PA interventions are developed that can be broadly applicable across target populations, intervention delivery locations, and staff of differing levels of expertise.

Health care in the USA hanging in in the balance
The Lancet offers some editorial insight and comment on healthcare in the US of A. The editorial is an excellent review of Obamacare with no hyperbole and written simply in plain Queens English. I am sure from their vantage point they are missing all the hairs growing out of each ACA wart. This is a great easy read to wrap your head around. 

The closing paragraph offers insight on what the world sees.

What is clear is that, even under optimal conditions, the health insurance marketplace is a work in progress, involving the commitment of thousands of civil servants, administrators, consultants, programmers, and, ultimately, consumers. As part of risky manoeuvring to extract political concessions, gutting the ACA and scrapping the state exchanges is an irresponsible and short-sighted assault on the promotion of the health and wellbeing of Americans. Irrespective of meeting arbitrary deadlines, the efforts of these individuals converge on the vital goal to overhaul the health-care system in the USA. Health-care reform is a process that must start somewhere and will adapt and evolve over time. The ACA offers that starting point—there should be no turning back now.

Vaccine Conspiracy Theorists More Likely To See Conspiracy Everywhere
File this under the biggest tin foil hat wearers are the vaccine conspiracy theorists. Leaders of the pack. I am of the age I still think there was a shooter on the grassy knoll but, I am not grabbing huge real estate on the Web to drive my theory. 

Emily Willingham a contributor to Forbes gives a nice review of current thinking about vaccine conspiracy theorists and specifically autism. She notes research results from PLOS ONE that found conspiracy theories are lock stepped with a rejection of science. The authors also find that vaccine conspiracy theories have a political flavor and fit libertarian leanings and those not as conservative reject immunization because of the pharmo industrial complex. Who can trust anyone that sell a drug proven to be equal to placebo?

Least we forget there are health consequences to the continued vaccine-autism conspiracy crap. It harms others and the child. The woman who was killed in Washington DC had her 1 year old daughter in the car. Some have said that she put that child in direct danger and harm. Not vaccinating does the same. 

What can we do? Not much. 

Lewandowsky and co-authors close their paper almost dejectedly, noting that because “conspiracist ideation” leads believers to resist evidence contrary to their conspiracy theory, presenting them with scientific evidence tends to amplify that rejection. They recommend affirming the competence and character of the conspiracy theorist and kind of leaving it at that. Please, consider yourself affirmed.

Not so much it seems. But we can not let those to are anti vaccination not drive the message or control the voice online. Reason and science must prevail since we are seeing outbreaks of measles, mumps, etc. 

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