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Published on 27.03.15 in Vol 3, No 1 (2015): Jan-Mar
Preprints (earlier versions) of this paper are available at http://preprints.jmir.org/preprint/3861, first published Sep 26, 2014.
This paper is in the following e-collection/theme issue:
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Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps
Deborah Vollmer Dahlke1, MPAff, DrPH ;
Kayla Fair1, RN, MPH ;
Y Alicia Hong1, PhD ;
Christopher E Beaudoin2, PhD ;
Jairus Pulczinski2, BA ;
Marcia G Ory1, MPH, PhD
1Texas A&M School of Public Health, Health Promotion and Community Health Sciences, Texas A&M University, College Station, TX, TX, United States
2Texas A&M University, Department of Communications, College Station, TX, TX, United States
Corresponding Author:
Deborah Vollmer Dahlke, MPAff, DrPH
Texas A&M School of Public Health
Health Promotion and Community Health Sciences
1266 TAMU
College Station, TX, TX, 77843
Fax:1 979 845 3322
Background: Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories.
Objective: This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps.
Methods: The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems.
Results: A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen's kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps.
Conclusions: Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice.
JMIR mHealth uHealth 2015;3(1):e31
doi:10.2196/mhealth.3861
mobile apps;
health behavior;
survivorship;
health promotion;
eHealth;
mobile health
We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.
[Roy Amara, leader at the Institute for the Future]
The use of mobile phones has shifted from voice and text only to the Internet accessibility of smartphones. In this shift, a large market of mobile software apps has emerged. As of May 2014, the United States had 345.2 million mobile subscribers [1]. This is more than one mobile subscription per person, based on US population estimates of 313.9 million [2]. According to the Pew Internet and American Life Surveys, 91% of US adults own a cell phone and 60% use their phone to access the Internet [3].
Mobile technology, smartphones, and tablets provide anytime anywhere access to health information, health promotion, and behavioral interventions. Use of mobile technology for health-seeking information is high, with 31% of smartphone owners using the device to search for health information [3]. Personal mobile apps are a critical component of mHealth, providing educational resources, decision-making tools, psychosocial communication, and social support.
For the growing population of cancer survivors, who experience differing needs in terms of medical care, psychosocial support, and practical needs of daily living, mHealth apps have the potential to provide access to information and health behavior interventions that are low cost, easy to access, and personalized to their specific needs. Increasingly, socially disadvantaged populations including racial/ethnic minorities, those with lower incomes, and elderly persons use mobile phones as their primary or only connection to the Internet [4,5]. While sparse, studies such as those by Bender et al are beginning to explore the efficacy and potential of mobile app interventions [5]. With relation to disease-specific apps, previous reviews have coded cancer apps to examine which apps were scientifically/clinically based or evidence-based or on the basis of the app's purpose and content such as awareness, cancer treatment information, fundraising, or early detection [6-8]. To date, none of the research on mHealth cancer apps has systematically assessed the extent to which cancer survivorship apps, as health behavioral interventions, are theory-based.
Study Aims
A sophisticated taxonomy of health behavior theories and behavior change frameworks developed by Abraham and Michie was later refined as a system to code Internet interventions associated with health behavior by Webb et al [9-11]. Our review further adapts that taxonomy to mHealth interventions for cancer survivorship and investigates if and how behavior change theories, some of which form the groundwork for human computer interactions and cognitive psychology, are being used. By doing so, we begin to answer two important theoretical and applied questions: "To what extent are apps for health promotion and disease prevention based on health behavior and communication theories and frameworks?" and "How can mHealth cancer survivorship apps be designed differently to be more effective health behavior change interventions?"
As a secondary aim, we considered the comparison of the degree to which the health behavior and communication theories appear to be taken into consideration based on the type of mobile platform (ie, iOS compared to Android) the apps used.
In preparation for this research and a number of other health communication and mobile app projects, we worked closely with over 30 cancer survivors from various racial, ethnic, age, and sociodemographic groups. We considered a cancer survivor to be any person who has been diagnosed with cancer from the time of diagnosis through the balance of life.
Prior to and during this research, we consistently received feedback on their informational needs and preferences in the use of mobile apps. In this study, we used such qualitative input in the formative stage. In November 2013, we conducted a computerized search for mHealth cancer survivorship apps on the Apple App Store for iPhone and iPad apps and on Google Play for Android apps. We explored other mobile app markets including those for Nokia, Microsoft, and Blackberry smartphones but found no cancer apps that met our criteria of being more than badges or skins. As a result of this preliminary analysis, we limited our search to native apps—software apps that must be installed on a device such as a smartphone, iPad, or table—available either for the iOS or Android platform or both. The apps could have elements or portions linked to websites or cloud-based servers, including assessments, videos, PDFs, or other linked materials, but the user interface must be initiated on the smartphone or tablet.
Inclusion and Exclusion Criteria
Mobile app searches were conducted on Google Play and the Apple App Store using the search terms cancer + survivor, cancer + survivorship, cancer + care, cancer + treatment, and cancer + management.
Web-based searches for mobile apps were also made on Google, Bing, and Yahoo, as these are among the top search engines used in English. Search terms included cancer + mobile web, cancer survivorship + mobile web, and cancer survivorship app.
Textbox 1. Inclusion criteria for survivorship apps
View this box
Textbox 2. Exclusion criteria for survivorship apps.
The taxonomy for behavior change techniques used in this research study was derived from a taxonomy of 26 health behavior change techniques (HBCTs) by Abraham and Michie with a few important changes based on the characteristics of mHealth apps [9-11]. The mHealth app taxonomy was limited to 15 HBCTs with each described by one or more health behavior or communication theories. An additional area of HBCTs included in the mHealth taxonomy but not found in the taxonomy of Abraham and Michie and the works by Webb et al is tailored health communications (THC) [9-11]. As indicated by Rimmer and Kreuter, THCs are important elements of health communication and persuasion and may promote action through increased relevance and motivation to process information actively [12].
