Evaluating The Effects of A Mobile Health App On Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study
Evaluating The Effects of A Mobile Health App On Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study
Original Paper
Tze-Fang Wang1, RN, MSN; Rou-Chen Huang1, RN, MSN; Su-Chen Yang2; Chyuan Chou3, DDS, MD, PhD; Lee-Chen
Chen2, RN, MSN
1
School of Nursing, National Yang-Ming University, Taipei City, Taiwan
2
Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
3
Excellent Dental Center, Taipei City, Taiwan
Corresponding Author:
Lee-Chen Chen, RN, MSN
Department of Nursing
Far Eastern Memorial Hospital
No. 21, Section 2, Nanya South Road
Banqiao District
New Taipei City, 220
Taiwan
Phone: 886 2 77281610
Email: [email protected]
Abstract
Background: Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and
the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced
within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects
and associated psychological problems.
Objective: This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving
the intervention of a newly developed mHealth app.
Methods: After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app
intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey
questionnaires were used to assess the patients’ quality of life, nursing care needs, and acceptance of the mHealth app.
Results: The physiological care needs were significantly decreased in the experimental group compared with the control group
(P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care
support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the
experimental group than in the control group (–7.24 vs –4.36). In terms of intention to use, perceived usefulness, and perceived
ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05).
Conclusions: Compared with routine health care and instruction, for patients after surgery, the education/information intervention
using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance
of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and
improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to
provide medical information quickly and improve their self-management abilities, thereby reducing the patients’ need for
physiological care and improving their quality of life.
Trial Registration: ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968
KEYWORDS
care needs; health information; mobile health app; oral cancer; technology acceptance; quality of life
treatment messages, oral care, and social resource delivery. The The mHealth app has four main interfaces: Latest News, Medical
intervention outcomes of the patients in both groups were Information, Self-Recording, and Revisit Reminders. The Latest
surveyed after 3 months using questionnaires. The study was News interface provides the latest exhortations for patients after
registered prior to launch (ClinicalTrials.gov NCT04049968). surgery and provides YouTube links to oral health education
and head and neck rehabilitation videos. In addition, the
Data Collection and Features of the mHealth App interface contains a link to join to other patient groups through
All included patients were randomly divided into an the LINE app. Therefore, patients with oral cancer after surgery
experimental group and a control group (Figure 1). The patients can share information about their lives and treatment experiences
in the control group received routine care and education, while after treatment. The Medical Information interface provides
the patients in the experimental group received 20 minutes of information about oral cancer, oral cancer treatment, pain
mHealth app education and guidance before being discharged information, hospice care, and any other supporting personnel
from the hospital. The educational content included helping the or cancer treatment institutions. The Self-Recording interface
participants to download, install, and use the mHealth app. It enables patients to record their own postoperative information
also included instructions to teach patients how to use the and symptoms, including date, body temperature, pain levels,
mHealth app at home after discharge to provide education about oral ulcer, vomiting, skin reactions, and diarrhea. On their next
oral cancer treatment (surgical treatment, chemotherapy, return visit, patients can provide this information to their
radiotherapy, rehabilitation exercise) and included links to physician for reference and discuss the response of their disease
videos about self-recording of symptoms, available support to treatment. Finally, the Revisit Reminder interface provides
groups, and other applicable information to help meet the needs a reminder function for patients to remember to return to the
of the patients. The two groups of patients received the same hospital. Screenshots of the interfaces are shown in Multimedia
routine care before discharge. The patients in the experimental Appendix 1.
group and the control group returned to the hospital 3 months
later to complete the questionnaires.
Figure 1. Flowchart of study sample selection.
a care needs scale, namely the short-form Cancer Needs analyses were performed using SPSS version 22 for Windows
Questionnaire (CNQ-SF), a 32-item self-administered (IBM Corp).
