Browsing by Subject "mHealth"

Introduction: The importance of good nutrition is not always recognized among athletes and their coaches. Young athletes need professional guidance, so they can learn how to execute dietary practices that support their athletic performance and overall well-being. The growing body of scientific evidence on performance enhancing nutrition and its practical applications challenges the Finnish field of competitive sports to invest in professional nutrition coaching among athletes. Aims of the study: The aim of this study was to examine, if eating habits of young endurance athletes can be influenced by a nutrition intervention carried out using a mobile application (MealLoggerTM) with an inbuilt nutrition program. We also examined, whether the motivation towards sports and nutrition and the perceived competence for following a certain diet are related to athletes’ adherence to the nutrition program and to the measured changes in food intake. Materials and methods: 17 young individual endurance athletes followed through a four-week nutrition intervention by keeping a photo food journal and logging their food servings with the smart phone application MealLoggerTM. A common application inbuilt nutrition program with servings goals for different food groups was designed in advance and implemented after a group education session on optimal sports nutrition. During the intervention period, the participants received real-time feedback from the mobile application on their adherence to the nutrition program. In addition, individualized meal photo comments were provided by a nutritionist three times a week. The athletes also received common weekly motivational messages through the application. Food intake was measured at baseline, after the intervention and 8-weeks after the intervention using food frequency questionnaire (FFQ). The motivation and perceived competence were assessed with Self-Determination theory (SDT) questionnaires. The adherence to the nutrition program was assessed by comparing the logged food servings to the defined nutrition goals. Results: Twelve participants (71%) completed the post-intervention questionnaires. No statistically significant changes in consumption of food groups included in the nutrition program were detected. The consumption of berries increased 2,36 times per week (SD 4,07 p=0,049). The consumption of skimmed milk decreased 3,00 times per week (SD 4,28, p=0,042) and the consumption of milk/alternatives in total decreased 3,67 times per week (SD 5,82, p=0,034). MealLoggerTM data was retrieved from 15 participants. Most of the participants (n=8) with high adherence (H) achieved at least 3 out of 4 goals on every week. Most participants (n=7) with low adherence (L) failed to achieve any of the nutrition goals on any of the four weeks. No statistically significant differences in motivation or perceived competence were found between the H and L. The overall engagement to the mobile application was lower in L compared to H. The participants in L were mostly female, significantly younger and more likely to be living with a guardian, responsible for the acquisition and preparation of food. Discussion: Despite detecting only small dietary improvements, the application showed good feasibility and acceptability among the high adherence participants. In the future, to provide more effective nutrition coaching an appropriate baseline assessment should be included. The goals of the nutrition program should be adjusted according to the athletes’ individual needs. More democratic coaching styles, with parental involvement should be explored in order to increase engagement and adherence of young athletes.

The usage of different types of wearable mHealth solutions for consumers has exploded especially since the start of the COVID-19 pandemic. A big question regarding these devices is the quality and accuracy of the data produced by them. When the consumer can use these devices to measure their heartbeat, blood sugar levels, sleep quality, blood oxygen levels etc. the quality and accuracy of this data is getting more important by the day. Not only for the consumer but also for the development of Artificial Intelligence the quality of data is of utmost importance. The importance of the data produced by these devices which the consumers wear voluntarily for long periods of time for the development of Artificial Intelligence in the medical sector cannot be overstated. Many of these mHealth devices also use Artificial Intelligence in one way or another already. In this Thesis the research question is how EU regulation affects the obligations of the producers of mHealth devices in regards the data quality of these devices. The starting point for the research is the define Artificial Intelligence in general and data quality by the EU standards. The method for this research is a legal dogmatic approach to present and future EU regulation surrounding this topic with the viewpoint of ensuring high quality data for Artificial Intelligence development. In the scope of this research there are the Medical Device Regulations for current regulation and the regulations based on the EU Data Strategy, Data Governance Act, the proposal for the Data Act and finally the proposal for the Artificial Intelligence Act. I note that there are many other important aspects to this topic that do not fit into the scope of this Thesis, namely access to data, movement of data, data protection, unfair commercial activities and “soft law” -type of regulation especially standards. The result of the research is that the situation is unclear in the light of the regulations inside the scope of this Thesis. For medical devices, the many obligations for medical devices do ensure that the devices need work as intended and as such ensure the data quality too. Many of the mHealth solutions, however, do not fit into the scope of either of the Medical Device Regulations, because their intended purpose is not ‘medical’. As these devices produce more and more intricate health data, the question left to be answered is when does the intended purpose become medical. EU has tried to tackle this problem mainly by soft law -instruments with the latest being the ISO/TS 82304-2 standard in regards the quality of health and wellness apps released in 2021. For the upcoming regulations the duo of Data related Acts do not bring any light to the problem. They mainly focus on access to data and movement of data with the data quality parts focusing on interoperability of data. The proposal for Artificial Intelligence Act has obligations mainly for the AI systems classified as ‘high-risk’. The interesting part for this paper is how medical devices and security systems for them would be classified as high-risk. This however leads the research back to the Medical Device Regulations and the issue with devices whose intended purpose is not medical.