The theoretical models and frameworks initially used by Abraham and Michie and Michie et al [9,11] and Webb et al [10] that were included in the mHealth survivorship app taxonomy are as follows: elaboration likelihood model (ELM) (Petty and Cacioppo), social cognitive theory (SCogT) (Bandura), information-motivation-behavioral skills model (IMB) (Fisher and Fisher), control theory (CT) (Carver and Scheier), and operant conditioning (OC) (Skinner). Also used were theories related to the impact of social support on health behaviors (SS) (Cohen) and social comparison (SC) (Festinger) and theory of planned behavior (Ajzen) [12-19].
A coding manual was developed specifically for use in coding the mHealth apps for cancer survivorship (Multimedia Appendix 1) based on the work of Michie et al, A Taxonomy of Behavior Change Techniques Used in Interventions [9]. A coding guide (Table 1) drawn from the mHealth cancer survivorship taxonomy of HBCTs and theories was developed, analyzed, and tested by the coders DVD, KF, JP. The team tested and trained with the coding guide using three apps that existed both on iOS and Android mobile platforms that were not specifically related to cancer. These apps were not included in the research assessment.
Master lists of identified iOS and Android apps were developed collectively by the coders for use in downloading the apps to their smartphones and tablets. Two coders were assigned to each type of app platform, and each coder independently loaded the apps that met the eligibility criteria onto one or more mobile devices. The coding rubric used a score of 1 to indicate that the HBCT was present and 0 to indicate that the HBCT was absent. Based on two raters for each app, total possible scores for the platforms are 72 for iOS apps (36 apps times 2 raters) and 64 (32 apps times 2 raters) for the Android apps. Several apps were not working and could not be loaded and a few crashed consistently, thus preventing coding. The only major difference in coding approach was related to coding of games, and that issue was easily resolved by consensus.
Behavior Change Techniques Theory Basis Definition
Personalized THCa,
SCogTb,
ELMc Rimer and Kreuter define personalization and tailoring as a process for creating individualized communications by gathering and assessing personal data, (ie, logging in with personal information)
Tailoring (macro/meso/micro) THC, ELM Macro occurs at the group level; meso is determined by individual needs of user but is not highly specific; micro is very specific to the user
Health behavior linkage IMBd General information about linkage of individual behavior and health (ie, benefits of good nutrition and physical activity)
Action/behavior consequences TRAe, TPBf,
SCogT,IMB Information about potential benefits and costs of action or inaction in relation to health and well-being (ie, stop smoking)
Intention formation TRA, TPB,
SCogT, IMB Encourage the person to take an action or decide on a goal to improve treatment response or survivorship
Provide instruction SCogT Show or tell the user how to perform a behavior (ie, asking your doctor questions)
Provide materials for education SCogT Provide information or educational materials about cancer care and survivorship
Goal setting CTg Prompt specific goal setting (ie, walk 5 miles daily)
Self-efficacy SCogT Aid user in recognizing skills or education developed
Feedback on performance CT Scores, tests, game results
Persuasion (general/targeted) OCh Messages to strengthen self-efficacy/control beliefs
Social influence: information on peer behavior (passive) SCogT Facilitate user access to information on how others have changed behavior or addressed challenges (nonexpert)
Opportunity for social comparison (active) SSi/SCj Facilitate active user engagement in social media for sharing and comparison
Mobilize social norms (exposure to important others) SS/SC Provide user exposure to expert opinions and information
aTHC, tailored health communication model
bSCogT, social cognitive theory
cELM, elaboration likelihood model
dIMB, information-motivation-behavioral skills model
eTRA, theory of reasoned action
fTBP, theory of planned behavior
gCT, control theory
hOC, operant conditioning
iSS, social support
jSC, social comparison
Table 1. mHealth cancer survivorship taxonomy for coding.
View this table
Ratings for Health Behavior Techniques
A search of the mHealth cancer survivorship apps yielded a total of 104 potentially relevant apps that appeared to meet the selection criteria. After removing the paid apps (N=7) and those that crashed or would not open (N=29), there were 68 apps that were coded. A flow diagram showing the numbers, source, and refinement of the apps identified for coding is shown in Figure 1.
There were three apps that were available on both the Apple App Store and Google Play, and both teams coded these apps. Seven of the Android cancer apps were configured as games, as were four iOS games. A total of 68 unpaid apps were coded and 65 of these were unique. Using a Cohen's kappa analysis statistic, the inter-rater reliability for the iOS apps was .86 (P<.001) and for the Android apps it was .77 (P<.001). Table 2 shows the results of the teams' scorings of the HBCT for both Android and iOS platforms.
In considering our secondary aim of comparing platforms, we found that the iOS cancer survivorship apps received higher scores across nearly all of the HBCT areas. Additionally, the iOS apps appeared to have greater functionality and appeared to include more of the HBCTs overall, per app, than the Android apps.
Techniques/Characteristics iOS HBCT Scores
(N=36) Android HBCT Scores
(N=32)
Personalization 48 24
Tailoring, macro 45 15
Tailoring, meso 8 6
Tailoring, micro 11 4
Health behavior linkage 32 32
Action/behavior consequences 21 2
Prompt for intention formation 48 10
Provide instruction 54 10
Provide materials for education 28 12
Prompt for specific goals 10 14
Review of goal activity 2 2
Self-monitoring of goals 24 13
Feedback/evaluation of goals 18 16
General persuasion 25 2
Tailored persuasion 10 0
Social influence (passive) 17 0
Social influence (active) 18 8
Social norms—opportunity for comparison to important others 8 1
Table 2. Rating totals for health behavior change techniques. Each item was scored as 1=present or 0=not present. Total possible scores for each platform are 72 (2×36) for iOS apps and 64 (2×32) for Android apps based on the use of two raters for each type of app.
Figure 1. Android and iOS app selection flow chart.