questionnaire that evaluates 5 domains of patient needs,
including psychological, health information, physical and daily Results
living, patient care and support, and interpersonal
communication needs. The CNQ-SF score ranges from 0 to Analytical Sample
100, where 0 means no need and 100 means the highest need A total of 120 participants were enrolled in this study. The
[15]. The questionnaires also included the European experimental group included 61 postoperative patients who used
Organization for Research and Treatment of Cancer Quality of the mHealth app within three months of discharge, while the
Life Questionnaire Core 30 (EORTC QLQ-C30) and Head and control group included 59 postoperative patients who received
Neck Module (EORTC QLQ-H&N35) [30] and the Science routine care and instruction but did not use the app. After 3
and Technology Acceptance Model (TAM) scale, which was months of follow-up, 11/61 patients in the experimental group
designed based on the information systems theory developed (18%) and 9/59 patients in the control group (15%) did not
by Davis [31] in 1989 to evaluate patients’ responses to health return to the hospital to fill out the questionnaires. The final
information technology. The Cronbach α values of the care sample therefore included 50 patients in the experimental group
needs scale and quality of life scale were .94 to .77 and .92, and 50 patients in the control group (Figure 1).
respectively. The content validity index of the TAM scale was
between 0.92 and 1.00, with an average of 0.96 (Cronbach Background Characteristics of the Study Population
α=.97). The questionnaires used in this study are shown in The study enrolled 100 postoperative oral cancer patients,
Multimedia Appendix 2. including 92 men (92.0%) and 8 women (8.0%), with a mean
age of 57.01 years (SD 8.87). Most patients were married
Statistical Analysis (68/100, 68.0%), had a middle school education (37, 37.0%),
Continuous variables are presented as mean (SD); categorical were unemployed (61, 61.0%), earned less than 20,000 NT$
variables are presented as n (%). Differences in categorical (US $677.13) per month (59, 59.0%), had a religious affiliation
variables were examined using the chi-square test or Fisher (87, 87.0%), and were self-caregivers (60, 60.0%). Most of the
exact test, and the differences in the continuous variables were 100 patients were diagnosed with stage I (32, 32.0%) or stage
examined using the independent t test. The paired t test was II (32, 32.0%) cancer, without cancer metastasis (65, 65.0%),
used to examine the differences between measurements before and the primary cancer was located at a buccal site in most cases
and after the intervention. After adjusting for age and sex, (53, 53.0%). Of the 100 patients, 92 (92.0%) received tumor
multivariate linear regression was used to assess the associations resection, 66 (66.0%) received radiation therapy, and 38 (38.0%)
between the patients’ care needs and quality of life before and received chemotherapy. In follow-up treatment, 35/100 patients
after using the app. All statistical assessments were two-sided, (35.0%) received radiation therapy and 3 patients (3.0%)
and P<.05 was considered statistically significant. Statistical received chemotherapy (Table 1).
Table 1. Baseline demographics and clinical characteristics of the patients in the study (N=100).
Variable Total (N=100) Experimental group (n=50) Control group (n=50) P value
Demographics
Sex , n (%) .72
Male 92 (92.0) 47 (94.0) 45 (90.0)
Female 8 (8.0) 3 (6.0) 5 (10.0)
Age (years), mean (SD) 57.01 (8.87) 58.7 (7.56) 55.32 (9.79) .06
Marital status, n (%) .39
Married 68 (68.0) 32 (64.0) 36 (72.0)
Other (unmarried/widowed/divorced) 32 (32.0) 18 (36.0) 14 (28.0)
Education, n (%) .10
Below primary school 28 (28.0) 18 (36.0) 10 (20.0)
Middle school 37 (37.0) 19 (38.0) 18 (36.0)
Above high school 35 (35.0) 13 (26.0) 22 (44.0)
Employment status, n (%) .54
No 61 (61.0) 32 (64.0) 29 (58.0)
Yes 39 (39.0) 18 (36.0) 21 (42.0)
Variable Total (N=100) Experimental group (n=50) Control group (n=50) P value
Radiation therapy 66 (66.0) 33 (50.0) 33 (50.0) >.99
Chemotherapy 38 (38.0) 23 (46.0) 21 (42.0) .68
Follow-up treatment .87
Radiation therapy 35 (35.0) 17 (34.0) 18 (36.0)
Chemotherapy 3 (3.0) 1 (2.0) 2 (4.0)
a
NT $1=US $0.034.
Table 2. Quality of life scores of patients in the study (N=100) before and after the mHealth app intervention measured with the European Organization
for Research and Treatment of Cancer Quality of Life Questionnaire Core 30.
