With more than 1 billion users having access to mobile broadband Internet and a rapidly growing mobile app market, all stakeholders involved have high hopes that this technology may improve health care. Expectations range from overcoming structural barriers to access in low-income countries to more effective, interactive treatment of chronic conditions. Before medical health practice supported by mobile devices ("mHealth") can scale up, a number of challenges need to be adequately addressed. From a psychological perspective, high attrition rates, digital divide of society, and intellectual capabilities of the users are key issues when implementing such technologies. Furthermore, apps addressing behavior change often lack a comprehensive concept, which is essential for an ongoing impact. From a clinical point of view, there is insufficient evidence to allow scaling up of mHealth interventions. In addition, new concepts are required to assess the efficacy and efficiency of interventions. Regarding technology interoperability, open standards and low-energy wireless protocols appear to be vital for successful implementation. There is an ongoing discussion in how far health care-related apps require a conformity assessment and how to best communicate quality standards to consumers. "Apps Peer-Review" and standard reporting via an "App synopsis" appear to be promising approaches to increase transparency for end users. With respect to development, more emphasis must be placed on context analysis to identify what generic functions of mobile information technology best meet the needs of stakeholders involved. Hence, interdisciplinary alliances and collaborative strategies are vital to achieve sustainable growth for "mHealth 2.0," the next generation mobile technology to support patient care.

Objectives In this article, we examine definitions of suggested approaches to measure the concept of good decisions, highlight the ways in which they converge, and explain why we have concerns about their emphasis on post-hoc estimations and post-decisional outcomes, their prescriptive concept of knowledge, and their lack of distinction between the process of deliberation, and the act of decision determination.

Intense pain is often exaggerated in retrospective evaluations, indicating a possible divergence between experience and memory. However, little is known regarding how people retrospectively evaluate experiences with both pleasant and unpleasant aspects. The Day Reconstruction Method (DRM; Kahneman. Krueger, Schkade, Schwarz, & Stone, 2004b) provides a unique opportunity to examine memory-experience gaps in recollections of individual days, which elicit a wide gamut of emotions. We asked female participants (N = 810, Study 1, and N = 615, Study 2) to reconstruct episodes of the previous day using the DRM and demonstrated that memory and experience diverge for both pleasant and unpleasant emotions. When they rated their day overall in a retrospectively evaluative frame of mind, the participants recalled more unpleasant and pleasant emotions than they reported feeling during the individual episodes, with a larger gap for unpleasant emotions than for pleasant emotions. The findings suggest that separate processes are used for committing positive and negative events to memory and that, especially when unpleasant emotions are involved, prudence is favored over accuracy.

Medication adherence is crucial for success in the management of patients with chronic conditions. This study analyzes whether a mobile application on a tablet aimed at supporting drug intake and vital sign parameter documentation affects adherence in elderly patients.Patients with coronary heart disease and no prior knowledge of tablet computers were recruited. They received a personal introduction to the mobile application Medication Plan, installed on an Apple iPad. The study was conducted using a crossover design with 3 sequences: initial phase, interventional phase (28 days of using the app system), and comparative phase (28 days of using a paper diary). Users experienced the interventional and comparative phases alternately.A total of 24 patients (12 males; mean age 73.8 years) were enrolled in the study. The mean for subjectively assessed adherence (A14-scale; 5-point Likert scale, from “never” to “very often” which results in a score from 0 to 56) before the study was 50.0 (SD = 3.44). After both interventions there was a significant increase, which was more pronounced after the interventional phase (54.0; SD = 2.01) than after the comparative phase (52.6; SD = 2.49) (for all pairs after both interventions, P <0.001). Neither medical conditions nor the number of drug intake (amount and frequency of drug taking) per day affected subjective adherence. Logging data showed a significantly stronger adherence for the medication app than the paper system for both blood pressure recordings (P <0.001) and medication intake (P = 0.033). The majority of participants (n = 22) stated that they would like to use the medication app in their daily lives and would not need further assistance with the app.A mobile app for medication adherence increased objectively and subjectively measured adherence in elderly users undergoing rehabilitation. The findings have promising clinical implications: digital tools can assist chronic disease patients achieve adherence to medication and to blood pressure measurement. Although this requires initial offline training, it can reduce complications and clinical overload because of nonadherence.

This study advances our understanding of how people arrive at retrospective evaluations of multiepisode experiences. Large samples from the United States, France, and Denmark (810, 820, and 805 participants, respectively) reported their feelings during each episode of the previous day using the Day Reconstruction Method. The duration-weighted average of these feelings represented the normative approach to evaluation, and, contrary to the predictions of the peak-end rule, the average was the best predictor of retrospective evaluations of the day. To capture participants' heuristic evaluation, they also reported having a wonderful (peak) and/or awful (low) moment during the previous day. The results indicate that retrospective evaluations of multiepisode events rely on the averaged ratings of emotions, ignore ends, and also consider the presence of lows, and occasionally peaks, as subjectively defined by those experiencing them. Peaks and lows contribute more to comparative, rather than absolute evaluations. Future research should examine whether these findings extend to other multiepisode events that, unlike days, form cohesive units in terms of their content, goal, and emotionality.

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Given the medical and psychological ramifications of genetic testing, healthcare professionals should consider devoting extra effort to ensuring proper comprehension of ambiguous and uninformative negative test results by women.

ObjectiveRates of pregnancy among women living with HIV (WLHIV) have increased with the availability of effective HIV treatment. Planning for pregnancy and childbirth is an increasingly important element of HIV care. Though rates of unintended pregnancies are high among women in general, among couples affected by HIV, significant planning and reproductive decisions must be considered to prevent negative health consequences for WLHIV and their neonates. To gain insight into this reproductive decision-making process among WLHIV, this study explored women’s knowledge, attitudes and practices regarding fertility planning, reproductive desires, and safer conception practices. It was hypothesized that pregnancy desires would be influenced by partners, families, the potential risk of HIV transmission to infants, and physicians’ recommendations.MethodsWLHIV of childbearing age were recruited from urban South Florida, and completed an assessment of demographics (N = 49), fertility desires and a conjoint survey of factors associated with reproductive decision-making.ResultsUsing conjoint analysis, we found that different decision paths exist for different types of women: Younger women and those with less education desired children if their partners wanted children; reproductive desires among those with less education, and with less HIV pregnancy-related knowledge, displayed a trend toward additional emphasis on their family’s desires. Conversely, older women and those with more education appeared to place more importance on physician endorsement in their plans for childbearing.ConclusionsResults of this study highlight the importance of ongoing preconception counselling for all women of reproductive age during routine HIV care. Counselling should be tailored to patient characteristics, and physicians should consider inclusion of families and/or partners in the process.