Johdanto: Ruokavaliomuutoksilla voi ehkäistä useita lihavuuteen liittyviä kansantauteja, kuten tyypin 2 diabetesta. Ryhmissä tai yksilöohjauksena tapahtuva elintapaohjaus on ollut lihavuuden hoidon perusta. Painonpudotusinterventioissa sähköiset työkalut ovat osoittautuneet tehokkaiksi. Sosiaalisen tuen hyödyntäminen parantaa intervention vaikuttavuutta edelleen. Tutkimustietoa virtuaalisen tuen hyödyntämisestä elintapamuutokseen ja painonhallinnan edistämiseen on kuitenkin vähän. Tavoitteet: Tavoitteena oli selvittää, miten ohjauksen ja vertaistuen mahdollistava valokuvallinen ruokapäiväkirja oli yhteydessä elintapamuutoksen toteutumiseen ylipainoisilla työterveyshuollon asiakkailla ja avohoidossa olevilla henkilöillä. Lisäksi tarkoituksena oli selvittää uudenlaisen menetelmän (älypuhelinsovelluksen, mHealth) toteutettavuutta ja käytettävyyttä. Aineisto ja menetelmät: Tutkimukseen osallistui 26 ylipainoista (BMI>25 kg/m²) aikuista miestä ja naista, jotka rekrytoitiin työterveyshuollon asiakasyrityksestä sekä Pääkaupunkiseudun Diabetesyhdistys ry:n kautta. Osallistujat pitivät pienryhmissä neljä viikkoa visuaalista ruokapäiväkirjaa ottamalla valokuvia aterioistaan käyttämällä älypuhelinsovellusta ja saivat ohjausta ryhmien ohjaajalta. Ryhmäläiset näkivät toistensa ateriakuvat ja pystyivät ”tykkäämään” ja kommentoimaan toistensa kuvia. Ruoankäyttöä mitattiin tutkimuksen alussa, intervention päätyttyä ja neljä viikkoa intervention päättymisestä ruoankäyttökyselyn (FFQ, engl. food frequency questionnaire) avulla. FFQ sisälsi kahdeksan ruoka-ryhmää ja 48 elintarviketta. Kyselylomakkeilla selvitettiin myös tavoitteita, kokemusta sosiaalisesta tuesta ja ryhmän ilmapiiriä. Sosiaaliseksi tueksi määriteltiin myös sovelluksen kautta annetut ja saadut tykkäykset sekä kirjoitetut kommentit. Lisäksi mitattiin lähtötilanteessa ja intervention jälkeen pituus, paino ja vyötärönympärys sekä analysoitiin sovelluksen käyttöaktiivisuutta (ateriakuvat, tykkäykset, kirjautuminen sovellukseen ja kommentit). Tulokset: Kukaan osallistujista ei keskeyttänyt tutkimusta. Naisia oli mukana 74,1 % ja osallistujien keski-ikä oli 48,5 vuotta. Osallistujien painoindeksi oli lähtötilanteessa keskimäärin 32,4 (SD 3,9). Osallistujat määrittelivät tavoitteikseen muun muassa ateriakoon pienentämisen ja sokerittomien juomien käytön lisääntymisen. Kasviksia, hedelmiä ja marjoja käytettiin lähtötilanteessa keskimäärin 3,89 (SD 2,07) kertaa päivässä. Heti intervention jälkeen kasviksia käytettiin 6,04 (SD 2,31) kertaa päivässä. Kasvisten, hedelmien ja marjojen syönti oli kasvanut 2,15 (SD 2,64) kerralla päivässä ja muutos oli tilastollisesti merkitsevä (p<0,001). Kasviksia, hedelmiä ja marjoja syötiin neljä viikkoa intervention päättymisen jälkeen keskimäärin 5,26 (SD 2,41) kertaa päivässä. Verrattuna lähtötasoon kasvisten päivittäinen käyttö oli neljä viikkoa intervention päättymisestä edelleen runsaampaa (p=0,019). Muiden tarkasteltujen ruokamuuttujien muutokset eivät olleet tilastollisesti merkitseviä. Neljän viikon interventiojakson aikana osallistujien paino putosi keskimäärin 1,54 kg (SD 1,82; p=0,001), eli yhteensä laskua tapahtui 2,3 %. Vyötärönympärys kaventui keskimäärin 2,40 cm (SD 2,42; p=0,001). Älypuhelinsovellusta käytettiin aktiivisesti, mutta käytössä oli vaihtelua. Ateriakuvia ladattiin yhteensä intervention aikana sovellukseen 4114 kappaletta (ka 158,2; SD 62,6), eli keskimäärin 5,7 ateriakuvaa päivässä osallistujaa kohden. Tykkäyksiä annettiin yhteensä 7580, (ka 291,5; SD 368 osallistujaa kohden), eli keskimäärin 10,5 tykkäystä päivässä osallistujaa kohden. Sovellukseen kirjauduttiin yhteensä 6921 kertaa (ka 266,2; SD 123,6 osallistujaa kohden), mikä tarkoittaa 9,5 kertaa päivässä osallistujaa kohden. Sovelluksen käyttöaktiivisuus tai koettu sosiaalinen tuki ei ollut yhteydessä ruoankäytön tai painon muutoksiin. Osallistujista 84 % koki kuitenkin saaneensa tukea muilta ryhmän jäseniltä. Johtopäätökset: Mobiiliteknologian välityksellä tapahtuvan ohjauksen avulla voidaan saavuttaa muutoksia ruoankäytössä ja edistää painonpudotusta. Jatkossa painonpudotukseen ja elintapamuutoksiin tähtäävien interventioiden tulisi olla pidempikestoisia ja näyttöä tarvitaan mobiiliteknologian tehokkuudesta pitkäaikaisessa painonhallinnassa. Sosiaalinen tuki ei tässä tutkimuksessa ollut yhteydessä syömis- ja painomuutoksiin, mutta kontrolliryhmän avulla saataisiin lisätietoa siitä, minkälaisiin tuloksiin päästään sovelluksen avulla yksilöohjauksella, verrattuna ryhmäominaisuuden sisältävään ohjaukseen.

