Background: Mobile app-assisted self-care interventions are emerging promising tools to support self-care of patients with chronic diseases such as type 2 diabetes and hypertension. The effectiveness of such interventions requires further exploration for more supporting evidence. Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to examine the effectiveness of mobile app-assisted self-care interventions developed for type 2 diabetes and/or hypertension in improving patient outcomes. Methods: We followed the Cochrane Collaboration guidelines and searched MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus for relevant studies published between January 2007 and January 2019. Primary outcomes included changes in hemoglobin A1c (HbA1c) levels, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Changes in other clinical-, behavioral-, knowledge-, and psychosocial-related outcomes were included as secondary outcomes. Primary outcomes and objective secondary outcomes that were reported in at least two trials were meta-analyzed; otherwise, a narrative synthesis was used for data analysis. Results: A total of 27 trials were identified and analyzed. For primary outcomes, the use of mobile app-assisted self-care interventions was associated with significant reductions in HbA1c levels (standardized mean difference [SMD] −0.44, 95% CI −0.59 to −0.29; P<.001), SBP (SMD −0.17, 95% CI −0.31 to −0.03, P=.02), and DBP (SMD −0.17, 95% CI −0.30 to −0.03, P=.02). Subgroup analyses for primary outcomes showed that several intervention features were supportive of self-management, including blood glucose, blood pressure, and medication monitoring, communication with health care providers, automated feedback, personalized goal setting, reminders, education materials, and data visualization. In addition, 8 objective secondary outcomes were meta-analyzed, which showed that the interventions had significant lowering effects on fasting blood glucose levels and waist circumference. A total of 42 secondary outcomes were narratively synthesized, and mixed results were found. Conclusions: Mobile app-assisted self-care interventions can be effective tools for managing blood glucose and blood pressure, likely because their use facilitates remote management of health issues and data, provision of personalized self-care recommendations, patient–care provider communication, and decision making. More studies are required to further determine which combinations of intervention features are most effective in improving the control of the diseases. Moreover, evidence regarding the effects of these interventions on the behavioral, knowledge, and psychosocial outcomes of patients is still scarce, which warrants further examination.

Background: Technological surrogate nursing (TSN) derives from the idea that nurse-caregiver substitutes can be created by technology to support chronic disease self-care. Objective: This paper begins by arguing that TSN is a useful and viable approach to chronic disease self-care. The analysis then focuses on the empirical research question of testing and demonstrating the effectiveness and safety of prototype TSN supplied to patients with the typical complex chronic disease of coexisting type 2 diabetes and hypertension. At the policy level, it is shown that the data allow for a calibration of TSN technology augmentation, which can be readily applied to health care management. Methods: A 24-week, parallel-group, randomized controlled trial (RCT) was designed and implemented among diabetic and hypertensive outpatients in two Hong Kong public hospitals. Participants were randomly assigned to an intervention group, supplied with a tablet-based TSN app prototype, or to a conventional self-managing control group. Primary indices—hemoglobin A1c, systolic blood pressure, and diastolic blood pressure—and secondary indices were measured at baseline and at 8, 12, 16, and 24 weeks after initiation, after which the data were applied to test TSN effectiveness and safety. Results: A total of 299 participating patients were randomized to the intervention group (n=151) or the control group (n=148). Statistically significant outcomes that directly indicated TSN effectiveness in terms of hemoglobin 1c were found in both groups but not with regard to systolic and diastolic blood pressure. These findings also offered indirect empirical support for TSN safety. Statistically significant comparative changes in these primary indices were not observed between the groups but were suggestive of an operational calibration of TSN technology augmentation. Statistically significant changes in secondary indices were obtained in one or both groups, but not between the groups. Conclusions: The RCT’s strong behavioral basis, as well as the importance of safety and effectiveness when complex chronic illness is proximately self-managed by layperson patients, prompted the formulation of the empirical joint hypothesis that TSN would improve patient self-care while satisfying the condition of patient self-safety. Statistical and decision analysis applied to the experimental outcomes offered support for this hypothesis. Policy relevance of the research is demonstrated by the derivation of a data-grounded operational calibration of TSN technology augmentation with ready application to health care management. Trial Registration: ClinicalTrials.gov NCT02799953; https://clinicaltrials.gov/ct2/show/NCT02799953

Visualizations have been found to be a promising solution to aid individuals’ comprehension of digital health information. However, how visualizations can be better contextualized remains unclear. This study aimed to examine the effects of visualizations of digital health information with various contextual cues and age on comprehension through eye-tracking techniques. A two-way mixed design was employed, with visualization (basic, color, color + text, and color + text + personalized statement) and age (young and older adults) as independent variables. Forty-one participants attended an experiment where they were asked to perform verbatim comprehension and value interpretation tasks in response to varied visualizations of digital health information. The results indicated that the four visualizations yielded comparable task completion time and accuracy. Older adults had longer task completion time and more errors compared with their counterparts. While eye movement measures were comparable across different visualizations, they were mostly affected by age and areas of interests. Different visualizations might attract different patterns of visual attention and yield varied effectiveness across age groups. Future research should focus on how to better visualize digital health information for older adults. Design practitioners should carefully consider how to attract patients’ visual attention to important information to improve comprehension.

A systematic review and meta-analysis were conducted to examine the effectiveness of facial anthropomorphism of learning material design in improving learning and other relevant outcomes. We searched Web of Science, PsycInfo, and PsycArticle for studies published before February 2023. Learning outcomes included transfer, retention, and comprehension. Other relevant outcomes included affective-motivational, effort, and experience outcomes. Outcomes that were reported in at least five independent experiments were meta-analyzed; otherwise, a narrative synthesis was performed. Subgroup analysis by participants’ age and material type was employed for learning outcomes. A total of 33 independent experiments from 13 research articles were identified and analyzed. For learning outcomes, facial anthropomorphism yielded significant improvements in transfer (standardized mean difference [SMD] 0.28, 95% CI 0.15 to 0.40, p < 0.001), retention (SMD 0.31, 95% CI 0.14 to 0.48, p < 0.001), and comprehension (SMD 0.46, 95% CI 0.27 to 0.64, p < 0.001). Anthropomorphism yielded stronger effect in retention among juvenile students and for static learning materials. Additionally, anthropomorphism design achieved significantly positive effects in positive affect, intrinsic motivation, intrinsic motivation change, perceived difficulty, intrinsic cognitive load, germane cognitive load, perceived learning outcome, aesthetics, and enjoyment. Nineteen outcomes were narratively analyzed and mixed results were found. Facial anthropomorphism design of multimedia learning materials can induce positive emotions in learners and improve their intrinsic motivation that in turn facilitates learners’ transfer, retention, and comprehension performance. The study provides valuable insights that can guide educators and multimedia designers in applying facial anthropomorphism with learning materials to facilitate learning outcomes.