View this figure
Percentages of Health Behavior Change by Category
The percentage of HBCTs for each category of both the iOS and the Android platforms is shown in Table 3. A discussion of the percentages and interpretation of the results is found in the section following Table 3.
Technique/Characteristic iOS Platform, %
(N=36) Android Platform, %
(N=32) Total for Both
Platforms, %
Personalization 67 38 53
Tailoring, macro 63 23 44
Tailoring, meso 11 9 10
Tailoring, micro 15 6 11
Health behavior linkage 44 50 47
Action/behavior consequences 29 3 11
Prompt for intention formation 67 16 25
Provide instruction 75 16 32
Provide materials for education 39 19 30
Prompt for specific goals 14 22 18
Review of goal activity 3 3 3
Self-monitoring of goals 33 20 27
Feedback/evaluation of goals 25 25 25
General persuasion 35 3 20
Tailored persuasion 14 0 7
Social influence (passive) 24 0 13
Social influence (active) 25 0 19
Social norms—opportunity for comparison to important others 11 2 6
Table 3. Category and platform percentages for health behavior characteristics. Each item was scored as 1=present or 0=not present.
Personalization in the apps includes requiring that the user log in with a username and password and was present in 67% of the iOS apps (48/72) and 38% (24/64) of the Android apps. For most of the apps, personalization enabled access to selected parts of the app and also allowed data to be entered and maintained on the app's server rather than being stored on the phone, thus providing adequate security for sensitive health information. Several apps requested specific information about the user's type of cancer and then provided meso- or micro-level tailoring regarding concerns such as types of treatment and late effects. Macro-tailoring was the most commonly found technique with 63% (45/72) for iOS and 23% (15/64) for Android. An example of personalization (Figure 2), with both macro- and meso-level tailoring, is found in the Cancer Side Effects Helper app developed by PearlPoint Cancer Support. The app allows users to identify the side effects they may be experiencing (eg, fatigue, dry mouth, nausea). Once a user selects a side effect, the app provides education and health behavior linkages and may also suggest specific goals or actions to reduce the identified side effect.
Scoring on health behavior linkages was indicative of the app providing basic information about cancer care and survivorship, including diagnosis, treatment, and/or availability of resources for clinical or non-clinical purposes. Based on the high scores for this HBCT on both iOS and Android apps, it appears that most of the apps, 94% (64/68), provide a basic level of health behavior information.
iOS apps had much higher scores for action/behavior consequences at 29% (21/72) as compared to the Android platform apps at 3% (19/64). Scoring for this category indicates that the app provides information or feedback on health behavior changes suggested or stimulated by the app.
The prompt for intention formation HBCT was coded as positive if the app included suggestions for general behavior or for formulating desired outcomes of a behavior for healthy survivorship (eg, maintain a healthy weight, exercise daily, stop smoking, and consider medication). The scoring of the apps indicated that iOS apps at 67% (48/72) included this technique more frequently than Android apps at 16% (10/64). This HBCT concerns the user's intent to do something and is different from taking the step to set a goal or initiate an action. Such behavioral intention is a critical motivational factor in determining whether a person actually adopts a behavior, as discussed by Ajzen [17]. An example of prompting for intent formation can be found in the AYA Healthy Survivorship app, an iOS app, shown in Figure 3.
The iOS app Lymphedema Tracker, shown in Figure 4, provides instruction on how to measure a survivor's arm to set a baseline and do ongoing measurements to track lymphedema. Following the trend, a greater percentage of the iOS apps (54/72, 75%) provided instruction on this HBCT as compared to the Android apps (10/64, 16%).
A significantly greater percentage of the iOS apps (28/72, 39%) demonstrated the provide materials for education HBCT when compared to the Android platform apps (12/64, 19%). To be coded as positive, the material on the app had to be directly related to showing or telling the user ways to facilitate a specific health behavior change. An example of education specific to managing fatigue, a common concern for survivors and in post-treatment, is found in the iOS app My Cancer Manager from the Cancer Support Community (Figure 5). The app educates patients on the activity of tracking their fatigue and also instructs them to consider sharing information with a provider if the score stays persistently high. Overall the app scores for this HBCT were low at 39% (28/72) for the iOS apps and 19% (12/64) for the Android apps.
The presence of activities or information across both iOS and Android platform apps for goal-setting activities (eg, prompts for specific goals, review of goals, self-monitoring of goals, and feedback or evaluation of goals) was low overall. Examples in the area of self-monitoring of goals were suggestions found in several apps for the survivor to record brief notes or keep a diary or journal to record behaviors and actions related to health behaviors. Examples found among the apps included journals or tracking tools for pain and distress monitoring, as well as suggestions for practicing meditation. Among the iOS apps, these categories ranged from a low of 3% (2/72) for reviews of goal activity to a high of 33% (24/72) for self-monitoring of goals. Similarly, but lower still, the Android apps ranged from a low of 3% (2/64) to a high of 25% (16/64). These low scores included activities in the mHealth cancer survivor game apps for engaging in a first-person shooter cancer-destroying activity with goals for hitting targets. The user generally received feedback on scores for numbers of strikes or targets acquired. Other apps prompted goal setting via use of guided imagery suggesting that the user focus energy and concentration on specific body parts or processes affected by cancer.
The delivery of personalized or tailored messages designed to strengthen efficacy/control beliefs related to the initiation or execution of health behavior change has been heralded as an area of promise for mHealth apps. The use of mHealth persuasion in cancer survivorship apps includes activities or signaling for new beliefs and or new information. Scores in this area were low for both general and targeted persuasion. As an example, Figure 6 shows use of general persuasion that can be found in the AYA Healthy Survivorship iOS app that allows the user to elect to receive a "health tip of the day." The highest scores were found among the iOS apps, with a low for targeted persuasion of 14% (10/72) and a high of 35% (25/72) for general persuasion. Persuasion barely registered as an HBCT area on the Android apps with a low of zero for tailored persuasion and 3% (2/64) for general persuasion.