Gestational diabetes mellitus (GDM) is a condition of glucose intolerance with onset or first recognition during pregnancy, and it poses multiple health risks for both the mother and the child. The prevalence of GDM is increasing globally and effective interventions are needed to reduce the associated risks. Mobile health (mHealth) solutions have a great potential in answering this need since they are cost-effective and able to reach large groups of people. mHealth solutions might be especially effective for management of chronic conditions that require patient behavior change. Investigating intervention acceptability has an important part in the process of developing successful interventions. The aim of this thesis is to investigate the prospective acceptability of an mHealth intervention for GDM from the perspective of its potential recipients. The thesis also seeks to find out whether there are any associations between technological experience and perceptions of intervention acceptability as well as ways in which the intervention acceptability could be improved. The thesis utilizes data collected in the first phase of the eMOM GDM study, a research project with the aim of developing an mHealth intervention to support the self-management of GDM. The application acceptability was studied with semi-structured interviews with 10 women currently diagnosed with GDM. Previous technological experience was self-reported by the participants in a background questionnaire. Theory-driven content analysis was used to analyze the interviews. The results show that the intervention has high prospective acceptability from the perspective of the potential participants. For most of the domains of acceptability there is still room for improvement, and several ideas for further improving the intervention’s acceptability are discussed. The results could also indicate a possible relationship between technological experience and mHealth intervention acceptability. This thesis contributes to the development of an intervention by providing insight on the factors influencing intervention acceptability and ideas on how to improve it. The results also provide valuable information for developing future mHealth solutions for GDM. The potential association between technological experience and intervention acceptability are interesting regarding all mHealth intervention development and should be studied further.

Digitalization is part of a cultural change that can change people’s attitudes towards food and eating habits. Over the past decade the use of various mobile applications has increased both in people’s daily lives and in scientific research. However, from the health promotion perspective the previous studies have found that health and nutrition related mobile applications are not being used or evaluated in a versatile manner. This study examines the experiences of people who participated in a nutrition intervention at the City of Helsinki's health centers. The study examines participants’ experiences of using a MealLogger-application, its significance for the participants' food relationship and the changes experienced in their own food relationship. MealLogger is a digital food diary. The duration of the intervention was three months. It included group counseling by a nutritionist, weekly challenges and three meetings with the group. During the intervention participants actively used a digital food diary and photographed all the meals and snacks they ate during the day. The study uses a qualitative research approach. The theoretical framework of the thesis is based on the food relationship approach, including the dimensions of thoughts, emotions, senses, behavior and values. The research material consists of twenty thematic interviews. The study material was analyzed using thematic analysis and typification. Participants perceived the use of a digital food diary as positive and as a useful tool. The study identified two types of user experiences relating to the use of phone application: social and independent usage. Changes in eating habits were described in terms of developing a regular meal rhythm, reduction in portion size and reduction or substitution of certain foods, such as junk food or candy. The types of food relationships identified were based on values, behavior, emotions or information. Participants described the changes in food relationship as relationship becoming more relaxed or coherent. Some participants described having a more positive attitude towards a healthy diet. Some participants described not experiencing any changes in their relationship with food after using the digital food diary.