Importance Mobile health interventions are increasingly popular in pediatrics; however, it is unclear how effective these interventions are in changing health outcomes. Objective To determine the effectiveness of mobile health interventions for improving health outcomes in youth 18 years or younger. Data Sources Studies published through November 30, 2016, were collected through PubMed, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, and PsychINFO. Backward and forward literature searches were conducted on articles meeting study inclusion criteria. Search terms included telemedicine , eHealth , mobile health , mHealth , app , and mobile application . Study Selection Search results were limited to infants, children, adolescents, or young adults when possible. Studies were included if quantitative methods were used to evaluate an application of mobile intervention technology in a primary or secondary capacity to promote or modify health behavior in youth 18 years or younger. Studies were excluded if the article was an unpublished dissertation or thesis, the mean age of participants was older than 18 years, the study did not assess a health behavior and disease outcome, or the article did not include sufficient statistics. Inclusion and exclusion criteria were applied by 2 independent coders with 20% overlap. Of 9773 unique articles, 36 articles (containing 37 unique studies with a total of 29 822 participants) met the inclusion criteria. Data Extraction and Synthesis Of 9773 unique articles, 36 articles (containing 37 unique studies) with a total of 29 822 participants met the inclusion criteria. Effect sizes were calculated from statistical tests that could be converted to standardized mean differences. All aggregate effect sizes and moderator variables were tested using random-effects models. Main Outcomes and Measures Change in health behavior or disease control. Results A total of 29 822 participants were included in the studies. In studies that reported sex, the total number of females was 11 226 (53.2%). Of those reporting age, the average was 11.35 years. The random effects aggregate effect size of mobile health interventions was significant (n = 37; Cohen d  = 0.22; 95% CI, 0.14-0.29). The random effects model indicated that providing mobile health intervention to a caregiver increased the strength of the intervention effect. Studies that involved caregivers in the intervention produced effect sizes (n = 16; Cohen d  = 0.28; 95% CI, 0.18-0.39) larger than those that did not include caregivers (n = 21; Cohen d  = 0.13; 95% CI, 0.02-0.25). Other coded variables did not moderate study effect size. Conclusions and Relevance Mobile health interventions appear to be a viable health behavior change intervention modality for youth. Given the ubiquity of mobile phones, mobile health interventions offer promise in improving public health.

Mobile Health Interventions for Improving Health Outcomes in Youth: A Meta-analysis.

Distal technologies and type 1 diabetes management

Mobile phone text messaging in improving glycaemic control for patients with type 2 diabetes mellitus: A systematic review and meta-analysis.

Exploring app features with outcomes in mHealth studies involving chronic respiratory diseases, diabetes, and hypertension: a targeted exploration of the literature.

Background:There is growing evidence for the feasibility of text-based interventions for pediatric patients with type 1 diabetes (T1D). However, less is known regarding whether the use of personalized text messages with high-risk youth and their caregivers is associated with improvements in youth health. This study examines the use of diabetes-specific texts and associated health outcomes for participants of the Novel Interventions in Children’s Healthcare (NICH) program.Methods:Text messages sent to youth with T1D and their caregivers during NICH intervention were coded regarding diabetes relevance and adherence-related content. Health outcome data (eg, HbA1c values, hospital admissions) prior to and following NICH program enrollment were collected.Results:Fewer than half (43%) of texts sent to patients and their caregivers were identified as being related to diabetes, and over 95% of diabetes-related texts were identified as adherence-related. Participants in the NICH program demonstrated a significant ...

NICH at Its Best for Diabetes at Its Worst: Texting Teens and Their Caregivers for Better Outcomes

We conducted a feasibility study of a mobile phone messaging service for children and adolescents with type 1 diabetes. Two hundred children with type 1 diabetes took part in a six-month trial. The children were provided - through their parents - with daily information messages, with weekly interactive messages, and on request, with multimedia video messages about procedures related to diabetes care. During the study, approximately 30,000 information messages and 2800 interactive messages were sent. One month before the trial, the mean fasting blood glucose level of the children was 150 mg/dl. After the trial, the mean fasting blood glucose level was 133 mg/dl (P < 0.001). There were also significant reductions in post prandial blood glucose level, HbA1c, frequency of simple hypoglycaemic attacks and frequency of blood glucose monitoring. A before and after questionnaire showed that the parents' knowledge of diabetes had improved significantly during the trial. Mobile phone text messaging offers a useful means of contact between clinic visits. The results of the trial suggest that it increases adherence to diabetes therapy and improves clinical outcomes in children and adolescents with type 1 diabetes.

Effect of mobile phone short text messages on glycaemic control in children with type 1 diabetes.

Five Saudi children with type 1 diabetes mellitus were selected and started on determir-based basal-bolus insulin therapy. Selection criteria included diabetic children with poor diabetic control and recurrent daytime and nocturnal hypoglycemic episodes. The patients were on conventional insulin therapy that included two injections of insulin per day before shifting them to detemir-based basal bolus insulin regimen. They had type 1 diabetes mellitus for a mean duration of 3 years and were followed on basal-bolus insulin regimen therapy using detemir insulin for a mean duration of 3.5 months. Post basal-bolus regimen, there was no significant change in HbA1c level, however, there was significant reduction in frequency of hypoglycemic episodes. The frequency of hypoglycemic episodes (defined as a blood glucose level of 40 mg/dl or less) ranged from 4 to 9 episodes per month on conventional insulin therapy and dropped to 2-5 per month post basal-bolus therapy. The present study showed that basal-bolus insulin regimen is effective in improving the metabolic control in type 1 diabetic Saudi children. The results of this local experiment are encouraging to implement this mode of intensive insulin therapy in all candidate diabetic Saudi children.

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Musleh Jabbari

Papers

Effect of mobile phone short text messages on glycaemic control in children with type 1 diabetes.

Basal-Bolus Insulin Regimen Using Insulin Detemir in Type 1 Diabetic Saudi Children