Social influence is an area of HBCT techniques that would appear to be a strong opportunity area for mHealth apps in cancer survivorship, given the easy access to mobile communities including Twitter, Facebook, YouTube, and numerous other cancer-related blog and social networking sites. The presence of passive social influence, where the app provides stories, anecdotes, interviews, or case histories about what other cancer survivors have done or experienced was, again, unexpectedly low. For the iOS apps, only 24% (17/72) offered access to such stories and Android apps had no scores for this HBCT. Active social influence, wherein a survivor might be invited to participate in a group or peer discussion and relay activities about their own, also was relatively low with a score of 25% (18/72) for iOS and 0 for the Android apps.
The apps were examined for examples of mobilization of social norms in which the user would be exposed to the social norms of important others in relation to a healthy survivorship activity or health behavior change. Important others could include a valued and trusted expert such as a health care professional or a celebrity cancer survivor advocate. One of the apps that uses this HBCT most effectively is the Cancer.net app (Figure 8), which supports RSS feeds on the app linking users to physicians and important role models. Cancer.Net was developed by the American Society of Clinical Oncology and is offered on both the iOS and Android platforms.
Cancer.net also provides the user with links for brief videos of well-respected cancer researchers and clinicians on a range of topics, including HBCTs. While this is an area of HBCT that offers easy access on mHealth apps, few of the apps reviewed in the study incorporated this potentially important element. Scores for these apps were 11% (8/72) for iOS apps and 2% (1/64) for Android apps. The evidence base for considering highly interactive mobile games and interactive game-like elements for guided imagery in apps is very limited. The potential applications of health behavior change theories in the design of game and game-like interventions are significant, ranging from elements of personalization and tailoring for scoring to goal setting, tracking and feedback, and potentially powerful elements of social interaction among game participants.
Figure 2. My PearlPoint app.
Figure 3. AYA Healthy Survivorship app: intent formation.
Figure 4. Lymphedema Tracker app.
Figure 5. My Cancer Manager app.
Figure 6. AYA Healthy Survivorship app: daily tip.
Figure 8. Re-Mission 2: Nanobot's Revenge app.
Games for Cancer Survivorship
Our team was initially optimistic about the inclusion and rating of the four iOS and Android mHealth games and interactive apps for cancer survivorship. App names such as Cancer Fighter, Whip Cancer, and Play to Cure promised much but delivered little as HBCT interventions. Few of the interactive or game apps provided even basic education or information for HBCTs. Rather, the user was launched into series of images and audio effects with opportunities to score by shooting down images on the mobile screen but offered little or no explanation about what might be of benefit to the cancer survivor. An exception was found in Re-Mission2: Nanobot's Revenge (Figure 7), a project of HopeLab that initiates the shooter game by explaining that the user is the Nanobot and the goal is to "fire targeted treatment at growing cancer and prevent it from escaping into the blood stream."
Figure 7. ASCO's Cancer.Net app.
Principal Findings
A primary aim of this study was to analyze the linkage of HBCT interventions in cancer survivorship mHealth apps to theories and models that are used to predict health behavior change and communications, including those that are specific to information processing and human computer interaction such as control theory and feedback systems. The mHealth apps in this study varied greatly in how they ranked in the use of theoretical elements of health behavior change. This study's findings are consistent with prior research that asserts that mHealth interventions could benefit from increased use of behavior and communications theories in their design [10-16,20,21]. In reviewing the HBCT scores for the apps, three theories/models appeared to be most influential: SCogT, THC, and CT. However, with no explicit discussion regarding the design or development of the apps reviewed in this study, it is not clear if these theories were intentionally applied or that the design deliberately reflected a theoretical approach. Moreover, the HBCT elements were just barely present in the game apps, which made up 16% (11/68) of all coded apps.
The mHealth cancer survivorship apps that appeared to be firmly based in HBCT theory were similar in that they offered multiple types of HBCTs, required personalization and some degree of tailoring, were highly interactive, included some type of questions or assessments, suggested goals and actions, and provided social engagement and the mobilization of social norms. Most of these examples were either developed by cancer advocacy groups, clinical associations, or academic researchers, which suggests that the information provided was more likely to be based in evidence and clinical research and health behavior theory. Examples include (1) Livestrong Cancer Guide and Tracker app, available only for iPad (see Figure 9); (2) Cancer.net, developed by the American Society of Clinical Oncology, available on iOS and Android platforms (see Figure 8) and also offers a Web-based version and one that is translated into Spanish; (3) AYA Healthy Survivorship, an iOS app, developed for Adolescent and Young Adult (AYA) survivors by Texas A&M School of Public Health with late effects guidelines provided by the Children's Oncology Group (see Figures 4 and 6); and (4) My Cancer Manager developed by the Cancer Support Community and available only as an iOS app (see Figure 5).
An area of HBCT that demonstrated weak results in the coding of the mHealth apps considered in this study but one that bears additional research consideration is the theoretical realm of social influence and social media. Cancer survivors are strongly influenced by their social ties and connections with others, and social networks can have important effects on survivor health and wellbeing [4,8,22].
Figure 9. Livestrong Cancer Guide and Tracker app.
The strength of this study is based in its reliance on the prior work of Abraham, Webb and Michie in defining the taxonomy and coding of behavior change techniques used in interventions and their basis in theory [9-11]. This research on mHealth cancer survivorship apps had certain limitations. The initial search and selection of cancer survivorship apps was restricted to the commercial descriptions of apps available for Microsoft, Nokia, Blackberry, Apple, and Android phones. Based on that review and the application of our criteria, we narrowed our search to the Apple App Store and Google Play. Based on input from a variety of cancer survivors, we included only unpaid apps, although we did examine the paid apps to see if they appeared to include greater HBCT in their design. They did not. The search results for this study were dependent on the terms included in the search strategy and the functionality of the search engines used. We attempted to overcome the search limitation by choosing common terms and combinations of terms, including those we found in literature reviews of cancer care and cancer survivorship. We considered only apps that were in English. Moreover, we only considered apps that were focused on cancer and included the word cancer in the title or the description. It is possible that we missed apps that include cancer care and survivorship in addition to other chronic diseases.
