Smartphones and Pediatric Apps to Mobilize the Medical Home

doi:10.1016/j.jpeds.2014.05.037

The Journal of Pediatrics

Volume 165, Issue 3, September 2014, Pages 606-610

An abstract of the study was presented at the Pediatric Academic Societies' meeting, May 4-7, 2014, Vancouver, British Columbia, Canada.

https://doi.org/10.1016/j.jpeds.2014.05.037 Get rights and content

Objectives

To assess digital access and mobile health in urban pediatric clinics by measuring demographics of smartphone ownership, primary uses of mobile devices by teens vs parents/caregivers, and interest levels in using smartphone health apps.

Study design

This cross-sectional survey studied teenagers and caregivers from 2 urban pediatric practices in Bronx, New York; 148 surveys were administered verbally in waiting rooms using a 24-item “iHealthNYC” questionnaire. A demonstration of smartphone health apps was then conducted and data analyzed using bivariate analysis and χ² statistics.

Results

Overall, 84% of subjects were smartphone owners, with 57% using smartphones as their primary internet source. There was no statistical difference in smartphone ownership between age groups or demographics of sex, ethnicity, and socioeconomic status. Smartphone users had a mean 14.5 apps, with 70.4% accessing apps >3 times a day. The majority of participants stated interest in medical apps, although caregivers were significantly more motivated. Likewise, caregivers are more likely to search health topics via their phone (76.7% vs 47.9%, P < .01) and own medical apps vs teens (35.1% vs 16.9%, P = .02).

Conclusion

The prevalence of smartphone and app use in urban pediatric populations is high. With increased interest in mobile health, smartphones are an attractive modality for patient education, disease management, and streamlining health care communication in diverse settings, thus “mobilizing” the medical home. Further research is needed so that pediatricians can promote evidence-based apps, thus enabling patients to take ownership of their health.

Section snippets

Methods

A 24-item “iHealthNYC” questionnaire was developed according to published recommendations for survey methodology from the US Census Bureau.⁶ This survey was composed of demographic data, 6 items adapted from the PEW Research Center, and remaining questions designed by the multidisciplinary research team to measure rates of smartphone/app ownership, internet use, and mobile health interest. Demographics included self-reported answers on sex, age, race, ethnicity, educational level, family size,

Results

Of the 270 individuals approached for this study, 164 (60.7%) agreed to participate as part of this convenience sample. In total, 148 subjects completed the survey, that is, 71 teens and 77 caregivers. Sixteen additional surveys were not analyzed because they were incomplete (12 subjects discontinued after being called in by nurse/physician, 4 because of fatigue).

During the recruitment period, there seemed to be no significant difference in patient demographics, although 78.4% of surveys

Discussion

Well above national estimates, 85% of caregivers and teenagers from these underserved urban pediatric clinics were smartphone owners. App use is already prevalent in diverse pediatric communities, making it a viable digital platform of communication in primary and subspecialty care. Because the majority of participants affirm medical app interest but only 26% (39 of 148 total) own them, the challenge is converting interest to usage. During feedback, participants cited “lack of awareness,

References (24)

E. Jacob et al.
Facilitating pediatric patient-provider communications using wireless technology in children with sickle cell disease
J Pediatr Health Care
(2013)
M. McKenna et al.
Social networks and the practice of medicine: harnessing powerful opportunities
J Pediatr
(2011)
J. Gordon
Educating the patient: challenges and opportunities with current technology
Nurs Clin North Am
(2011)
Crossing the Quality Chasm: The IOM Health Care Quality Initiative [updated 2013 May 8, cited 2014 February 23]....
NORC at University of Chicago. Briefing Paper: Understanding the Impact of Health on Underserved Communities and those...
Zickuhr K, Smith A. PEW Research Center's Internet & American Life Project. [Internet]. Digital Differences. [2012...
C. Free et al.
The effectiveness of M-health technologies for improving health and health services
BMC Res Notes
(2010)
Brustein J. Coming Next: Using an App as Prescribed. New York Times. August...
Smith, Aaron. PEW Research Center's Internet & American Life Project. Smartphone Ownership. [updated 2013 June 5, cited...
Madden M, Lenhart A, Duggan M, Cortesi S, Gasser U. PEW Research Center Internet and American Life Project. Teens &...

T. DeMartini et al.

Access to digital technology among families coming to urban pediatric primary clinics

Pediatrics

(2013)

Fox S, Duggan M. PEW Research Center Internet & American Life Project. [Internet] Mobile Health 2012. [2012 November...

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: The authors declare no conflicts of interest.

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Original ArticleSmartphones and Pediatric Apps to Mobilize the Medical Home

Objectives

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Pediatr Health Care

J Pediatr

Nurs Clin North Am

The effectiveness of M-health technologies for improving health and health services

BMC Res Notes

Access to digital technology among families coming to urban pediatric primary clinics

Pediatrics

Original Article
Smartphones and Pediatric Apps to Mobilize the Medical Home