Variable Before After
Control group, Experimental Control group, Experimental
mean (SD) group, mean (SD) P valuea mean (SD) group, mean (SD) P value
Overall quality of life score 28.99 (16.40) 32.15 (18.65) .37 24.63 (16.97) 24.91 (17.13) .94
Change of overall quality of life score N/Ab N/A N/A –4.36 (10.26) –7.24 (12.77) .22
Quality of life scores
Pain 19.50 (20.10) 22.50 (22.40) .48 19.33 (18.24) 18.99 (20.89) .93
Swallowing 25.50 (26.69) 31.50 (29.03) .29 26.16 (24.80) 30.83 (26.09) .36
Teeth 40.00 (34.99) 42.00 (37.38) .78 38.66 (33.23) 40.00 (34.99) .85
Opening mouth 41.33 (35.99) 48.00 (35.74) .36 39.99 (31.58) 43.33 (33.16) .61
Dry mouth 46.67 (33.67) 40.00 (36.89) .35 45.33 (29.16) 34.66 (26.90) .06
Sticky saliva 43.33 (35.16) 37.33 (35.41) .40 39.99 (29.35) 23.33 (25.42) .003c
Senses problems 18.33 (21.09) 18.33 (27.20) >.99 15.66 (17.94) 14.66 (18.63) .79
Coughing 17.33 (24.50) 24.00 (27.80) .21 27.33 (94.44) 17.33 (24.50) .47
Felt ill 16.67 (27.15) 21.33 (27.57) .40 13.99 (27.01) 11.99 (21.03) .68
Trouble with social eating 29.50 (28.78) 30.83 (27.63) .81 25.66 (27.39) 29.66 (28.23) .47
Speech problems 22.00 (21.59) 23.55 (28.36) .76 18.22 (21.38) 16.22 (22.47) .65
Trouble with social contact 16.27 (20.16) 15.33 (20.03) .82 14.26 (20.47) 13.60 (18.75) .87
Less sexuality 11.33 (18.27) 17.00 (24.86) .20 7.66 (15.50) 12.66 (22.22) .20
Pain killers 54.00 (50.35) 56.00 (50.14) .84 40.00 (40.00) 44.00 (50.14) .69
Nasogastric tube feeding 42.00 (49.86) 62.00 (49.03) .046c 32.00 (47.12) 56.00 (50.14) .015c
Nutritional supplements 28.00 (33.75) 45.00 (35.36) .016c 23.00 (32.27) 35.00 (35.35) .08
Weight loss 22.00 (41.85) 30.00 (46.29) .37 6.00 (23.98) 6.00 (23.98) >.99
Weight gain 28.00 (45.36) 14.00 (35.05) .09 10.00 (30.30) 0 .024c
a
P value was used to identify statistical significance between the experimental group and control group.
b
N/A: not applicable.
c
P<.05.
The CNQ-SF measures baseline postoperative care needs (Table and 63.86 vs 57.0 for health information needs, respectively.
3). The higher the scores on the scale, the higher the patient’s These results show that the experimental group (mHealth app
need for care. Before the intervention, the mean scores of the intervention) had significantly reduced physiological needs
5 care domains in the experimental group and control group compared to the control group (P=.015, Table 3). Although the
were 26.33 vs 21.33 for physiological needs, 24.55 vs 26.27 for results were not statistically significant, the experimental group
psychological needs, 13.50 vs 16.75 for communication needs, had more obvious reductions in psychological needs,
26.92 vs 19.58 for care support needs, and 64.0 vs. 60.29 for communication needs, and care support needs than the control
health information needs, respectively. After 3 months of group. Multivariate linear regression analysis also confirmed
intervention, the mean scores for the experimental group and that after adjusting for age and sex variables, the experimental
control group were 20.67 vs 20.25 for physiological needs, group had significantly greater improvement in physiological
18.18 vs 23.14 for psychological needs, 8.25 vs 12.75 for needs compared to the control group (P=.022, Table 4).
communication needs, 23.75 vs 17.67 for care support needs,
Table 3. Care needs of patients in the study (N=100) before and after the mHealth app intervention measured with the short-form Cancer Needs
Questionnaire.