Future Directions in App Development
Clearly, the taxonomy provided in this research for mHealth cancer apps is not exhaustive, and additional theories and models across different behavioral change techniques should be defined. As the more highly rated apps in our study offered multiple HBCT techniques, it may be beneficial to design a study that takes into account the interaction across multiple HBCT aspects. It may also be helpful to explore the differences in use, HBCT efficacy, and persistence on the device for single purpose apps for specific survivorship concerns in comparison to apps that offer multiple types of HBCT elements. Research and exploration into the theories and models relevant to interactive apps, mobile games, and the use of sensors in mHealth is timely and needed.
An article by Tomlinson et al further articulates concerns about both the lack of evidence and theory in mHealth and how theory, when referenced, is actually applied. Tomlinson's article addresses use of mHealth primarily in lesser-developed and under- resourced countries but raises concerns about level of evidence and generalizability of mHealth apps [23]. A World Health Organization report by Kay and associates that tracked over 500 mHealth pilot studies reported that very little is known about likely uptake, best strategies for engagement, efficacy, or effectiveness of these initiatives [24]. Kay and colleagues' review of mHealth interventions suggests that the apps they reviewed lacked both theoretical foundations and evidence sufficient to support an evidence-based scale-up. The most recent systematic review on mHealth for health behavior change by Free et al was not able to identify the theoretical basis for the research studies reviewed [22]. Both reviews confirm that there is mixed evidence for the effectiveness of health intervention delivery to health care consumers using mobile technologies. Moreover, both reviews' conclusions highlighted the need for additional high-quality controlled trials of mHealth apps. These findings regarding the potential for use of theory support a call for mHealth intervention designers to reflect more deeply and extensively on the application of theoretical models and frameworks in the design and development of mobile HBCT apps.
The study provides a framework for future research and contributes to the emerging science of mHealth interventions for behavior change. The findings suggest a strong rationale for investing the time and diligence into more rigorous theory-based mHealth interventions that may incorporate, as did the apps reviewed, multiple levels and types of health behavior change strategies and techniques. Similarly, our results reinforce the need for carefully constructed studies to measure the effect and impact of mHealth interventions.
Our findings contribute to behavioral health literature and health policy initiatives by demonstrating that mHealth intervention design needs stronger theoretical and evidence-based underpinning. The field of research on mHealth interventions for behavior change is rapidly shifting with new technologies and systems for sensors, big data analytics, and opportunities for more patient-centric health care. The integration of apps with mobile hardware, including sensors, and electronic medical records is rapidly emerging as evidenced by the ongoing announcements of such integrated solutions. While the promise of interoperability of apps, sensors, and clinical data will soon be a reality, what is missing is the understanding of how this will translate into benefits to users with chronic medical conditions, such as cancer survivors. What is also missing is how, where, and when clinicians will access and use this data to educate, inform, and offer improved opportunities for health and wellness to their patients.
The Open Access Publishing Fees for This Article Have Been Covered by the Texas A&M University Online Access to Knowledge (oak) fund, supported by the University Libraries and the Office of the Vice President for Research.
None declared.
Multimedia Appendix 1
Survivorship App Coding Manual.
PDF File (Adobe PDF File), 23KB
Mobithinking.com. 2013. URL: http://mobithinking.com/mobile-marketing-tools/latest-mobile-stats/e [accessed 2014-09-13] [WebCite Cache]
2012 World Development Indicators. 2012. World Bank URL: http://data.worldbank.org/sites/default/files/wdi-2012-ebook.pdf [accessed 2014-09-13] [WebCite Cache]
Fox S, Duggan M. Washington, DC: Pew Internet & American Life Project. Washington, DC; 2012. Mobile Health 2012 URL: http://www.pewinternet.org/2012/11/08/mobile-health-2012/ [accessed 2014-09-13] [WebCite Cache]
Lester RT, van der Kop M, Taylor D, Alasaly K, Coleman J, Marra F. m-health: Connecting patients to improve population and public health. B C Med J 2011;53(5):218-219.
Bender JL, Yue RYK, To MJ, Deacken L, Jadad AR. A lot of action, but not in the right direction: Systematic review and content analysis of smartphone applications for the prevention, detection, and management of cancer. J Med Internet Res 2013;15(12). [CrossRef]
Rosser BA, Eccleston C. Smartphone applications for pain management. J Telemed Telecare 2011;17(6):308-312. [CrossRef] [Medline]
O'Neill S, Brady RRW. Colorectal smartphone apps: opportunities and risks. Colorectal Dis 2012 Sep;14(9):e530-e534. [CrossRef] [Medline]
Pandey A, Hasan S, Dubey D, Sarangi S. Smartphone apps as a source of cancer information: changing trends in health information-seeking behavior. J Cancer Educ 2013 Mar;28(1):138-142. [CrossRef] [Medline]
Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol 2008;27(3):379.
Webb TL, Joseph J, Yardley L, Michie S. Using the Internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Internet Med Res 2010:12-31. [CrossRef]
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013 Aug;46(1):81-95. [CrossRef] [Medline]
Petty RE, Cacioppo JT. The elaboration likelihood model of persuasion. Adv Exp Soc Psychol 1986;19:123-181.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977 Mar;84(2):191-215. [Medline]
Fisher WA, Fisher JD, Harman J. The information-motivation-behavioral skills model: A general social psychological approach to understanding and promoting health behavior. In: Social Psychological Foundations of Health and Illness. Victoria, Australia: Australia Blackwell Publishing, Ltd; 2003:82-106.
Carver CS, Sheier MF. Attention and self-regulation: A control-theory approach to human behavior. In: Springer-Verlag. New York, New York: Springer-Verlag; 1981:219-247.
Skinner BF. Operant Behavior. Am Psychol 1963;18(8):501-503.
