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The prevalence of long-term or chronic conditions that limit activity and reduce quality of life in young people aged 10-24 years is rising. This group has distinct health care needs and requires tailored support strategies to facilitate increasing personal responsibility for the management of their condition wherever possible, as they mature. Mobile phone and tablet mobile technologies featuring software program apps are already well used by young people for social networking or gaming. They have also been utilized in health care to support personal condition management, using condition-specific and patient-tailored software. Such apps have much potential, and there is an emerging body of literature on their use in a health context making this review timely.
The objective of this paper is to develop a systematic review protocol focused on identifying and assessing the effectiveness of mobile phone and tablet apps that support young people’s management of their chronic conditions.
The search strategy will include a combination of standardized indexed search terms and free-text terms related to the key concepts of young people; long-term conditions and mobile technology. Peer-reviewed journal articles published from 2003 that meet the inclusion and exclusion criteria will be identified through searching the generated hits from 5 bibliographical databases. Two independent reviewers will screen the titles and abstracts to determine which articles focus on testing interventions identified as a mobile phone or tablet apps, and that have been designed and delivered to support the management of long-term conditions in young people aged 10-24 years. Data extraction and quality assessment tools will be used to facilitate consistent analysis and synthesis. It is anticipated that several studies will meet the selection criteria but that these are likely to be heterogeneous in terms of study design, reported outcomes, follow-up times, participants’ age, and health condition. Sub-group analyses will be undertaken and where possible meta-analyses will take place.
This review will synthesize available knowledge surrounding tablet and mobile phone apps that support management of long term physical health conditions in young people. The findings will be synthesized to determine which elements of the technologies were most effective for this population.
This systematic review aims to synthesize existing literature in order to generate findings that will facilitate the development of an app intervention. The review will form the first phase of development and evaluation of a complex intervention as recommended by the United Kingdom Medical Research Council. The knowledge gained from the review will be verified in subsequent phases, which will include primary qualitative work with health professionals and young people with long term conditions as research participants. Young people living with long-term conditions will be involved as co-researchers and consumer advisors in all subsequent phases to develop and evaluate an app to support the management of long-term physical health conditions.
PROSPERO International prospective register of systematic reviews: CRD42014015418; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014015418#.VRqCpTpnL8E (Archived by Webcite at http://www.webcitation.org/6XREcWqQY).
Globally, the pattern of illness in young people aged 10-24 years (hereafter referred to as young people) has shifted from acute episodes, to long-term or chronic conditions that will potentially affect them across the life course [
Survival rates for this group have improved due to better screening, earlier detection, and improvements in the delivery of specialized care [
Delivering safe and timely health care that is accessible and tailored to the individuals’ needs and preferences is a central feature of international health care strategies [
A recent systematic review of self-care support interventions for children and young people found that effective interventions included those that used the Internet and text messaging for delivery, although none of the reviewed studies were reported to use mobile phone or tablet apps [
The potential of mobile technologies in this area is increasingly recognized as being significant. For example, health management behaviors can be integrated with other daily activities by technologies that are capable of tracking information whilst “on the go”. An emerging body of literature on the use of mobile technologies in a health context makes a systematic review timely, to collate and build on lessons learnt as well as prevent duplication of research effort.
In this current review, young people are defined as those aged 10-24 years who are undergoing key elements of development, particularly brain development, which continues until the early 20s [
The new generation of inexpensive, powerful, hand-held computers (mobile electronic devices) were first described in 1987 [
In a recent review of the effectiveness of mobile health technology-based health behavior change or disease management interventions for adults, only 6 of the 49 disease management interventions used apps and none of these involved young people with long-term conditions [
In a recent commentary, Wu and Hommel [
There are barriers to the use of mobile technologies by young people, including the disparity of access to mobile devices and the potential for habituation, suggesting that the use of IT to address health issues may be limited or even harmful to young people [
Nevertheless mobile apps are widely acceptable to young people living in an increasingly technology-rich environment with good access to mobile phones and tablets in their day-to-day lives [
In 2013, the UK National Health Service (NHS) Commissioning Board unveiled a library of NHS reviewed health apps [
Mobile phone and tablet applications can be used in a host of ways to support the management of physical long-term conditions. Namely, these apps seek to define and refine the practices and procedures required for behavioral change; which in turn are anticipated to improve clinical and psychosocial outcomes.
Management of long-term physical health conditions involves 5 core skills: problem solving, decision making, resource utilization, forming patient-health care professional relationships, and taking action [
For example, interventions delivered through a mobile phone or tablet app could include: an electronic diary which would serve as a medication or appointment reminder, a symptom monitor, a meaningful way of displaying clinical data to patients, educational materials tailored to individual patients’ needs and preferences, and/or a way of enabling patients to choose whether or not to share their data with health professional(s) for more meaningful consultations [
This systematic review will synthesize the evidence on all types of mobile phone and tablet apps that are used to support the management of physical long-term conditions in young people. Metaanalyses will be performed where possible. This systematic review will follow the methods described in the Cochrane Handbook for Systematic Reviews of Intervention [
Eligible studies will be identified through a comprehensive literature search of 5 bibliographical databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and the Web of Science). The search strategy has been developed in consultation with an information scientist.