Variable Before After Change
Control group, Experimental P valuea Control Experimen- P value Control Experimen- P value
mean (SD) group, mean group, mean tal group, group, mean tal group,
(SD) (SD) mean (SD) (SD) mean (SD)
Physiological needs 21.33 (18.36) 26.33 (20.03) .20 20.25 20.67 .90 –1.08 (7.80) –5.67 .015b
(15.95) (15.45) (10.47)
Psychological needs 26.27 (23.07) 24.55 (23.98) .71 23.14 18.18 .19 –3.14 (8.04) –6.36 .16
(20.40) (17.29) (13.88)
Communication needs 16.75 (22.53) 13.50 (21.70) .46 12.75 8.25 (17.97) .27 –4.0 (12.74) –5.25 (9.81) .58
(21.94)
Care support needs 19.58 (21.33) 26.92 (18.52) .07 17.67 23.75 .05 –2.0 (12.88) –3.17 (7.79) .59
(15.92) (15.48)
Health information 60.29 (25.72) 64.00 (28.78) .50 57.00 63.86 .17 –3.29 –0.14 .34
needs (25.95) (23.61) (19.06) (13.15)
a
P value was used to identify statistical significance between the experimental group and control group.
b
P<.05.
Table 4. Multivariate linear regression analysis of patients’ care needs after the mHealth app intervention.
CNQ-SFc
a
Model adjusted for sex and age.
b
EORTC QLQ-H&N35: Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Head and Neck Module.
c
CNQ-SF: short-form Cancer Needs Questionnaire.
d
P<.05.
aspects increased in the intervention group to 3.02, 2.95, and significantly increased after the intervention (P<.01, Table 5).
3.01, respectively. All three aspects of app acceptability
Table 5. Acceptability of the mHealth app by patients based on the Science and Technology Acceptance Model scale.
Variable Before After
Control group, mean Experimental group, P valuea Control group, mean Experimental group, P valueb
(SD) mean (SD) (SD) mean (SD)
Intention to use 2.68 (1.12) 2.54 (1.05) .52 N/Ac 3.02 (0.87) .002
Perceived usefulness 2.49 (1.14) 2.52 (1.09) .90 N/A 2.95 (0.99) .004
Perceived ease of use 2.49 (1.04) 2.32 (0.77) .37 N/A 3.01 (0.90) <.001
a
Independent t test with P value was used to identify statistical differences between the experimental group and the control group.
b
Paired t test with P value was used to identify statistical differences before and after the mHealth app intervention.
c
N/A: not applicable.
using DVDs for pretreatment consultation also demonstrated In the future, patients from different medical centers or
that a DVD-based intervention can significantly reduce the nonmedical centers should be included. In addition, treatment
incidence and severity of sensory, psychological, and procedural plans for each patient can be included in the analysis to provide
concerns as well as of vomiting [14]. A review study also researchers with an understanding of the association of treatment
supported our findings that technology-based interventions can plans with the care needs of postoperative patients. Based on
have positive effects on pain, depression, and quality of life in participants’ feedback, rehabilitation videos and oral cancer
cancer patients [19]. The results of this and the above studies support groups provided the most useful information, and the
indicate that mHealth app interventions may also provide health participants suggested that doctors and nursing staff should be
education benefits for postoperative oral cancer patients. invited to join the mHealth app to provide immediate
consultation.
Limitations and Recommendations
The present study has several limitations. Due to time Conclusions
constraints, the number of trained researchers, budget An mHealth app intervention can significantly reduce
constraints, and other factors, patients could only be followed physiological needs in postoperative oral cancer patients, and
for 3 months. Despite the positive results observed during this use of the mHealth app was highly accepted by patients. These
period, we recommend conducting longer intervention studies data may also provide health care professionals with a better
in the future, such as those including 3-month, 6-month, understanding of the optimal course of patient care after surgery.
9-month, and 12-month intervals. We believe that some The main results of this study indicated that the mHealth app
statistically insignificant results will improve if the study is can be easily incorporated into routine care of postoperative
expanded to a longer time frame (eg, psychological needs and oral cancer patients to conveniently provide medical information
communication needs). In addition, all the oral cancer patients and improve patients’ self-management abilities, thereby
in this study were recruited from one medical center. Therefore, reducing their physiological care needs and promoting better
the results may not be applicable to oral cancer patients from health.
other medical centers or patients treated at nonmedical centers.