Ajzen I. The theory of planned behavior. Organ Behav Hum Dec 1991 Dec;50(2):179-211. [CrossRef]
Cohen S, Willis TA. Stress, social support, and the buffering hypothesis. Psychol Bull 1995;98(2):310.
Festinger L. A theory of social comparison processes. Hum Relat 1954;7(2):117-140.
Riley WT, Rivera DE, Atienza AA, Nilsen W, Allison SM, Mermelstein R. Health behavior models in the age of mobile interventions: Are our theories up to the task? Transl Behav Med 2011;1(1):53-71. [CrossRef]
Rimer BK, Kreuter MW. Advancing tailored health communication: A persuasion and message effects perspective. J Commun 2006;56(s1):S184-S201. [CrossRef]
Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med 2013;10(1):e1001362 [FREE Full text] [CrossRef] [Medline]
Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC. Scaling up mHealth: where is the evidence? PLoS Med 2013;10(2):e1001382 [FREE Full text] [CrossRef] [Medline]
Kay M. mHealth: new horizons for health through mobile technologies. In: mHealth: New Horizons for Health through Mobile Technologies: Second Global Survey on eHealth (Global Observatory for Ehealth). Geneva, Switzerland: World Health Organization; 2011.
CT: control theory
ELM: elaboration likelihood model
HBCT: health behavior change techniques
IMB: information-motivation-behavioral skills model
OC: operant conditioning
SC: social comparison
SS: social support
SCogT: social cognitive theory
THC: tailored health communications
Edited by K Jethwani; submitted 26.09.14; peer-reviewed by M Mobasheri, A Weinberg, M Johnston, S Agboola, S Mishra; comments to author 20.10.14; revised version received 31.12.14; accepted 22.01.15; published 27.03.15
©Deborah Vollmer Dahlke, Kayla Fair, Y. Alicia Hong, Christopher E. Beaudoin, Jairus Pulczinski, Marcia G. Ory. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 27.03.2015.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.


accompanies dangers if the correct gear and extras are not utilized amidtraining. A standout amongst the most important bit of security gear is the airtrack mats. As this game includes many falls and drops, the mat is basic to keep the dangers of harming your head or your appendages. With the mat, you can ensure your exercise can be done in a more safe manner. Below, we will discuss the facts which you ought to know on how to choose an airtrack mat factory.
Many individuals think about how an gymnast will utilize an airtrack mat at home. The fact of the matter is these mats are used for multiple reasons and can be utilized for considerably more than simply essential tumbling practice. For instance, your gymnast will love their mat to hone fundamental tumbling like moves, walkovers, handstands, and even cartwheels. Mats will be utilized by experienced gymnasts to work on standing back tucks and front tucks too. A home air mat is likewise ideal for sleep parties, general tomfoolery, and the mother can even utilize it for yoga activities.
Before moving to an airtrack mat factory to purchase a mat for use at home, the company has to consider a few factors prior to manufacturing airtrack mats. Below are the most important features of home mats to consider in your factory of choice to know whether that is the right factory for you.
A mat that is too thin won't give the padding and security you want if your athlete falls while tumbling on it. Then again, if the mat is too thick, your tumbler will be unable to rehearse stunts in light of the fact that their hands or feet will sink into the mat when they should. Standard mat thickness should be about 1 3/8″ thick.
Before purchasing a mat, you have to consider where your tumbler will utilize it. You likewise want to ensure it is sufficiently huge for an athlete to rehearse stunts on. Since mats are offered in a wide range of sizes, it shouldn't be elusive a glad medium that satisfies the two needs.
The second thought is to search for a mat which is delicate, made of froth and giving other defensive layering. This will guarantee that its safeguard qualities can go far. The surface of the mat ought to likewise be precisely taken a gander at . Since this game includes heaps of running and bouncing, you will want to ensure that it is made of good quality and not tricky which can prompt genuine damage.
It is important to likewise consider the weight and tallness of the client while picking the correct mat. The length of their hands and feet are important factors that can affect their landing.
There are many diverse sorts of mats to choose from with regards to home utilization which is a factor you should consider when choosing an air mat factory. The most famous mat types are discussed in detail below.
A standout amongst the most prominent vaulting mats utilized as a part of the exercise center and homes are paneled mats. Paneled mats are offered in many distinctive hues and crease up for simple storage. This kind of athlete mat is offered in many distinctive sizes. The most well known size is 4 feet wide by 8 feet long. This sort of mat normally has Velcro connected on the closures, so more mats can be added to make a more drawn out mat. Paneled mats are additionally frequently alluded to as collapsed mats. Regardless of whether the mat you are thinking about is a collapsing mat or tumbling mat, it offers similar advantages and is normally offered in similar lengths and thicknesses.
A cartwheel bar mat is an awesome home mat choice for a novice or youthful athlete. The mat is made with legitimate hand and feet arrangement that aides gymnasts in the correct approach to do a cartwheel. Indeed, even after the tumbler has culminated the cartwheel, the mat can be utilized to hone handstands and handstand rolls. Most cartwheel pillar mats have a bar alternative too. To utilize the pillar alternative basically flip the mat over and you will discover a training bar. With this matted practice bar, an athlete can rehearse pillar balance abilities and different aptitudes that are typically performed on the shaft.
A covered or flexi-move mat is made to closely resemble an opposition floor. Obviously, it doesn't offer the very same feel since it isn't made with springs, yet it is the best alternative for those that want to get settled with the vibe of an opposition floor at home. The best thing about a covered mat is that it can be moved up and stored effortlessly.
A slope mat is ideal for youthful gymnasts that are figuring out how to do moves in reverse or advances. This sort of mat can likewise be utilized for log rolls too. The immense thing around a grade mat is it enables a tumbler to make body mindfulness and diminishes weight on the body while learning. It's not prescribed for advanced gymnasts to utilize a grade mat for harder aptitudes due to the danger of damage. On the off chance that a tumbler is searching for an acrobatic mat for home utilize intended for more troublesome aptitudes, it's smarter to buy a bigger grade mat.