The search strategy uses a combination of standardized indexed search terms and free-text terms that relate to the three key concepts (young people; physical long-term conditions and mobile technology). The search includes British and North American terms and spellings. The search strategy was initially devised in MEDLINE and then adapted to the other databases (see
In addition to testing search sensitivity, those journals associated with the most retrieved citations will be hand-searched from 2009 to 2014. Supplementing the search with hand-searching decreases the likelihood of missing relevant studies. The production of any studies additional to those we have already identified from hand-searching will also allow us to comment on the rigour of the search strategy and the quality of indexing in the said bibliographic databases. This would be particularly useful in the relatively new domain of mobile technology. Also, due to the emerging nature of mobile technology, the search will include conference abstracts published in peer-reviewed journals, and authors will be contacted requesting additional related published or unpublished work.
Two reviewers will independently screen all titles and abstracts retrieved by the search using a screening tool with study inclusion criteria as a prompt (see
Criteria for included studies are in
Population:
Young people aged 10-24 years old (WHO definition 2001 [
Intervention:
Any application for a mobile phone or tablet that can be considered a management intervention (or a component of an intervention) in terms of content and/or delivery. This judgment will be based on the 5 core management skills for long-term physical health conditions, as outlined by Lorig [
Comparisons:
Intervention versus usual care OR intervention variant versus intervention variant OR pre and post.
Outcomes:
Any physiological, attitudinal, behavioral or knowledge outcomes.
Study design:
Randomized controlled trial OR controlled clinical trial OR cohort analytic OR case-control OR cohort OR interrupted time series.
While international literature will be included, non-English language publications will be excluded from the review due to resource limitations. Interventions using mobile phone technology only in the context of delivering/receiving text messages or phone calls will also be excluded. Given the review focus, the technology context is considered key so we will apply a publication start date of 2003. This is the year when 3G networks (required by apps) were launched in the United Kingdom [
For every included study, two reviewers will extract relevant data independently. A tool based on the Data Extraction Template for Cochrane reviews [
The evidence and quality of the papers included in the systematic review will be assessed using a recognized tool [
It is anticipated that there will be several studies that have focused on the effectiveness of mobile phone or tablet apps to facilitate the management of long-term physical conditions in young people. There are expected to be various outcome measures at various time-points for different conditions.
Where there is sufficient homogeneity amongst trials, metaanalyses will be undertaken with the RevMan software as used by the Cochrane Collaboration (RevMan v 4.2.8, Cochrane IMS). Levels of homogeneity can be determined using the chi-squared statistical test. Similar outcome measures will enable a pooled effect size and confidence intervals to be calculated as well as establishing level of publication bias through the use of funnel plots.
Based on the review’s broad inclusion criteria, it is likely that interventions will be implemented at different time points and at various stages of an individual’s illness trajectory. Moreover the population will likely be different age groups living with various physical long-term conditions. To counter this, the following categorizations will be considered for the synthesis: different age categories of young people; interventions developed to facilitate self-management and shared/joint management; whether or not interventions have a theoretical underpinning; short-term and long-term, based on whether any differentiation was made on length of time patient had lived with the condition. Wherever appropriate, pooled estimates will be created and sensitivity analyses will be used to assess the appropriateness of this.
This systematic review aims to determine whether mobile phone and tablet apps are effective in young people’s management of physical long-term conditions. Currently, the reviewers are screening papers meeting the search strategy. It is anticipated that by synthesizing included studies, the systematic review results can comment on what components of interventions are most associated with their effectiveness. The completion date for the review is projected to be early-mid-2015.
Health care advancements mean young people living with long-term physical conditions have improved survival rates [
We have an established multidisciplinary team of experts including health care professionals, consumer representatives, and researchers to take this project forward and ultimately develop evidence-based mobile phone and tablet apps for young people with physical long-term conditions. The consumer representatives on the research team have previously undertaken an online survey of 11-19 year olds with Juvenile Idiopathic Arthritis (JIA), which confirmed the need for an app that is codeveloped by people with experience of JIA (personal communication S Stones and S Douglas, 2013). This echoes other reports of young people calling for Web-based interventions to support self-management [
A particular strength of this review is that it aims to identify what interventions exist for a variety of long-term conditions (as opposed to condition specific reviews, for example in asthma [
As yet, the effectiveness of mobile phone or tablet apps to support young people living with long-term conditions is unknown. With the emphasis on limited resources and technology, it is imperative to wholly understand the existing evidence base. This knowledge will serve those considering developing, using or recommending health care apps. Ultimately therefore, this systematic review aims to identify the existing evidence and evaluate the effectiveness of mobile phone and tablet apps for the management of physical long term conditions in young people.
Moreover, by identifying existing evidence and examined current apps, the review’s results will form the first phase of the Medical Research Council (MRC) framework for developing and evaluating complex interventions [
Example search strategy for Medline Database: Ovid MEDLINE 1946 to January Week 2 2014.
This work is supported by a University of Manchester (UoM) Pump Priming Grant and a National Institute of Health Research, Manchester Musculoskeletal Biomedical Research Unit small research grant. We are very grateful for the support of other research team members on this project (Eileen Baildam, Alice Chieng, Sharon Douglas, Helen Foster, Simon Stones, and Wendy Thomson).
None declared.