Acknowledgments
We would like to thank Convergence CT for language editing assistance. This study was supported by the National Yang-Ming
University-Far Eastern Memorial Hospital Joint Research Program (106DN01).
Authors' Contributions
LCC and TFW conceptualized the study and conducted the formal analysis and investigation. LCC and RHC wrote the first draft
of the paper. LCC, RHC, SCY, and CC conducted the investigation. TFW provided resources and helped write, review, and edit
the paper.
Conflicts of Interest
None declared.
Multimedia Appendix 1
Screenshots of the interfaces of the app.
[PDF File (Adobe PDF File), 5614 KB-Multimedia Appendix 1]
Multimedia Appendix 2
Questionnaires used in the study.
[DOCX File , 52 KB-Multimedia Appendix 2]
Multimedia Appendix 3
CONSORT-EHEALTH checklist (V. 1. 6. 1).
[PDF File (Adobe PDF File), 355 KB-Multimedia Appendix 3]
References
1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011 Mar;61(2):69-90
[FREE Full text] [doi: 10.3322/caac.20107] [Medline: 21296855]
2. de Leeuw J, van den Berg MGA, van Achterberg T, Merkx MAW. Supportive care in early rehabilitation for advanced-stage
radiated head and neck cancer patients. Otolaryngol Head Neck Surg 2013 Apr;148(4):625-632. [doi:
10.1177/0194599812474797] [Medline: 23348870]
3. Whelan TJ, Mohide EA, Willan AR, Arnold A, Tew M, Sellick S, et al. The supportive care needs of newly diagnosed
cancer patients attending a regional cancer center. Cancer 1997 Oct 15;80(8):1518-1524. [doi:
10.1002/(sici)1097-0142(19971015)80:8<1518::aid-cncr21>3.0.co;2-7] [Medline: 9338478]
4. Shah JP, Gil Z. Current concepts in management of oral cancer--surgery. Oral Oncol 2009;45(4-5):394-401 [FREE Full
text] [doi: 10.1016/j.oraloncology.2008.05.017] [Medline: 18674952]
5. Coleman JP. Cancer in the oral area. Tex Dent J 2012 May;129(5):442. [Medline: 22779197]
6. Stark DP, House A. Anxiety in cancer patients. Br J Cancer 2000 Nov;83(10):1261-1267 [FREE Full text] [doi:
10.1054/bjoc.2000.1405] [Medline: 11044347]
7. Zainal N, Hui K, Hang T, Bustam A. Prevalence of distress in cancer patients undergoing chemotherapy. Asia-Pacific J
Clinical Oncology 2007 Oct 11;3(4):219-223. [doi: 10.1111/j.1743-7563.2007.00114.x]
8. Saevarsdottir T, Fridriksdottir N, Gunnarsdottir S. Quality of life and symptoms of anxiety and depression of patients
receiving cancer chemotherapy: longitudinal study. Cancer Nurs 2010;33(1):E1-E10. [doi: 10.1097/NCC.0b013e3181b4adb5]
[Medline: 20010331]
9. Schliephake H, Jamil MU. Prospective Evaluation of Quality of Life After Oncologic Surgery for Oral Cancer. Int J Oral
Maxillofac Surg 2002 Aug;31(4):427-433 [FREE Full text] [doi: 10.1054/ijom.2001.0194] [Medline: 12361079]
10. Hassanein KAM, Musgrove BT, Bradbury E. Psychological outcome of patients following treatment of oral cancer and its
relation with functional status and coping mechanisms. J Craniomaxillofac Surg 2005 Dec;33(6):404-409 [FREE Full text]
[doi: 10.1016/j.jcms.2005.05.005] [Medline: 16253509]
11. Kessler PA, Bloch-Birkholz A, Leher A, Neukam FW, Wiltfang J. Evaluation of quality of life of patients with oral squamous
cell carcinoma. Comparison of two treatment protocols in a prospective study. Radiother Oncol 2004 Mar;70(3):275-282
[FREE Full text] [doi: 10.1016/j.radonc.2003.11.017] [Medline: 15064013]
12. Waller A, Forshaw K, Bryant J, Mair S. Interventions for preparing patients for chemotherapy and radiotherapy: a systematic
review. Support Care Cancer 2014 Aug;22(8):2297-2308 [FREE Full text] [doi: 10.1007/s00520-014-2303-3] [Medline:
24906837]
13. Butow PN, Phillips F, Schweder J, White K, Underhill C, Goldstein D, Clinical Oncological Society of Australia. Psychosocial
well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support
Care Cancer 2012 Jan;20(1):1-22. [doi: 10.1007/s00520-011-1270-1] [Medline: 21956760]
14. Aranda S, Jefford M, Yates P, Gough K, Seymour J, Francis P, et al. Impact of a novel nurse-led prechemotherapy education
intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results
from a randomised, controlled trial. Ann Oncol 2012 Jan;23(1):222-231. [doi: 10.1093/annonc/mdr042] [Medline: 21471562]
15. Cossich T, Schofield P, McLachlan SA. Validation of the cancer needs questionnaire (CNQ) short-form version in an
ambulatory cancer setting. Qual Life Res 2004 Sep;13(7):1225-1233. [doi: 10.1023/B:QURE.0000037496.94640.d9]
[Medline: 15473501]
16. Chen SC, Yu WP, Chu TL, Hung HC, Tsai MC, Liao CT. Prevalence and correlates of supportive care needs in oral cancer
patients with and without anxiety during the diagnostic period. Cancer Nurs 2010;33(4):280-289. [doi:
10.1097/NCC.0b013e3181d0b5ef] [Medline: 20467308]
17. Yun YH, Shon EJ, Yang AJ, Kim SH, Kim YA, Chang YJ, et al. Needs regarding care and factors associated with unmet
needs in disease-free survivors of surgically treated lung cancer. Ann Oncol 2013 Jun;24(6):1552-1559 [FREE Full text]
[doi: 10.1093/annonc/mdt032] [Medline: 23471105]
18. Ziegler L, Newell R, Stafford N, Lewin R. A literature review of head and neck cancer patients information needs, experiences
and views regarding decision-making. Eur J Cancer Care (Engl) 2004 May;13(2):119-126. [doi:
10.1111/j.1365-2354.2004.00449.x] [Medline: 15115467]
19. Zan S, Agboola S, Moore SA, Parks KA, Kvedar JC, Jethwani K. Patient engagement with a mobile web-based telemonitoring
system for heart failure self-management: a pilot study. JMIR Mhealth Uhealth 2015;3(2):e33 [FREE Full text] [doi:
10.2196/mhealth.3789] [Medline: 25842282]
20. Ryu S. Book Review: mHealth: New Horizons for Health through Mobile Technologies: Based on the Findings of the
Second Global Survey on eHealth (Global Observatory for eHealth Series, Volume 3). Healthc Inform Res 2012;18(3):231.
[doi: 10.4258/hir.2012.18.3.231]
21. Dounavi K, Tsoumani O. Mobile Health Applications in Weight Management: A Systematic Literature Review. Am J Prev
Med 2019 Jun;56(6):894-903 [FREE Full text] [doi: 10.1016/j.amepre.2018.12.005] [Medline: 31003801]
22. Boulos MNK, Wheeler S, Tavares C, Jones R. How smartphones are changing the face of mobile and participatory healthcare:
an overview, with example from eCAALYX. Biomed Eng Online 2011;10:24 [FREE Full text] [doi:
10.1186/1475-925X-10-24] [Medline: 21466669]
23. Helbostad JL, Vereijken B, Becker C, Todd C, Taraldsen K, Pijnappels M, et al. Mobile Health Applications to Promote
Active and Healthy Ageing. Sensors (Basel) 2017 Mar 18;17(3) [FREE Full text] [doi: 10.3390/s17030622] [Medline:
28335475]
24. Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone
personalized behavioral intervention for blood glucose control. Diabetes Care 2011 Sep;34(9):1934-1942 [FREE Full text]
[doi: 10.2337/dc11-0366] [Medline: 21788632]
25. Carrasco MP, Salvador CH, Sagredo PG, Márquez-Montes J, González DMMA, Fragua JA, et al. Impact of patient-general
practitioner short-messages-based interaction on the control of hypertension in a follow-up service for low-to-medium risk