Regardless of whether your acrobat has quite recently begun tumbling or you have an accomplished tumbler at home, you and they will profit by having vaulting mats at home. The reality of the situation is a tumbler is never still and soon the majority of the furniture in your home will be utilized as a device! Shockingly, dissimilar to the exercise center, a home's floors aren't padded or extremely lenient. On the off chance that you have an acrobatic mat accessible to pad falls, you will have the capacity to urge your athlete to rehearse without getting wounds or possibly getting hurt.


Where are all the #LGBTSuperheroes?
Muslim, Gay, Terrorist, Christian, Black, Brown, Refugee, Foreigner… the walls that divide us have many names. Each name comes with a perceived value and worth. After the recent tragedy #Orlandoshooting in Florida, I wonder if we have gotten closer to answering these questions? Have we found a way to know whose life matters more or has more value? Of course this sounds crass and provacative, but really could we just look at someone and figure it out? What if we look at their family name? Profession? Or perhaps nationality? Ethnicity? While it seems obvious that implicit bias is not way of measuring ones worth, that is the focal point for this powerful PSA by Momondo. It asks who belongs to whom and who should we include.
The premise of the video begins with each person claiming their supremacy – something perhaps more often said in our thick skulls than out loud – but non-the less these are thoughts we humans do have. It is fascinating to hear statements that can only emerge from a collective memory each nation teaches its children.
The PSA continues by asking the participants to give a large sample of spit to test their DNA to see where they are really from. While this is naturally part of the DNA collecting process, I found it rather poetic that the rudimentary way in which we find how we are all connected is in itself an act that is uncivilized and savage at its core. When the results of the DNA test are finally shared we all collectively along with the participants have an 'aha moment'… "YES…we are all connected, of course you belong to me and I belong to you." This is what we always knew but somehow the DNA now draws us together, like a magnet. In a way it reminded me of the magnetic attraction some adopted children have towards finding their biological mother. It reminds us all that we are roots from the same tree.
This PSA is one part of a larger campaign by the travel company to sell 'purpose' and 'existential fulfillment' as the reason to travel and see the world. This approach is much more in the social marketing vein of advertising – looking for that core product to sell. In this case it is building empathy and community across stereotypes and discrimination. I have seen travel agencies sell the augmented product for social good such as travel for volunteering or ecotourism, but this is not that… travel where you may, enjoy every minute just make sure that the human connection is front and center. In many ways Momondo is selling brotherhood. After #Orlando I hope all of us are buying it.


First festival took place in 2012. A small but quality group of Scotttish authors gather to entertain in this lovely location.
A sound line-up of authors has been announced for the two-day event – dubbed a "lite..
2014 -Val McDermid, Christopher Brookmyre, Jackie Kay, Andrew Greig, Lesley Glaister and Patrick Richardson.
Alexander McCall Smith's first equally illustrious career was as an academic lawyer, Professor of Medical Law, at Edinburgh University. Before he achieved world-wide fame as a writer of books for adults, he wrote for children, and among his many hugely popular titles were 'The Perfect Hamburger', 'The Little Theatre', 'The Bubblegum Tree' and the Akimbo series.
It was his 'No. 1 Ladies' Detective Agency' series, set in Botswana, that brought him to international notice. These books have now sold over 10 million copies in English alone, and are being translated into 34 languages world-wide. The most recent book is 'The Saturday Big Tent Wedding'.
Alexander's other series have been equally popular: '44 Scotland Street', first issued in daily episodes in the Scotsman newspaper, the latest edition being 'Bertie Plays the Blues', and the Isabel Dalhousie novels, which feature an Edinburgh philosopher with an incorrigible curiosity into the foibles of human behaviour. The latest in this series is 'The Forgotten Affairs of Youth'. 'Corduroy Mansions' and 'The Dog Who Came In From The Cold' - set in Pimlico - were also written in daily chapters for the Daily Telegraph online.
Since becoming a full-time writer, James has published more than 20 books, both for adults and children. Between 1993-95 he was writer-in-residence at Brownsbank Cottage, near Biggar, the former home of Hugh MacDiarmid. He set up the Scots language children's imprint, Itchy Coo, and has published numerous new works, such as the Katie stories, and reworkings of old tales, in Scots. He also runs a website - www.kettillonia.co.uk - which issues new writings, poems, essays etc, from all over Scotland.
A poet and essayist as well as novelist - in 2005 he published 'Voyage of Intent: Sonnets and Essays from the Scottish Parliament' - his first book for adults was 'The Fanatic' (2000). His second, 'Joseph Knight', based on the true story of a slave who came from the Caribbean to Scotland, won both the Saltire Society and the Scottish Arts Council Book of the Year Awards for 2003/04. 'The Testament of Gideon Mack' (2006) was long-listed for the Man Booker Prize and several other awards. "And The Land Lay Still', a panoramic look at Scottish politics and culture in the latter part of the 20th century, won the Saltire Society's Scottish Book of the Year Award in 2010, and is still in the best-seller charts.
Appointed Scotland's Makar in succession to Edwin Morgan, poet and playwright Liz Lochhead originally studied at the Glasgow School of Art and taught art in schools in Glasgow and Bristol. Writer in Residence at Edinburgh University (1986-87) and at the Royal Shakespeare Company (1988), her poems have been published in many collections, and she has won several awards for her work. Her collection, 'The Colour of Black and White - Poems 1984-2003', was published in 2003. Her latest collection, 'The Choosing', was issued in 2011.
She is also known as a performance poet, broadcaster and playwright. "Mary Queen of Scots Got Her Head Chopped Off (1987) was recently restaged to great acclaim at the Royal Lyceum Theatre, Edinburgh. Other theatre work includes 'Dracula' (1989), 'Cuba' (1999), a play for young people, and "Perfect Days' (1998). She has also translated and adapted many classic works, including Moliere's 'Tartuffe', Euripedes' 'Medea' (which won her the Scottish Saltire Society's Book of the Year Award in 2000), and Moliere's 'The Misanthrope' (2002) which, under the title 'Misery Guts', she transposed to the modern-day Scottish Parliament.
