Smartphone Medical Applications for Women’s Health: What Is the Evidence-Base and Feedback?

Table 2

Mobile medical applications and women’s health.

Health outcome, publication, and location	Study population	Methods	Health application	Findings
Breast cancer
Lakkis et al. [20] (2011), Lebanon	𝑛=385 females aged 40–75 years with a Health Insurance Plan	Prospective RCT. Randomized to two subgroups receiving SMS mobile phone texts: (1) to do a mammogram or (2) containing information about mammogram screening.	SMS tests either inviting women to do a mammogram or containing information about mammograms.	31% from group 1 and 32% from group 2 did a mammogram during the 6 months after intervention.
Heart health
Park and Kim [21] (2012), Republic of Korea	𝑛=67 postmenopausal women	12-week RCT. Participants were asked to record their waist circumference and body weight, diet, and exercise levels using a weekly diary through the internet or by cellular phone.	Participants received weekly SMS/internet reminders about diet and exercise.	Systolic and diastolic blood pressure decreased by 6.5 and 4.6 mmHg in the intervention group. No significant changes were observed in the control group. Total cholesterol also reduced by 12.9 mg/dL in the intervention group but increased by 1.5 mg/dL in the control group.
Nutrition
Mehran et al. [22] (2012), Iran	𝑛=205 females ≥ 18 yrs.	6-week RCT. Randomized to an intervention group that received text messages to enhance knowledge, attitudes, and practice concerning iron deficiency and iodized salt consumption.	The intervention group received daily text messages over 6 weeks. Urinary iodine concentration was measured at baseline and 8 weeks to see if there were any improvements.	Knowledge significantly improved by the end of the study (𝑃=0.004) but urinary iodine levels did not increased.
Norman et al. [23] (2013), USA	𝑛=52 overweight/obese adults, 80% female	4-month RCT. Randomized to intervention group receiving 2–5 weight management texts daily or a usual care comparison group.	Changes in fruit and vegetable intake and body weight were also measured.	Text messaging led to significant improvements in fruit and vegetable intake and eating behavior inventory scores.
Pregnancy
Evans et al. [35] (2012), USA	𝑛=123, average age 27.6 years	RCT. Underserved pregnant women and new mothers were randomized to receive text messages to change their health, health beliefs, practices and behaviors to improve clinical outcomes, or to continue with usual health care.	Text4baby delivers text messages (https://text4baby.org/) to pregnant women and new mothers targeting underserved women facing health disparities.	There was an improvement of attitudes toward alcohol consumption from baseline to followup (𝑃=0.029).
Naughton et al. [24] (2012), UK	𝑛=207 pregnant mothers	11-week RCT. Women randomized to receive (1) a tailored self-help leaflet and 11-week tailored text messages or (2) a nontailored self-help leaflet.	11-weeks of tailored text messaging to quit smoking (MiQuit).	Those receiving the tailored text messages were more likely to set a quit date (𝑃=0.04) than controls.
Jareethum et al. [25] (2008), Thailand	𝑛=68 pregnant mothers	28-week RCT. Women randomized to receive prenatal support text messages sent from 28 weeks of pregnancy or a control group.	Two messages received per week from 28 weeks.	The confidence level was higher (𝑃=0.001) and anxiety level was lower (𝑃=0.002) amongst women receiving the text messages.
Weight loss
Brindal et al. [26] (2013), Australia	𝑛=58 overweight and obese women	8-week RCT. Allocated to a weight loss or control group.	With the support of an app the intervention group received information about meal replacement programme.	The weight loss difference between groups was not significant (𝑃=0.08) although women in the intervention reported a greater increase in positive mood (𝑃=0.012)
Carter et al. [27] (2013), UK	𝑛=128 overweight volunteers, 33% females	6-month RCT. Randomized to a smartphone application or a website or paper diary weight loss intervention.	The app was used to self-monitor diet and activity and feedback was provided via weekly message.	Body mass index reductions after 6 months were the highest amongst the app users (−1.6 kg/m^2), followed by the diary group (−1.0 kg/m^2) and the website group (−0.5 kg/m^2), indicating that this app was acceptable and feasible.
Donaldson et al. [28] (2013), UK	𝑛=23 overweight and obese females	12-week RCT. Randomized to receive tailored practitioner weight loss feedback or weight checks only (control).	Patients texted their weight loss progress to practitioners and received tailored feedback.	Body weight, BMI, and waist circumference all reduced significantly in the intervention compared with the control group.
Napolitano et al. [29] (2013), USA	𝑛=52 students (87% female)	8-week RCT. Randomized to (1) Facebook, (2) Facebook + text messaging, and personalised feedback (3) control group.	Messages were received over 8 weeks with weight loss measured at 4 and 8 weeks.	The Facebook + messaging group lost significantly more weight (−2.4 kg) after 8 weeks compared with the other branches.
Norman et al. [23] (2013), USA	𝑛=52 overweight/obese adults, 80% female	4-month RCT. Randomized to intervention group receiving 2–5 weight management texts daily or a usual care comparison group.	Changes in fruit and vegetable intake and body weight were also measured.	Text messaging led to significant improvements in body weight.
Park and Kim [21] (2012), Republic of Korea	𝑛=67 postmenopausal women	12-week RCT. Participants were asked to record their waist circumference and body weight, diet, and exercise levels using a weekly diary through the internet or by cellular phone.	Participants received weekly SMS/internet reminders about diet and exercise.	Waist circumference and body weight significantly decreased by 3.0 cm and 2.0 kg at 12 weeks compared with baseline. Increases were found in the control group.
Shapiro et al. [30] (2012), USA	𝑛=170 overweight and obese adults, 65% females	12-month RCT. Randomized to receive daily interactive and personally weight-relevant text messages or monthly e-newsletters.	Daily weight-relevant SMS and MMS received 4 times/day over 12 months.	Participants with greater adherence lost more weight 6 (𝑃=0.39) and 12 months (𝑃=0.23) than loss who were less adherent. Text messaging could be a useful adjunct to weight loss treatments.
Turner-McGrievy and Tate [31] (2011), USA	𝑛=96 overweight females	6-month RCT. Assigned to Podcast-only or Podcast + Mobile groups.	The Podcast + Mobile group uses a diet and physical activity monitoring app on the mobile devise and interacted with study counsellors using twitter.	Prompting and mobile communication via twitter did not enhance weight loss.
Haapala et al. [32] (2009), Finland	𝑛=125 overweight 22–44 year olds, 96 females	12-month RCT. Randomized to (1) use a mobile phone operated weight loss programme or (2) control	Participants received texts messages over 12 months and instructed on how to reduce food intake with daily weight reporting and tailored feedback.	After 12 months the experimental group had lost significantly more weight than the control (𝑃=0.006)
Patrick et al. [33] (2009), USA	𝑛=75 overweight men and women, 52% females	4-month RCT. Randomized to receive (1) printed materials about weight control, (3) MMS, and SMS messaging intervention.	Participants received personalised MMS and SMS messages were send 2–5 times per day.	The group receiving the messages lost more weight (−1.97 kg; 𝑃=0.02) compared with the control group by the end of the study.

BMI: body mass index; MMS: multimedia messaging service; RCT: randomized controlled trial; SMS: short messaging service.