hypertensive patients: a randomized controlled trial. IEEE Trans Inf Technol Biomed 2008 Nov;12(6):780-791. [doi:
10.1109/TITB.2008.926429] [Medline: 19000959]
26. Bexelius C, Löf M, Sandin S, Lagerros YT, Forsum E, Litton JE. Measures of physical activity using cell phones: validation
using criterion methods. J Med Internet Res 2010;12(1):e2 [FREE Full text] [doi: 10.2196/jmir.1298] [Medline: 20118036]
27. Birur PN, Sunny SP, Jena S, Kandasarma U, Raghavan S, Ramaswamy B, et al. Mobile health application for remote oral
cancer surveillance. J Am Dent Assoc 2015 Dec;146(12):886-894. [doi: 10.1016/j.adaj.2015.05.020] [Medline: 26610833]
28. Agboola S, Flanagan C, Searl M, Elfiky A, Kvedar J, Jethwani K. Improving outcomes in cancer patients on oral anti-cancer
medications using a novel mobile phone-based intervention: study design of a randomized controlled trial. JMIR Res Protoc
2014 Dec 23;3(4):e79 [FREE Full text] [doi: 10.2196/resprot.4041] [Medline: 25537463]
29. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on
antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 2010 Nov 27;376(9755):1838-1845.
[doi: 10.1016/S0140-6736(10)61997-6] [Medline: 21071074]
30. Singer S, Wollbrück D, Wulke C, Dietz A, Klemm E, Oeken J, et al. Validation of the EORTC QLQ-C30 and EORTC
QLQ-H&N35 in patients with laryngeal cancer after surgery. Head Neck 2009 Jan;31(1):64-76. [doi: 10.1002/hed.20938]
[Medline: 18972411]
31. Davis FD. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology. MIS Quarterly
1989 Sep;13(3):319. [doi: 10.2307/249008]
32. Karvonen-Gutierrez CA, Ronis DL, Fowler KE, Terrell JE, Gruber SB, Duffy SA. Quality of life scores predict survival
among patients with head and neck cancer. J Clin Oncol 2008 Jun 01;26(16):2754-2760. [doi: 10.1200/JCO.2007.12.9510]
[Medline: 18509185]
33. Ali EE, Leow JL, Chew L, Yap KYL. Patients' Perception of App-based Educational and Behavioural Interventions for
Enhancing Oral Anticancer Medication Adherence. J Cancer Educ 2018 Dec;33(6):1306-1313. [doi:
10.1007/s13187-017-1248-x] [Medline: 28707206]
34. Newell S, Sanson-Fisher RW, Girgis A, Ackland S. The physical and psycho-social experiences of patients attending an
outpatient medical oncology department: a cross-sectional study. Eur J Cancer Care (Engl) 1999 Jun;8(2):73-82. [doi:
10.1046/j.1365-2354.1999.00125.x] [Medline: 10476109]
Abbreviations
CNQ-SF: short-form Cancer Needs Questionnaire
EORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire
Core 30
EORTC QLQ-H&N35: European Organization for Research and Treatment of Cancer Quality of Life
Questionnaire Core 30 and Head and Neck Module
mHealth: mobile health
PDA: personal digital assistant
TAM: Technology Acceptance Module
WHO: World Health Organization
Edited by G Eysenbach; submitted 05.02.20; peer-reviewed by B Chaudhry, C Jacob; comments to author 06.04.20; revised version
received 26.05.20; accepted 03.06.20; published 27.07.20
Please cite as:
Wang TF, Huang RC, Yang SC, Chou C, Chen LC
Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer
Surgery: Quasiexperimental Study
JMIR Mhealth Uhealth 2020;8(7):e18132
URL: http://mhealth.jmir.org/2020/7/e18132/
doi: 10.2196/18132
PMID: 32716303
©Tze-Fang Wang, Rou-Chen Huang, Su-Chen Yang, Chyuan Chou, Lee-Chen Chen. Originally published in JMIR mHealth and
uHealth (http://mhealth.jmir.org), 27.07.2020. This is an open-access article distributed under the terms of the Creative Commons
Attribution License (https://creativecommons.org/licenses/by/4.0/), 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.