Another former academic - she is Emeritus Professor in the Department of English Studies at the University of Strathclyde - Margaret's first novel was published in 1987. She has written poetry, short stories and eight novels.
She describes her fiction as mostly historical. "I usually write about people living 'on the edge' .... on journeys to places on the edge - islands, frontiers - where cultures and ideas meet and evolve." 'The Sea Road' (2000) concerns the Viking exploration of the North Atlantic. 'Voyageurs' (2003) is about a Cumbrian Quaker caught up in the North American war of 1812. 'Light', set in the 1830s, examines the repercussions when an Edinburgh surveying team arrives on a remote island off the Isle of Man to build a lighthouse. 'Hy Brasil' (2002), a political thriller set on the famously fictitious island, also examines 'the myths surrounding real and imagined islands'. Her most recent novel, 'The Gathering Night' published in 2009, is set in Mesolithic times.
Primarily a poet who has published several collections of his poems, Kenneth also writes picture books and novels for children, and has published three novels concerning the land - 'The Highland Trilogy'. His work is inspired by the land, and the umbilical relationship between people and the land, especially in remote places.
Kenneth also leads workshops on the writing process for younger children and older students, and runs a writing retreat - 'Write from the Heart' - on Iona.
His poetic works include 'Columba', 'Iona', 'Salt and Light', 'Imagining Things' and 'Wild Horses'. His most recent collection, 'Evensong', was published in November 2011.
Robin Laing is one of those lucky individuals who have turned their hobbies and interests into a career. On the one hand, Robin is passionate about whisky; Scotland's most important export, her most successful traditional industry and perhaps her greatest contribution to humanity. Robin chairs the tasting panel for the Scotch Malt Whisky Society and writes many of their almost poetic tasting descriptions. He also contributes regularly to Whisky Magazine and has published The Whisky Muse (Luath Press), which is a collection of poems and songs on the subject of Scotch whisky. On the other hand, Robin is also a musician. As a songwriter and interpreter of traditional Scots song, he has recorded seven cds. Three of those are whisky cds; 'The Angels' Share' (1997), 'The Water of Life' (2003) and 'One for the Road' (2007). Robin performs his 'Whisky and Song' shows all over the world, thus being an ambassador for Scotland in the most enjoyable way imaginable.


Nothing is more overwhelming to a gardener than researching plant material for a landscape. Whether you are choosing trees, shrubs or perennials, there is an extraordinary number of plant references! Ask a handful of gardeners to name their favorite perennial reference, and you will probably receive a handful of titles! There are books, magazines, journals, television shows, web sites and CD-Roms, all designed to assist you, the gardener, to select plants.
By physically seeing various books, you can decide for yourself which ones are better for you. Next seasons' plant catalogues that seem to arrive before the New Year's Eve champagne goes flat are excellent for pictures. But do keep in mind that catalogues are meant to entice you into purchasing a plant. Pictures often are taken with special color enhancing filters, and the descriptions are always glorious.
A word of caution when reviewing horticultural reference materials. Horticulture is not an exact science. In fact, many consider it an art, open to many different interpretations. Several times in this website, it has been pointed out that there are no rights or wrongs. Plants are living entities that react and grow differently under different circumstances. You may encounter contradictory information.
One reference may expound upon the many merits of a plant they enjoy growing, while another will give it a thumbs down. Take for example the Chameleon plant or Rainbow plant (Houttuynia cordata 'Chameleon'), a beautifully variegated plant offering yellow, green, bronze and red colorations. One author may have success with this plant in a large setting, not minding its extremely invasive behavior. Another gardener tells you to avoid it at all costs. Or, one book will list a particular garden phlox as having salmon colored flowers, but in your garden it is plain orange! These discrepancies are bound to happen as long as there are different gardeners with different tastes and different opinions.
Nothing can replace the hands-on experience you will receive over the years as you garden. Do give the process time. A gardener never stops learning. A favorite garden saying of late is "to plant a garden is to believe in tomorrow." So true. Realize that patience is needed as your dreams of today evolve into tomorrow's beautiful garden.


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text:
Celebrate Hanukkah
Is Hanukkah in the Bible?
The story of the Jewish revolt against Antiochus is contained in the Books of Maccabees, but these are not considered part of the biblical canon.
By MJL
Ambivalence Toward Hanukkah
The History of Hanukkah
There is no mention either of the holiday of Hanukkah, nor of the historical events that led to its establishment, in the Bible.
The most detailed account of the story of Hanukkah is contained in the First and Second Books of Maccabees. However, these books are not included in the Hebrew Bible.
The Books of Maccabees are part of what are known as the Apocrypha (Greek for "hidden things"), which was considered part of the biblical canon by the Jews of Alexandria, but not by the Jews in ancient Israel.
It is not clear exactly why these books were excluded, though there are several theories — none of them completely satisfying. One is that the ancient rabbis who established the biblical canon preferred older works, and Maccabees is comparatively new (though just as new as the Book of Daniel, which is included). Others have suggested the exclusion was the result of ancient Jewish rivalries or due to the practical desire not to promote the story of an earlier successful Jewish rebellion at a time when the Jews had recently failed in their revolt against the Romans.
The holiday of Hanukkah only appears in later Jewish texts, specifically the Talmud, where the earliest details of the practice of the holiday and the kindling of lights are contained.
Why is Hanukkah Eight Nights?
The reasons this holiday lasts so long.
Hanukkah in the Community
What happens in synagogue and beyond.
Why the Maccabees Aren't in the Bible
The books that tell the Hanukkah tale didn't make it into the Hebrew Bible -- but they are in the Catholic one.

redpajama_set_name: RedPajamaCommonCrawl